A Behavioral analysis of nurses’ and pharmacists’ role in addressing vaccine hesitancy: scoping review

Figures & data

Figure 1. Behavior change wheel.

Table 1. Characteristics of included records

Authors	Country	Study aim/ purpose	Study design	Population	Population to be vaccinated	Setting
American Pharmacists Association^Citation29	USA	Prepare pharmacists to engage in productive conversations with patients about immunizations.	Informative/ Descriptive	Pharmacists	General Population	Pharmacies
Anderson et al.^Citation30	USA	Review the origin of vaccine hesitancy, explores common misconceptions about vaccine hesitancy	Review	Nurses	Children	Primary Care
Anderson^Citation31	USA	Address how nurse practitioners can improve vaccination rates by developing trusting relationships with parents and being armed with information based on sound clinical evidence.	Informative/ Descriptive	Nurse Practitioners	Children	NR
Apfel et al.^Citation32	Europe	Provide practical evidence-based and peer- reviewed advice for public health programme managers and communicators involved with immunization services	Informative/ Descriptive	Nursing Managers	NR	Primary healthcare, hospitals
Bernard et al.^Citation33	Australia	Examine the experience of fear, the fear response, and factors affecting fear in adolescents undergoing school-based HPV vaccination.	Qualitative	Immunization Nurses	Adolescent females	School
Berry et al.,^Citation34	Australia	Understand the challenges faced and strategies used when general practitioners and immunizing nurses encounter parents who choose not to vaccinate their children.	Qualitative	Practice or Community Nurses	Children	Primary Care
Black et al.,^Citation35	Canada	Determine if a public health nurse intervention to addressing/ promoting influenza immunization is effective	RCT	Seniors Programs Public Health Nurses	Seniors	Urban- rural community
Blackford,^Citation36	USA	Provide an educational resource about vaccinations, particularly regarding misconceptions and concerns, for school nurses, parents, and children	Qualitative	School Nurses	Children	School
Bowling^Citation37	USA	Understand the role that nursing intervention have to enhance vaccination rates (historical aspects as well as present day information)	Review	Pediatric Nurses	General Population	Primary Care
Brackett et al.,^Citation38	USA	Investigate whether the use of MI in the community pharmacy improves immunization readiness and rates for hepatitis B, hepatitis A/B combination, herpes zoster, pneumococcal, and tetanus–diphtheria–acellular pertussis immunizations.	Cross- sectional	Pharmacists	Community Members	Grocery Store Pharmacy
Carhart et al.,^Citation39	USA	Understand the reasoning behind low-uptake of the HPV vaccine in the state of Virginia	Qualitative	Nurses (Stakeholder Nurses in Cancer prevention)	Adolescents	NR
Courtney^Citation40	Canada	Address the Problem of Practice (PoP), what training is needed to ensure HCPs are capable to communicate effectively with vaccine-hesitant patients	Organizational improvement plan	Public Health Nurses	NR	Public Health Units
D’Arrigo^Citation41	USA	Understand the impacts of the Mumps outbreak in Hawaii and figure out what can be done to better understand vaccine hesitancy in parents and find clear ways to address this at the pharmacy	Informative/ Descriptive	Pharmacists	NR	Pharmacies
Dahlqvist et al.,^Citation42	Sweden	Describe how nurses in child health centers deal with parents who are hesitant to child vaccinations.	Qualitative	Child Health Nurses	Children	Hospitals, Child Health Centers
Davis et al.,^Citation43	USA	Determine whether an intervention similar to the private office-based intervention, but tailored to PHNs and with the addition of an immunization booklet designed for parents, could improve vaccine risk/benefit communication in a timely manner among PHNs	Pre- Post Design	Public Health Nurses	Children	Primary Care
Deem^Citation44	USA	Discuss the ethical questions that arise when a parent refuses some or all recommended childhood vaccines for nonmedical reasons, and discuss ways in which nurses and other HCP can respond ethically and effectively to vaccine refusal	Descriptive	Nurses	Children	Primary Care
Dempsey & Zimet^Citation45	USA	Describe a selection of recent intervention studies for increasing adolescent vaccination.	Review	Nurses	Adolescents	Varies
Donavan & Bedford^Citation46	United Kingdom	Analyze and inform on current common questions parents ask about immunization in the United Kingdom.	Descriptive	Primary Care Nurses	Children	Primary Care
Dubé et al.^Citation47	Canada	Understand the determinants of low HPV vaccine uptake and identify strategies to enhance vaccine acceptance using the socio-ecological model.	Qualitative	School Nurses	School aged children	Schools
Dubé et al.,^Citation48	Canada	Describe good practices in developing communication materials to address vaccine hesitancy	Inventory Assessment/Analysis	Nurse Practitioners	General Population	Virtual assessments
Fernbach^Citation49	USA	Discuss the ethical dilemma that a primary care NP must face when parents refuse to have their children immunized.	Review	Primary Care Nurse Practitioners	Children	Primary Healthcare
