OBJECTIVES: The anti-vaccination movement is prevalent in today's media with claims which continue to create feelings of fear and trepidation in the minds of many parents. The C.A.S.E. Approach (Corroboration, About Me, Science, Explain/Advise) is a method ofcommunication to be used in formulating meaningful, rapid responses to parents hesitant to vaccinating their children. This DNP project assessed the effects of a C.A.S.E. Approach learning module on family nurse practitioner (FNP) students' perceived levels of knowledge and self-efficacy regarding vaccination discussion with vaccine hesitant parents (VHPs). METHODS: This DNP project used a pretest-posttest design to measure the effects of the C.A.S.E. Approach training intervention on both knowledge and self-efficacy levels of FNP students. Fourteen students participated in this study. Each took the 20-question pretest C.A.S.E. Approach Questionnaire, then participated in the C.A.S.E. Approach learning module,and finished by repeating the questionnaire as a posttest following the intervention. The questionnaire was designed using four-item Likert questions scored 1 (strongly disagree) to 4(strongly agree), wherein higher scores reflected better understanding and self-efficacy in the C.A.S.E. Approach. Students were recruited via an online classroom format within a nursing course offered at the University of Arizona: Nursing 612, Introduction to Pediatrics. All testing and module information was accessed online and questionnaire responses were stored at Qualtrics.com, also online. RESULTS: Students' posttest scores following the intervention of the C.A.S.E. Approach learning module were significantly higher than pretest scores. Perceived knowledge (p< 0.001)of the C.A.S.E. Approach increased more significantly than did perceived self-efficacy (p =0.001) of the C.A.S.E. Approach following the module. Mean test scores increased on average 14.29 points in perceived knowledge of the C.A.S.E. Approach following the module, and 7.93 points for perceived self-efficacy following the module. CONCLUSION: Key findings included an observed increase in participating students' perceived knowledge regarding the C.A.S.E. Approach as well as an observed increase inparticipating students' perceived self-efficacy in using the C.A.S.E. Approach. There was strong statistical evidence (p≤0.05) to suggest the learning module increased student knowledge andself-efficacy regarding vaccine discussion.

BACKGROUND: The widespread use of vaccines led to significant decline in multiple potentially fatal infectious diseases. Recently, there has been an increase in vaccine hesitancy. Measles and pertussis outbreaks throughout the United States have put a spotlight on this urgent healthcare issue. Motivational interviewing is a counseling tactic that is gaining popularity and is being studied for its efficacy in preventative medicine and psychological disorders. It aims to inspire people to make behavioral changes through collaborative relationships with their provider by understanding how current actions do not translate into their health goals. LITERATURE REVIEW FINDINGS: Vaccine hesitancy is growing. Communities with decreased immunization rates are associated with a higher risk of disease outbreak. Increasing rates of undervaccinated children are likely due to increases in non-medical exemptions. Many parents, regardless of their vaccine hesitancy status, are concerned about vaccine safety. Vaccine hesitant parents refuse vaccines due to philosophical and religious beliefs, conspiracy theories, and safety concerns. Parents feel that providers do not adequately address their concern. Providers report not having the training to discredit parental concerns. The majority of parents describe their child’s pediatrician as their most trusted source of vaccine information. Parents who receive vaccine information from a provider are more likely to comply with the recommended childhood vaccine schedule. The most efficient way to discuss vaccines with parents has yet to be determined. PROPOSED PROJECT: This is a proposed QI research project for the Pediatric Clinic at Boston Medical Center. Providers would be trained in motivational interviewing during several sessions that included lectures and small group practice sessions with systematic feedback. During the intervention, parents who refuse vaccines for their child, aged 0-6 years old, will receive motivational interviewing from the provider. The proportion of the vaccine hesitant parents who accept the offered vaccine after will be analyzed. The pre and post intervention vaccination rates for the entire clinic will also be assessed. Data collection will be preformed through retrospective chart review. The project aims to increase provider confidence on vaccine counseling, educate providers on reasons for hesitancy, and improve compliance with the CDC recommended vaccine schedule. CONCLUSION: While most Americans continue to vaccinate their children according to the CDC’s recommended schedule, constant vigilance is required to maintain high immunization rates to protect our communities. Motivational interviewing is goal-oriented to alter a specific behavior and would allow providers to engage in an open, persuasive dialogue about parental vaccine concerns.