3Cs-Based intervention to improve influenza and pneumococcal vaccination in COPD patients: An RCT

To explore the impact of integrated medical and preventive interventions—comprising vaccine health promotion materials and a “vaccine health prescription” designed based on the 3Cs vaccine hesitancy model, led by CDC departments and implemented by hospital respiratory physicians—on the knowledge levels and vaccination rates of influenza vaccine (InfV) and pneumococcal polysaccharide vaccine (PPV) among COPD patients. Using convenience sampling, we recruited COPD patients who met the inclusion and exclusion criteria from the respiratory outpatient department of Guizhou Provincial People’s Hospital from June 2025 to January 2026 as study subjects. Inclusion criteria: (1) Aged ≥18 years and meeting COPD diagnostic criteria (post-bronchodilator FEV 1 /FVC < 0.70) with exclusion of other diseases; (2) Permanent residents of Guiyang City (referring to both registered and non-registered residents who have resided for more than half a year); (3) Meet the indications for InfV and/or PPV vaccination; (4) Voluntarily participate in the research and sign the informed consent form. Exclusion criteria: (1) Patients with contraindications to vaccination; (2) Patients who are unable to complete the questionnaire or refuse to participate in the study; (3) Patients who were vaccinated with InfV in 2025 and with PPV during the period from 2021–2025. A medical-prevention integrated intervention strategy designed by the Guizhou Provincial Center for Disease Control and Prevention based on the 3Cs vaccine hesitancy model, and implemented by respiratory outpatient doctors at Guizhou Provincial People’s Hospital.Outpatient doctors collected relevant information from COPD patients through questionnaires. Patients were randomly assigned to the control group and the intervention group. Vaccine hesitancy refers to the behavior of delaying or refusing vaccination when vaccines are available. The 3Cs model of vaccine hesitancy includes three dimensions: Confidence, Complacency, and Convenience. Confidence refers to the level of trust that individuals have in the safety and efficacy of vaccines, the healthcare system, and policymakers; Complacency refers to the perception that one is at low risk of infection, or the underestimation of the risk of vaccine-preventable diseases, leading individuals to believe that vaccination is unnecessary; Convenience refers to the accessibility of vaccination, including geographical reach, economic cost, service hours, and ease of procedures.The intervention group received vaccine health education based on the 3Cs model and were recommended a “vaccine health prescription” for receiving InfV and PPV. The control group did not receive the aforementioned interventions. A second questionnaire survey was conducted by telephone one month after the patient was enrolled. Query the actual administration of InfV and PPV within 6 months after patient enrollment through the vaccination service system. The primary outcomes observed were InfV and PPV vaccination rates, hesitancy rates, and changes in the three dimensions of the 3Cs model. Of the 265 initially enrolled subjects, 9 were lost to follow-up (3.4%), leaving 256 for analysis (128 in each group). Post-intervention, hesitancy rates for InfV were significantly lower in the experimental group than in the control group (21/128 vs 45/128), hesitancy rates for PPV were significantly lower in the experimental group than in the control group (31/128 vs 60/128) ; vaccination rates for InfV were significantly higher in the experimental group than in the control group(54/128 vs 12/128), PPV vaccination coverage within the previous 5 years were significantly higher in the experimental group than in the control group(42/128 vs 12/128). Health promotion materials and ‘vaceine health preseriptions’ designed based on the 3C’s vaecine hesitancymodel, led by the CDC and implemented by hospital respiratory physicians, as part of a medical.prevention integrated intervention, can reduce vaccine hesitaney for Infv and PpV among COPD patients.increase awareness ofthe 3Cs, and improve vaccination rates.