Fogarty et al.,^Citation50	USA	Disseminate what works in their practice (we have developed a team-based routine that has improved our efficiency and effectiveness in getting our patients vaccinated)	NR	Licensed Practical Nurse	General Population	Primary Care
Gagneur et al.^Citation1	Canada	Develop and validate immunization-specific MI training for immunization nurses.	Pre- post test	Immunization Nurses	Children	Community clinics
Greene^Citation51	USA	Discuss some of the latest findings on vaccination and suggest responses that school nurses can use to reassure parents	Informative	School Nurses	School aged children	Schools
Hidalgo^Citation52	USA	Increase Gardasil 9 rates in a small, rural school-based health center	Plan-Do-Study-Act quality-improvement model	Doctorate of Nursing Student	School aged children	Rural school- based health clinic
Hinman^Citation53	USA	A tool to think about carefully developed and forthright responses to immunization and helping people make truly informed immunization decisions	Informative	Nurses	NR	Cases across U.S. and Canada
Hoekstra et al.^Citation54	USA	Reinforce the unique skills that nurses bring to what must be interdisciplinary approaches in the persistent struggle to address vaccine hesitancy.	Commentary	Nurses	Children	Any clinical setting
Holland Wade^Citation55	USA	Address issues associated with refusal to immunize children and how nurses can influence immunization decisions.	Review	Nurses	Children	Primary Care
Hurley-Kim^Citation56	USA	Review strategies pharmacists can use to reduce the burden of vaccine hesitancy	Informative/ Descriptive	Pharmacists	NR	NR
Kenney et al.,^Citation57	USA	Inform pharmacists on how to counter vaccine hesitancy in parents and the general population	Descriptive	Pharmacists	NR	NR
Koslap-Petraco et al.,^Citation58	USA	Educate nurses on communicating the benefits of combination vaccines to parents and other healthcare providers.	Descriptive	Nurses	Children and Infants	Primary Care
Koslap-Petraco^Citation59	USA	Review the history of vaccine hesitancy and discuss a successful paradigm for speaking with vaccine-hesitant parents	Review	Nurse Practitioners	NR	NR
Kubin^Citation60	USA	Review the current literature regarding U.S. vaccine compliance data and the three VPD with continued prevalent outbreaks. Literature regarding influencing factors leading to outbreaks, changes in vaccination practices, and how nurses can best intervene will also be discussed.	Review	Nurses	NR	NR
Lisenby et al.,^Citation61	USA	Help pharmacists provide evidence-based facts and education to address common misconception and influence the anti-vaccination movement	Informative	Pharmacists	NR	Community and ambulatory settings
Ludwikowska et al.^Citation62	Poland	An analysis of the structure of the Prophylaxis Program against HPV in Wroclaw, Poland, (afterward – the Program) as well as on the attitudes to the HPV vaccination among its participants: parents, 13-year-old girls and the nurses who administer the vaccination.	Program evaluation	Nurses	Teenage Girls	GP offices
Luthy et al.,^Citation63	USA	Review evidence-based answers to common parental questions regarding childhood vaccinations.	Integrative literature review	School Nurses	School aged children	Schools
MacDonald & Wick^Citation64	USA	Provide a comprehensive understanding of such influences can help pharmacists and pharmacy technicians identify and communicate with hesitant individuals better	Educational Resource	Pharmacists and pharmacy technicians	Infants and Children	Pharmacies
Maurici et al.,^Citation65	Italy	Assess the impact of a three-day residential course concerning empathy and counseling abilities on patients’ ratings of the level of empathy of physicians and nurses working in vaccination centers.	Pre- post Design	Nurses	NR	Local Health Units
Marcus^Citation66	USA	Useful tips to address vaccine hesitancy through effective communication and evidence-based answers to common and uncommon vaccine myths for communities and discuss	Program Evaluation Paper	Nurses	Vulnerable communities	Orthodox Jewish Community
Mossey et al.,^Citation67	Canada	Understand parents’ and nurses’ experiences of decision-making about childhood immunization, specifically measles-mumps-rubella and/or diphtheria-tetanus-acellular pertussis.	Interpretative description	Primary Care or Public Health Nurses	Children	Small Urban centers
Navin et al.,^Citation68	USA	Understand the dispositions of the public health staff who provide “waiver education”	Descriptive	Public Health Nurses	Daycare and school-aged children	Local Health departments
Nicastro et al.,^Citation69	USA	Discuss the scope of the problem (parental rejection of vaccines for their children), explore the parental decision-making process regarding vaccines for their children, and consider the implications for nurse practitioners with regard to increasing vaccination uptake rates among their patients	Informative/ Descriptive	Nurse Practitioners	Children	NR
Nold et al.,^Citation70	USA	Describes the development and integration of the simulation experience, its aims and outcome measures, and students’ evaluations of the experience.	Qualitative	Nursing Students	A simulation of a parent (infant child)	Nursing school (clinical simulation)
