Chatbot-delivered intervention increases seasonal influenza vaccine uptake in older adults

Key takeaways:

• Intervention participants had over 15% greater vaccine uptake vs. controls.
• Researchers noted the intervention was more likely to create personal relevance among participants, influencing vaccine uptake.

A chatbot-delivered, personally tailored intervention was associated with increased uptake in seasonal influenza vaccinations among older adults, a study in JAMA Network Open showed.

According to CDC data, just 53% of Medicare fee-for-service beneficiaries aged 65 years and older were vaccinated for influenza as of Feb. 25, 2023.

“There is an urgent need to improve [seasonal influenza vaccination (SIV)] uptake among adults [aged] 65 years or older,” Zixin Wang, PhD, from the School of Public Health at Prince of Wales Hospital in Hong Kong, and colleagues wrote.

The researchers conducted a randomized trial comparing the efficacy of a chatbot-delivered, stage of change (SOC)-tailored online intervention vs. a non-SOC-tailored online intervention. A core concept of the transtheoretical model (TTM), the SOC “is a measure of readiness for behavioral change,” researchers explained. “According to the TTM, different health promotion strategies should be applied to people at different SOC.” This approach has proven more effective than non-SOC-tailored interventions in previous research, but to the researchers’ knowledge, no studies have used it to improve SIV uptake.

In the intervention group (n = 198), a chatbot assessed participants’ SOC related to SIV uptake and then sent them SOC-tailored online health promotion videos through either WhatsApp or Meta every 2 weeks for a total of four sessions.

Participants would receive a different video based on their SOC, which included:

• precontemplation, defined as no intent to receive SIV in the next 6 months;
• contemplation, defined as intention to receive SIV in the next 6 months but not within the next month; and
• preparation, defined as intention to receive SIV in the next month.

The control group (n = 198) was exposed to the same digital method but instead received general SIV information.

Overall, participants had a mean age of 72 years, and 62.9% were women.

The researchers found SIV uptake was significantly higher in the intervention group (50.5%) vs. the control group (35.3%) at 6 months (RR = 1.43; 95% CI, 1.13-1.8).

The intervention group also possessed a higher mean SOC score than those in the control group (2.8 vs. 2.4), whereas more intervention participants completed at least one session vs. control participants (77.3% vs. 62.6%).

Wang and colleagues highlighted several possible reasons for greater SIV uptake in the intervention group.

“First, as documented by the intervention system, the SOC-tailored intervention helped in facilitating the intervention group to progress to a higher SOC, which might lead to the observed behavioral changes,” they wrote.

The researchers added that the “online interventions for the intervention group were guided by behavioral change strategies recommended by the TTM, whereas those for the control group did not involve such strategies.”

“In addition, interventions that were tailored to users’ SOC were more likely to create personal relevance, an essential component for intrapersonal health communication,” they wrote.

Ultimately, the intervention “may be a sustainable new method for increasing SIV uptake for this population,” Wang and colleagues concluded.

References:

• Wang Z, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.32568.
• Weekly flu vaccination dashboard. https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-dashboard.html. Accessed Sept. 11, 2023.