Does enhanced educational intervention reduce breakthrough infection and mental health problems via improving acceptance of COVID-19 booster shots in Chinese non-healthcare workers: A randomized controlled trial?

Background: Despite vaccination and booster shots proving more effective than workplace measures in controlling the COVID-19 pandemic, hesitancy towards compulsory booster shots remains. This study aimed to evaluate the effectiveness of an enhanced educational intervention program in improving the a...

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Main Authors: Lap Ah Tse, Feng Wang, Phoenix Kit Han Mo, Cherry Choi Miu Wan, Natalie Hiu Yu Tang, Shuyuan Yang, Dong Dong, Kin Fai Ho, Samuel Yang-shan Wong
Format: Article
Language:English
Published: Elsevier 2025-05-01
Series:Journal of Infection and Public Health
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Online Access:http://www.sciencedirect.com/science/article/pii/S1876034125000681
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Summary:Background: Despite vaccination and booster shots proving more effective than workplace measures in controlling the COVID-19 pandemic, hesitancy towards compulsory booster shots remains. This study aimed to evaluate the effectiveness of an enhanced educational intervention program in improving the acceptance of COVID-19 booster shots and reducing breakthrough infections among non-healthcare workers in Hong Kong. Methods: In this 9-month randomized controlled trial (RCT), workers were randomly allocated to either the intervention or control group. The intervention group received educational sessions at baseline and at 3-month, covering general health and evidence-based information on the efficacy and safety of COVID-19 vaccines and booster shots. The control group received only general health information. All participants were followed up for an additional 6 months. The primary outcomes were intention and acceptance of booster shots, as well as breakthrough infections. The DASS-21 scale was used to evaluate participants’ mental health status, and two-way mixed ANOVA to analyze the group effect. A difference of ≥ 5 % in booster uptake between the intervention and control group indicated a practical significance in infection control. Results: Among 310 consenting workers, 282 (91.0 %) of them completed the trial. At recruitment, the booster uptake rate was similar between the intervention and control groups (62.0 % vs. 62.1 %). After the educational intervention sessions, the intervention group showed a higher booster uptake rate (76.1 % vs. 67.9 %). A lower rate of breakthrough infection was observed in the intervention group during the latest follow-up period (23.2 % vs. 29.5 %); however, no change in the intention to get booster shots were recorded for all subjects. Conclusion: This enhanced educational intervention program significantly improves booster uptake rates and reduces COVID-19 breakthrough infection rates among non-healthcare workers. (Trial registration: ClinicalTrials.gov - NCT05197673)
ISSN:1876-0341