NR^Citation71	Varied	Review of the unmet vaccine needs for high-risk populations, detailed targeted approaches to improving immunization rates in high-risk populations, shared insights on developing collaborations, and outlined strategies for developing partnerships and overcoming challenges.	Ask the Expert	Pharmacists	High- Risk population	Pharmacies
Nutty^Citation72	USA	Discussion about the responsibility of healthcare professionals to educate anti- vaccinators and lay their fear to rest.	Informative	Nurses	Children	NR
O’Keefe et al.^Citation73	USA	Inform nurses about important facts about vaccines and what populations are crucial for vaccination.	Informative (Textbook chapter)	Nurses	NR	All Healthcare settings
Omecene et al.^Citation74	USA	Discuss the implementation of the PPAG position paper recommendations, including key barriers in outpatient settings and potential strategies to successfully incorporate the recommendations into practice.	Position paper	Pharmacists	Children	Outpatient clinic/ pharmacy
Orenstein et al.^Citation75	USA	Examine the factors that affect vaccine confidence	Informative/ Descriptive	Nurses	Children	Varied
Poudel et al.^Citation76	Australia	Review the barriers and challenges to vaccination with a focus on the role of pharmacists as vaccinators, and the challenges associated with effective implementation of pharmacist administered vaccination services	Qualitative	Pharmacists	NR	Community pharmacies
Pullagura et al.^Citation77	Canada	Understand community pharmacists’ attitudes toward, and experiences with, influenza VH, and explore factors impacting their engagement with patients on the influenza vaccine.	Qualitative	Pharmacists	General Population	Community pharmacies
Punch^Citation78	Canada	Understand what worked/ happened to Oxford county with 2 outbreaks in 2003 and 2008	Case Study	Nurses	Children	Orthodox Jewish Community
Queeno^Citation79	USA	Detail the implementation of a pharmacist-driven education program targeting patients who originally declined pneumococcal or influenza vaccination upon hospital admission and to evaluate the results.	Pre-post Design	Pharmacists	Patients admitted to hospital	Hospitals
Rawson et al.^Citation80	USA	Provide valuable information for pharmacists and pharmacies to reference when con-fronting vaccine hesitancy.	Informative (update on best practices)	Pharmacists	NR	NR
Rivera^Citation81	USA	Develop a clinical practice guideline with recommendations for vaccination and vaccine hesitancy in the pediatric setting.	Clinical Practice Guideline Development	Pediatric Nurses	Children	Pediatric Primary Care
Schollin Ask et al.^Citation82	Sweden	Identify why parents refused to let their infant have the vaccination or were unsure	Cross- sectional	Child Health Nurses	Infants	Child Health Center
Scott & Batty^Citation83	Canada	Investigate factors related to HPV vaccine uptake in Canada. An overview of the disease, vaccinations, emerging issues, and the role of a PCP, specifically NP’s.	Review	Nurse Practitioners	NR	Schools
Sharpe et al.,^Citation84	USA	Discuss strategies to respond to individuals who are vaccine hesitant	Informative/ Descriptive	Pharmacists	Children	Community pharmacies
Speck et al.,^Citation85	USA	Identify interventions healthcare providers can use to acknowledge and address parents who are vaccine- hesitant	Review	Childcare Nurses	Children	Primary Care, hospitals
Stevens^Citation86	USA	Assess the effects of a C.A.S.E. Approach learning module on family nurse practitioner students’ perceived levels of knowledge and self-efficacy regarding vaccination discussion with vaccine hesitant parents	Pre- post design	Family Nurse Practitioner Students	NR	University
Stinchfield^Citation87	USA	Provide research-based answers to practice questions submitted by JSPN readers.	Ask the expert	Pediatric Nurses & NPs	NR	Varies
Taddio et al.^Citation88	Canada	Document acceptability of key tools included in the multifaceted KT intervention and their effectiveness in improving knowledge and attitudes about vaccination pain and fear	Mixed methods	Immunization, School & Charge Nurses	Grade 7 students	School
Venzke et al.^Citation89	USA	Evaluate an online, interactive, learning module to enhance knowledge of nurse practitioner students on vaccine hesitancy and refusal issues and examine the effectiveness of the learning module on enhancing nurse practitioner student knowledge of MI communication skills to address issues of vaccine hesitancy and refusal	Pre- post design	NP students	NR	University
Violette et al.,^Citation90	Canada	Educate pharmacists about way to communicate people who may be vaccine hesitant	Commentary	Pharmacists	NR	Community pharmacies
Vyas et al.,^Citation91	USA	Determine the impact of a vaccine hesitancy learning unit on student knowledge, attitudes, and ability to address vaccine hesitancy and/or refusal.	Pre-Post Design	Pharmacy Students	NR	University
Warner^Citation92	England	Explore the external and internal influences related to the uptake of flu vaccination with regard to both healthcare workers and their patients and discuss the ways in which nurses can help patients eligible for free flu vaccinations to make informed choices.	Informative	Nurses	General Population	NR
Ziemczonek^Citation93	Canada	Discuss approaches the author found worked in their practice to address vaccine hesitancy	Case Study	Pharmacists	NR	Pharmacies

