A school-based educational on-site vaccination intervention for adolescents in an urban area in Germany: feasibility and psychometric properties of instruments in a pilot study

Abstract

Background Vaccination rates for measles, mumps, and rubella (MMR) and diphtheria, tetanus, pertussis, and polio (Tdap-IPV) are not optimal among German adolescents. Education in combination with easy access to vaccination may be a promising approach to improve vaccination rates. The present paper describes a pilot study of a planned cluster randomized controlled trial (cRCT) in which we aim to improve MMR and Tdap-IPV vaccination rates together with knowledge and self-efficacy in a school setting. Methods The study covered 863 students from 41 classes of four schools. The optimization and feasibility of access to schools, recruitment strategies, intervention, and assessment procedures were examined. The course and content of the educational unit were evaluated with a mixed-methods approach. A pre-post measurement design was tested for the vaccination rate in all schools. Additionally, at two schools, improvement in vaccination-related knowledge and perceived self-efficacy were measured by questionnaire pre-educational unit (n=287) and post-educational unit (n=293). The remaining two schools provided only postintervention data. Finally, we evaluated the psychometric properties (i.e., reliability, retest reliability, and change rates) of the questionnaire, applying Cronbach’s alpha, factor analyses, generalized estimating equations and linear mixed models. Results The findings of the pilot study indicated good feasibility. Of the total sample, 437 students (50.9%) brought their vaccination cards to school, 68 students received Tdap-IPV vaccinations, and 11 received MMR vaccinations. Out of six knowledge questions, on average, the students had M=2.84 (95% CI [2.69, 3.10]) correct answers before and M=4.45 (95% CI [4.26, 4.64]) after the class. Ranging from 1 to 4, the self-efficacy scale changed by 0.3 points (p <.001); Cronbach’s alpha was 0.67 and 0.76 pre- and post-educational unit, respectively, and a one-factor solution was found. Content analysis of the five semistructured group interviews (n=12, 58.3% female) showed that all students found the length of the intervention to be appropriate. The teaching methods, including interactive and social media components, were perceived as very good. Conclusions A school-based educational and on-site vaccination intervention appears to be feasible in terms of procedures and the adequacy of the instruments for the adolescent target group. Trial registration ISRCTN, ISRCTN18026662. Pilot study for main trial registered 8 December 2017.

Digital Health in Schools: A Systematic Review

“…The study quality assessment is presented in Table 2. Concerning methodological quality, none of the articles included was classified as strong, five obtained moderate classification [23,25,27,29,30], and eight were poor quality [24,26,[31][32][33][34][35]. Considering the instruments categories, it was verified that: (1) only one study was classified as strong in the selection of bias parameter [23], since the rate of participants exceed the 80%, which may be representative of the target population; (2) the randomized controlled trials or controlled clinical trials were classified as strong study design (n = 5) [27,29,[33][34][35], while other type of design was classified as moderate (n = 8) [23][24][25][26]28,[30][31][32]; (3) seven studies revealed no baseline differences between groups in the confounders' section or accounted for at least 80% of significant confounders [24,25,27,29,30,33,35], whereas the studies performed with only one group were not evaluated at this point (n = 5) [23,26,28,31,32]; (4) only one study blinded the assessors and participants, being classified as strong [27]; (5...…”

“…Concerning methodological quality, none of the articles included was classified as strong, five obtained moderate classification [23,25,27,29,30], and eight were poor quality [24,26,[31][32][33][34][35]. Considering the instruments categories, it was verified that: (1) only one study was classified as strong in the selection of bias parameter [23], since the rate of participants exceed the 80%, which may be representative of the target population; (2) the randomized controlled trials or controlled clinical trials were classified as strong study design (n = 5) [27,29,[33][34][35], while other type of design was classified as moderate (n = 8) [23][24][25][26]28,[30][31][32]; (3) seven studies revealed no baseline differences between groups in the confounders' section or accounted for at least 80% of significant confounders [24,25,27,29,30,33,35], whereas the studies performed with only one group were not evaluated at this point (n = 5) [23,26,28,31,32]; (4) only one study blinded the assessors and participants, being classified as strong [27]; (5) all studies presented valid and reliable data collection instruments; and (6) in the withdrawals and dropouts parameter, ...…”

“…However, PA levels have slightly decreased after the intervention, particularly in the CG. [25] 863 students aged between 14 and 17 years To improve vaccination rates and knowledge and self-efficacy in a school context.…”

“…The study's duration is displayed in Figure 2. Four studies evaluated a digital tool for four weeks or less [25,26,28,32], three studies lasted between four and eight weeks [23,27,30], while the majority varied from eight to 16 weeks [24,29,31,33,34]. The longest intervention was performed for 24 weeks [35].…”

“…The students' age ranged from 9 to 18 years. Six studies included participants over 15 years [23][24][25]30,31,33,34], and five studies included children below 13 years [26][27][28][29]34,35]. One investigation has also included a sample of 23 teachers [32].…”