Keywords

vaccination, influenza, COVID-19, behavioral nudge, text message

Abstract

Purpose: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.

Design: Randomized, controlled trial.

Setting: Two health systems in the Northeastern US between September 2020 and March 2021.

Subjects: 74,811 adults.

Interventions: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content.

Measures: Influenza vaccination.

Analysis: Intention-to-treat.

Results: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as “reserved for you” and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as “reserved for you.” None of the interventions performed worse than control.

Conclusions: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.

Original Publication Citation

“A Randomized Trial of Behavioral Nudges Delivered through Text Messages to Increase Influenza Vaccination Among Patients with an Upcoming Primary Care Visit.” 2023. American Journal of Health Promotion, 37(3) 324-332 (with Katherine L. Milkman, Mitesh S. Patel, Linnea Gandhi, Heather Graci, Dena Gromet, Quoc Dang Hung Ho, Joseph Kay, Timothy Lee, Modupe Akinola, Joshn Beshears, Jonathan Bogard, Alison Buttenheim, Christopher Chabris, Gretchen B. Chapman, James J. Choi, Hengchen Dai, Craig R. Fox, Amir Goren, Matthew Hilchey, Jilian Hmurovic, Leslie John, Dean Karlan, Melanie Kim, Melanie David I. Laibson, Cait Lamberton, Michelle N. Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renate Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda Evans, Christopher Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin Volpp, Kevin and Angela Duckworth). http://doi:10.1177/08901171221131021

Document Type

Peer-Reviewed Article

Publication Date

2023

Publisher

American Journal of Health Promotion

Language

English

College

Marriott School of Business

Department

Finance

University Standing at Time of Publication

Full Professor

Download

Share

COinS