Tailored online interventions to advertise seasonal influenza vaccination

In a recent study published in JAMA Network Open, researchers evaluated the efficacy of tailored online interventions in improving seasonal influenza vaccination (SIV) uptake amongst older adults.

Study: Chatbot-Delivered Online Intervention to Promote Seasonal Influenza Vaccination Through the COVID-19 Pandemic. Image Credit: BaLL LunLa/Shutterstock.com

Background

SIV can effectively prevent influenza and mortality amongst older adults. The Center for Health Protection in Hong Kong recommends that adults aged 65 or older receive SIV yearly.

Although SIV is free for this age group in Hong Kong, its coverage is insufficient and was 40.4% in 2021-22. Fewer trials have compared the efficacy of mailing reminders to no intervention but had small effect sizes.

Although home visits and telephone sessions appear effective and have larger effect sizes, they’re more resource-intensive.

One study observed that standard verbal education by medical students was effective in increasing SIV uptake. Nevertheless, tailored interventions for SIV are lacking amongst older adults.

A stage of change (SOC) measures readiness for behavioral change. A meta-analysis revealed higher efficacy of SOC-tailored interventions, especially in less motivated subjects, than interventions not tailored to SOCs. Chatbots might be potentially helpful in delivering SOC-tailored interventions promoting SIV.

In regards to the study

In the current study, researchers assessed the efficacy of chatbot-delivered SOC-tailored interventions in improving SIV uptake amongst older adults in Hong Kong. This non-blinded randomized controlled trial (RCT) was performed between December 2021 and July 2022.

Eligible subjects were community-dwelling, Cantonese- or Mandarin-speaking smartphone users aged 65 or older who didn’t take SIV through the 2021-22 influenza season.

Individuals with contraindications to SIV, cognitive impairment, deafness, blindness, or the shortcoming to speak were excluded. Random telephone sampling was implemented for recruitment. Participants were offered supermarket coupons after the baseline survey and 6 months post-intervention.

Subjects were randomized to the intervention or control arm after the baseline survey. Intervention participants watched one among the SOC-tailored health promotional videos on SIV uptake every two weeks for 4 sessions. The messages within the videos followed strategies to facilitate SOC progression. 4 videos with slight variations were prepared to stop repetition.

Participants’ SOC was assessed based on their intention to receive SIV. SOCs included pre-contemplation, contemplation, and preparation stages. The pre-contemplation stage was defined as having no intention to take SIV in the following six months.

The contemplation stage was the intention to receive SIV in the following six months without plans to take SIV in the following month. The preparation stage was the intention to take SIV in the following month.

Starting the second session, subjects were asked in the event that they had already been vaccinated for the upcoming influenza season, and positive responders were deemed to be on the motion stage. Similarly, controls received standard videos at the identical intervals. Information in these videos was similar to that disseminated by the federal government through mass media. The study’s outcomes included SIV uptake at six months and SOC at baseline and 6 months.

Findings

Overall, 396 participants accomplished the baseline survey; they were aged, on average, 70.2. Most subjects (62.9%) were females. Roughly 60% of participants had ever been vaccinated for influenza.

About 37.4%, 22%, and 40.6% of participants were on the pre-contemplation, contemplation, and preparation stages, respectively. At six months, 100 and 70 participants within the intervention and control groups were on the motion stage.

The SIV uptake rate and the common SOC rating were significantly higher amongst intervention subjects than controls.

Among the many 117 intervention participants completing not less than two sessions, 55.6% progressed to the next SOC, with a statistically significant increase of their mean SOC rating from the primary to the (most) recent session.

More intervention participants accomplished not less than one session than controls, and plenty of within the intervention group (80%) were satisfied with the promotional messages within the videos.

Conclusions

The study revealed the next efficacy of SOC-tailored intervention in improving SIV uptake than the usual, non-SOC-tailored intervention, with about ten percentage points higher SIV uptake rate within the intervention group than the general SIV coverage amongst older adults in Hong Kong.

The intervention system was viable to supply tailored health promotional messages in keeping with participants’ SOC and required fewer resources, on condition that it will probably robotically evaluate SOC and choose appropriate interventions.

Overall, the findings suggest that SOC-tailored interventions could also be (more) sustainable in increasing SIV uptake.