A Public Health Initiative: Influenza Vaccination for Medical Students

This report proposes a public health initiative aimed at increasing influenza vaccination uptake among medical students in Central Saudi Arabia. It begins with background information on influenza and justifies the focus on medical students in Saudi Arabia. The proposal outlines a plan to assess knowledge and perceptions related to flu vaccination through questionnaires and a social media campaign designed to enhance knowledge and address misconceptions. The initiative also includes implementing vaccination programs. The report details plans to evaluate the campaign's success and the vaccination program. The evaluation section will overview initiatives to track the success of the social media campaign and the vaccination program and the recommendations for improvement in the initiative post eight-nine months of the implementation of the program. The report is based on social marketing and asset-based approaches, incorporating stages of planning, formative research, intervention planning, implementation, and evaluation. The goal is to reduce the burden of influenza through increased vaccination rates, particularly among future healthcare workers who are at high risk of exposure. The initiative addresses the low vaccination rates and knowledge gaps identified in Saudi Arabia, emphasizing the role of social media in disseminating accurate information and influencing perceptions. The report concludes with a call for comprehensive programs to control influenza in healthcare settings, especially in regions with high pilgrim traffic.

Running head: PUBLIC HEALTH
Public health
Name of the student:
Name of the University:
Author’s note

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Table of Contents
Introduction:....................................................................................................................................2
Aims and Objectives of Proposal:...................................................................................................4
Justification for the topic:................................................................................................................4
Underpinning Models/Concepts:.....................................................................................................6
Outline of Proposed Action Plan:....................................................................................................8
Resources/Funding Issues:.............................................................................................................11
Evaluation:.....................................................................................................................................12
Conclusion:....................................................................................................................................12
References:....................................................................................................................................14

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A public health initiative to assess knowledge of influenza and improve vaccination
uptake among medical students in Central Saudi Arabia
Introduction:
This report will propose a public health initiative to assess the knowledge and increase
uptake of influenza vaccination among medical students in Central Saudi Arabia. It will give
background information about influenza and the justification for choosing medical students
in Saudi Arabia for the public health initiative. The paper will describe the actions planned to
assess the knowledge and perception related to flu vaccination among medical students and
suggest the process to implement social media campaign to enhance knowledge and
eliminate misconceptions about vaccination. The evaluations section will give an overview of
initiatives to track the success of social media campaign and the vaccination program and the
recommendations for improvement in the initiative post eight-nine months of the
implementation of the program.
Influenza is the most common and highly contagious airborne infection resulting in acute
febrile illness and other diverse symptoms like sudden onset of fever, cough, headache,
malaise, sore throat and muscle and joint pain. The symptoms vary from mild sickness to
acute respiratory discomfort as well as death (Lee et al., 2018). Some of the population
groups who are at high risk of influence include patients with other co-morbid conditions like
elderly people, children, immune-compromised individuals, pregnant women and health care
workers. Health care workers are at high risk because of increased exposure to the patients
and the likelihood of getting the infection after contact with patients (Abalkhail et al., 2017).
According to WHO, the burden of influenza epidemic is understood from the fact that 3 to 5

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million cases of severe illness and about 290, 000 to 650, 000 cases of respiratory deaths
occur due to influenza (WHO 2018). This data exemplifies the need to pay attention to risk
of influenza in high risk groups.
Vaccination is the most effective intervention to prevent influenza and its associated
severe outcomes (Demicheli et al., 2018). WHO has identified six priority groups for
influenza vaccination namely pregnant women, elderly persons, health care workers,
residents of aged care services, children aged 6-59 years and people with more than six
months of chronic disease. To reduce the burden of serious complications from influenza
infection, WHO has recommended that health care staffs and other risk groups should be
vaccinated every year before the start of autumn (WHO, 2018). In UK, the NICE guideline
mandates the need to increase uptake of flu vaccination by using multi-component approach,
raising awareness, increasing vaccination and enhancing uptake rate in health and social care
staffs. The significance of this document is that it will facilitate collaboration with
intervention developers and other local stakeholders to increase vaccination uptake (NICE,
2018). NHS England has implemented initiatives to boost the uptake of flu vaccinations and
they are directing NHS trusts to ensure that vaccines are readily available (NHS England,
2017). However, the weakness of the NHS action is that it targeted support to improving the
clinical education environment, but no suggestions was proposed to implement educational
campaigns for health care workers. This proposal will enlighten about the effective steps to
implement wider educational campaigns for raising awareness about the benefits of
vaccination.

