Effectiveness of Video Versus Pamphlet Education on Knowledge, Attitude, and Practice toward Influenza Vaccination among Pregnant Women in Malaysia: A Randomized Controlled Trial

Abstract

Introduction: Pregnant women face an elevated risk of severe influenza, yet global vaccination uptake remains suboptimal because of limited awareness. As maternal influenza vaccination is not routinely offered in Malaysia, effective educational strategies are crucial for addressing low levels of knowledge, attitude, and practice (KAP). This study aimed to compare the effectiveness of video versus pamphlet education, both combined with standardised counselling, in improving KAP towards influenza vaccination among pregnant women. Methods: A randomised parallel controlled trial was conducted in two Malaysian primary health clinics. Eligible pregnant women were recruited and randomly allocated to receive standardised counselling with either a bilingual educational pamphlet or a short educational video. Some eligible women declined participation, and some participants did not complete the 2-week follow-up questionnaire. Consequently, complete paired data from 139 participants (pamphlet n = 71; video n = 68) were included in the final analysis. Knowledge, attitude, and practice (KAP) were assessed at baseline and two weeks using a validated questionnaire. Repeated-measures ANCOVA was used to compare within- and between-group changes after adjustment for baseline differences. Results: Knowledge scores improved significantly in both the pamphlet (+0.98, p < 0.001) and video (+1.06, p < 0.001) groups. However, the between-group comparison showed a significantly higher mean knowledge score in the pamphlet group (4.01 vs. 3.55, p = 0.041). Practice improved modestly only in the pamphlet group (+0.44, p = 0.017), whereas attitude scores remained unchanged in both groups. Conclusion: Both educational modalities improved knowledge, with the pamphlet achieving a significantly higher post-intervention knowledge score and a modest improvement in practice. However, neither intervention significantly changed attitudes or vaccination uptake, suggesting that additional strategies, such as tailored counselling and motivational interviewing, may be needed to translate knowledge into preventive action. The findings should be interpreted in light of the modest sample size, loss to follow-up, and short 2-week follow-up period.