A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit

Author:

Patel Mitesh S.1ORCID,Milkman Katherine L.2,Gandhi Linnea2,Graci Heather N.3ORCID,Gromet Dena3,Ho Hung4,Kay Joseph S.3ORCID,Lee Timothy W.5,Rothschild Jake3,Akinola Modupe6,Beshears John7,Bogard Jonathan E.8,Buttenheim Alison9,Chabris Christopher10,Chapman Gretchen B.11,Choi James J.12,Dai Hengchen13,Fox Craig R.13,Goren Amir14,Hilchey Matthew D.15ORCID,Hmurovic Jillian16,John Leslie K.7,Karlan Dean17ORCID,Kim Melanie15,Laibson David7,Lamberton Cait18,Madrian Brigitte C.19,Meyer Michelle N.10,Modanu Maria6,Nam Jimin7,Rogers Todd7,Rondina Renante15,Saccardo Silvia11,Shermohammed Maheen10,Soman Dilip15,Sparks Jehan8,Warren Caleb20ORCID,Weber Megan8,Berman Ron18ORCID,Evans Chalanda N.21,Lee Seung Hyeong7,Snider Christopher K.22,Tsukayama Eli23,Van den Bulte Christophe18,Volpp Kevin G.24,Duckworth Angela L.2

Affiliation:

1. Department of Clinical Transformation and Behavioral Insights, Ascension, St. Louis, MO, USA

2. Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA

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

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

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

6. Department of Management, Columbia Business School, Columbia University, New York, NY, USA

7. Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA

8. Department of Behavioral Decision Making, Anderson School of Management, University of California, Los Angeles, CA, USA

9. Department of Family and Community Health, The University of Pennsylvania School of Nursing, Philadelphia, PA, USA

10. Behavioral and Decision Sciences Program, Geisinger Health System, Danville, PA, USA

11. Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA

12. Department of Finance, Yale School of Management, Yale University, New Haven, CT, USA

13. Department of Management and Organization, Anderson School of Management, University of California Los Angeles, Los Angeles, CA, USA

14. Behavioral Insights Team, Geisinger Health System, Danville, PA, USA

15. Department of Behavioural Science and Economics, University of Toronto, Toronto, ON, Canada

16. Department of Marketing, Drexel University, Philadelphia, PA, USA

17. Department of Finance, Kellogg School of Management, Northwestern University, Evanston, IL, USA

18. Department of Marketing, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA

19. Department of Finance, Marriott School of Business, Brigham Young University, Provo, UT, USA

20. Department of Marketing, Eller College of Management, University of Arizona, Tucson, AZ, USA

21. Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

22. Center for Health Care Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

23. Business Administration Division, University of Hawai`i-West O`ahu, Kapolei, HI, USA

24. 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, USA

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.

Funder

Mark J. Leder

The Flu Lab

Bill and Melinda Gates Foundation

John Alexander

AKO Foundation

National Institute on Aging

Warren G. Lichtenstein

University of Pennsylvania Health System

Robert Wood Johnson Foundation

Penn Center for Precision Medicine Accelerator Fund

Publisher

SAGE Publications

Subject

Public Health, Environmental and Occupational Health,Health (social science)

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