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Aims and Objectives of Proposal:
The main aim of this public health initiative is to increase the uptake of influenza
vaccination among medical students in Central Saudi Arabia. The key objectives of the
public health initiatives were as follows:
 Develop a questionnaire to assess previous history of influenza vaccination and gain
knowledge related to determinants of vaccination denial and acceptance among
medical student
 Develop social media campaign to increase knowledge about influenza vaccination
and increasing the rate in children
 Implement influenza vaccination programs for medical students in medical
universities
 Measure the level of awareness and increase in uptake of influenza vaccines before
and after the social media campaign
Justification for the topic:
The significance of the topic can be interpreted based on statistical data related to burden
of influenza across the world. According to Abalkhail et al. (2017), 9% of the world population
has been affected by influenza and it has resulted in 3-5 millions severe cases and deaths. In
developed countries like United States, influenza is the reason for around 2, 25, 000
hospitalizations per year. The severity and mortality rate is found to be unusually high in high
risk groups. According to the annual flu report for UK, low rate of vaccination coverage has
been found in high risk groups. For example, in pregnant women, the vaccination uptake rate
was 45.2% in pregnant women and 72% in old adults. In addition, the vaccine uptake rate for

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frontline healthcare workers showed that 73% were vaccinated by 28th February, 2019 compared
to 68.7% in 28th February, 2018 (Public Health England, 2019). Although the statistics shows
that the prevalence rate increased in 2019, however the numbers are expected to be much higher
for health care workers. The data indicates gaps in coverage rate among health care workers and
initiative must start from the time health care staffs are medical students so that exposure rate
could be minimized during daily practice
There are many rationale behind prioritizing influenza vaccination knowledge and
increasing uptake rate particularly in medical students of central Saudi Arabia.. This is because
medical students are the most vulnerable group who are likely to be health care workers in the
future and there are various evidence to show the increase in risk of influenza among health care
staffs because of contact with infected residents in the community (Kuster et al., 2013; Dini et
al., 2018).Kuster et al. (2013) affirms that contact with persons with acute respiratory illness and
performing aerosol generating medical procedure is associated with influenza infection among
health care workers. Dini et al. (2018) highlighted an important gap in attitude among health care
professionals and this included high rate of vaccine hesitancy because of low risk perception,
negative attitude towards vaccine and poor influenza-specific knowledge. These evidences
indicate the need for wider public health initiative and programs particularly to control the rate of
influenza in health care workers.
These public health initiatives particularly prioritize assessment of vaccine knowledge
among medical students in Saudi Arabia. The attitudes and knowledge related to vaccination in
Saudi Arabia deserves better attention because it is a place with greatest annual turnover of
millions of pilgrims from across the world (Abalkhail et al., 2017). Thus, civilians and tourists
are at greater risk of transmission of infections from health care staffs and airport personnel. The

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pilgrims travelling to their home country could transmit the infection their too (Goeijenbier et al.,
2016). Hence, the consequences of poor vaccine uptake among health care staffs in Saudi Arabia
are clear. Surveys conducted in Saudi Arabia has revealed low rate of awareness among health
staffs. Alshammari et al. (2019) highlighted the issue of safety concerns among health staffs and
some rate of misconceptions about vaccines among staffs. 42.3% had the perception that
Influenza is caused due to infection. This evidence supports the need for assessment of
vaccination practices and increasing training programs in the future.
As medical students represents a subset of health care staffs, investigating awareness and
knowledge among these group can be effective in identifying gaps in knowledge and get idea for
planning effective public health initiatives for comprehensive coverage. Influenza in health staffs
can have major impact in Saudi Arabia because of large inflow of pilgrims every year (Chaouk,
Pagliari & Miyoshi, 2019). Saudi Arabia is a place with high annual turnover of pilgrims from
across the world and high risk of transmission of infection (Shafi et al., 2016; Gautret et al.,
2016). If health care workers (HCWs) are not vaccinated, transmission of infection increases the
risk of spreading of the epidemics not only in host country but also in international scale
(Alsahafi & Cheng, 2019). This justifies the significance of this public health initiative.
Underpinning Models/Concepts:
This public health initiative is influenced by the social marketing and assets based
approach. This model has been selected because social marketing has a wider reach and it will be
possible to easily pass on the right message to the medical students without much effort. Social
marketing is an approach to persuade people to accept ideas and attitudes and follow a specific
healthy behaviour (Goldberg, Fishbein & Middlestadt, 2018). The significance of social

