A Pre and Post Intervention Study Measuring the Effect of Interactive Education on Adolescent Perceptions of Vaccines, Vaccine Safety and Disease Risk

"We begin to make our own decisions about immunization in adolescence, which should be informed by valid, evidence-based information from reputable sources."

Researchers have described compliance with immunisation recommendations in adolescence as a complex process involving the adolescents' thoughts and opinions, the information they receive from the mass media, and their relationships with parents, friends, and physicians. Because adolescents make decisions about their own vaccinations, it is essential to educate them about the risks of vaccine-preventable diseases (VPDs) and immunisation safety. This study evaluated whether a brief, interactive, school-based educational session at a high school in North Bay Ontario, Canada, could enhance adolescents' understanding of VPDs and reposition the value of vaccines.

The interactive session drew 598 students between the ages of 13 and 18 years. It focused on 3 concepts:

• The risks of VPDs - Tools to illustrate the impact VPDs can have on people's lives after infection included interactive scenarios, graphic images and videos, and presentations of local outbreak statistics. For example, because the students said playing hockey was an important part of their life, a volunteer was asked to demonstrate what movements are important when playing hockey. The presenters then asked the students to imagine the negative effects polio-related paralysis would have on the volunteer's ability while playing hockey.
• The benefits of vaccination - The concept of herd immunity was presented to participants with simple, understandable graphics such as the image above, which highlighted how vulnerable community members (the young child) are protected from VPDs when those around them are immunised (the adolescents).
• The challenges in communicating information about vaccination to adolescents - The presenters discussed how countering vaccine hesitancy can be difficult when there are barriers to effective communication, as well as the presence of misinformation. To explore this, they presented pictures of well-known celebrities with a large number of followers on Twitter. They then asked students to identify pictures of scientists whose work has had real impact on adolescent health, of which only one was recognised. This demonstrated how difficult it can be for public health experts to be visible in today's information age. Also discussed: how using scientific language to deliver information about vaccine safety can create a barrier to knowledge for people without a background in science.

The presenters ended the session by sharing more facts about vaccine safety and disease risk and emphasising the importance of making informed decisions about immunisation for this and upcoming generations.

An anonymised questionnaire to assess knowledge, attitudes, and beliefs about immunisation and VPDs was administered before and after delivering an interactive session. Chi-squared and Kruskal-Wallis tests were performed to test for differences between pre and post responses.

The most common sources of information about immunisation identified by the 221 students who provided responses to the post intervention survey were school (228, 85%), healthcare provider (165, 62%), and family (134, 50%). Obtaining information from the internet was identified by 52 (19%) students, while friends were identified by 39 (14%) students as an information source. Most of the responding students (148, 55%) indicated they participate in decisions regarding their health care, alongside their parents. One-third of students were unsure of their immunisation status.

The intervention was found to have increased the students' awareness that measles is a disease that affects their generation (P < 0.05). Improvements were also noted in the perceived risk of pertussis (P < 0.05) and tetanus (0.05). After the session, respondents were more willing to participate with their parents in decisions affecting their healthcare (P < 0.05). The intervention improved the students perception that immunisations are important to their health (median increase in agreement from 6 (neutral) to 8 (agree), P < 0.001). The intervention also appears to have influenced the students' motivation to encourage their friends and family to be immunised (median increase in agreement from 5 (neutral) to 7 (agree), P < 0.001). Students found increased confidence in having an opinion about VPDs and immunisation following the intervention: There was a significant reduction in the proportion of "do not know" responses in survey questions where this was an option.

In short, post-survey results suggest that the interactive educational intervention had a positive effect on the adolescents' perceptions and attitudes towards immunisation. The researchers say they were surprised that the internet was not indicated by more students as an information source; this may mean that "adolescence is an ideal time to educate young people about how to find high-quality evidence about immunization, before they start looking to the internet for information."

The researchers add that this intervention was inexpensive and did not require a large time commitment from teachers, public health staff, or the participating students. "This session also demonstrates how collaboration between public health and schools can provide an opportunity to educate an age group that can be hard to reach."