| Title: |
Pay-it-forward intervention increased pneumococcal vaccine uptake among older adults in China: a randomized controlled trial. |
| Authors: |
Qin, Jiao; Tao, Chunxing; Huang, Ting; Wei, Liangjia; He, Jinfeng; Wang, Ruby Congjiang; Wu, Dan; Qin, Shiyu; Su, Qiuqian; Gao, Yanxiao; Chen, Shuiming; Wang, Ganqin; Lin, Zhifeng; Huang, Xinju; Tang, Xianyan; Ning, Chuanyi; Liang, Hao; Tang, Weiming; Gayed, Salma; Ong, Jason J; Jiang, Junjun; Ye, Li; Tucker, Joseph D; Liang, Bingyu |
| Publisher Information: |
Springer Science and Business Media LLC |
| Publication Year: |
2026 |
| Collection: |
London School of Hygiene & Tropical Medicine: LSHTM Research Online |
| Description: |
BACKGROUND: Pneumococcal vaccination reduces morbidity and mortality among older adults, yet coverage remains suboptimal in China. This study aimed to assess the effectiveness of a pay-it-forward intervention (covering two-thirds of the pneumococcal vaccination cost and offering the option to donate) in increasing pneumococcal vaccination among older adults (aged 60 years or older) in China, compared to standard-of-care self-paid vaccination. METHODS: We used block randomization (block size = 4) to assign participants to a pay-it-forward arm and a standard-of-care arm in a 1:1 ratio. The primary outcome was pneumococcal vaccination. Secondary outcomes included influenza vaccine uptake, vaccine confidence, successful vaccine referral, and cost-effectiveness. Logistic regression analysis was used to compare PPSV-23 and influenza vaccination coverage and vaccine confidence between the two groups. The cost-effectiveness of the interventions was assessed using a micro-costing approach from the healthcare provider's perspective. RESULTS: From January to September 2024, 221 older adults were randomized (110 in the pay-it-forward group and 111 in the standard-of-care group). Pneumococcal and influenza vaccine uptake were significantly higher in the pay-it-forward arm (70.9% and 30.0%) than in the standard-of-care arm (13.5% and 17.1%), with adjusted odds ratios of 17.20 (95% CI, 8.39-37.60) and 2.29 (95% CI, 1.17-4.65). The pay-it-forward group also exhibited greater confidence in the safety (4.29, 95% CI, 1.78-11.50), importance (5.15, 95% CI, 2.05-14.60), and effectiveness (7.14, 95% CI, 2.36-27.50) of the vaccine than that in the standard-of-care group. The pay-it-forward group had a higher successful vaccine referral rate (15.5% vs. 10.8%) and had a lower economic cost per person vaccinated (US $95.67 vs. US $278.56) compared with the standard-of-care arm. CONCLUSIONS: Our findings demonstrate that the pay-it-forward intervention significantly enhances pneumococcal and influenza vaccination coverage and improves ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| ISSN: |
1741-7015 |
| Relation: |
https://researchonline.lshtm.ac.uk/id/eprint/4678969/1/Qin-etal-2026-Pay-ot-forward-intervention.pdf; Qin, Jiao; Tao, Chunxing; Huang, Ting; Wei, Liangjia; He, Jinfeng; Wang, Ruby Congjiang; Wu, Dan; Qin, Shiyu; Su, Qiuqian; Gao, Yanxiao; +14 more.Chen, Shuiming; Wang, Ganqin; Lin, Zhifeng; Huang, Xinju; Tang, Xianyan; Ning, Chuanyi; Liang, Hao; Tang, Weiming; Gayed, Salma; Ong, Jason J; Jiang, Junjun; Ye, Li; Tucker, Joseph D ORCID logo; and Liang, Bingyu (2026) Pay-it-forward intervention increased pneumococcal vaccine uptake among older adults in China: a randomized controlled trial. BMC medicine, 24 (1). p. 93. ISSN 1741-7015 DOI:10.1186/s12916-026-04624-2 |
| DOI: |
10.1186/s12916-026-04624-2 |
| Availability: |
https://researchonline.lshtm.ac.uk/id/eprint/4678969/; https://doi.org/10.1186/s12916-026-04624-2 |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.AC2EBFF6 |
| Database: |
BASE |