Challenge | Conversations about divisive health topics can burn out community health workers and erode trust in public health.

Louisiana is one of the most conservative states in the US— and has one of the lowest rates of Covid vaccine uptake. Through early discussions with the University of Louisiana Lafayette (ULL), the Louisiana Department of Health (LDH), community health workers, and vaccine canvassers, it became clear that one key barrier to vaccine uptake was that people in a position to be trusted messengers (such as healthcare workers) were avoiding conversations about vaccines.

As a Southerner, the cultural tendency toward harmony and conflict avoidance was one I understood well— but we needed to find a way to overcome it to enable important health conversations and rebuild trust in healthcare institutions.

Approach | Sorting through data-driven conversation tools.

I reviewed several data-driven approaches to reducing controversy and building trust. Comparing a range of approaches such as Motivational Interviewing and Deep Canvassing, I was looking for a framework that:

• Would be easy to learn (requiring less than 4 hours of training)
• Had empirical support for its effectiveness
• Had been designed for or effectively applied to situations of disagreement— ideally intense disagreement

With just four key pillars, Conversational Receptiveness offered a method that was both teachable and evidence-based.

Conversational receptiveness (CR) is the use of language to communicate your willingness to thoughtfully engage with opposing views, even if the other person strongly disagrees with you, or is not receptive themselves. The goal in using CR is to have a positive conversation, where the other person leaves feeling like they were heard. People who use CR are seen as more reasonable and objective, which can encourage the person they were talking to to shift their behavior positively, or at least have a future conversation.

Design | I created a training based on conversational receptiveness.

I led my team in designing a training that applied CR to controversial health topics such as vaccines, reproductive healthcare, and gender-affirming care, and could be delivered to health workers with a range of educational attainment levels.

I knew that in order for participants to walk away able to practice conversational receptiveness independently in a variety of challenging contexts, they needed a lot of practice and feedback. We developed one of BIT's most interactive trainings ever: a short teaching component, followed by scripted role play exercises, written practice, rounds of feedback, and unscripted role play practice.

The training focused on four key principals, captured by the acronym HEAR:

• Hedge your claims. Demonstrating humility through hedging (rather than making unequivocal claims) shows that you are aware of the nuance of a topic and have arrived at your position after seriously considering others. Using words like 'might,' 'most,' and 'somewhat' can help convey this sentiment.

• Emphasize agreement: While the focus of the conversation might be one specific topic, it can be helpful to look for tangential points that you agree on and point them out. For public health, that might look like emphasizing agreement about being concerned for the health of vulnerable family members.
• Acknowledge other perspectives: Paraphrasing what another speaker has said about a particular point can show that you’re listening to them carefully and genuinely trying to understand their perspective. It is not enough to use phrases like 'I hear you'— you need to show receipts (e.g., 'I hear you, that you’re worried about your daughter getting the vaccine after your aunt had a bad reaction').
• Reframe to positive: Framing ideas and messages in a positive way can express that you come in peace. Particularly if you can sense the tone of the interaction becoming adversarial, complimenting something the other person said that impressed you or expressing gratitude for their willingness to even have the conversation can get you back on the same side before you continue.

Results | We evaluated five of the trainings and saw a jump in receptiveness!

This training was the first of its kind. Conversational receptiveness itself is a relatively nascent field, and no one had tried applying it in a live training format or to public health topics.

So, we wanted to know if it worked!

We designed a pre-post evaluation in which workshop participants responded to a hypothetical controversial situation before and after the training. We then ran their responses through a 'politeness library,' or language model built to detect specific words and phrases linked to conversational receptiveness. The evaluation showed that the training was effective: our participants were using a broader range of conversational receptiveness words and phrases after the training.

In other words, they were walking away with measurably better skills to navigate conversations about controversial topics.

Reflections

Having now facilitated this training seven times to over 100 participants, I picked up several lessons along the way. For example, I noticed that during facilitated discussion in the first part of the training when we introduced the CR principles, lots of participants seemed confident that they already knew and could use them.

However, during various written and verbal practice exercises, they struggled to employ a range of CR techniques in response to specific types of discussion challenges— instead, we would often see participants falling back on the approaches with which them were most comfortable or accustomed. Adding small adjustments during practice to force participants to practice each principle separately before combining them in a real time discussion helped them feel more comfortable with each individual technique before combining them in a real time discussion.

‍

‍