JMIR Publications

ABSTRACT

Background:

Mycoplasma pneumoniae (M. pneumoniae) is a primary cause of pediatric respiratory infections worldwide. In China, macrolide resistance rates exceeding 80% make timely diagnostic testing essential to replace empirical treatment with targeted therapy. However, most symptomatic children are not tested during clinic visits, representing a missed opportunity for effective infection management.

Objective:

This study evaluated whether a pay-it-forward (PIF) pro-social intervention could increase M. pneumoniae testing uptake among children compared to standard-of-care (SOC).

Methods:

This two-arm, pragmatic superiority cluster randomized controlled trial was conducted in December 2023 at two pediatric clinics in Wuxi, China. We enrolled 320 symptomatic children under 14 years, randomly assigned to either the PIF or SOC arm (n=160 each). Clusters, each comprising 10 consecutively eligible children and their caregivers, were randomized to either the pay-it-forward arm or the standard-of-care arm (16 clusters per arm, total 32 clusters). In the PIF arm, participants received a donated test and could voluntarily contribute to a fund for future participants. The primary outcome was M. pneumoniae testing uptake documented in administrative records.

Results:

A total of 320 participants were enrolled and evenly randomized. Caregivers were predominantly mothers (66·9%) with a mean age of 37·5 years, who largely resided in urban areas (65·6%), were employed (88·8%), and held an undergraduate degree or higher (63·5%). Children had a mean age of 7·3 years (SD 3·4) and were 55·0% male. M. pneumoniae testing uptake was significantly higher in the PIF arm (72·5%) compared to the SOC arm (34·4%), with an adjusted proportion difference of 39·6% (95% CI, 23·6%-55·7%). Subgroup analyses revealed stronger intervention effects among caregivers with higher education (P= 0·004) and income (P= 0·039). In the PIF arm, 9·5% of participants voluntarily contributed to the fund. Approximately 12% of tested participants in both groups were positive for M. pneumoniae. No adverse events were reported.

Conclusions:

A pay-it-forward intervention significantly increased the uptake of M.pneumoniae testing among symptomatic children, demonstrating the feasibility and effectiveness of this innovative approach to improve access to diagnostic testing for respiratory pathogens. Clinical Trial: This trial is registered with Chinese Clinical Trial Registry, ChiCTR 2300078623.