Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 Jul 1;5(7):e2222116.
doi: 10.1001/jamanetworkopen.2022.22116.

Effect of Text Message Reminders and Vaccine Reservations on Adherence to a Health System COVID-19 Vaccination Policy: A Randomized Clinical Trial

Mitesh S Patel  1 , Richard Fogel  1 , Angela L Winegar  1 , Charles Horseman  1 , Allison Ottenbacher  1 , Saleem Habash  1 , Jonathan L Dukes  1 , Teresa C Brinson  1 , Shanda C Price  1 , Frederick A Masoudi  1 , Joseph Cacchione  1 , Baligh R Yehia  1
Affiliations
Randomized Controlled Trial

Effect of Text Message Reminders and Vaccine Reservations on Adherence to a Health System COVID-19 Vaccination Policy: A Randomized Clinical Trial

Mitesh S Patel et al. JAMA Netw Open. .

Abstract

Importance: Many organizations implemented COVID-19 vaccination requirements during the pandemic, but the best way to increase adherence to these policies is unknown.

Objective: To evaluate if behavioral nudges delivered through text messages could accelerate adherence to a health system's COVID-19 vaccination policy.

Design, setting, and participants: This randomized clinical trial was conducted within Ascension health system from October 11 to November 8, 2021. Participants included health system employees in the Midwest or South US who were not adherent with the vaccination policy 1 month before its deadline. Data were analyzed from November 17, 2021, to February 25, 2022.

Interventions: Participants were randomly assigned to control or to receive a text message intervention that stated a vaccine had been reserved for the participant, with a scheduled date for vaccination within a 2-week period. Participants could reschedule to a different date within the period or upload a copy of their vaccination card. Follow-up text message reminders were sent the day before and the day of the appointment.

Main outcomes and measures: The primary outcome was adherence to the health system's vaccination policy during the 2-week intervention. Secondary outcomes included time to vaccination during a 4-week follow-up period.

Results: The sample included 2000 participants (mean [SD] age, 36.4 [12.3] years; 1724 [86.2%] women), with 1000 participants randomized to the control group and 1000 participants randomized to the intervention group. Overall, there were 164 Hispanic participants (8.2%), 46 non-Hispanic Asian participants (2.3%), 202 non-Hispanic Black participants (10.1%), and 1418 non-Hispanic White participants (70.9%). By the end of the 2-week intervention, 363 participants in the text message nudge group (36.3%) and 318 participants in the control group (31.8%) were adherent with the vaccination policy, representing a significant increase of 4.9 (95% CI, 0.8 to 9.1) percentage points in adjusted analyses comparing the nudge group with the control group (P = .02). Among participants who became adherent by the end of the 4-week follow-up period, the text message nudge significantly reduced time to adherence by a mean of 2.4 (95% CI, 2.1 to 4.7) days (P < .001) and a median of 5.0 (95% CI, 2.5 to 7.7) days (P < .001) compared with the control group. At 4 weeks, overall vaccination adherence was no longer different between groups (control: 477 participants [47.7%]; intervention: 472 participants [47.2%]).

Conclusions and relevance: This randomized clinical trial found that a behavioral nudge delivered through text messages accelerated adherence to a health system's COVID-19 vaccination policy but did change overall adherence by the time of the policy deadline.

Trial registration: ClinicalTrials.gov Identifier: NCT05037201.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Patel reported receiving personal fees from Catalyst Health, Humana, and GlaxoSmithKline outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Participant Recruitment Flowchart
Figure 2.
Figure 2.. Vaccination Adherence by Time
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Richardson S, Hirsch JS, Narasimhan M, et al. ; the Northwell COVID-19 Research Consortium . Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775 - DOI - PMC - PubMed
    1. Huang C, Huang L, Wang Y, et al. . 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-232. doi:10.1016/S0140-6736(20)32656-8 - DOI - PMC - PubMed
    1. Patel M. Test behavioural nudges to boost COVID immunization. Nature. 2021;590(7845):185. doi:10.1038/d41586-021-00329-z - DOI - PubMed
    1. Volpp KG, Cannuscio CC. Incentives for immunity—strategies for increasing COVID-19 vaccine uptake. N Engl J Med. 2021;385(1):e1. doi:10.1056/NEJMp2107719 - DOI - PubMed
    1. Walkey AJ, Law A, Bosch NA. Lottery-based incentive in Ohio and COVID-19 vaccination rates. JAMA. 2021;326(8):766-767. doi:10.1001/jama.2021.11048 - DOI - PMC - PubMed

Publication types

Associated data