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Randomized Controlled Trial
. 2023 Jan 20;23(1):143.
doi: 10.1186/s12889-022-14439-4.

Can uptake of childhood influenza immunisation through schools and GP practices be increased through behaviourally-informed invitation letters and reminders: two pragmatic randomized controlled trials

Rebecca Howell-Jones  1 , Natalie Gold  2   3   4 , Sarah Bowen  1   5   6 , Amanda Bunten  1 , Karen Tan  1 , Ayoub Saei  7 , Sarah Jones  8 , Pauline MacDonald  9   10 , Robin Watson  1   11   12 , Kirsty F Bennett  1   12   13 , Tim Chadborn  1
Affiliations
Randomized Controlled Trial

Can uptake of childhood influenza immunisation through schools and GP practices be increased through behaviourally-informed invitation letters and reminders: two pragmatic randomized controlled trials

Rebecca Howell-Jones et al. BMC Public Health. .

Abstract

Background: The UK is rolling out a national childhood influenza immunisation programme for children, delivered through primary care and schools. Behaviourally-informed letters and reminders have been successful at increasing uptake of other public health interventions. Therefore, we investigated the effects of a behaviourally-informed letter on uptake of the vaccine at GP practices, and of a letter and a reminder (SMS/ email) on uptake at schools.

Methods and results: Study 1 was a cluster-randomised parallel trial of 21,786 two- and three-year olds in 250 GP practices, conducted during flu season (September to January inclusive) 2016/7. The intervention was a centrally-sent behaviourally-informed invitation letter, control was usual care. The proportion of two- and three-year olds in each practice who received a vaccination by 31st January 2017 was 23.4% in the control group compared to 37.1% in the intervention group (OR = 1.93; 95% CI = 1.82, 2.05, p < 0.001). Study 2 was a 2 (behavioural letter vs standard letter) × 2 (reminder vs no reminder) factorial trial of 1108 primary schools which included 3010 school years 1-3. Letters were sent to parents from providers, and reminders sent to parents from the schools. In the standard-letter-no-reminder arm, an average of 61.6% of eligible children in each school year were vaccinated, compared to 61.9% in the behavioural-letter-no-reminder arm, 63.5% in the standard-letter-plus-reminder arm, and 62.9% in the behavioural-letter-plus reminder condition, F(3, 2990) = 2.68, p = 0.046. In a multi-level model, with demographic variables as fixed effects, the proportion of eligible students in the school year who were vaccinated increased with the reminder, β = 0.086 (0.041), p < 0.036, but there was no effect of the letter nor any interaction effect.

Conclusion: Sending a behaviourally informed invitation letter can increase uptake of childhood influenza vaccines at the GP surgery compared to usual practice. A reminder SMS or email can increase uptake of the influenza vaccine in schools, but the effect size was minimal.

Trial registration: Study 1: Trial registration: ClinicalTrials.gov Identifier: NCT02921633. Study 2: Trial registration: ClinicalTrials.gov Identifier: NCT02883972.

Keywords: Behaviourally-informed invitation letter; Childhood flu; Influenza immunization; Primary care; Text message reminders; UK childhood influenza immunisation programme; Vaccination.

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Conflict of interest statement

There are no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
GP Flu participant flow diagram
Fig. 2
Fig. 2
School Flu participant flow diagram
See this image and copyright information in PMC

References

    1. Joint Committee on Vaccination and Immunisation . JCVI statement on the annual influenza vaccination programme – extension of the programme to children. 2012.
    1. Public Health England, National Childhood Influenza Vaccination Programme 2015 to 2016: Seasonal influenza vaccine uptake for children of primary school age 2016.
    1. Hardelid P, et al. Factors associated with influenza vaccine uptake during a universal vaccination programme of preschool children in England and Wales: a cohort study. J Epidemiol Community Health. 2016;70(11):1082–1087. doi: 10.1136/jech-2015-207014. - DOI - PubMed
    1. Paterson P, Chantler T, Larson HJ. Reasons for non-vaccination: parental vaccine hesitancy and the childhood influenza vaccination school pilot programme in England. Vaccine. 2018;36(36):5397–5401. doi: 10.1016/j.vaccine.2017.08.016. - DOI - PubMed
    1. MacDougall D, et al. Parental perceptions of school-based influenza immunisation in Ontario, Canada: a qualitative study. BMJ Open. 2014;4(6). - PMC - PubMed

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