Abbreviations: RCT: Randomized Control Trial, HPV: Human Papilloma Virus, MI: Motivational Interviewing, HCP: Health-Care Practitioner, PHN: Public Health Nurse, NP: Nurse Practitioner, VPD: Vaccine Preventable Disease, PPAG: Pediatric Pharmacy Advocacy Group, VH: Vaccine hesitancy, PCP: Primary Care Provider, C.A.S.E: Corroborate, About Me, Explain/Advise, JSPN: Journal for Specialist in Pediatric Nursing, KT: Knowledge Translation.

Figure 2. PRISMA flow chart.

Table 2. Reported barriers to addressing vaccine hesitancy

COM-B	COM-B Sub-component	Barrier	Nurse source(s)	Pharmacist source(s)
Capability
	Psychological	Lack of understanding of vaccine hesitancy	Anderson,^Citation30 Gagneur,^Citation94 Venzke,^Citation89 O’Keefe,^Citation73 Fogarty^Citation50 (n = 5)	Queeno,^Citation79 Pullagura,^Citation77 Poudel,^Citation76 Violette^Citation90 (n = 4)
Capability & Opportunity	Psychological, social & physical	Lack of communication aids and guidance	Anderson,^Citation30 Marcus,^Citation66 Berry,^Citation34 Stevens,^Citation86 Dube (2020), Rivera,^Citation81 Venzke,^Citation89 O’Keefe,^Citation73 Dube (2019), Hidalgo,^Citation52 Orenstein,^Citation75 Nold,^Citation70 Bowling,^Citation37 Navin,^Citation68 Hinman,^Citation53 Koslap- Petraco,^Citation59 Punch,^Citation78 Kubin^Citation60 (n = 18)	Sharpe,^Citation84 Pullagura^Citation77Deepti Vyas,^Citation91 MacDonald^Citation64 (n = 4)
		Healthcare provider- patient relationship	Mossey,^Citation67 Maurici,^Citation65 Deem,^Citation44 Courtney^Citation40 (n = 4)	Brackett^Citation38 (n = 1)
		Lack of time to address vaccine hesitancy	Berry,^Citation34 Hinman,^Citation53 O’Keefe,^Citation73 Hoekstra,^Citation54 Dube (2019), Stinchfield,^Citation87 Carhart^Citation39 (n = 7)	N/A
Opportunity
	Social & physical	Lack of opportunities to discuss vaccine hesitancy	Scott,^Citation83 Gagneur,^Citation94 Warner,^Citation92 Hidalgo,^Citation52 Carhart^Citation39 (n = 5)	N/A
		Health-care provider collaboration	Davis,^Citation43 Hidalgo,^Citation52 Orenstein^Citation75 (n = 3)	Brackett,^Citation38 NR^Citation71 (n = 2)
Opportunity & Motivation	Social, physical, automatic & reflective	Patients are misinformed about vaccinations	Black,^Citation35 Greene,^Citation51 Luthy,^Citation63 Speck,^Citation85 Scott,^Citation83 Mossey,^Citation67 Schollin (2019), Warner,^Citation92 Anderson,^Citation31 Blackford,^Citation36 Davis,^Citation43 Hinman,^Citation53 Koslap- Petraco,^Citation58 Nold,^Citation70 Koslap- Petraco,^Citation59 Ludwikowska,^Citation62 O’Keefe,^Citation73 Franklin,^Citation32 Nicastro,^Citation69 Dahlqvist,^Citation42 Fogarty,^Citation50 Dube (2019), Stinchfield,^Citation87 Carhart,^Citation39 Kubin,^Citation60 Holland Wade,^Citation55 Hidalgo,^Citation52 Bernard,^Citation33 Fernbach (2010) (n = 29)	Lisenby,^Citation61 Sharpe,^Citation84 Kenny (2019), Poudel,^Citation76 Hurley- Kim,^Citation56 D’Arrigo^Citation41 (n = 6)
		Patients have a mistrust in the system	Donavan,^Citation46 Marcus,^Citation66 Berry,^Citation34 Navin,^Citation68 Blackford,^Citation36 Nutty,^Citation72 Hoekstra,^Citation54 Bowling,^Citation37 Carhart,^Citation39 Orenstein^Citation75 (n = 10)	American Pharmacist Association (2020), Sharpe,^Citation84 Kenny (2019), Rawson,^Citation80 D’Arrigo^Citation41 (n = 5)
		Influence of social media	Mossey,^Citation67 Koslap- Petraco,^Citation58 Koslap- Petraco,^Citation59 Dahlqvist,^Citation42 Fogarty,^Citation50 Dube (2019), Fernback (2011), Orenstein^Citation75 (n = 8)	MacDonald,^Citation64 Kenny (2019), Hurley- Kim^Citation56 (n = 3)

