Trial reportBMC medicine2026
Pay-it-forward intervention increased pneumococcal vaccine uptake among older adults in China: a randomized controlled trial.
Trial report in BMC medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
24 authors.
Funding
Abstract
backgroundPneumococcal 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.
methodsWe 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.
resultsFrom 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.
conclusionsOur findings demonstrate that the pay-it-forward intervention significantly enhances pneumococcal and influenza vaccination coverage and improves vaccine confidence among the older adults. This study highlights the potential of the pay-it-forward intervention as an effective means to boost health service utilization.
trial registration2024-01-03, Chinese Clinical Trial Registry, ChiCTR2400079410.
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