EXPLORING
MINDSETS
Hepatitis B Dialogue Guide
Exploring Common Mindsets
Strategies to address concerns common in RIM communities using the Motivational Interviewing framework.
This section can be used during a counseling session with a patient:
- If you have the mindset poster printed, refer to it and invite the patient to choose one or two mindsets that best represent them
- You can skip the poster if you’ve already gained a good understanding of the patient’s mindset around hepatitis B screening or vaccination during your conversation
- Once identified, refer to the provider strategies that align with the selected mindset(s)
- These strategies are designed to support you—they don’t need to be used word-for-word. Feel free to adapt or ad-lib so your delivery feels natural and authentic
“Vaccines scare me.”
What this might signal
This can signal a fear of side effects, uncertainty about vaccine safety, or past negative experiences with medical systems. Misinformation may play a role, and for many RIM patients, fear of the unknown is made worse when trust has been broken before. Normalizing this fear and showing empathy helps open the door to real conversation.
Engage
Build Trust First
“I understand —lots of people feel nervous about shots.”
Focus
Clarify What’s at Stake
“Can I share how the hepatitis B vaccine works to protect you?”
Evoke
Hear Their Why
“What worries you most about getting vaccinated?”
Plan
Move Forward Together
“How about we start with just the first dose today? You can see how you feel and decide about the next ones later.”
💡 Tip to try
Use a familiar analogy: “Think of it like training your body’s security system to recognize a threat before it causes harm.”
“I am not at risk for hepatitis B.”
What this might signal
This can mean the patient doesn’t see themselves as at risk — maybe they feel healthy, don’t know how hepatitis B spreads, or believe it only affects certain people. They might also see it as “someone else’s problem” or think testing is only for people who already feel sick.
Engage
Build Trust First
“I hear you—a lot of people feel that way at first.”
Focus
Clarify What’s at Stake
“Hepatitis B can live in the body for years with no signs at all. That’s why this test is a routine recommendation for everyone — it’s a simple way to catch it early and keep you healthy.”
Evoke
Hear Their Why
“What have you heard about how people get hepatitis B?”
Plan
Move Forward Together
“I recommend we do this standard blood test today. If you’re not protected, we can start the vaccine series—it’s an easy step to protect you and your family.”
💡 Tip to try
Use a simple metaphor: “Think of it like a seatbelt—you wear it even if you haven’t had an accident yet.”
“I feel healthy, I don’t need the hepatitis B virus screening or vaccine.”
What this might signal
This often shows that the patient may misunderstand how hepatitis B works—they may equate feeling healthy with not being at risk. For many people, especially from communities where you only see a doctor when you’re sick, preventive screening for an asymptomatic infection can feel confusing or unnecessary. They may not realize that hepatitis B
can live silently in the body for years without symptoms and still cause permanent liver damage if left untreated.
Engage
Build Trust First
“I can understand—it’s hard to see the need when you feel fine.”
Focus
Clarify What’s at Stake
“Can I explain how hepatitis B can stay hidden for years and why we screen even when you’re healthy?”
Evoke
Hear Their Why
“How would knowing your status now help you protect your health, get treatment if needed, and protect your family?”
Plan
Move Forward Together
“Let’s do the blood test today—it’s quick, and it gives you peace of mind.”
💡 Tip to try
Use a relatable metaphor: “It’s like checking your roof for leaks—you fix small problems before they become big ones.”
“I have a lot happening in my life, it’s difficult to make time for the hepatitis B screening & vaccination.”
What this might signal
Many patients face competing priorities such as work obligations, childcare responsibilities, or challenges with transportation to the clinic. When hepatitis B infections are asymptomatic, healthcare may not feel urgent, making it easier to delay or deprioritize care. Often, logistical barriers—not reluctance about the medical aspect—are the real obstacles. For care to be effective, emotional safety must be paired with practical ease.
Engage
Build Trust First
“I get it—you’ve got a lot going on. Your time matters.”
Focus
Clarify What’s at Stake
“Would it help if I explained exactly how quick and simple this step is?”
Evoke
Hear Their Why
“How would it feel to take care of this today and not worry later?”
Plan
Move Forward Together
“We can do the test right now. It takes just a few minutes.”
💡 Tip to try
Offer future planning: “Let’s schedule the next dose before you leave.”
“Is screening or getting vaccinated going to be an added expense?”
What this might signal
This often shows that the patient is worried about surprise costs—especially if they’ve had bad experiences with unclear insurance coverage or hidden fees in the past. This may cause them to delay or avoid screening and vaccination altogether. Addressing cost concerns up front builds trust and makes it more likely they’ll follow through.
Engage
Build Trust First
“That’s an important question— thank you for asking.”
Focus
Clarify What’s at Stake
“Most insurance plans cover hepatitis B testing and vaccination at no cost to you.”
Evoke
Hear Their Why
“Would it help to check your coverage together right now?”
Plan
Move Forward Together
“I’ll have our staff confirm what’s covered before we do anything and then we can proceed to getting you tested.”
💡 Tip to try
Reassure that prevention now saves bigger costs later: “Catching hepatitis B early can prevent expensive liver treatments in the future.”
“I’m worried about the side effects of the hepatitis B vaccine.”
What this might signal
This often shows that the patient has heard mixed information about vaccine safety or has general fear about side effects. Without clear, simple facts and reassurance, this fear can easily lead to delay or refusal.
Engage
Build Trust First
“It’s completely normal to feel nervous—many people have the same worry.”
Focus
Clarify What’s at Stake
“Can I share how the hepatitis B vaccine works and why it’s so safe?”
Evoke
Hear Their Why
“What have you heard about side effects? What concerns you most?”
Plan
Move Forward Together
“Most people have no side effects at all, or maybe a sore arm. How about we start with the first dose today, and you can see how you feel before the next one?”
💡 Tip to try
Share real-life examples to build reassurance. “‘Many of my other patients have felt the same and did fine.”