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marketing approach is that it focuses on understanding the perspective of the entire target
audience and it recognized the need to include all marketing mix elements (product, price, place
and promotion) to bring about the behaviour change (Shams, 2018). Aras (2011) argues that
selection of right product, right place, promotion and right price is crucial to enhance the
sustainability and success of social marketing. Thus, social marketing principle can add value to
the public health program in order to influence target behaviour. Hence, using this approach,
relevant product can be developed according to consumer’s needs and preferences and
distributed through convenient channels.
In the context of this public health program, it will be necessary to choose an appropriate
program based on which education related to vaccine could be provided to students. Hence,
understanding how medical students feel and think in relation to vaccination will help in
planning effective educational interventions and vaccine programs. The social marketing model
has seven stages which can guide in planning appropriate interventions. The first stage involves
preliminary planning which involves identification of the health problem, development of goals
and estimating program cost. The stage 2-4 involves formative research stage during which
primary idea is generated through qualitative approaches like interviews and quantitative surveys
(Shams, 2018). The significance of this formative research is that it make social marketers and
health promotion staffs aware about the factors influencing a particular behaviour and the
activities needed to engage audience in the desired behaviour (Lim et al., 2017). This stage is
highly flexible and it depends on the judgment of health promotion staffs to decide the best
method to collect data and identify the cause behind the health behaviour. The fifth stage of the
development involves planning ideas for intervention and pretesting all the communications
methods and strategies. The sixth stage is the implementation stage during which all strategies

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and tactics are used to initiate a mass media campaign or an education session (Gough et al,
2017). The final phase is the evaluation stage during which the quality of the program is assessed
by means of consumer orientation, impact evaluation and outcome evaluation (Shams, 2018).
Firestone et al. (2017) supports too that the stages in his models supports markets to develop
health products and services that are appealing and affordable both for health care providers and
consumers.
Social marketing campaigns have been implemented widely in health care. There are
many evidence which shows the application of social marketing in health programs and in
vaccine uptake programs too. Lee and Kotler (2015) analyzing social marketing framework
remarked social marketing as a good solution focused framework for interpreting barriers to
behaviour change and designing interventions accordingly. Kolff, Scott and Stockwell (2018)
gave evidenceregarding the utilization of social media platforms such as Facebook and Instagram
to change the perception of families and friends perception about vaccine efficacy and safety.
Social media had great effect on vaccine perceptions and it enables effective exchanges of ideas
about vaccine perceptions from various sources like family and friends. However, one drawback
found in the literature was that interactive ability of the media can leads to debates and
reconsider of a user’s beliefs towards vaccines. To address this issue, it is necessary that the
social media content related to vaccination is carefully planned.
Outline of Proposed Action Plan:
To increase knowledge and perception to improve vaccine uptake rate among medical
students in Central Saudi Arabia, it is planned to implement the intervention in three phases. The
first stage will involve collecting data to interpret current level of knowledge and identify the

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barriers to vaccination among. The following steps will be undertaken to complete the first stage
of the program:
 A questionnaire will be developed to collect knowledge about influenza vaccination,
perception and barriers to uptake of the same among medical students. The data will be
collected mainly related to socio-demographic information, previous history of
vaccinations, knowledge related to influences and factors determining the acceptance and
denial of the vaccines.
 The participants will be categorized based on those who accept influenza vaccines and
those who deny using it because of various concerns. This is important as per the social
marketing model as such evaluation will help to understand the beliefs of the target
population and identify the strategies needed to address false perception and beliefs and
give new insight to participants (Veludo-de-Oliveira et al., 2015).
The second step will involve implement a social media campaign in the universities of Central
Saudi Arabia. The following steps will be undertaken to enhance knowledge and perception
towards influenza and vaccination:
 Best YouTube videos on flu and flu immunization will be searched. The focus will be to
select those videos that give an overview of the disease and positive and negative stance
related to the topic. The focus will be to select video of not more than five minutes and
those which gives all relevant information about the significance of vaccination for health
care staffs
 Health promotion staffs will visit universities and orient the students to the vaccination
uptake programs. In a single large auditorium, students of each university will be

