The health and economic consequences of seasonal influenza present great costs to communities. Promoting voluntary uptake of the seasonal influenza vaccine among university students, particularly during the COVID-19 pandemic, can deliver protective effects for both individuals and the wider community. Vaccine uptake will be greatest when more of the social marketing benchmarks are applied. This systematic review summarizes evidence from programs aiming to increase seasonal influenza vaccination among university students. Six major electronic databases for health promotion studies (PubMed, EBSCO, ProQuest, Ovid, Web of Science, and ScienceDirect) were searched in November 2021 to capture peer-reviewed studies reporting field trials that have sought to increase seasonal influenza vaccination in university student populations, without any restrictions regarding the publication period. Following PRISMA guidelines, this paper identified 12 peer-reviewed studies that were conducted in the field in the United States, Australia, and Spain. Three studies were targeted at healthcare students and the rest focused on wider university student populations. Studies were narratively summarized, evidence of social marketing principles were identified, and quantitative outcomes were meta-analyzed. The findings indicate that none of the field studies, even a self-classified social marketing study, had adopted all eight of the social marketing benchmarks in program design and implementation. The two studies that only used promotion, but not other marketing-mix and social marketing principles, reported increases in students' intention to be vaccinated but not actual behavior. Given that change is more likely when more social benchmarks are applied, this paper identifies activities that can be included in flu vaccine programs to improve flu vaccine uptake rates. The analysis highlights a lack of field studies focusing on increasing rates of vaccination behavior as research outcomes in countries beyond the United States.
Keywords: flu immunization; health behavior change; healthcare student; meta-analysis; seasonal flu vaccine; seasonal influenza vaccination; social marketing; systematic review; university student.