Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States: A Decentralized Randomized Clinical Trial (Preprint)

Abstract

Seasonal influenza affects 5%-15% of Americans annually, resulting in preventable deaths and significant economic impact. Influenza infection is particularly dangerous for people with cardiovascular disease, who therefore represent a priority group for vaccination campaigns.

We aimed to assess the effects of digital intervention messaging on self-reported rates of seasonal influenza vaccination.

This was a randomized, controlled, single-blind decentralized trial conducted at individual locations throughout the United States over the 2020-2021 influenza season. Adults with self-reported cardiovascular disease who were members of the mobile Achievement platform were randomized to receive or not receive a series of 6 patient-centered digital intervention messages promoting influenza vaccination. The primary endpoint was the between-group difference in self-reported vaccination rates at 6 months after randomization. Secondary outcomes included levels of engagement with messages and the relationship between vaccination rates and engagement with messages. Subgroup analyses examined variation in intervention effects by race. Controlling for randomization group, we examined the impact of other predictors of vaccination status, including cardiovascular condition type, vaccine drivers/barriers, and vaccine knowledge.

Of the 49,138 randomized participants, responses on the primary endpoint were available for 11,237 (23%; 5575 in the intervention group and 5662 in the control group). The vaccination rate was significantly higher in the intervention group than among controls: 3418/5575 (61.31%) vs. 3355/5662 (59.25%), respectively; relative risk 1.03 [95% CI 1.004-1.066]; P=.027). Participants who were older, more educated, and White or Asian were more likely to report being vaccinated. The intervention was effective among White participants (P=.004) but not among people of color (P=.422). The vaccination rate was 15 percentage points higher among participants who completed all 6 intervention messages versus none, and at least 2 completed messages appeared to be needed for effectiveness. Participants who reported a diagnosis of COVID-19 were more likely to be vaccinated for influenza regardless of treatment assignment.

This personalized, evidence-based digital intervention was effective in increasing vaccination rates in this population of high-risk people with cardiovascular disease.

ClinicalTrials.gov NCT04584645; https://clinicaltrials.gov/ct2/show/NCT04584645