A cluster randomized trial of a vaccination communication educational intervention: Impact on COVID-19 vaccine uptake in Veterans

Abstract: BACKGROUND: Despite its safety and effectiveness, COVID-19 vaccine uptake declined later in the pandemic. OBJECTIVE: To evaluate the effectiveness of a Motivational Interviewing (MI)-informed educational intervention for healthcare providers and staff on vaccination communication. We hypothesized that educating providers and staff about non-judgmental, collaborative discussions would enhance vaccine uptake in veterans. DESIGN: A multi-site cluster randomized controlled implementation-effectiveness trial conducted at ten separate Veterans Health Administration (VA) facilities from February 2022 to May 2023. PARTICIPANTS: Veteran patients with a clinical visit at an enrolled VA facility within a year of the start of the trial and at least one primary care visit during 1-year follow-up. INTERVENTIONS: VA facilities were randomized to either a Vaccine Communication Educational Intervention (VCI), which included provider and staff MI training and implementation facilitation, or usual care (UC) vaccination promotional activities. MAIN MEASURES: Primary outcome was receipt of any COVID-19 vaccine, and secondary outcome was completion of the COVID-19 vaccine primary series; receipt of COVID-19 booster and influenza (flu) vaccinations were exploratory outcomes. KEY RESULTS: Among 338,718 veterans, there was no significant difference between facilities randomized to VCI and UC regarding receipt of any COVID-19 vaccine (Adjusted Odds Ratio=1.16, 95% Confidence Interval (0.89, 1.50), p=0.28). There were also no significant differences in COVID-19 primary series and booster completion, or flu vaccine uptake. Significant predictors of vaccination among veterans included age, non-White race, Hispanic ethnicity, and greater primary care utilization. CONCLUSIONS: MI-informed vaccination communication education of VA providers and staff did not significantly improve uptake of COVID-19 and flu vaccination in veterans. Targeted outreach to sub-populations (e.g., younger veterans) and increased primary care utilization may enhance vaccination uptake. Lessons learned from this trial, including barriers to implementation, may inform future vaccine communication interventions given increasing vaccine hesitancy amid current outbreaks and the threat of future pandemics. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT05027464.