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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.

Publication ,  Journal Article
Wu, D; Jin, C; Bessame, K; Tang, FF-Y; Ong, JJ; Wang, Z; Xie, Y; Jit, M; Larson, HJ; Chantler, T; Lin, L; Gong, W; Yang, F; Jing, F; Wei, S ...
Published in: The Lancet. Infectious diseases
October 2022

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.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.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).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.Bill & Melinda Gates Foundation and the UK National Institute for Health Research.

Duke Scholars

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Published In

The Lancet. Infectious diseases

DOI

EISSN

1474-4457

ISSN

1473-3099

Publication Date

October 2022

Volume

22

Issue

10

Start / End Page

1484 / 1492

Related Subject Headings

  • Vaccination
  • Odds Ratio
  • Microbiology
  • Influenza, Human
  • Influenza Vaccines
  • Infant
  • Humans
  • China
  • Child
  • Aged
 

Citation

APA
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ICMJE
MLA
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Wu, D., Jin, C., Bessame, K., Tang, F.-Y., Ong, J. J., Wang, Z., … Tucker, J. D. (2022). 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. The Lancet. Infectious Diseases, 22(10), 1484–1492. https://doi.org/10.1016/s1473-3099(22)00346-2
Wu, Dan, Chenqi Jin, Khaoula Bessame, Fanny Fong-Yi Tang, Jason J. Ong, Zaisheng Wang, Yewei Xie, et al. “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.The Lancet. Infectious Diseases 22, no. 10 (October 2022): 1484–92. https://doi.org/10.1016/s1473-3099(22)00346-2.
Wu D, Jin C, Bessame K, Tang FF-Y, Ong JJ, Wang Z, Xie Y, Jit M, Larson HJ, Chantler T, Lin L, Gong W, Yang F, Jing F, Wei S, Cheng W, Zhou Y, Ren N, Qiu S, Bao J, Wen L, Yang Q, Tian J, Tang W, Tucker JD. 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. The Lancet Infectious diseases. 2022 Oct;22(10):1484–1492.
Journal cover image

Published In

The Lancet. Infectious diseases

DOI

EISSN

1474-4457

ISSN

1473-3099

Publication Date

October 2022

Volume

22

Issue

10

Start / End Page

1484 / 1492

Related Subject Headings

  • Vaccination
  • Odds Ratio
  • Microbiology
  • Influenza, Human
  • Influenza Vaccines
  • Infant
  • Humans
  • China
  • Child
  • Aged