Impact of a Website Based Educational Program for Increasing Vaccination Coverage among Adolescents

"The widespread use of the new media by the general population, including adolescents, has led to the use of internet-based interventions to improve education and the community demand for immunization."

Compliance with recommendations from health authorities regarding vaccination in adolescence is poor worldwide. Moreover, adolescents' knowledge of immunisation has been found to be even lower than that of providers and parents, thus suggesting that education may be essential to improve compliance with recommendations. Designed to analyse whether different web-based educational programmes for adolescents might increase vaccination coverage, this prospective, randomised controlled trial took place over one school year (November 2015 - June 2016), involving 4 secondary schools for adolescents 11-13 years old and 8 schools for adolescents 14-18 years old in Milan, Italy.

Overall, 917 unvaccinated adolescents (389 males) were randomised 1:1:1 into the following groups: (i) access to a specific website dedicated to vaccines and vaccination (n = 281) providing information tailored to the users (because individualisation of educational materials to reflect the unique experiences, beliefs, and concerns of each user has been found to be an effective strategy for improving compliance); (ii) access to that website plus participation in a lecture on vaccines and vaccination from medical experts in classrooms (n = 302) groups; or (iii) no intervention (n = 334).

Table 2 in the paper describes personal knowledge and attitudes toward vaccination before and after intervention according to randomisation groups in subjects who completed the study. The results showed that the use of the website plus the lesson significantly increased the overall awareness of the benefits of vaccinations against diseases (p < 0.01) and knowledge on vaccine-preventable disease (e.g., potential severity, p = 0.001; transmission route of meningitis, p < 0.01) and reduced the fear of vaccines (p < 0.001). A significant increase in vaccination coverage was observed for tetanus, diphtheria, acellular pertussis, and conjugated meningococcal ACYW vaccines in the 2 groups using the website (p < 0.001), and better results were observed in the group that had also received the lesson; in this last group, significant results were observed in the increase in vaccination coverage for meningococcal B vaccine (p < 0.001).

Overall, the website was appreciated mainly for its clarity of language and easy navigation. The mechanism of action of vaccines and vaccine safety were the sections for which further details were requested. The majority of the participants liked the experience of the website, although they considered it important to discuss vaccines with parents, experts, and teachers.

In conclusion, the results demonstrate the possibility of increasing vaccination coverage by using a website-based educational programme with tailored information. However, to be most effective, the researchers stress that this programme should be supplemented with face-to-face discussions of vaccines at school and at home. Thus, specific education should also include teachers and parents so they will be prepared to discuss vaccination with adolescents.