Effectiveness of an ADDIE and Health Belief Model-Based Influenza Prevention Program in Urban and Rural China: A Quasi-Experimental Study

Every winter, a familiar virus circulates through cities and villages, causing millions of severe illnesses and hundreds of thousands of deaths worldwide. In China, despite the availability of vaccines and simple protective habits like wearing masks or washing hands, many people still do not adopt these measures. The reasons are often not a lack of information, but a complex mix of doubt, fear, and practical obstacles. Some people do not believe they are likely to get sick, while others feel the vaccine is unsafe or too difficult to obtain. To bridge this gap between knowing what is safe and actually doing it, health experts rely on two guiding frameworks. One is a structured way of building educational programs, ensuring they are analyzed, designed, developed, tested, and evaluated with care. The other is a model of human psychology that suggests people take action when they feel a threat is real, believe the solution works, and feel confident they can do it.

A team of researchers in Henan Province decided to test whether combining these two approaches could change how people protect themselves against the flu. They set up a study in two very different places: a bustling city neighborhood in Zhengzhou and a quiet rural community in Zhumadian. They recruited 282 adults, half from the city and half from the countryside, and invited them to participate in an eight-week program. The goal was not just to hand out flyers, but to create a tailored experience that addressed the specific fears and daily realities of each group. For the city dwellers, the program leaned heavily on digital tools like WeChat articles and videos. For the rural residents, the team blended those digital messages with traditional methods, including broadcasts in the local dialect and illustrated pamphlets that used stories and examples the villagers could recognize immediately.

The results showed that this carefully constructed approach worked remarkably well for everyone, but it had a particularly powerful effect on the rural participants. Before the program began, the city residents generally knew more about the flu and felt more confident in their ability to protect themselves. After the eight weeks, both groups showed significant improvements in their knowledge, their attitudes toward prevention, and their actual habits. However, the rural participants made larger gains than their urban counterparts. They learned more new facts, felt much more capable of taking action, and felt fewer barriers stopping them from getting vaccinated or wearing a mask. Because the rural group started with lower scores and ended with much higher ones, the gap between city and country knowledge narrowed significantly. The difference in knowledge between the two groups shrank by nearly two-thirds, suggesting that a well-designed intervention can help level the playing field.

The study also looked at the psychological reasons behind these changes. The rural participants showed the most dramatic shifts in their belief that they could successfully perform preventive actions and in their perception that the benefits of staying safe outweighed the difficulties. This suggests that the program did more than just teach facts; it successfully addressed the deep-seated doubts and logistical worries that often keep people from protecting themselves. The researchers found that the program worked across different ages, education levels, and income groups, with the greatest benefits seen among those with the least money and the least formal education. This indicates that the method is not just effective, but also fair, reaching those who need it most.

While the study offers strong evidence that this combined approach works, the researchers note that it was conducted in only two communities and followed the participants for a relatively short time. They cannot yet say how long these new habits will last or if the method would work exactly the same way in other parts of China. Nevertheless, the findings provide a clear roadmap for public health officials. By using a systematic design process to create materials that fit the local culture and directly address the specific fears of a community, health workers can help people move from knowing what to do to actually doing it. This approach offers a practical, replicable model for improving health in places where resources are limited, proving that with the right structure and the right message, even the most persistent gaps in health behavior can be closed.