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

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.

The Role of Information and Nudges on Advance Directives and End-of-Life Planning: Evidence From a Randomized Trial

“…In addition, we sent letter reminders to patients 2 weeks in advance of primary care visits. This approach, like the one recently used to increase flu vaccination rates (Patel et al, 2023), helped patients in two ways: (a) individuals would be primed to complete health forms for their upcoming appointment and (b) patients would have an easy way to give the forms to physicians in-person, in addition to the option of uploading the documents electronically.…”

“…Studies on behavioral interventions in health show that behavioral nudges may improve health outcomes to a greater extent than a simple financial incentive: lottery-based and team incentives have improved adherence to medication (Kimmel et al, 2012), completion of health risk assessments (Haisley et al, 2012), and weight loss (Volpp et al, 2008). In particular, nudges from sending letters, texts, and messages through patient portals are frequently used and have been effective in increasing cervical cancer screening (Tseng et al, 2001), medication adherence (Schwebel & Larimer, 2018), appointment attendance (Horvath et al, 2011; Schwebel & Larimer, 2018), and most recently, vaccine uptake (Dai et al, 2021; Patel et al, 2023). Previous studies on patient-side interventions in ACP have involved improving patients’ knowledge of ADs in China (Wang et al, 2021), using an online tool to guide patients through ACP during the coronavirus pandemic (Auriemma et al, 2020), and educating patients in a small inpatient setting to improve AD completion (Harlow, 2017).…”

How to build up big team science: a practical guide for large-scale collaborations

“…Some BTS projects are created to crowdsource multiple hypotheses or interventions to address a research question [14][15][16][23][24][25][26]. Doing so often allows these projects to draw from multiple sources of expertise.…”

How to build up big team science: A practical guide for large-scale collaborations

“…We elaborate with examples of each of these approaches below. Some BTS projects are explicitly created to crowdsource multiple hypotheses or interventions to address a research question [12][13][14][15][16][17][18]. Doing so often allows these projects to draw from multiple sources of expertise.…”