Motivational interview training improves self-efficacy of GP interns in vaccination consultations: A study using the Pro-VC-Be to measure vaccine confidence determinants

ABSTRACT

Immunization-specific motivational interviewing (MI), a patient-centered communication style used to encourage internal motivation for attitudinal and behavioral change, can provide healthcare professionals (HCPs) with the skills and practice required to respond to patients’ doubts and concerns related to vaccines. We sought to assess the impact of an MI-training of General Practitioner (GP) interns on the psychosocial determinants of their vaccine confidence and behaviors. French GP interns participated in a virtual three-day MI-workshop in southeastern France. We used the validated Pro-VC-Be questionnaire – before and after the MI-workshop spanning over three months – to measure the evolution of these determinants. Scores before and after workshop trainings were compared in pairs. Participants’ scores for commitment to vaccination (+10.5 ± 20.5, P = .001), perceived self-efficacy (+36.0 ± 25.8, P < .0001), openness to patients (+18.7 ± 17.0, P < .0001), and trust in authorities (+9.5 ± 17.2, P = 0.01) significantly increased after the training sessions, but not the score for confidence in vaccines (+1.5 ± 11.9, P = .14). The effect sizes of the four score improvements were moderate to large, with self-efficacy and openness to patients having the largest effect sizes (P = .83 and 0.78, respectively). This study provides evidence that certain determinants of overall vaccine confidence in HCPs, reflected respectively in the openness to patients and self-efficacy scores of the Pro-VC-Be, improve after immunization MI-training workshops. Incorporating immunization-specific MI-training in the curriculum for HCPs could improve several necessary skills to improve HCP-patient relationships and be useful for vaccination and other healthcare services.

KEYWORDS:

• Vaccine confidence
• motivational interview
• general practitioners
• clinical training
• self-efficacy
• vaccination

Introduction

In 2019, the World Health Organization (WHO) ranked vaccine hesitancy as one of the 10 most important health threats in the world,¹ defined as a “[m]otivational state of being conflicted about, or opposed to, getting vaccinated; including intentions and willingness.”² Vaccine hesitancy can be context- and vaccine-specific and be the result of various psychosocial determinants, such as the perceived risk of both the vaccine and the disease itself, trust in political and public health institutions, and perceived accessibility of vaccines. General Practitioners (GPs) are regularly confronted with patients having doubts and concerns about vaccination,³ and many of them express a lack of adequate training in addressing these concerns.⁴ GPs have a central role in the vaccination of the general public; they provide recommendations to target-groups for vaccines,⁵ motivate patients to get vaccinated,⁶ and should provide accurate information regarding vaccines (including potential side effects).⁷ Additionally, GPs’ own vaccine hesitancy could negatively influence their vaccination recommendations to patients.^8–10

Motivational interviewing (MI) is a patient-centered communication style used to encourage internal motivation for attitudinal and behavioral change.¹¹ The skills of MI include asking open-ended questions, using affirmations and reflective listening/summaries, and asking permission before sharing information (Supplemental Table S1). The Promovac study in Quebec that an immunization-specific MI educational strategy increased postpartum parents’ intentions to vaccinate by up to 15%, decreased vaccine hesitancy scores by 40%, and increased infant immunization coverage by up to 7%.^12–14 MI educational strategies are now a generalized practice of care in all maternity wards in Quebec, referred to as the EMMIE program, demonstrating the feasibility of MI on a large scale.^15,16 Quebec nurses received targeted immunization-specific MI trainings in order to curb parental hesitancy for child vaccinations.¹⁷ They reported having more self-confidence in applying what they learned in MI training in their own clinical practice. Recent studies have also shown how these educational strategies improve COVID-19 vaccination uptake.^18–20 Providing sufficient training, such as immunization-specific MI workshops, for GPs and nurses geared toward improving patient communication and understanding around vaccination is of public health importance.^4,21,22

In order to evaluate the effectiveness of healthcare professional (HCP) trainings, the use of validated tools to measure their confidence in vaccines and preparedness is necessary. Few resources are available to measure HCPs’ confidence in vaccines; however, the recently validated Health Professionals Vaccine Confidence and Behaviors (Pro-VC-Be) questionnaire provides an evaluation of the psychosocial determinants of HCPs’ vaccination attitudes and behaviors.²³ From March to May 2021, the Motivac study tested the feasibility and effectiveness of an immunization-specific MI training via videoconference for GP interns in southeastern France.²⁴ The objective of this paper is to compare the evolution of psychosocial determinants of vaccine confidence and behaviors in these interns before and after this training using the validated Pro-VC-Be.

