Addressing needle fear early pays off

5 minute read

Distraction and memory tricks prevent a lifetime of vaccine hesitancy.

Addressing needle fears while children are being vaccinated at a young age may help prevent needle hesitancy in adulthood, a new South Australian feasibility study suggests.

The findings follow the release last month of the Melbourne Vaccine Education Centre’s (MVEC) updated guidelines on treating patients with needle phobia.

Health departments around the country are also rolling out advice for vaccinating vaccine-hesitant people. With covid and flu cases reaching record numbers this winter, minimising needle fear and phobia is critical to maintain vaccination rates at levels that protect all Australians.

A pre-covid systematic review and meta-analysis published in 2019 in the Journal of Advanced Nursing revealed the majority of children exhibit needle fear, as do 20-50% of adolescents and 20-30% of young adults.

They found that in general, needle fear decreased with increasing age. Both needle fear and needle phobia were more prevalent in females than males.

“Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients, 27% of hospital employees, 18% of workers at long-term care facilities, and 8% of healthcare workers at hospital,” the researchers wrote.

They recommended that more attention be directed to interventions which alleviate fear in high-risk groups.

And University of South Australia researchers have been working on just that – a feasibility study to see whether vaccination delivery practices can prevent long-term needle hesitancy.

They randomly assigned 41 child-parent dyads to receive one of four interventions: best practice usual care, divided attention, positive memory reframing or a combination of divided attention and positive memory reframing.

While the researchers found no differences in reported pain across the groups, some interventions appeared to reduce how much fear the primary school-aged children recalled and their fear of future needles by up to one point on a five-point scale, compared to immediately post-vaccination.

Children who received both divided attention and positive memory reframing also appeared to have a moderate reduction in fear, although the study was geared to focus on the feasibility of these interventions rather than the magnitude of the results, the authors noted.

The divided attention intervention involved the nurse playing a short (one to two minute) distraction game with the child. The nurse tapped the child’s arm above and below the vaccination spot in random order and instructed the child to guess which spot was touched each time, drawing attention away from the needle.

The positive memory reframing intervention involved the nurse talking to the child about previous injections or vaccinations and focusing on positive aspects (e.g., “you were really brave”) and providing positive feedback on strategies the child used to minimise their own distress, to help children believe they have appropriate coping skills.

Study author Dr Felicity Braithwaite noted that only 10-22% of the children first recruited received the full intervention, with nurses using their clinical experience to adjust to modify the approach for particularly anxious children.

Professor Stefan Friedrichsdorf, president of the International Association for the Study of Pain’s Special Interest Group on Pain in Childhood Is excited about the approach and its potential uses.

“This well-performed feasibility study suggests it is possible to use these techniques but does not show us whether they are as good, or better, than best practice yet,” he said.

“Now these excellent researchers have undertaken this feasibility study, we look forward to a much-needed clinical RCT.”

Professor Friedrichsdorf said memory reframing was a key tool for managing needle-related fear in children.

“There are four proven steps that should be offered to reduce pain and anxiety in needle-related procedures,” he said

“Always use a numbing cream if it is available … ensure the child is sitting (or held) in a comfortable position, use age-appropriate distraction, and, in infants younger than 12 months, use either sucrose or breastfeed.”

The interventions used in the study and the four steps detailed by Professor Friedrichsdorf align with the practical advice suggested by the MVEC. In addition, the MVEC recommends:

  • Acknowledging needle phobia is real, and that it’s okay to be scared.
  • Encouraging parents not to discuss the vaccine or needle procedure with the child until they arrive at the clinic, as to reduce fear and anxiety.
  • Not rushing the procedure, forcing the vaccination, or restraining the individual while administering the vaccine.

It’s good news for the covid vaccination campaign. An article published in June 2021 in the journal Psychological Medicine, revealed treating needle fears may reduce covid vaccination hesitancy rates by 10%.

Researchers from the University of Oxford asked a representative group of 15,014 UK adults to rate their anxieties about needles and blood and asked them about their willingness to receive a covid-19 vaccine. 

On release of the research, Professor Sir Andrew Pollard, director of the university’s Oxford Vaccine Group, said addressing this issue must be a priority.

“The coronavirus as a public health threat remains with us and those who are unvaccinated will continue to be at risk,” he said.

“Strategies to address protection for the unvaccinated are urgently needed, including getting access to vaccines for those without it and addressing fears and concerns of those who decline.”

European Journal of Pain 2022, online 12 August

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