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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author 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
author_facet 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
author_sort Lap Ah Tse
collection DOAJ
description 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)
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spelling doaj-art-92ccf1e060f846cdb0fd0bec033a53382025-08-20T02:15:51ZengElsevierJournal of Infection and Public Health1876-03412025-05-0118510271910.1016/j.jiph.2025.102719Does 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?Lap Ah Tse0Feng Wang1Phoenix Kit Han Mo2Cherry Choi Miu Wan3Natalie Hiu Yu Tang4Shuyuan Yang5Dong Dong6Kin Fai Ho7Samuel Yang-shan Wong8JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong; CUHK Centre for Public Health and Primary Care (Shenzhen), Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China; Correspondence to: JC School of Public Health and Primary Care, the Chinese University of Hong Kong. 4/F School of Public Health and Primary Care, Prince of Wales Hospital, Sha Tin, N.T., Hong Kong.JC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong; CUHK Centre for Public Health and Primary Care (Shenzhen), Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, ChinaJC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong KongJC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong KongJC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong KongJC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong KongJC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong KongJC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong KongJC School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong KongBackground: 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)http://www.sciencedirect.com/science/article/pii/S1876034125000681COVID-19Booster vaccinesRandomized controlled trialVaccine hesitancyEducational prevention
spellingShingle 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
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?
Journal of Infection and Public Health
COVID-19
Booster vaccines
Randomized controlled trial
Vaccine hesitancy
Educational prevention
title 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?
title_full 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?
title_fullStr 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?
title_full_unstemmed 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?
title_short 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?
title_sort 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
topic COVID-19
Booster vaccines
Randomized controlled trial
Vaccine hesitancy
Educational prevention
url http://www.sciencedirect.com/science/article/pii/S1876034125000681
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