Table 3. Reported enablers to addressing vaccine hesitancy

COM-B	COM-B sub-component	Enabler	Nurse source(s)	Pharmacist source(s)
Capability & Opportunity	Psychological, social & physical	Availability and dissemination of resources to support education	Luthy,^Citation63 Speck,^Citation85 Scott,^Citation83 Marcus,^Citation66 Mossey,^Citation67 Anderson,^Citation31 Davis,^Citation43 Dube (2020), Nutty,^Citation72 Rivera,^Citation81 Venzke,^Citation89  Franklin Apfel,^Citation32 Nicastro,^Citation69 Greene,^Citation51 Gagneur,^Citation94 Stevens,^Citation86 Blackford,^Citation36 Nold,^Citation70 Taddio,^Citation88 Ludwikowska,^Citation62 Dahlqvist,^Citation42 Deem,^Citation44 Hidalgo,^Citation52 Fernback (2011), Courtney^Citation40 (n = 25)	Lisenby,^Citation61 Deepti Vyas,^Citation91 Queeno,^Citation79 Rawson,^Citation80 Hurley- Kim,^Citation56 D’Arrigo,^Citation41 Ziemczonek^Citation93 (n = 7)
Opportunity	Social & physical	Reminder systems for health-care providers	Anderson,^Citation30 Amanda (2015), Carhart,^Citation39 Bernard^Citation33 (n = 4)	N/A
Opportunity & Motivation	Social, physical, automatic & reflective	Health-care provider–patient relationship	Donavan,^Citation46 Speck,^Citation85 Scott,^Citation83 Berry,^Citation34 Mossey,^Citation67 Stevens,^Citation86 Navin,^Citation68 Warner,^Citation92 Blackford,^Citation36 Hinman,^Citation53 Maurici,^Citation65 Nutty,^Citation72 Venzke,^Citation89 Koslap- Petraco,^Citation59 O’Keefe,^Citation73 Hoekstra (2013), Punch,^Citation78 Nicastro,^Citation69 Dahlqvist,^Citation42 Dube (2019), Stinchfield,^Citation87 Kubin,^Citation60 Deem,^Citation44 Fernbach,^Citation49 Orenstein^Citation75 (n = 25)	MacDonald,^Citation64 Brackett,^Citation38 Pullagura,^Citation77 Poudel,^Citation76 D’Arrigo,^Citation41 Ziemczonek^Citation93 (n = 6)
		Agreement on a revised schedule	Navin,^Citation68 Bowling^Citation37 (n = 2)	N/A
		Collaborative practice to support vaccine acceptance	Marcus,^Citation66 Fogarty,^Citation50 Dube (2019), Carhart,^Citation39 Bernard,^Citation33 Orenstein^Citation75 (n = 6)	NR,^Citation71 Poudel,^Citation76 Omecene^Citation74 (n = 3)
Motivation	Automatic & reflective	Health-care provider’s identity and role in addressing vaccine hesitancy	Speck,^Citation85 Berry,^Citation34 Scholin Ask,^Citation82 Stevens,^Citation86 O’Keefe,^Citation73 Dube (2019), Bernard,^Citation33 Courtney^Citation40 (n = 8)	N/A

