Efficacy of codesigned COVID-19 booster vaccine promotion materials for long-term care staff: a cluster-randomized trial.

Publication date: Jun 25, 2026

Among health care workers, long-term care center (LTCC) staff are among the most hesitant to obtain COVID-19 vaccines and boosters. Our objective was to compare the effectiveness of enhanced usual care (EUC) to codesigned materials (Codesign) in increasing COVID-19 booster vaccination rates and willingness to promote the booster among long term care center (LTCC) staff. We conducted a two-arm cluster-randomized trial in 40 LTCCs in Georgia (n = 21) and Washington (n = 19) from August 2021 to December 2023. EUC LTCCs distributed standard government COVID-19 booster promotion materials. LTCCs in the Codesign arm allowed staff to participate in virtual codesign teams. Over 10 weekly meetings, the teams developed tailored COVID-19 booster promotion materials. Materials were distributed to both arms in January 2023. Primary outcomes were LTCC-level COVID-19 booster vaccination and a Net Promoter Score (NPS) measuring booster promotion to coworkers. Secondary outcomes included staff-level vaccine hesitancy and confidence scores and booster promotion to friends and family. We did not detect a significant difference between the EUC and Codesign arms in COVID-19 booster rates or primary NPS measure. Similarly, secondary and exploratory outcomes were not significantly different between either arm. The null findings of this trial are consistent with the challenges of other clinical trials of COVID-19 vaccine-promotion interventions in improving COVID-19 vaccine uptake among LTCC staff. Lessons for future research include identifying better ways to: (1) engage leaders and staff, (2) design more effective targeting messages, and (3) develop ways to target and customize dissemination. This study is registered at www. gov. gov #NCT05449418. Date of registration: 6/22/2022.

Open Access PDF

Semantics

Original Article