A PRImary care randomised trial of an internet intervention to Modify Influenza-like illness and respiratory infection Transmission (PRIMIT trial.)

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
2D.6

The problem

. Hand-washing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic, but the role of hand-washing is debated, and no good randomised evidence exists among adults in non-deprived settings. This study aimed to demonstrate whether an intervention to modify hand-washing reduces RTIs among adults.

The approach

Individuals sharing a household were recruited by mailed invitation through their general practice. Following consent, participants were randomised on-line by an automated computer-generated random number programme either to no access, or to access a bespoke automated web-based intervention which maximised hand-washing intention, monitored hand-washing behaviour, provided tailored feedback, reinforced helpful attitudes and norms and addressed negative beliefs. Participants could not be blinded, but the analysis syntax was constructed blind to group.

Findings

20,066/16,908 (84%) participants were followed up. An intention-to-treat analysis documented fewer RTIs reported after 16 weeks (intervention 51% (4242/8241); controls 59% (5135/8667); multivariate risk ratio 0.86; 95% confidence intervals 0.83 to 0.89). The intervention reduced transmission of RTIs (reported within one week of another household member) both to and from the index person. The intervention reduced gastrointestinal infections, antibiotic prescriptions, and consultations, and was very cost-effective - saving NHS resource use and increasing quality of life. There was a modest increase in minor self-reported skin irritation (4.3% (231/5429) versus 1.3% (79/6087)) and no serious adverse events.

Consequences

In non-pandemic years an effective internet intervention designed to increase hand-washing could have an important impact in reducing infection transmission. Given the heightened concern during a pandemic and the likelihood of accessing the internet for advice, the intervention also has potential for effective implementation during a pandemic.

Credits

  • Paul Little, University of Oxford, Oxford, UK
  • Beth Stuart, University of Oxford, Oxford, UK
  • Richard Hobbs, University of Birmingham, Birmingham, UK
  • Mike Moore, University of Oxford, Oxford, UK
  • Jane Barnett, University of Oxford, Oxford, UK
  • Deborah Popoola, University of Glasgow, Glasgow, UK
  • Karen Middleton, University of Oxford, Oxford, UK
  • Joanne Kelly, University of Oxford, Oxford, UK
  • Mark Mullee, University of Oxford, Oxford, UK
  • James Raftery, University of Oxford, Oxford, UK
  • Guiqing Yao, University of Oxford, Oxford, UK
  • William Carman, RCGP Surveillance Unit, Birmingham, UK
  • Douglas Fleming
  • Helen Stokes-Lampard, University of Glasgow, Glasgow, UK
  • Ian Williamson, University of Oxford, Oxford, UK
  • Judith Joseph, University of Oxford, Oxford, UK
  • Sascha Miller, University of Oxford, Oxford, UK
  • Lucy Yardley, University of Oxford, Oxford, UK