Table 4. Reported interventions and corresponding intervention functions

Type of intervention	Description of interventions	BCW intervention function	Nursing	Pharmacy
Communication Tools/ Guidelines to Educate patients	Educational sessions to teach nurses how to discuss vaccine hesitancy with patients and/ or parents	Education, persuasion	Anderson,^Citation30 Berry,^Citation34 Schollin Ask,^Citation82
	Physical tools to give to patients and/or parent (e.g., Pamphlets. magazines, workshops for patients, toolkits)	Education	Donavan,^Citation46 Scott,^Citation83 Speck,^Citation85 Marcus,^Citation66 Stevens,^Citation86 Anderson,^Citation31 Davis^Citation43	Lisenby^Citation61
	Teach nurses/ pharmacists about how to talk about alternatives to the typical plan (e.g., combination vaccines, agreeing upon a revised schedule)	Education, Training	Koslap- Petraco,^Citation58 Rivera,^Citation81 Holland Wade^Citation55	Kenny (2019)
Strategies for Open Communication with Patients	Identify ways to openly communicate with patients and/ or parents and ensure that they are making an informed decision and/or informed consent (e.g., C.A.S.E. approach, allowing patients to make informed decisions, understanding of vaccine hesitancy as a continuum)	Education	Black,^Citation35 Greene,^Citation51 Speck,^Citation85 Navin,^Citation68 Warner,^Citation92 Blackford,^Citation36 Ludwikowska,^Citation62 Kubin^Citation60	Ziemczonek^Citation93
	Imploring a culturally sensitive dialogue with people who are opposed to vaccine because of religion or culture reasons	Enablement	Marcus,^Citation66 Punch^Citation78
	Focus on including parents in the dialogue as opposed to talking at them (e.g., Familiarizing patients with nurses to build trustworthiness, educational sessions with parents)	Education, Persuasion	Mossey,^Citation67 Stevens,^Citation86 Schollin Ask,^Citation82 Holland Wade^Citation55	MacDonald,^Citation64 Violette^Citation90
	Therapeutic communication strategies for providers (e.g., identify factors for why someone might be hesitant and try to understand those decisions, call parents personally to discuss vaccination plan before appointments)	Enablement, Persuasion	Hoekstra,^Citation54 Deem,^Citation44 Hidalgo,^Citation52 Bernard^Citation33	D’Arrigo^Citation41
	Tell personal stories about vaccination experience, from nurse and pharmacist perspective	Modeling, education	Fogarty^Citation50	American Pharmacists Association^Citation29
Workshops	Training workshops on how to communicate effectively with patients and/ or parents, simulation in school settings (e.g., simulation training with students, workshops on tips and tricks to communicate with vaccine hesitant individuals)	Education, Training	Dube (2020), Maurici,^Citation65 Nold,^Citation70 Nutty,^Citation72 Venzke,^Citation89 Fernback (2011), Orenstein^Citation75	Deepti Vyas,^Citation91 Brackett^Citation38
	Provide multiple strategies for health-care providers to choose from (e.g., motivational interviewing techniques, C.A.S.E approach)	Education+ Enablement+ Training	Gagneur,^Citation94 Speck,^Citation85 Marcus,^Citation66 Mossey (2019), Stevens,^Citation86 Navin,^Citation68 Davis^Citation43
	Teach providers how to have empathetic and effective discussions with patients and/ or parents (e.g., having a communication plan, advanced nurses aiding in this process)	Education + Training + Persuasion	Koslap- Petraco,^Citation59 O’Keefe,^Citation73 Courtney,^Citation40 Warner^Citation92	Queeno,^Citation79 Rawson^Citation80
Social Support	Nurse managers available to help nurses address vaccine hesitancy	Environmental restructuring	Apfel^Citation32

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