483 - “Every day is harder.” A Qualitative Study of Primary Care Pediatricians’ Response to Increased Measles Prevalence and the Fluoride Ban in Utah

Publication Number: 4474.483

Rachel Tanz, University of Utah School of Medicine, Salt Lake City, UT, United States; Jacob Nelson, University of Utah, Salt Lake City, UT, United States; Echo L. Warner, University of Utah, Salt Lake City, UT, United States; Cindy A. Turner, University of Utah School of Medicine, Salt Lake City, UT, United States; Andy J. King, University of Utah School of Medicine, Salt Lake City, UT, United States

Background: Pediatric primary care providers (PCPs) are on the front lines responding to diminishing public trust in healthcare. Understanding how emerging health topics impact parents' interactions with PCPs, the questions parents have during well child checks (WCCs), and how PCPs respond, can inform future efforts aimed at improving patient-provider communication about emerging health topics and acceptance of PCP recommendations.

Objective: To understand the perspectives and experiences of pediatric PCPs communicating about emerging health topics with parents in Utah, where a state-level fluoride ban was enacted in early 2025 and measles cases have been increasing.

Design/Methods: We conducted semi-structured interviews with PCPs who currently practice in Utah, asking about their experiences discussing emerging public health topics-measles, fluoride, vaccine-hesitancy-with families, as well as their approaches to building trust. We transcribed and de-identified recorded interviews prior to analysis. An inductive thematic analysis was completed to identify themes.

Results: To date we have completed 9 of 30 planned interviews. Four themes have emerged from these preliminary data (see Table 1): (1) The rise in measles cases and fluoride ban have made WCCs more challenging for PCPs. Families have questions about measles, PCPs want to ensure understanding about fluoride, and discussing these two complex issues leaves less time for other routine WCC topics. (2) Even vaccine-hesitant families are open to guidance regarding fluoride, but are not as open to data surrounding measles. (3) PCPs believe their patients get much of their (mis)information about measles, fluoride, and vaccines from social media (e.g., TikTok). (4) PCPs find that their success in building trust with families hinges less on drawing on empirical evidence and professional expertise than on forging meaningful connections with patients over time and demonstrating humility and relatability.

Conclusion(s): Emerging public health topics have made WCCs more challenging and time-consuming. PCPs are adapting by leaning into existing longitudinal trust-building strategies rather than data-driven refutation. Our initial findings suggest communication strategies should be topic specific. For vaccine-related concerns, managing incomplete, inaccurate, or uncertain information depends critically on establishing (and established) PCP-parent-patient relationships. Long-term solutions for addressing emerging public health topics will require adaptable strategies that address the realities and complexities of the current communication environment.

Table 1