Effectiveness of pay it forward intervention compared to free and user-paid vaccinations on seasonal influenza vaccination among older adults across seven cities in China: study protocol of a three-arm cluster randomized controlled trial
Abstract Background Seasonal influenza poses an enormous burden worldwide, with older adults facing preventable morbidity and mortality. However, seasonal influenza vaccination coverage is poor among older populations in China. Pay-it-forward (giving a person a free vaccine and an opportunity to don...
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BMC
2025-07-01
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| Online Access: | https://doi.org/10.1186/s12889-025-23301-2 |
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| author | Qing-Qing Li Zizhen Huang Jiangyun Chen Junjie Wang Duqiao Li Xiaoshan Chen Qing Zhao Siyuan Liu Wenjun He Huanyuan Luo Yuting Wan Guangyu Tong Dexing Zhang Yiyuan Cai Huijuan Liang Dan Wu David Bishai Dong Roman Xu |
| author_facet | Qing-Qing Li Zizhen Huang Jiangyun Chen Junjie Wang Duqiao Li Xiaoshan Chen Qing Zhao Siyuan Liu Wenjun He Huanyuan Luo Yuting Wan Guangyu Tong Dexing Zhang Yiyuan Cai Huijuan Liang Dan Wu David Bishai Dong Roman Xu |
| author_sort | Qing-Qing Li |
| collection | DOAJ |
| description | Abstract Background Seasonal influenza poses an enormous burden worldwide, with older adults facing preventable morbidity and mortality. However, seasonal influenza vaccination coverage is poor among older populations in China. Pay-it-forward (giving a person a free vaccine and an opportunity to donate to support others) and financial incentives (e.g. free vaccination) could be effective in improving influenza vaccine uptake, but there are no prospective comparisons of these two strategies among older adults. The proposed study aims to compare the effectiveness of the pay-it-forward strategy in increasing influenza vaccination against free vaccination and user-paid vaccination among older adults in China. Methods This study is a three-arm cluster randomized controlled trial, which will be conducted in 21 community health centers across seven cities in China. A total of 1113 eligible older adults aged ≥ 60 years will be recruited. Three clusters in each city (total of 21 clusters in 7 cities) will be randomized into three arms in a 1:1:1 ratio, including (1) pay-it-forward arm: free vaccination and participants donate any amount of money to help other people; (2) free vaccination arm; and (3) standard-of-care arm (user-paid vaccination). The primary outcome is influenza vaccination verified by administrative records. Secondary outcomes include willingness to be vaccinated, willingness to donate, amount of donation, and incremental cost-effectiveness ratio. The primary outcome will be calculated for each arm and compared using one-way variance analysis. Discussion This study will examine the effectiveness of pay-it-forward strategy in comparison to the free vaccination and user-paid vaccination in improving influenza vaccination among older adults. Our findings will provide insights into better strategies for enhancing influenza vaccination, and support evidence-based policy decisions for promoting influenza vaccination. Trial registration Chinese Clinical Trial Registry (No. ChiCTR2400086840). Registered on 11 July 2024. |
| format | Article |
| id | doaj-art-da79c581ab3f40b7a9c04caba4d3f0ed |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj-art-da79c581ab3f40b7a9c04caba4d3f0ed2025-08-20T03:42:02ZengBMCBMC Public Health1471-24582025-07-0125111010.1186/s12889-025-23301-2Effectiveness of pay it forward intervention compared to free and user-paid vaccinations on seasonal influenza vaccination among older adults across seven cities in China: study protocol of a three-arm cluster randomized controlled trialQing-Qing Li0Zizhen Huang1Jiangyun Chen2Junjie Wang3Duqiao Li4Xiaoshan Chen5Qing Zhao6Siyuan Liu7Wenjun He8Huanyuan Luo9Yuting Wan10Guangyu Tong11Dexing Zhang12Yiyuan Cai13Huijuan Liang14Dan Wu15David Bishai16Dong Roman Xu17Acacia Lab for Implementation Science, Institute for Global Health, Dermatology Hospital of Southern Medical UniversityAcacia Lab for Implementation Science, School of Health Management, Southern Medical UniversityAcacia Lab for Implementation Science, School of Health Management, Southern Medical UniversitySchool of Foreign Studies, Southern Medical UniversityAcacia Lab for Implementation Science, School of Health Management, Southern Medical UniversityAcacia Lab for Implementation Science, School of Health Management, Southern Medical UniversityAcacia Lab for Implementation Science, School of Health Management, Southern Medical UniversityAcacia Lab for Implementation Science, School of Health Management, Southern Medical UniversityAcacia Lab for Implementation Science, Institute for Global Health, Dermatology Hospital of Southern Medical UniversityAcacia Lab for Implementation Science, Institute for Global Health, Dermatology Hospital of Southern Medical UniversityAcacia Lab for Implementation Science, School of Health Management, Southern Medical