. 2024 Feb 17;14(2):e076194.

doi: 10.1136/bmjopen-2023-076194.

Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children: EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics

Bing Wang^{1

2

3}, Prabha Andraweera^{1

2

3}, Margaret Danchin^{4

5

6}, Christopher C Blyth^{7

8

9}, Ivo Vlaev¹⁰, Jason Ong¹¹, Jodie M Dodd^{2

3

12}, Jennifer Couper^{2

3

13}, Thomas R Sullivan^{14

15}, Jonathan Karnon¹⁶, Nicola Spurrier^{17

18}, Michael Cusack¹⁷, Dylan Mordaunt¹⁸, Dimi Simatos¹⁹, Gustaaf Dekker^{2

3

20}, Samantha Carlson⁷, Jane Tuckerman^{4

6}, Nicholas Wood^{21

22}, Lisa J Whop²³, Helen Marshall^{24

2

3}

Affiliations

¹ Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia.
² Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
³ Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
⁴ Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
⁵ The Royal Children's Hospital, Melbourne, Victoria, Australia.
⁶ Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
⁷ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
⁸ Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.
⁹ Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre (QEIIMC), Perth, Western Australia, Australia.
¹⁰ School of Business, Warwick University, Warwick, UK.
¹¹ Melbourne Sexual Health Clinic & LSHTM, Monash University, Carlton, Victoria, Australia.
¹² Women's and Babies Division, Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹³ Division of Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹⁴ South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
¹⁵ School of Public Health, The University of Adelaide, Adelaide, Adelaide, South Australia, Australia.
¹⁶ Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia.
¹⁷ SA Health, South Australian Government, Adelaide, South Australia, Australia.
¹⁸ Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia.
¹⁹ Discipline of Paediatrics Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.
²⁰ Discipline of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.
²¹ Discipline of Paediatrics, University of Sydney, Sydney, New South Wales, Australia.
²² Children's Hospital Westmead, Sydney, New South Wales, Australia.
²³ Discipline of Public Health, Australian National University, Canberra, ACT, Australia.
²⁴ Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia helen.marshall@adelaide.edu.au.

PMID: 38367966
PMCID: PMC10875525
DOI: 10.1136/bmjopen-2023-076194

Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children: EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics

Bing Wang et al. BMJ Open. 2024.

. 2024 Feb 17;14(2):e076194.

doi: 10.1136/bmjopen-2023-076194.

Authors

Affiliations

¹ Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia.
² Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
³ Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
⁴ Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
⁵ The Royal Children's Hospital, Melbourne, Victoria, Australia.
⁶ Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
⁷ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
⁸ Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.
⁹ Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre (QEIIMC), Perth, Western Australia, Australia.
¹⁰ School of Business, Warwick University, Warwick, UK.
¹¹ Melbourne Sexual Health Clinic & LSHTM, Monash University, Carlton, Victoria, Australia.
¹² Women's and Babies Division, Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹³ Division of Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹⁴ South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
¹⁵ School of Public Health, The University of Adelaide, Adelaide, Adelaide, South Australia, Australia.
¹⁶ Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia.
¹⁷ SA Health, South Australian Government, Adelaide, South Australia, Australia.
¹⁸ Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia.
¹⁹ Discipline of Paediatrics Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.
²⁰ Discipline of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.
²¹ Discipline of Paediatrics, University of Sydney, Sydney, New South Wales, Australia.
²² Children's Hospital Westmead, Sydney, New South Wales, Australia.
²³ Discipline of Public Health, Australian National University, Canberra, ACT, Australia.
²⁴ Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia helen.marshall@adelaide.edu.au.

PMID: 38367966
PMCID: PMC10875525
DOI: 10.1136/bmjopen-2023-076194

Abstract

Introduction: Children with chronic medical diseases are at an unacceptable risk of hospitalisation and death from influenza and SARS-CoV-2 infections. Over the past two decades, behavioural scientists have learnt how to design non-coercive 'nudge' interventions to encourage positive health behaviours. Our study aims to evaluate the impact of multicomponent nudge interventions on the uptake of COVID-19 and influenza vaccines in medically at-risk children.

Methods and analyses: Two separate randomised controlled trials (RCTs), each with 1038 children, will enrol a total of approximately 2076 children with chronic medical conditions who are attending tertiary hospitals in South Australia, Western Australia and Victoria. Participants will be randomly assigned (1:1) to the standard care or intervention group. The nudge intervention in each RCT will consist of three text message reminders with four behavioural nudges including (1) social norm messages, (2) different messengers through links to short educational videos from a paediatrician, medically at-risk child and parent and nurse, (3) a pledge to have their child or themselves vaccinated and (4) information salience through links to the current guidelines and vaccine safety information. The primary outcome is the proportion of medically at-risk children who receive at least one dose of vaccine within 3 months of randomisation. Logistic regression analysis will be performed to determine the effect of the intervention on the probability of vaccination uptake.

Ethics and dissemination: The protocol and study documents have been reviewed and approved by the Women's and Children's Health Network Human Research Ethics Committee (HREC/22/WCHN/2022/00082). The results will be published via peer-reviewed journals and presented at scientific meetings and public forums.

Trial registration number: NCT05613751.

Keywords: COVID-19; INFECTIOUS DISEASES; Primary Prevention; Public health.

PubMed Disclaimer

Conflict of interest statement

Competing interests: HM acknowledges support from the National Health and Medical Research Council of Australia: Practitioner Fellowship (APP1155066). CCB acknowledges support from the National Health and Medical Research Council of Australia: Investigator Grant (APP1173163). HM is an independent investigator on clinical trials of investigational vaccines manufactured by pharmaceutical companies including Pfizer, ILiAD Biotechnologies and Merck. The institution at which HM, BW and PA are employed has received funding for investigator-led research from GlaxoSmithKline, Sanofi-Pasteur and Pfizer Vaccines. All authors receive no personal payments from industry. There are no other conflicts of interest to declare.

Cited by

Understanding barriers to influenza vaccination among parents is important to improve vaccine uptake among children.
Davey SA, Elander J, Woodward A, Head MG, Gaffiero D. Davey SA, et al. Hum Vaccin Immunother. 2025 Dec;21(1):2457198. doi: 10.1080/21645515.2025.2457198. Epub 2025 Jan 23. Hum Vaccin Immunother. 2025. PMID: 39848626 Free PMC article.

References

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Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children: EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics

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Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children: EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics

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