Impact of patient and provider nudges on addressing herpes zoster vaccine series completion

Gatwood, Justin; Brookhart, Andrea; Kinney, Olivia; Hagemann, Tracy M.; Chiu, Chi‐Yang; Ramachandran, Sujith; Gravlee, Emily

doi:10.1016/j.vaccine.2022.12.016

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…First, participants noted that the time constraints and competing priorities of their schedules led them to frequently forget to seek vaccination, even if they were willing to receive it. Past studies in pharmacy have demonstrated clearly that technology-enabled interventions that either prompt the pharmacist to have a conversation with the patient or message the patient directly on their phone are effective in prompting vaccinations [35][36][37]. Given that most patients visit a pharmacy almost twice as often as a primary care provider [38], the numerous touchpoints with the patient represent opportunities for reminding those patients who are already predisposed to accepting a vaccine recommendation.…”

Section: Discussionmentioning

confidence: 99%

Views of the Pharmacists’ Role in HPV Vaccinations: A Qualitative Study in Tennessee

Cernasev,

Hohmeier,

Oyedeji

et al. 2024

Pharmacy

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The Human Papillomavirus (HPV) is a frequently occurring sexually transmitted infection in adults and is associated with various cancers that can affect both males and females. Recently, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendations for the HPV vaccine to include patients aged 27–45 years with shared clinical decision-making. A commonly reported obstacle to receiving the HPV vaccine among adults is a lack of healthcare provider recommendations. Considering the suboptimal HPV vaccine coverage figures and noting that the vast majority of hesitancy research has been conducted among children and adolescents, limited research is available on the adult perception of HPV vaccination in pharmacies. This study focuses on understanding adults’ opinions and perceptions regarding the role of pharmacists in the uptake of the HPV vaccine and awareness of its availability in the pharmacy setting. Methods: After receiving approval from the Institutional Review Board (IRB), the qualitative study was initiated using virtual focus groups (FGs). Concepts from the Transtheoretical Model, the Health Belief Model, and the Social Cognitive Theory guided the study design. The corpus of data was collected in 2021 and 2022 by two researchers, and a third party transcribed the FGs to avoid any biases. The data were analyzed using Braun and Clarke’s Thematic Analysis. Results: Out of 35 subjects that participated in six FGDs, most identified as female, with ages ranging from 18 to 45 years. The following four themes emerged: (1) HPV vaccine awareness; (2) stigmas leading to reduced education and vaccination rates; (3) education preferences; (4) follow-up in vaccination series reminders and preferences. Conclusion: Participants’ views of the HPV vaccine and the ability to receive the vaccine in a pharmacy are influenced by a myriad of factors. Common factors include improved awareness, preferences for educational modalities, avoiding stigmas associated with HPV vaccination, combating gender-focused biases, and preferences for the location of vaccination. These barriers provide opportunities for pharmacists to promote and enhance vaccine uptake.

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Section: Discussionmentioning

confidence: 99%

Views of the Pharmacists’ Role in HPV Vaccinations: A Qualitative Study in Tennessee

Cernasev,

Hohmeier,

Oyedeji

et al. 2024

Pharmacy

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“… 45 Changes to the way information is offered at the point of decision making are considered ethically acceptable if opting out of the default option remains easy and the range of clinical choices is preserved. 46 In previous examples, clinician nudges using behavioral economic principles helped increase adherence to targeted guidelines, including for statin initiation, 47 vaccination, 48 and lung cancer screening. 49 To our knowledge, this is the first study in oncology to compare implementation strategies to improve TUT using behavioral economic nudges aimed at clinicians, patients, or both.…”

Section: Discussionmentioning

confidence: 99%

Cluster Randomized Pragmatic Clinical Trial Testing Behavioral Economic Implementation Strategies to Improve Tobacco Treatment for Patients With Cancer Who Smoke

