Does enhanced educational intervention reduce breakthrough infection and mental health problems via improving acceptance of COVID-19 booster shots in Chinese non-healthcare workers: A randomized controlled trial?

• Published in: Journal of infection and public health Vol. 18; no. 5; p. 102719
• Main Authors: Tse, Lap Ah, Wang, Feng, Mo, Phoenix Kit Han, Wan, Cherry Choi Miu, Tang, Natalie Hiu Yu, Yang, Shuyuan, Dong, Dong, Ho, Kin Fai, Wong, Samuel Yang-shan
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2025; Elsevier
• Subjects: Adult; Booster vaccines; Breakthrough Infections; COVID-19; COVID-19 - prevention & control; COVID-19 - psychology; COVID-19 Vaccines - administration & dosage; East Asian People; Educational prevention; Female; Health Education - methods; Hong Kong - epidemiology; Humans; Immunization, Secondary - psychology; Immunization, Secondary - statistics & numerical data; Male; Mental Disorders - prevention & control; Mental Health; Middle Aged; Patient Acceptance of Health Care; Randomized controlled trial; Vaccine hesitancy; Young Adult; Hong Kong; COVID-19; Educational prevention; Vaccine hesitancy; Booster vaccines; Randomized controlled trial
• ISSN: 1876-0341; 1876-035X; 1876-035X
• DOI: 10.1016/j.jiph.2025.102719

Despite vaccination and booster shots proving more effective than workplace measures in controlling the COVID-19 pandemic, hesitancy towards compulsory booster shots remains. This study aimed to evaluate the effectiveness of an enhanced educational intervention program in improving the acceptance of COVID-19 booster shots and reducing breakthrough infections among non-healthcare workers in Hong Kong. In this 9-month randomized controlled trial (RCT), workers were randomly allocated to either the intervention or control group. The intervention group received educational sessions at baseline and at 3-month, covering general health and evidence-based information on the efficacy and safety of COVID-19 vaccines and booster shots. The control group received only general health information. All participants were followed up for an additional 6 months. The primary outcomes were intention and acceptance of booster shots, as well as breakthrough infections. The DASS-21 scale was used to evaluate participants’ mental health status, and two-way mixed ANOVA to analyze the group effect. A difference of ≥ 5 % in booster uptake between the intervention and control group indicated a practical significance in infection control. Among 310 consenting workers, 282 (91.0 %) of them completed the trial. At recruitment, the booster uptake rate was similar between the intervention and control groups (62.0 % vs. 62.1 %). After the educational intervention sessions, the intervention group showed a higher booster uptake rate (76.1 % vs. 67.9 %). A lower rate of breakthrough infection was observed in the intervention group during the latest follow-up period (23.2 % vs. 29.5 %); however, no change in the intention to get booster shots were recorded for all subjects. This enhanced educational intervention program significantly improves booster uptake rates and reduces COVID-19 breakthrough infection rates among non-healthcare workers. (Trial registration: ClinicalTrials.gov - NCT05197673)