Publications

Randomized Controlled Trial Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Ppublish 47 citations

PubMed: 36195982 DOI: 10.1177/08901171221131021

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

Am J Health Promot 37(3):324-332

Authors: Mitesh S Patel, Katherine L Milkman, Linnea Gandhi, Heather N Graci, Dena Gromet, Hung Ho, Joseph S Kay, Timothy W Lee, Jake Rothschild, Modupe Akinola, John Beshears, Jonathan E Bogard, Alison Buttenheim, Christopher Chabris, Gretchen B Chapman, James J Choi, Hengchen Dai, Craig R Fox, Amir Goren, Matthew D Hilchey, Jillian Hmurovic, Leslie K John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C Madrian, Michelle N Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N Evans, Seung Hyeong Lee, Christopher K Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin G Volpp, Angela L Duckworth

Affiliations

  • 2974Department of Clinical Transformation and Behavioral Insights, Ascension, St. Louis, MO, USA.
  • 6569Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
  • 6569Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
  • 3270Department of Marketing, The University of Chicago Booth School of Business, Chicago, IL, USA.
  • 5798School of Professional Studies, Northwestern University, Evanston, IL, USA.
  • 1812Department of Management, Columbia Business School, Columbia University, New York, NY, USA.
  • Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA.
  • Department of Behavioral Decision Making, Anderson School of Management, University of California, Los Angeles, CA, USA.
  • 6612Department of Family and Community Health, The University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
  • 2780Behavioral and Decision Sciences Program, Geisinger Health System, Danville, PA, USA.
  • 7938Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA.
  • 6756Department of Finance, Yale School of Management, Yale University, New Haven, CT, USA.
  • 8783Department of Management and Organization, Anderson School of Management, University of California Los Angeles, Los Angeles, CA, USA.
  • 2780Behavioral Insights Team, Geisinger Health System, Danville, PA, USA.
  • Department of Behavioural Science and Economics, University of Toronto, Toronto, ON, Canada.
  • Department of Marketing, Drexel University, Philadelphia, PA, USA.
  • Department of Finance, Kellogg School of Management, Northwestern University, Evanston, IL, USA.
  • Department of Marketing, The Wharton School, 6569University of Pennsylvania, Philadelphia, PA, USA.
  • Department of Finance, Marriott School of Business, 33865Brigham Young University, Provo, UT, USA.
  • Department of Marketing, Eller College of Management, University of Arizona, Tucson, AZ, USA.
  • Center for Digital Health, Perelman School of Medicine, 6569University of Pennsylvania, Philadelphia, PA, USA.
  • Center for Health Care Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • Business Administration Division, University of Hawai`i-West O`ahu, Kapolei, HI, USA.
  • 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% ( = .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; < .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.

MeSH

Vaccines, Vaccination, Influenza, Human, Health Promotion

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