Community Pharmacist Gains Trust of Skeptical Patients in Rural Community

Erica Mabry, PharmD, met with “Tom” once a month for this patient’s diabetes management appointments at Eden Drug, a pharmacy in rural Eden, North Carolina, where Mabry recently completed a PGY1 community pharmacy residency and is now a full-time pharmacist. As a result of these ongoing visits, Tom changed his diet, started exercising, and always disclosed his struggles with medication adherence. But when the conversation shifted to vaccines, which was a part of Mabry’s agenda for these diabetes management visits, Tom shifted too. He became quiet and guarded.

“He’d get defensive and would have some reason he didn’t want to talk about [getting vaccinated], so I didn’t force it, but I told him to be ready because we were going to talk about vaccines at our next appointment,” Mabry said.

Mabry knew that convincing Tom to get vaccinated against COVID-19 was going to be a challenge. Since the onset of the pandemic, he had dismissed the virus altogether. Like many people who shop at the rural pharmacy, he’d say, “‘I’m not wearing a mask. I’m not getting the vaccine. This doesn’t affect me. This is something the government made up,’” Mabry said.

The next month, Tom repeatedly canceled and rescheduled his monthly appointment with Mabry. When he finally came in, almost a month behind schedule, he was wearing a mask for the first time. This time, when Mabry brought up the topic of vaccines, Tom didn’t interrupt or get defensive. He let her continue, so she did.

Mabry asked whether he was up to date on all other vaccines before she dove into the touchier subject of COVID-19 vaccine. He was up to date, which indicated to Mabry that her patient wasn’t categorically against vaccines.

“So, I said, ‘And how about the COVID-19 vaccine? Is that something you have received or are interested in talking about?’” Mabry said.

Tom hesitated at first but finally shared with Mabry that he had a friend who was at that moment seriously ill and in the hospital with COVID-19. That was why he had pushed back his appointment with Mabry the previous month. Tom told Mabry that he hadn’t thought the virus would hit this close to home or that someone as healthy as his friend would end up in the hospital from it. If his friend, who was healthy, could go to the hospital for COVID-19, he wondered about his own chances as a person with diabetes.

After Mabry asked about Tom’s friend and empathized with him, she asked, “Is the COVID-19 vaccine something you’d now be willing to get to protect yourself and to protect your friend when he gets out of the hospital?”

Tom asked how he could get the vaccine and scheduled an appointment for Mabry’s next clinic day.

Mabry believes she earned her patient’s trust during those diabetes management appointments throughout the pandemic. She didn’t force the vaccine topic on him, but instead waited until he was ready. She said, “I think that showing empathy, letting him open up to me, and hearing him out were all that he needed.”

Not everyone in the community was reluctant to be vaccinated as Tom had been at first. Eden Drug also had many patients line up to get the vaccine. On clinic days, cars wrapped around the building for patients to drive up, get vaccinated, and then wait in the parking lot for the 15-minute observation period.

Yet plenty of pharmacy patrons did share Tom’s initial views. “People were scared of the vaccine and didn’t fully understand it. They were questioning it and questioning why we would be giving it out,” Mabry said.

With each patient, Mabry took a similar approach to the one she used with Tom. “You’ve got to hear people out. Rather than force the conversation all at once, follow up with them later. That’s what makes you a trusted health care provider when you give them the time they need. When they’re ready to, they will talk with you about it.”

—Sonya Collins
May 2022

Tools and resources to Know What Drives Vaccine Confidence and Answer Common Questions about COVID-19 vaccine are available at APhA’s Vaccine Confident microsite.