A behaviour change techniques analysis, systematic review, meta-analysis and meta-regression of behavioural communication interventions supporting influenza vaccination uptake in adults in primary care settings

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

4E.5

Presenter:

Melissa Chang

Twitter:

@N/A

Co-authors:

Daniel-Paul Osahon, Nia Roberts, Melissa Chang, Ibrahim El-Gaby, Faraaz Khan, Charlotte Albury, Joseph Lee

Author institutions:

Nuffield Department of Primary Care Health Sciences, University of Oxford (Bilal Qureshi, Daniel-Paul Osahon, Melissa Chang, Charlotte Albury, Joseph Lee), Bodleian Health care Libraries, University of Oxford (Nia Roberts), John Radcliffe Hospital (Ibrahim El-Gaby and Faraaz Khan)

Problem

Low vaccine uptake and vaccine hesitancy is a limitation for influenza vaccination programmes. Communication from healthcare professionals plays a critical role in decisions about vaccination uptake. Behavioural communication interventions designed to increase vaccine uptake have used many approaches. The active ‘ingredients’ of these interventions can be classified using Behaviour Change Techniques (BCTs), allowing meta-analyses of different trials, and comparison between approaches. We systematically reviewed randomised controlled trials of behavioural communication interventions aiming to increase adult influenza vaccination uptake in primary care settings, classified by their BCTs.

Approach

We searched Medline, Embase, CINAHL and the Cochrane library. We screened studies in duplicate. Two authors independently screened by title and abstract and then full text. We coded BCTs using BCT taxonomy version 1 (BCTTv1). We assessed risk of bias using the Cochrane Risk of Bias tool 2.0 and assessed publication bias by generating a funnel plot. We performed prespecified subgroup analyses and meta-regression of studies using BCTs from domains 5 (natural consequences) and 9 (comparison of outcomes), and the number of BCTs used. These BCT domains align with those used in NICE guidelines for increasing flu vaccine uptake.

Findings

We identified and screened 1,662 studies, 14 were included. We judged all studies as ‘some concern’ of risk of bias. We found evidence of possible publication bias. The most common BCTs were: ‘information about health consequences,’ ‘credible source,’ and ‘adding objects to the environment’. Other BCTs commonly used in effective interventions were ‘social support (emotional)’ and ‘instruction on how to perform the behaviour.’ Pooled results showed that behavioural communication intervention improves vaccine uptake (odds ratio 1.43, 95% CI 1.21-1.69); no significant differences were found between subgroups. The meta-regression found significant improvements associated with using more BCTs (p=0.026, R2=40.00%), and the BCTs 5.1 (information about health consequences) and 9.1(credible source) was associated with higher vaccine uptake (p=0.018 and p=0.027 respectively, adjusted R2=41.94%).

Consequences

We found evidence that behavioural communication interventions with higher numbers of BCTs and those using 5.1 (information about health consequences) or 9.1 (credible source) were associated with higher vaccine uptake. Our results support NICE best practice for increasing influenza vaccine uptake, which centres around the BCTs 5.1 (information about health consequences) and 9.1 (credible source). The BCTs ‘social support (emotional)’ and ‘instruction on how to perform the behaviour’ should be added in future trials to assess their effectiveness. Guidance should be updated to reflect evidence we found that using higher numbers of BCTs increases the effectiveness of interventions. Overall, to improve the effectiveness of communication interventions for influenza vaccine communication should include information about health consequences, originate from a credible source, and include a higher number of BCTs.

Submitted by:

Bilal Qureshi

Funding acknowledgement:

No funding was received for this work.