In Thailand, outbreaks of influenza have had grave consequences; in 2008, the H1N1 pandemic infected 8.4 million people and caused 191 deaths. Despite these headline-grabbing figures, a free vaccination program spearheaded by the government only resulted in 38% coverage in its first year.

To improve coverage, one program designed a leaflet using a two-phased approach. First, it sought to motivate recipients to vaccinate by providing information that, for instance, increased perceptions of the personal risk of getting the virus. Second, the leaflet helped recipients with an action plan, including a fill-in-the-blank form about their planned appointment at a health facility. The program’s stated goals were to strengthen intentions to seek a flu vaccination and translate these intentions into behavior change.

The program achieved its first goal: recipients of the new leaflet had much stronger intentions to vaccinate compared to a control group that received a traditional leaflet. However, there was no significant difference between a control and an intervention group regarding actual vaccination behavior. Despite attempts to increase risk perception, along with providing a basic action plan*, increased intentions didn’t lead to action. Something more was needed.

The findings affirm that immunization programs should be designed to facilitate the full journey to vaccination, not simply to change attitudes, risk perceptions, or stated intentions. That effort requires correctly diagnosing and addressing the particular bottlenecks preventing individuals from turning positive intentions into corresponding actions.

Source: Payaprom et al (2011), Using the Health Action Process Approach and Implementation Intentions to Increase Flu Vaccine Uptake in High Risk Thai Individuals: A Controlled Before-After Trial
*While action plans (also referred to in this Field Guide as ‘implementation intentions’) can be a helpful tool to bridge intention and action, its unsuccessful use suggests that this solution didn’t adequately address the barriers keeping the intention-action gap open in this situation.