| Title | Effectiveness of a pay-it-forward intervention compared with user-paid vaccination to improve influenza vaccine uptake and community engagement among children and older adults in China: a quasi-experimental pragmatic trial |
| Authors | Wu, Dan Jin, Chenqi Bessame, Khaoula Tang, Fanny Fong-Yi Ong, Jason J. Wang, Zaisheng Xie, Yewei Jit, Mark Larson, Heidi J. Chantler, Tracey Lin, Leesa Gong, Wenfeng Yang, Fan Jing, Fengshi Wei, Shufang Cheng, Weibin Zhou, Yi Ren, Nina Qiu, Shuhao Bao, Jianmin Wen, Liufen Yang, Qinlu Tian, Junzhang Tang, Weiming Tucker, Joseph D. |
| Affiliation | Sichuan Univ, West China Hosp 4, West China Sch Publ Hlth, Chengdu 610041, Peoples R China London Sch Hyg & Trop Med, Dept Clin Res, Fac Infect & Trop Dis, London, England London Sch Hyg & Trop Med, Fac Epidemiol & Populat Hlth, London, England London Sch Hyg & Trop Med, Fac Publ Hlth & Policy, London, England Univ N Carolina, Chapel Hill Project China, Guangzhou, Peoples R China Chinese Acad Sci, Shanghai Inst Nutr & Hlth, Shanghai, Peoples R China Univ Hong Kong, Li Ka Shing Fac Med, Hong Kong, Peoples R China Monash Univ, Fac Med, Cent Clin Sch, Melbourne, Vic, Australia Alfred Hlth, Melbourne Sexual Hlth Ctr, Melbourne, Vic, Australia Univ Sheffield, Sch Hlth & Related Res, Sheffield, S Yorkshire, England Duke Univ, Duke Global Hlth Inst, Durham, NC USA Lab Data Discovery Hlth, Hong Kong Sci Pk, Hong Kong, Peoples R China Bill & Melinda Gates Fdn, Beijing Representat Off, Beijing, Peoples R China Peking Univ, Inst Populat Res, Beijing, Peoples R China Guangdong Secondary Prov Gen Hosp, Guangzhou, Peoples R China Zhuhai Ctr Dis Control & Prevent, Zhuhai, Peoples R China Macau Univ Sci & Technol, Fac Med, Macau, Peoples R China Yangshan Hlth Ctr, Vaccinat Clin, Qingyuan, Peoples R China Fenghuang Community Hlth Serv Ctr, Zengcheng, Peoples R China Xinhua Community Hlth Serv Ctr, Guangzhou, Peoples R China Community Hlth Ctr, Guangzhou, Peoples R China Univ N Carolina, Inst Global Hlth & Infect Dis, Sch Med, Chapel Hill, NC 27515 USA |
| Keywords | MEN SEX IMMUNIZATION GONORRHEA INCREASE BEHAVIOR |
| Issue Date | Oct-2022 |
| Publisher | LANCET INFECTIOUS DISEASES |
| Abstract | Background China has low seasonal influenza vaccination rates among priority populations. In this study, we aimed to evaluate a pay-it-forward strategy to increase influenza vaccine uptake in rural, suburban, and urban settings in China. Methods We performed a quasi-experimental pragmatic trial to examine the effectiveness of a pay-it-forward intervention (a free influenza vaccine and an opportunity to donate financially to support vaccination of other individuals) to increase influenza vaccine uptake compared with standard-of-care user-paid vaccination among children (aged between 6 months and 8 years) and older people (>= 60 years) in China. Recruitment took place in the standard-of-care group until the expected sample size was reached and then in the pay-it-forward group in primary care clinics from a rural site (Yangshan), a suburban site (Zengcheng), and an urban site (Tianhe). Participants were introduced to the influenza vaccine by project staff using a pamphlet about influenza vaccination and were either asked to pay out-of-pocket at the standard market price (US$8.5-23.2; standard-of-care group) or to donate any amount anonymously (pay-it-forward group). Participants had to be eligible to receive an influenza vaccine and to have not received an influenza vaccine in the past year. The primary outcome was vaccine uptake. Secondary outcomes were vaccine confidence and costs (from the health-care provider perspective). Regression methods compared influenza vaccine uptake and vaccine confidence between the two groups. This trial is registered with ChiCTR, ChiCTR2000040048. Findings From Sept 21, 2020, to March 3, 2021, 300 enrolees were recruited from patients visiting three primary care clinics. 55 (37%) of 150 people in the standard-of-care group (40 [53%] of 75 children and 15 [20%] of 75 older adults) and 111 (74%) of 150 in the pay-it-forward group (66 [88%] of 75 children and 45 [60%] of 75 older adults) received an influenza vaccine. People in the pay-it-forward group were more likely to receive an influenza vaccine compared with those in the standard-of-care group (adjusted odds ratio [aOR] 6.7 [95% CI 2.7-16.6] among children and 5.0 [2.3-10.8] among older adults). People in the pay-it-forward group had greater confidence in vaccine safety (aOR 2.2 [95% CI 1.2-3.9]), importance (3.1 [1.6-5.9]), and effectiveness (3.1 [1.7-5.7]). In the pay-it-forward group, 107 (96%) of 111 participants donated money for subsequent vaccinations. The pay-it-forward group had a lower economic cost (calculated as the cost without subtraction of donations) per person vaccinated (US$45.60) than did the standard-of-care group ($64.67). Interpretation The pay-it-forward intervention seemed to be effective in improving influenza vaccine uptake and community engagement. Our data have implications for prosocial interventions to enhance influenza vaccine uptake in countries where influenza vaccines are available for a fee. |
| URI | http://hdl.handle.net/20.500.11897/667708 |
| ISSN | 1473-3099 |
| DOI | 10.1016/S1473-3099(22)00346-2 |
| Indexed | SCI(E) |
| Appears in Collections: | 人口研究所 |