Jenssen

Schnoll

Beidas

et al. 2023

JCO

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PURPOSE Few cancer centers systematically engage patients with evidence-based tobacco treatment despite its positive effect on quality of life and survival. Implementation strategies directed at patients, clinicians, or both may increase tobacco use treatment (TUT) within oncology. METHODS We conducted a four-arm cluster-randomized pragmatic trial across 11 clinical sites comparing the effect of strategies informed by behavioral economics on TUT engagement during oncology encounters with cancer patients. We delivered electronic health record (EHR)–based nudges promoting TUT across four nudge conditions: patient only, clinician only, patient and clinician, or usual care. Nudges were designed to counteract cognitive biases that reduce TUT engagement. The primary outcome was TUT penetration, defined as the proportion of patients with documented TUT referral or a medication prescription in the EHR. Generalized estimating equations were used to estimate the parameters of a linear model. RESULTS From June 2021 to July 2022, we randomly assigned 246 clinicians in 95 clusters, and collected TUT penetration data from their encounters with 2,146 eligible patients who smoke receiving oncologic care. Intent-to-treat (ITT) analysis showed that the clinician nudge led to a significant increase in TUT penetration versus usual care (35.6% v 13.5%; OR = 3.64; 95% CI, 2.52 to 5.24; P < .0001). Completer-only analysis (N = 1,795) showed similar impact (37.7% clinician nudge v 13.5% usual care; OR = 3.77; 95% CI, 2.73 to 5.19; P < .0001). Clinician type affected TUT penetration, with physicians less likely to provide TUT than advanced practice providers (ITT OR = 0.67; 95% CI, 0.51 to 0.88; P = .004). CONCLUSION EHR nudges, informed by behavioral economics and aimed at oncology clinicians, appear to substantially increase TUT penetration. Adding patient nudges to the implementation strategy did not affect TUT penetration rates.

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“…The nudge approach can be effective in promoting vaccine adherence and reducing vaccine hesitancy, as advocated by the World Health Organization (WHO) in 2019 health care [8][9][10][11][12]. It involves the use of gentle "nudges", which influence the architecture of choice while respecting freedom of choice [13][14][15][16][17][18][19][20]. The nudge interventions can be carried out through various modalities, such as reminders and recall, different ways of accessing information, message delivery procedures, and the use of emotional associations (e.g., videos and images) or even economic incentives [15].…”

Section: Introductionmentioning

confidence: 99%

“…The content of the messages intersects with the heuristics and beliefs that underlie vaccine trust [15,21,22]. The form of the message (SMS, video, motivational cards, or other) is important as it activates different thought processes, such as Type 1 "automatic" or Type 2 "reflective" nudges [14][15][16][17][18][19][20]. Type 1 nudges aim to influence automatic behavior and utilize behaviors that are not conscious and deliberate.…”

Section: Introductionmentioning

confidence: 99%

Anti-Herpes Zoster Vaccination of Fragile Patients in Hospital Setting: A Nudge Intervention in Italy

De Caro,

Malatesta,

Pecoraro

et al. 2024

Vaccines

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Background: A nudge intervention against Herpes Zoster, created and implemented in Italy, is presented in order to administer the Shingrix vaccine on a sample of frail patients, as required by the National Prevention Plan. Individual and contextual factors associated with vaccine adherence were investigated. Method: 300 frail adult subjects underwent a full vaccine cycle with recombinant-Shingrix vaccine (RZV vaccine). Hospital Presidia of the Salerno University Hospital Authority, a Hospital Presidium of the Salerno Local Health Authority, and the Public Health Laboratory of the University of Salerno (Campania) participated in the intervention. An ad hoc questionnaire was administered with the following scales: EQ-5D, PSS-10, MSPSS, and representations of HZ and its consequences. Results: Some variables, such as peer support, doctor–patient relationship, level of education, and perception of health, are important in vaccine adherence and information processing. The following factors emerged from the factor analysis: Trust in collective knowledge and collective responsibility (F1); beliefs about virus risk and vaccine function (F2); information about virus and symptomatology (F3); and vaccine distrust (F4). Factor 4 correlates negatively with social support indices (R = −0.363; p < 0.001). There is a significant relationship between factor 3 and satisfaction with national information campaigns (F = 3.376; gdl = 5; p-value = 0.006). Conclusions: Future vaccination campaigns should be built with the aim of personalizing information and developing contextualized strategies, starting from understanding the stakeholders involved, cultural contexts, and organizational settings.

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Impact of patient and provider nudges on addressing herpes zoster vaccine series completion

Cited by 5 publications

References 21 publications

Views of the Pharmacists’ Role in HPV Vaccinations: A Qualitative Study in Tennessee

Views of the Pharmacists’ Role in HPV Vaccinations: A Qualitative Study in Tennessee

Cluster Randomized Pragmatic Clinical Trial Testing Behavioral Economic Implementation Strategies to Improve Tobacco Treatment for Patients With Cancer Who Smoke

Anti-Herpes Zoster Vaccination of Fragile Patients in Hospital Setting: A Nudge Intervention in Italy

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