Materials and methods

Population

French GP interns in their final year of clinical training were invited to participate in an immunization-specific MI workshop during the 2020/2021 academic year. An MI-training curriculum developed by Gagneur et al¹⁷ was adapted for use in a virtual three-day workshop via Zoom with a focus on vaccination and vaccine hesitancy. The first two days of the workshop (March 2021) focused on the philosophy and principles of MI and its fundamental skills; interns then had two months to apply their newly acquired MI skills within their daily practice before returning for the final day (3-hour session) of the workshop (May 2021). This final session revisited the MI skills learned during the initial sessions, and interns shared their experiences and challenges encountered with vaccine-hesitant patients within supervised group feedback discussions.

The MI workshop was offered to 70 randomly selected interns, with the anticipation of refusals, in their final year of initial clinical training at the Marseille and Nice Faculties of Medicine in southeastern France. Participation was strictly voluntary and limited to 51 places, in order to have three training groups of maximum 17 participants each. The sole inclusion criteria for participating was that interns were in their final year of medical studies at either faculty.

Instrument and procedure

The Pro-VC-Be questionnaire was given to interns before and several days after the MI-workshop and measured the evolution of the psychosocial determinants of their vaccine confidence and behaviors. Eight of the ten psychosocial determinants (dimensions) identified in the Pro-VC-Be were measured: perceived risks of vaccines, complacency (i.e. the perceived lack of disease risks and therefore the usefulness of vaccines), perceived benefit/risk balance of vaccines, collective responsibility (making up the second-order dimension confidence in vaccines), commitment to vaccination, perceived self-efficacy in addressing vaccination concerns (making up the second-order dimension proactive efficacy), trust in authorities, and openness to patients’ concerns regarding vaccination. These second-order dimensions were composed of the previously mentioned first-order dimensions that were closely correlated. The Pro-VC-Be enquires about the most common and the most controversial vaccines in recent history (i.e. the vaccines for influenza, Hepatitis B, and MMR, to name a few). These vaccines were chosen to be included in the Pro-VC-Be questionnaire through expert opinion, as well as cognitive and pilot testing in the early development stages of the questionnaire. Detailed information on the construction and validation of the Pro-VC-Be can be found in a preceding publication.²³ Table 1 illustrates the items included in the questionnaire and used to construct vaccine confidence scores pre- and post-workshop. Dimensions were measured using 5-point Likert-style questions (from ‘strongly disagree’ to ‘strongly agree’ with a ‘don’t know’ option). GPs were also asked about their vaccination recommendation frequency behaviors, using 5-point Likert-style questions (scale from 1 = ‘never’ to 4 = ‘always,’ with a ‘does not apply to my practice’ option).

Table 1. Items from the Pro-VC-Be used in the measure of vaccine confidence before and after motivational interviewing workshop for GP interns.

Dimension		Items used in vaccine scores (from validated long-form tool)
Confidence in vaccines	Perceived risks of vaccines	1. Some vaccines can cause autoimmune diseases 2. The measles vaccine can cause autism in children 3. Some vaccines can cause multiple sclerosis
	Complacency	1. Today, some vaccines recommended by authorities are not useful, because the diseases they prevent are not serious 2. Children are vaccinated against too many diseases 3. Children are vaccinated at too young an age
	Perceived benefit/risk balance of vaccines	1. The benefits of the vaccine against measles are much greater than its potential risks 2. The benefits of the vaccine against influenza in people with chronic disease are much greater than its potential risks 3. The benefits of the vaccine against hepatitis B in infants (or as a catch-up in adolescents) are much greater than its potential risks 4. The benefits of the vaccine against human papillomaviruses are much greater than its potential risks
	Collective responsibility	1. I recommend the vaccines on the vaccination schedule to my patients because it’s essential to contribute to protection of the population (community immunity) 2. I recommend the vaccines in the official schedule to my hesitant patients, explaining to them the importance of community immunity
Trust in authorities		1. I trust the ministry of health to provide reliable information about the risks and benefits of vaccines 2. I trust the ministry of health to establish the vaccination strategy 3. I trust the ministry of health to ensure that vaccines are safe
Proactive efficacy	Commitment	1. I am actively involved in ensuring that my patients are vaccinated 2. I am committed to keeping my knowledge about vaccination up-to-date (i.e. CME, conferences, reading) 3. I am committed to developing the skills needed to communicate better with my patients about vaccination
	Perceived self-efficacy	1. I feel comfortable advising my patients about the risks and benefits of vaccines 2. I feel comfortable discussing vaccines with my patients who are highly hesitant about vaccination 3. I feel sufficiently trained and informed to discuss vaccines with all patients 4. I feel sufficiently trained on how to approach the question of vaccines with hesitant patients
Openness to patients		1. Patients who are hesitant about the benefits and risks of vaccines have legitimate questions 2. I inform my patients about the benefits and risks of vaccines but I let them make their decision without trying to influence them 3. I am willing to let parents delay immunizing their children
Vaccine recommendation frequency		1. How often do you recommend the following vaccines? A. Catch-up MMR vaccine for adolescents B. Meningitis C vaccine for unvaccinated adolescents C. Human papilloma virus vaccine in young boys aged 11 to 14 years old D. Human papilloma virus vaccine in young girls aged 11 to 14 years old E. Catch-up hepatitis B vaccine in adolescents F. Seasonal flu vaccine in adults under 65 years old with chronic illness

