Pay-it-forward intervention increased pneumococcal vaccine uptake among older adults in China: a randomized controlled trial

作者：Jiao Qin, Chunxing Tao, Ting Huang, Liangjia Wei, Jinfeng He, Ruby Congjiang Wang, Dan Wu, Shiyu Qin, Qiuqian Su, Yanxiao Gao, Shuiming Chen, Ganqin Wang, Zhifeng Lin, Xinju Huang, XianYan Tang, Chuanyi Ning, Hao Liang, Weiming Tang, Salma Gayed, Jason J Ong, Junjun Jiang, LI YE, Joseph D. Tucker, Bingyu Liang · 发表于：BMC Medicine · 年份：2026 · DOI：10.1186/s12916-026-04624-2 · 研究领域：Pneumonia and Respiratory Infections、Influenza Virus Research Studies、Immune responses and vaccinations

BACKGROUND: Pneumococcal 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. METHODS: We 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. RESULTS: From 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 th...