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introduced to the YouTube videos and additional pamphlets will be distributed so that
medical students can know when and where of getting vaccinated.
 Health care staffs will be trained regarding the way to pass on the message to medical
students and advocate for the need for vaccination to protect the health of both national
and international citizens of Saudi Arabia. By giving communication related training, it
will be possible to minimize conflicts and ensure maximum compliance to the desired
intervention. Both verbal and non-verbal interaction skill between trainees and medical
students can help in effective information sharing (Van Nuland et al., 2017).
 At the end of sessions, the participants will be informed about upcoming vaccination
programs and they will be asked to give confirmation for participating in the program
within one week. After participant’s confirmation, the program will move to the last
stage.
The final stage is the implementation of vaccination program and this stage is the most
crucial as the number of participants taking part in this program will determine the success of
the public health initiative and education intervention to change medical student’s view about
influenza vaccines. The final phase will be implemented in the following ways:
 Permission will be taken for medical college administrators regarding the best space
to implement the vaccination service. Clinics will be opened in the medical college to
increase access to vaccination
 The rate of medical students participating in the vaccination program will be judged
 Feedback will be taken from students regarding the benefits of the Youtube video and
educational session in increase vaccination uptake rate. Their intention to take regular
vaccines after entering the practice will be evaluated too. This action is in relevance

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with the NICE guideline as it mentioned about the need to use every opportunity to
identify people at risk and offer vaccines for flu.
Resources/Funding Issues:
The above public health intervention would be feasible to implement when all resources
are in place to successfully implement. The first important resource for the project is the health
promotion staffs or social workers with knowledge about vaccination. To ensure that they
understand the health problem and key objective of the program, it will be necessary to ensure
that proper training is provided to increase awareness about the program and develop
communication skills needed to interact with Saudi medical students. According to DeSalvo et
al. (2017), public health workforce must have specialized skills and they must have knowledge in
distinct disciplines. Such knowledge allows them to transcend to various disciplines and meet the
evolving health needs of the public (DeSalvo et al., 2017). Teaching persuasive communication
skill will be the most important part of the training program and this will ensure that compelling
public health message is given to the broad audiences (Stiff & Mongeau, 2016).
Estimating proper time and duration of the intervention is also crucial to achieve the
desired effect. It is expected to complete this social media based intervention for flu vaccination
within three months. The first stage of the intervention will be completed within one month and
by this time all activities such as development of questionnaire and data collection will be done.
The second stage will be completed within three weeks as several medical colleges in Saudi
Arabia will be covered. The final stage of vaccination program and feedback will be completed
in the last month. The key resources will use YouTube videos, educational pamphlets,
powerpoint presentations and pamphlets on websites to refer for more information. Although not

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enough expenditure is required for the first two stage, the third stage will be require funding
from Public Health England and other primary health agents can providing vaccines and
arranging vaccination camps will require additional costs (Crocker-Buque & Mounier-Jack,
2018; NICE, 2019).
Evaluation:
Evaluation of any intervention is necessary to ensure it matches with the program
objectives and promote long-term effective of the intervention. The evaluation of the social
media based intervention implemented in medical students will be done in two phases. Firstly,
the significance of the educational session will be judged based on calculating the number of
students who took part in educational campaign and those who took part in the vaccination
program. Secondly, the impact evaluation of the social media message will be done by taking
feedback from all medical students. They will be asked to give their rating about the impact of
YouTube message on clarifying perceptions related to vaccines and experiences of interacting
with the program staffs during the social media campaign. The results from the feedback will be
crucial in improving the content of the educational session and identifying other support needed
by medical staffs to enhance coverage.
Conclusion:
Prioritizing coverage of influenza vaccines among medical students in Saudi Arabia is a
crucial initiative as their knowledge and perspective will influence health of both national and
international pilgrims coming to the city. By use of questionnaires to identify knowledge gaps
and by using multimodal approach of YouTube videos and vaccination programs, it is possible to
cut down the rate of hospitalization and severe illness occurring due to flu in the country. By

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adhering to the guidelines of NICE, it is expected that the desired goal will be achieved. If the
program is successful, similar initiative will be rolled out in medical colleges of Saudi Arabia
every year.

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