UniversityDepartment of Internal Medicine, Yale School of MedicineJockey Club School of Public Health and Primary Care, The Chinese University of Hong KongAcacia Lab for Primary Healthcare, Department of epidemiology and health statistics, School of Public Health, Guizhou Medical UniversitySchool of Health Management, Inner Mongolia Medical UniversityDepartment of Social Medicine and Health Education, School of Public Health, Nanjing Medical UniversitySchool of Public Health, LKS Faculty of Medicine, The University of Hong Kong,Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical UniversityAbstract Background Seasonal influenza poses an enormous burden worldwide, with older adults facing preventable morbidity and mortality. However, seasonal influenza vaccination coverage is poor among older populations in China. Pay-it-forward (giving a person a free vaccine and an opportunity to donate to support others) and financial incentives (e.g. free vaccination) could be effective in improving influenza vaccine uptake, but there are no prospective comparisons of these two strategies among older adults. The proposed study aims to compare the effectiveness of the pay-it-forward strategy in increasing influenza vaccination against free vaccination and user-paid vaccination among older adults in China. Methods This study is a three-arm cluster randomized controlled trial, which will be conducted in 21 community health centers across seven cities in China. A total of 1113 eligible older adults aged ≥ 60 years will be recruited. Three clusters in each city (total of 21 clusters in 7 cities) will be randomized into three arms in a 1:1:1 ratio, including (1) pay-it-forward arm: free vaccination and participants donate any amount of money to help other people; (2) free vaccination arm; and (3) standard-of-care arm (user-paid vaccination). The primary outcome is influenza vaccination verified by administrative records. Secondary outcomes include willingness to be vaccinated, willingness to donate, amount of donation, and incremental cost-effectiveness ratio. The primary outcome will be calculated for each arm and compared using one-way variance analysis. Discussion This study will examine the effectiveness of pay-it-forward strategy in comparison to the free vaccination and user-paid vaccination in improving influenza vaccination among older adults. Our findings will provide insights into better strategies for enhancing influenza vaccination, and support evidence-based policy decisions for promoting influenza vaccination. Trial registration Chinese Clinical Trial Registry (No. ChiCTR2400086840). Registered on 11 July 2024.https://doi.org/10.1186/s12889-025-23301-2Older adultsInfluenza vaccinePay it forwardFree vaccinationCluster randomized controlled trial (RCT) |
| spellingShingle | Qing-Qing Li Zizhen Huang Jiangyun Chen Junjie Wang Duqiao Li Xiaoshan Chen Qing Zhao Siyuan Liu Wenjun He Huanyuan Luo Yuting Wan Guangyu Tong Dexing Zhang Yiyuan Cai Huijuan Liang Dan Wu David Bishai Dong Roman Xu Effectiveness of pay it forward intervention compared to free and user-paid vaccinations on seasonal influenza vaccination among older adults across seven cities in China: study protocol of a three-arm cluster randomized controlled trial BMC Public Health Older adults Influenza vaccine Pay it forward Free vaccination Cluster randomized controlled trial (RCT) |
| title | Effectiveness of pay it forward intervention compared to free and user-paid vaccinations on seasonal influenza vaccination among older adults across seven cities in China: study protocol of a three-arm cluster randomized controlled trial |
| title_full | Effectiveness of pay it forward intervention compared to free and user-paid vaccinations on seasonal influenza vaccination among older adults across seven cities in China: study protocol of a three-arm cluster randomized controlled trial |
| title_fullStr | Effectiveness of pay it forward intervention compared to free and user-paid vaccinations on seasonal influenza vaccination among older adults across seven cities in China: study protocol of a three-arm cluster randomized controlled trial |
| title_full_unstemmed | Effectiveness of pay it forward intervention compared to free and user-paid vaccinations on seasonal influenza vaccination among older adults across seven cities in China: study protocol of a three-arm cluster randomized controlled trial |
| title_short | Effectiveness of pay it forward intervention compared to free and user-paid vaccinations on seasonal influenza vaccination among older adults across seven cities in China: study protocol of a three-arm cluster randomized controlled trial |
| title_sort | effectiveness of pay it forward intervention compared to free and user paid vaccinations on seasonal influenza vaccination among older adults across seven cities in china study protocol of a three arm cluster randomized controlled trial |
| topic | Older adults Influenza vaccine Pay it forward Free vaccination Cluster randomized controlled trial (RCT) |
| url | https://doi.org/10.1186/s12889-025-23301-2 |
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