Randomised controlled trial of a theory-based intervention to prompt front-line staff to take up the seasonal influenza vaccine

Abstract

ObjectiveTo evaluate the effectiveness of reminder letters informed by social normative theory (a type of ‘nudge theory’) on uptake of seasonal influenza vaccination by front-line hospital staff.DesignIndividually randomised controlled trial.SettingA large acute care hospital in England.ParticipantsFront-line staff employed by the hospital (n=7540) were randomly allocated to one of four reminder types in a factorial design.InterventionsThe standard letter included only general information directing the staff to take up the vaccine. A second letter highlighted a type of social norm based on peer comparisons. A third letter highlighted a type of social norm based on an appeal to authority. A fourth letter included a combination of the social norms.Main outcome measureThe proportion of hospital staff vaccinated on-site.ResultsVaccine coverage was 43% (812/1885) in the standard letter group, 43% (818/1885) in the descriptive norms group, 43% (814/1885) in the injunctive norms group and 43% (812/1885) in the combination group. There were no statistically significant effects of either norm or the interaction. The OR for the descriptive norms factor is 1.01 (0.89–1.15) in the absence of the injunctive norms factor and 1.00 (0.88–1.13) in its presence. The OR for the injunctive norms factor is 1.00 (0.88–1.14) in the absence of the descriptive norms factor and 0.99 (0.87–1.12) in its presence.ConclusionsWe find no evidence that the uptake of the seasonal influenza vaccination is affected by reminders using social norms to motivate uptake.

Nudging toward vaccination: a systematic review

“… 51 On the other hand, using the same approach in terms of frequency and nature of reminders, an RCT in a large acute care hospital in the UK found no evidence that influenza vaccine uptake is affected by reminder letters. 52 …”

A nudge towards increased experimentation to more rapidly improve healthcare

“…Embedded research teams around the world have started to systematically test the impact of using subtle changes to the way information is framed or choices are offered to nudge medical decision making 6 7. The trial by Schmidtke demonstrates the feasibility and necessity of rapid-cycle, randomised testing within a healthcare system 8. The authors randomly assigned 7540 front-line staff to either receive a standard letter reminding them of influenza vaccination or one of three letters that used insights from behavioural economics to try and better nudge healthcare workers through different ways of framing social norms.…”

Promoting Influenza Vaccination among Staff of Nursing Homes According to Behavioral Insights: Analyzing the Choice Architecture during a Nudge-Based Intervention

“…Just a few primary studies have been already conducted in assessing the effectiveness of nudging in promoting vaccination uptake. Some of them have described the results of nudge interventions aimed at increasing influenza vaccination uptake—although different from those that have been used in this study—with inconsistent results: some authors have described a significant increase in vaccination acceptance, while others found no effects [ 40 , 41 , 42 ].…”