Statistical analysis

For each of the Pro-VC-Be dimensions, two scores were constructed (pre- and post-workshop) according to a validated methodology for the long-form tool,²³ by summing the corresponding items and applying a linear transformation to vary them on a scale from 0 to 100. Second-order dimension scores were constructed and linearized to evolve on the same scale as first-order dimensions. Pre- and post-workshop scores were compared using exact Wilcoxon-Pratt signed-rank tests for each dimension of the Pro-VC-Be, which can be used with small sample sizes.²⁵ Effect size, reflecting the magnitude of the training session’s effect, was calculated for each dimension using the Z-score of the signed-rank test as follows: r = Z/√n, with n the number of paired observations.²⁶ R-values between 0 and 0.3 reflect small effect sizes, between 0.3 and 0.5 reflect moderate effect sizes, and between 0.5 and 1 reflect large effect sizes. Analyses were performed on the entire sample, then stratified according to whether or not participants had former training in MI, communication or vaccination in order to evaluate how determinants of vaccine confidence evolved in interns without specific, prior training. Analyses were performed with R 4.1.2, and P < .05 indicates statistical significance.

Ethical approval

Ethical approval for this study was provided by the Committee of Personal Protection (CPP) Southwest and Overseas in France (#2020-A01440-39).

Results

In all, 45 GP interns participated in the first (2-day) session of the MI training workshop in March 2021; 64% were women and nearly all (91%) were 25 to 30 years old (Table 2). Some participants reported that they had received training in MI (9%), communication (18%), or vaccination (9%); 35/45 (78%) interns participated in the final workshop session. The characteristics of participants who did not participate in the final session were not significantly different from those who did.

Table 2. Characteristics of participants enrolled for the MI-training (n = 45).

	All (n = 45)	Participants in both sessions
		No (n = 10)	Yes (n = 35)	Fisher p-value
		N (%)
Sex
Female	29 (64.4)	8 (80.0)	21 (60.0)	.29
Male	16 (35.6)	2 (20.0)	14 (40.0)
Age (years)
25-30	41 (91.1)	8 (80.0)	33 (94.3)	.20
More than 30	4 (8.9)	2 (20.0)	2 (5.7)
Has already received training in MI
Yes	4 (8.9)	1 (10.0)	3 (8.6)	1.00
No	40 (88.9)	9 (90.0)	31 (88.6)
Do not know	1 (2.2)	0 (0.0)	1 (2.9)
Has already received training in communication
Yes	8 (17.8)	2 (20.0)	6 (17.1)	1.00
No	36 (80.0)	8 (80.0)	28 (80.0)
Do not know	1 (2.2)	0 (0.0)	1 (2.9)
Has already received training in immunization
Yes	4 (8.9)	1 (10.0)	3 (8.6)	1.00
No	41 (91.1)	9 (90.0)	32 (91.4)
Do not know	0 (0.0)	0 (0.0)	0 (0.0)

Before the workshop, participants’ scores for the dimensions of complacency and perceived risks of vaccines were quite low (7/100 and 16/100, respectively). They showed high scores for the dimensions of perceived benefit/risk balance of vaccines (89/100) and collective responsibility (88/100), resulting in high scores for the second-order dimension of confidence in vaccines (88/100). While their commitment to vaccination was high (75/100), they had low perceived self-efficacy (36/100), resulting in moderate scores for the second-order dimension of proactive efficacy (55/100). Trust in authorities was moderate to high (65/100), and openness to patients (48/100) and vaccine recommendations (50/100) were moderate.

