BACKGROUND:
Risk communication is essential for informed vaccine decision-making, especially when most parents have little first-hand experience with vaccine-preventable diseases.

OBJECTIVE:
To determine 1) appropriate and believable comparisons for risks of serious vaccine side effects and 2) preferred formats for presenting vaccine and vaccine-preventable disease risks

METHOD:
We conducted nine focus groups with women in three cities using trained moderators and a semi-structured moderator's guide. Questions included an assessment of relevant vaccine risk comparisons and preferred formats for presenting vaccine risks.

RESULT:
A total of 64 women participated in the focus groups. Comparisons for risks of serious vaccine side effects cited most often included: car accidents, allergies, falls, and illnesses. Most comparisons mentioned were considered to be more likely to happen than a serious vaccine side effect. Good risk comparisons were those that involved some kind of preventive action and also include benefit as well as risk. Participants preferred pie charts to bar charts or dot charts for visual appeal and information presentation, except when discussing mortality, when bar charts were slightly preferred. Pictures were more acceptable when combined with text. Combined formats were preferred to any single way of presenting risk information. Risk ladders were not well liked or understood.

CONCLUSION:
Appropriate vaccine risk comparisons are those that compare the risks of vaccines to other active measures that have an element of both benefit and risk. Using several formats (such as text, visual, and numeric) to convey the same information may help improve vaccine risk communication efforts with the public.

LEARNING OBJECTIVES:
Describe appropriate and believable comparisons for risks of serious vaccine side effects and preferred formats for presenting vaccine and vaccine-preventable disease risks among focus group participants.