Medical students who surfed the Web 2.0 vaccination page had a greater intention to get vaccinated compared with the reference group who received no intervention. The intention to get vaccinated was greater in students doing clinical rotations and those who had received influenza vaccination in previous seasons.
Investing time and effort in a Web-based strategy seemed to have a greater impact in terms of vaccination promotion in a group of medical students. A similar approach was taken at the University of Wisconsin , where researchers designed a web-based tool that allowed medical students to create their own health plan, focused on various factors such as nutrition or choice of lifestyle. The authors concluded that this tool encouraged self-reflection, positive lifestyle habits and education in key aspects of health and well-being. Results supporting web-based promotional strategies were also found in a study in which university students were randomly assigned to receive a web-based intervention involving seven theory-based lessons or to a control group that received minimal information on physical activity. The results showed that the web-based strategy increased the number of days on which students carried out moderate or vigorous physical activity compared with controls and demonstrated that a web-based strategy with attractive contents could induce behavioral changes, supporting the hypothesis of our study .
Using a pre-post survey methodology, researchers from Canada compared the impact of two of the most popular YouTube videos discussing and critizingseasonal influenza vaccineon the attitudes towards vaccination of first year medical students. Overall, there were no significant differences in pre and post attitudes to influenza vaccination after viewing the two videos.This suggests that medical students are relatively resistant to the predominately inaccurate, vaccine-critical messaging on YouTube, even when the message is framed as scientific reasoning . In our study, the use of a video including a short film featuring Hospital Clinic HCW and promotional messages apparently had no affect on students’ intention to get vaccinated. Unlike the vaccine-critical content of the videos used in the Canadian research, ours was presented in a friendly format, including four short films on vaccine promotion featuring HCW from the students’ own environment. The video may have had other, unmeasured, effects on the students, but certainly not the one we were looking for.
Our results showed that the tri-fold brochure seemed to have a negative impact, with a smaller number of students in this group reporting an intention to get vaccinated than in the reference group. We have found no reports evaluating the strategy of delivering a similar brochure as an independent intervention. Therefore, it is difficult to determine whether our results were an isolated phenomenon or whether leaflets and brochures are, in fact, ineffective in promoting vaccination.
The web-based strategy was, unlike the other interventions, Interactive. Therefore, future studies could examine whether Interactive offline promotion strategies might have a positive effect on acceptance of influenza vaccination, or whether the strategy needs to be both Interactive and online.
As found in a previous study , students who had done clinical rotations were more willing to receive vaccination than the rest. Contact with patients and HCW may have affected student’s attitudes in this respect. The hypothetical coverage that would be achieved in students with clinical experience was not significantly different to that obtained in Hospital Clinic HCW , reinforcing the idea that students doing clinical rotations behave more like HCW in their attitude to vaccination. As in HCW, a greater intention to get vaccinated was found in persons vaccinated in previous seasons . This, together with the previously-stated findings, suggests that strategies should be considered for students with clinical experience to ensure that they are vaccinated during their first contacts with patients and that, hopefully, this habit would continue during their professional career.
This study has some limitations. First, we did not design a cluster trail, with the corresponding calculation of sample size. The analytic design, without randomization, produced an imbalance in the number of students included in each group. The difference was greater in the Web group, which was smaller because some students did not agree to attend the computer room for the intervention, resulting in a lower proportion of female students in this group. Nevertheless, given that the variable “sex” was not significantly associated with the intention to get vaccinated in the bivariate analysis forany of the four groups, we did not consider this imbalance as a limiting factor in the regression model. Another limitation was the lack of records with information on whether, during the study season, the student was vaccinated or not after the intervention. While the intention to get vaccinated is not the same as actually being vaccinated, this outcome is widely reported as a proxy in the absence of recorded vaccination [17–19]. The third limitation was the lack of information on the characteristics of students who did not participate in the study. This limits the generalizability of the findings. Another limitation was that the intention to get vaccinated may be conditioned by variables other than those included in the study and which could act as confounders. Lastly, due to the design of this quasi-experimental study and the lack of randomization, we cannot make causal inferences. Therefore, the best option would be to conduct a controlled trial after this first approach to the issue.