Participants’ scores for proactive efficacy, commitment to vaccination, perceived self-efficacy, openness to patients, and trust in authorities significantly increased after the training sessions (+23.2 ± 18.7, P < .001; +10.5 ± 20.5, P = .001; +36.0 ± 25.8, P < .0001; +18.7 ± 17.0, P < .0001; +9.5 ± 17.2, P = .01), corresponding to increases of 42%, 14%, 100%, 39% and 15%, respectively (Table 3). The effect sizes of these score improvements were moderate to large: proactive efficacy, self-efficacy and openness to patients had the largest effect sizes (r = 0.79, 0.83 and 0.78, respectively); commitment to vaccination (r = 0.52) and trust in authorities (r = 0.44) were moderate. Confidence in vaccines scores and the recommendation score did not significantly increase after the workshop. Complacency scores were almost significantly lower (−4.8 ± 13.3, P = .054) and had a moderate effect size (r = 0.33).

Table 3. Comparison of mean scores of each long-form Pro-VC-Be dimension between questionnaires completed before and after the workshop (n = 35).

	Score pre-session 1	Score difference between post-session 2 and pre-session 1
Dimension (/100)	Mean ± SD	Mean ± SD	p-value*	Effect size r
Confidence in vaccines	88.4 ± 10.6	1,5 ± 11.9	.14	0.25 [0.02;0.54]
Perceived risks of vaccines	16.2 ± 20.6	−3.8 ± 23.9	.10	0.28 [0.02;0.57]
Complacency	7.3 ± 13.7	−4.8 ± 13.3	.054	0.33 [0.05;0.58]
Perceived benefit/risk balance	89.2 ± 15.4	1.8 ± 21.5	.30	0.18 [0.01;0.47]
Collective responsibility	88.1 ± 13.8	−4.5 ± 18.7	.19	0.22 [0.01;0.52]
Proactive efficacy	55.3 ± 12,5	23.2 ± 18.7	<.0001	0.79 [0.66;0.87]
Commitment	74.6 ± 15.6	10.5 ± 20.5	.001	0.52 [0.24;0.75]
Perceived self-efficacy	36.0 ± 17.1	36.0 ± 25.8	<.0001	0.83 [0.73;0.87]
Openness to patients	47.8 ± 17.8	18.7 ± 17.0	<.0001	0.78 [0.65;0.86]
Trust in authorities	65.1 ± 25.4	9.5 ± 17.2	.01	0.44 [0.12;0.69]
Vaccine recommendation frequency (n = 26)	49.9 ± 18.0	3.1 ± 22.8	.67	0.08 [0.01;0.46]

*p-value from Wilcoxon-Pratt signed-rank tests.

Stratified analyses in participants with and without former training experience in MI, communication, or vaccination showed some differences (Table 4). Exact Wilcoxon rank-sum tests, comparing scores between participants with and without former training, revealed no significant differences in pre-workshop scores, but a higher post-workshop score for trust in authorities among those who had no former training compared to those who had. (79.2 vs 64.6, p = .03). Compared to the results within the global sample, when considered separately, participants who had no former training had significantly increased scores for confidence in vaccines (+3.9 ± 8.5, p = .03) and significantly decreased scores for complacency (−7.4 ± 14.5, p = .03) after the workshop. There were more marked increases in scores of proactive efficacy, self-efficacy, trust in authorities, and openness to patients; however, commitment scores did not significantly increase. Participants who had former training did not show significantly increased scores for trust in authorities.

Table 4. Comparison of mean scores of each long-form Pro-VC-Be dimension between questionnaires completed before and after the workshop, according to their former training experience in MI, communication or vaccination (n = 35).

