Chen Jingyi, Xie Weiguang, Huang Xuehua, Huang Anzhong, Lu Tingyu, Zhang Ruihang, Xiao Jingyi, He Shaoyi, Wang Jiao, Xu Lin
School of Public Health, Sun Yat-Sen University, Guangzhou, China.
Center for Disease Control and Prevention of Dongguan City, Dongguan, China.
BMC Med. 2025 Jun 4;23(1):333. doi: 10.1186/s12916-025-04156-1.
Influenza remains a significant public health concern globally. We assessed the impact of multifaceted health education on influenza vaccination rates and health literacy among primary school students in China.
This cluster randomized controlled trial enrolled fourth- and fifth-grade students from 20 primary schools in Dongguan, China. Schools were randomly allocated (1:1) by a computer program to either the intervention group, receiving multifaceted health education, or the control group, receiving standard health education. Data were collected at baseline and post-intervention. The primary outcome was influenza vaccination rate. Secondary outcomes included health literacy, influenza incidence, influenza-like illness incidence, and influenza vaccine protection rate. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed.
A total of 3463 students (1544 [44.6%] females; mean [SD] age, 9.9 [0.7] years) were enrolled. The ITT analysis included 3463 participants (control group [n = 1811]; intervention group [n = 1652]) while the PP analysis included 3275 participants (control group [n = 1717]; intervention group [n = 1558]). The influenza vaccination rate was significantly higher in the intervention group than the control group (ITT: 173 [10.9%] vs 130 [7.4%], adjusted risk ratios 1.54 [95% CI, 1.23-1.93], P < 0.001; PP: 165 [10.6%] vs 116 [6.8%], adjusted risk ratios 1.61 [95% CI, 1.27-2.03], P < 0.001). The knowledge component of children's health literacy scores significantly increased in the intervention group post-intervention (ITT: mean differences 0.12 [95% CI 0.04-0.20], P < 0.01; PP: mean differences 0.12 [95% CI 0.04-0.21], P < 0.01). No significant differences were observed for other secondary outcomes.
The multifaceted health education significantly enhanced influenza vaccination uptake in primary school students. However, the increase was modest, indicating that more effective school-based influenza prevention programs are urgently needed to improve vaccine uptake in children.
Registered at ClinicalTrials.gov on 09/08/2023 (registration number: NCT06048406).
流感仍是全球重大的公共卫生问题。我们评估了多方面健康教育对中国小学生流感疫苗接种率和健康素养的影响。
这项整群随机对照试验纳入了中国东莞20所小学的四、五年级学生。学校通过计算机程序随机分配（1:1）至干预组（接受多方面健康教育）或对照组（接受标准健康教育）。在基线和干预后收集数据。主要结局是流感疫苗接种率。次要结局包括健康素养、流感发病率、流感样疾病发病率和流感疫苗保护率。进行了意向性分析（ITT）和符合方案分析（PP）。
共纳入3463名学生（1544名[44.6%]为女性；平均[标准差]年龄9.9[0.7]岁）。ITT分析纳入3463名参与者（对照组[n = 1811]；干预组[n = 1652]），而PP分析纳入3275名参与者（对照组[n = 1717]；干预组[n = 1558]）。干预组的流感疫苗接种率显著高于对照组（ITT：173例[10.9%]对130例[7.4%]，调整风险比1.54[95%CI，1.23 - 1.93]，P < 0.001；PP：165例[10.6%]对116例[6.8%]，调整风险比1.61[95%CI，1.27 - 2.03]，P < 0.001）。干预组干预后儿童健康素养得分的知识部分显著增加（ITT：平均差异0.12[95%CI 0.04 - 0.20]，P < 0.01；PP：平均差异0.12[95%CI 0.04 - 0.21]，P < 0.01）。其他次要结局未观察到显著差异。
多方面健康教育显著提高了小学生的流感疫苗接种率。然而，提高幅度不大，表明迫切需要更有效的基于学校的流感预防计划来提高儿童的疫苗接种率。
于2023年8月9日在ClinicalTrials.gov注册（注册号：NCT06048406）。
