Evaluating a WeChat-based Intervention to Enhance Influenza Vaccination Knowledge, Attitude and Behavior among Chinese University Students Residing in the UK: A Controlled, Quasi-experimental, Mixed-methods Study (Preprint)

Abstract

University students, often living in close quarters and engaging in frequent social interactions, face a heightened risk of influenza morbidity. Yet, vaccination rates among this group, particularly Chinese students, remain consistently low due to limited awareness and insufficient access to vaccinations.

This study examines the effectiveness of a WeChat-based intervention that targets Chinese Mainland university students in the UK, aiming to improve their knowledge, attitudes, and behavior towards seasonal influenza vaccination.

A quasi-experimental, mixed methods design was used, including an intervention and comparison group with baseline and follow-up assessment. The primary outcome is the knowledge, attitudes, and behavior scores measured before and after the intervention phases. System-recorded data and users’ feedback were included in the analysis as secondary outcomes.

Our study included 596 students, of which 303 were intervention group, and 293 were control group. The intervention group showed significant improvements in knowledge, attitude, and intended behavior scores over time, whereas the control group had only a slight increase in intended behavior scores. When comparing changes between the two groups, the intervention group displayed significant differences in knowledge and attitude scores compared to the control group, while intended behavior scores did not significantly differ. After the intervention, the actual vaccination rate was slightly higher in the intervention group (20.8%) compared to the control group (18.7%). Path analysis found that the intervention had a significant direct impact on knowledge but not on attitudes; knowledge strongly influenced attitudes and both knowledge and attitudes significantly influenced intended behavior; and a strong correlation between intended and actual behavior. In the intervention group, participants expressed a high level of satisfaction and positive review of the content and its usage.

This study shows how a WeChat intervention effectively enhances knowledge, attitude, and behavior regarding SIV among Chinese students, highlighting digital health interventions' potential for vaccination behavioral change. It contributes to the broader research on digital health intervention effectiveness and lays the groundwork for tailoring similar interventions to different health contexts and populations.