Former experience of training in MI, communication or vaccination	No (n = 24)			Yes (n = 11)
	Score pre-session 1	Score difference between post-session 2 and pre-session 1		Score pre-session 1	Score difference between post-session 2 and pre-session 1
Dimension (/100)	Mean ± SD	Mean ± SD	p-value*	Mean ± SD	Mean ± SD	p-value*
Confidence in vaccines	88.9 ± 10.4	3.9 ± 8.5	.03	87.4 ± 11.4	−4.0 ± 16.4	.62
Perceived risks of vaccines	16.2 ± 23.2	−7.9 ± 20.3	.06	16.2 ± 14.4	5.1 ± 29.5	.90
Complacency	9.3 ± 14.9	−7.4 ± 14.5	.03	3.0 ± 10.1	1.0 ± 7.8	1.00
Perceived benefit/risk balance	90.8 ± 12.4	4.3 ± 14.7	.22	85.6 ± 20.8	−3.8 ± 31.9	.94
Collective responsibility	90.3 ± 12.9	−3.8 ± 17.0	.50	83.3 ± 14.9	−6.1 ± 22.7	.38
Proactive efficacy	55.3 ± 12.7	23.3 ± 18.0	<.0001	55.2 ± 12.7	23.1 ± 20.9	.005
Commitment	77.3 ± 17.2	6.9 ± 21.9	.07	68.7 ± 9.7	18.2 ± 15.1	.01
Perceived self-efficacy	33.3 ± 15.3	39.6 ± 21.6	<.0001	41.7 ± 20.1	28.0 ± 33.0	.02
Openness to patients	44.2 ± 17.3	20.8 ± 16.2	<.0001	55.6 ± 17.2	14.1 ± 18.7	.05
Trust in authorities	68.1 ± 25.7	11.1 ± 19.1	.01	58.6 ± 24.9	6.1 ± 28.7	.47
Vaccine recommendation frequency (n = 26)	52.2 ± 19.5	−2.5 ± 16.8	.37	45.2 ± 14.5	13.7 ± 29.4	.17

*p-value from Wilcoxon-Pratt signed-rank tests.

^§Mean scores differences between participants according to their former training experience in MI, communication or vaccination; in pre-session 1 and in post-session 2.

Discussion

For the 35 participants who attended all three MI-workshop training days, long-form Pro-VC-Be scores for the dimensions of proactive efficacy, commitment, perceived self-efficacy, openness to patients, and trust in authorities were significantly higher at the end of the workshop. Except for the commitment score, these results were even more marked among participants who had no former training in MI, communication or vaccination; these participants also had significantly lower complacency scores, indicating higher perception of usefulness of vaccines, and higher confidence in vaccines scores after the second session.

MI-training techniques have been used in several domains of public health to encourage the adoption of positive behaviors.^{27– 32} Several of these studies, including those related to vaccination, demonstrate how MI education significantly increase patients’ self-efficacy for behavioral change. In HCPs, MI education improves their feelings of preparedness when providing care and counsel to patients, particularly for vaccination.^{8,27–29,31,33} Our results among GP interns were in agreement with these previous results and showed a 100% increase in perceived self-efficacy post-workshop.

HCPs’ openness to patients, which represents the acceptance and empathy HCPs have toward their patients, was also shown to significantly increase by 39%. One of the mechanisms behind the impacts of MI educational strategies on behavioral change is the acquirement of therapeutic skills of accurate empathy, non-judgment, and the ability to listen to the patient and respect her/his autonomy, as indicated by Supplemental Table S1.³⁴ These skills facilitate establishing a relationship of trust between HCPs and patients based on mutual respect and understanding. This allows patients to feel valued and have the autonomy to seek out resources related to their own behavioral changes regarding vaccination, without HCPs imposing these changes onto them. There is evidence that MI-training for HCPs improves both inter-personal (openness to patients) and personal (perceived self-efficacy) competences that could better equip HCPs to discuss and recommend vaccination to their patients.^35–38

More broadly, this is the first study, to our knowledge, to show changes in psychosocial determinants of vaccine confidence and recommendation behaviors in HCPs before and after an immunization-focused MI-training workshop. This study provides some evidence that certain determinants of overall vaccine confidence in HCPs improved after this workshop. The persistence of these effects two months after the first training session suggests the prolonged impact that immunization-specific MI educational strategies among GP interns. This MI-training of GP interns, and the original training of nurses by Gagneur et al., both show that MI can be applicable to different types of HCPs, in face-to-face or distance learning, and in different cultural contexts.¹³ MI educational strategies can be effective in initial clinical training, such as in this study, and in continued medical education.

Our results within the entire population of interns did not show a significant increase in confidence in vaccines post-workshop. However, these scores were already elevated in this population and the MI-workshop did not aim to improve knowledge of vaccinations themselves and did not offer answers to interns’ questions related to vaccines. However, after stratification of analyses based on previous training, we found that the scores of interns without prior training showed a significant increase in confidence in vaccines and a decrease in complacency scores. Within the entire population of interns, we found increased scores for proactive efficacy, openness to patients, and trust in authorities; although the latter was observed only in those with no prior training. While interns with prior MI, communication, or vaccination training showed improved scores post-workshop, those who were completing the MI-workshop for the first time in their career training benefited from stronger improvements in Pro-VC-Be scores, thus demonstrating the impact that this type of workshop can have in those without any previous complementary training.

