A 680,000-person megastudy of nudges to encourage vaccination in pharmacies

Author:

Milkman Katherine L.1ORCID,Gandhi Linnea1,Patel Mitesh S.2ORCID,Graci Heather N.3ORCID,Gromet Dena M.3,Ho Hung4,Kay Joseph S.3ORCID,Lee Timothy W.5ORCID,Rothschild Jake3,Bogard Jonathan E.6ORCID,Brody Ilana6ORCID,Chabris Christopher F.7ORCID,Chang Edward8ORCID,Chapman Gretchen B.9ORCID,Dannals Jennifer E.10ORCID,Goldstein Noah J.11,Goren Amir7,Hershfield Hal12,Hirsch Alex13,Hmurovic Jillian14ORCID,Horn Samantha9ORCID,Karlan Dean S.15ORCID,Kristal Ariella S.16ORCID,Lamberton Cait17,Meyer Michelle N.7ORCID,Oakes Allison H.18,Schweitzer Maurice E.1ORCID,Shermohammed Maheen7ORCID,Talloen Joachim9,Warren Caleb19ORCID,Whillans Ashley8ORCID,Yadav Kuldeep N.20,Zlatev Julian J.8ORCID,Berman Ron17ORCID,Evans Chalanda N.21ORCID,Ladhania Rahul22ORCID,Ludwig Jens23,Mazar Nina24ORCID,Mullainathan Sendhil25ORCID,Snider Christopher K.26ORCID,Spiess Jann27,Tsukayama Eli28ORCID,Ungar Lyle13ORCID,Van den Bulte Christophe17ORCID,Volpp Kevin G.29ORCID,Duckworth Angela L.130

Affiliation:

1. Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104

2. Ascension Health, St. Louis, MO 63105

3. Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104

4. Department of Marketing, The University of Chicago Booth School of Business, Chicago, IL 60637

5. School of Professional Studies, Northwestern University, Evanston, IL 60208

6. Department of Behavioral Decision Making, Anderson School of Mangement, University of California, Los Angeles, CA 90095

7. Behavioral Insights Team, Steele Institute for Health Innovation, Geisinger Health System, Danville, PA 17822

8. Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA 02163

9. Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213

10. Department of Strategy and Management, Tuck Business School, Dartmouth College, Hanover, NH 15213

11. Department of Management and Organizations, Anderson School of Management, University of California, Los Angeles, CA 90095

12. Department of Marketing, Anderson School of Management, University of California, Los Angeles, CA 90095

13. Department of Computer and Information Science, School of Engineering, University of Pennsylvania, Philadelphia, PA 19104

14. Wharton Risk Management and Decision Processes Center, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104

15. Department of Finance, Kellogg School of Management, Northwestern University, Evanston, IL 60208

16. Department of Organizational Behavior, Harvard Business School, Boston, MA 02163

17. Department of Marketing, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104

18. Anthem, Inc., Indianapolis, IN 46203

19. Department of Marketing, Eller College of Management, University of Arizona, Tucson, AZ 85721

20. Department of Biostatistics, Epidemiology, & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104

21. Penn Medicine Nudge Unit, Penn Medicine, Philadelphia, PA 19104

22. Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109

23. Harris School of Public Policy, University of Chicago, Chicago, IL 60627

24. Department of Marketing, Questrom School of Business, Boston University, Boston, MA 02215

25. Department of Behavioral Science, Booth School of Business, University of Chicago, Chicago, IL 60637

26. Center for Health Care Innovation, Penn Medicine, Philadelphia, PA 19104

27. Department of Operations, Information, and Technology, Graduate School of Business, Stanford University, Stanford, CA 94305

28. Business Administration Division, University of Hawai`i–West O`ahu, Kapolei, HI 96707

29. Penn Center for Health Incentives and Behavioral Economics, Departments of Medical Ethics and Health Policy and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104

30. Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104

Abstract

Significance Encouraging vaccination is a pressing policy problem. Our megastudy with 689,693 Walmart pharmacy customers demonstrates that text-based reminders can encourage pharmacy vaccination and establishes what kinds of messages work best. We tested 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination. Reminder texts increased vaccination rates by an average of 2.0 percentage points (6.8%) over a business-as-usual control condition. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts 3 d apart and stated that a vaccine was “waiting for you.” Forecasters failed to anticipate that this would be the best-performing treatment, underscoring the value of testing.

Funder

National Philanthropic Trust

Bill and Melinda Gates Foundation

Robert Wood Johnson Foundation

Publisher

Proceedings of the National Academy of Sciences

Subject

Multidisciplinary

Reference36 articles.

1. H. Ritchie Coronavirus (COVID-19) vaccinations – Statistics and research . https://ourworldindata.org/covid-vaccinations. Accessed 19 January 2022.

2. National Governors Association COVID-19 vaccine incentives. https://www.nga.org/center/publications/covid-19-vaccine-incentives/. Accessed 19 January 2022.

3. The White House FACT SHEET: President Biden to announce national month of action to mobilize an all-of-America sprint to get more people vaccinated by July 4th. https://www.whitehouse.gov/briefing-room/statements-releases/2021/06/02/fact-sheet-president-biden-to-announce-national-month-of-action-to-mobilize-an-all-of-america-sprint-to-get-more-people-vaccinated-by-july-4th/. Accessed 19 January 2022.

4. Using implementation intentions prompts to enhance influenza vaccination rates

5. Opting In vs Opting Out of Influenza Vaccination

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