Employing validated tools to measure the effectiveness of MI-training provides a means of systematic evaluation, a necessary component to quality assurance of MI trainings according to S. Rollnick, the original author of these techniques.³⁴ In this study, the Pro-VC-Be was a complimentary instrument used alongside the Motivational interviewing skills in immunization (MISI) questionnaire, a tool specifically validated to assess the acquisition of skills from MI-training.³⁹ The Pro-VC-Be proved to be a sensitive instrument for measuring variations in psychosocial determinants of vaccination behavior. This instrument was designed to allow researchers to evaluate and compare the impact of various kinds of interventions and studies, not solely MI-specific, on the determinants of vaccine confidence in HCPs, which have been shown to influence recommendation behaviors.²³ In this study, the Pro-VC-Be showed how sensitive some psychosocial determinants of vaccine confidence – such as openness to patients – could be to MI trainings. Other types of training that focus on vaccination knowledge, for example, may influence different determinants of vaccine confidence measured by the Pro-VC-Be.

There are limitations to this work, including that GP interns’ participation was voluntary, suggesting those that completed the MI-workshop were already more motivated and open to its techniques than non-participants. However, the response rate for this population remained high, with 45 out of 70 (64.3%) agreeing to participate in the initial workshop, thus limiting the potential for this selection bias. Furthermore, there is a potential for bias from the Hawthorne effect in post-workshop measurements; however, this was minimized within our study since interns completed the Pro-VC-Be several days after the final MI-training. This study was also not a randomized trial with a control group, but a study of feasibility evaluating the impacts of MI training. Therefore, further work is needed in randomized controlled studies in order to support our findings. Although scores for various determinants of vaccine confidence improved in the entire population, this was not translated into an improvement of behaviors through significantly increased reported vaccine recommendation frequency scores. A possible explanation for this is that the two-month period between MI-workshops was too short to discern such a difference in behavior. Vaccine confidence can be influenced by certain contextual factors, such as gender, region, age, and profession. This study took place in southeastern France, a region where HCPs are shown to have less vaccine confidence than HCPs in other areas of the country.⁴⁰ Additionally, our population consisted solely of interns practicing general medicine, which could affect the generalizability of our results since GPs have more experience and may have acquired attitudes and behaviors that are difficult to change. Moreover, GPs are often more confident in vaccines than nurses or other types of medical professions.^41,42 HCPs with children have also been shown to be more confident in vaccines, as they have been confronted in their personal life with vaccinating their children.⁴³ Therefore, future studies using the Pro-VC-Be should include other professional categories and take into account these varying demographic characteristics within their population and control for these factors. Another limitation is the attrition between the 1^st and 2^nd workshop sessions (22%), reasoning that the interns with heavier workloads and/or who were less motivated could have been among those most likely to not return, with a potential overestimation of the impact of the MI training. However, these interns still benefited from the first MI-workshop and therefore may have more opportunity to transmit these skills during patient interactions. The original, 31-item Pro-VC-Be has undergone validation to provide HCPs with a more time- and cost-effective 10-item short-form version.⁴⁴

Incorporating immunization-specific MI-training in the curriculum for GP interns, and other HCPs, could improve several necessary skills for patient interactions, such as increased empathy, active listening, more openness to patients, and feeling more comfortable evoking the subject of vaccination, all of which could subsequently improve HCP-patient relationships and be useful for vaccination and other healthcare services. Proper evaluation of these trainings via systematic, validated tools such as the Pro-VC-Be would ensure the quality control necessary to maximize their benefits to HCPs and patients. The long- and short-form versions of the Pro-VC-Be could also be useful in evaluating different types of interventions geared toward HCPs and their impacts on overall vaccine confidence and behaviors, which would allow for the comparison of various interventions.

Acknowledgments

We would like to thank the medical residents who participated in this study, the teachers of the University Department of General Medicine of the Faculty of Medicine of Marseille who allowed and organized trainings, as well as Gwenaelle Maradan and Cyril Bérenger for their invaluable help in data collection management.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website at https://doi.org/10.1080/21645515.2022.2163809.

Additional information

Funding

This work was supported by the GIRCI Méditerrannée (Groupement Interrégional pour la Recherche Clinique et l’Innovation) and by the European Union’s Horizon 2020 research and innovation program under Grant agreement number 964728 (JITSUVAX).