Randomized Controlled Trial

. 2023 Mar;37(3):324-332.

doi: 10.1177/08901171221131021. Epub 2022 Oct 4.

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

Mitesh S Patel¹, Katherine L Milkman², Linnea Gandhi², Heather N Graci³, Dena Gromet³, Hung Ho⁴, Joseph S Kay³, Timothy W Lee⁵, Jake Rothschild³, Modupe Akinola⁶, John Beshears⁷, Jonathan E Bogard⁸, Alison Buttenheim⁹, Christopher Chabris¹⁰, Gretchen B Chapman¹¹, James J Choi¹², Hengchen Dai¹³, Craig R Fox¹³, Amir Goren¹⁴, Matthew D Hilchey¹⁵, Jillian Hmurovic¹⁶, Leslie K John⁷, Dean Karlan¹⁷, Melanie Kim¹⁵, David Laibson⁷, Cait Lamberton¹⁸, Brigitte C Madrian¹⁹, Michelle N Meyer¹⁰, Maria Modanu⁶, Jimin Nam⁷, Todd Rogers⁷, Renante Rondina¹⁵, Silvia Saccardo¹¹, Maheen Shermohammed¹⁰, Dilip Soman¹⁵, Jehan Sparks⁸, Caleb Warren²⁰, Megan Weber⁸, Ron Berman¹⁸, Chalanda N Evans²¹, Seung Hyeong Lee⁷, Christopher K Snider²², Eli Tsukayama²³, Christophe Van den Bulte¹⁸, Kevin G Volpp²⁴, Angela L Duckworth²

Affiliations

¹ 2974Department of Clinical Transformation and Behavioral Insights, Ascension, St. Louis, MO, USA.
² 6569Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
³ 6569Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
⁴ 3270Department of Marketing, The University of Chicago Booth School of Business, Chicago, IL, USA.
⁵ 5798School of Professional Studies, Northwestern University, Evanston, IL, USA.
⁶ 1812Department of Management, Columbia Business School, Columbia University, New York, NY, USA.
⁷ Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA.
⁸ Department of Behavioral Decision Making, Anderson School of Management, University of California, Los Angeles, CA, USA.
⁹ 6612Department of Family and Community Health, The University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
¹⁰ 2780Behavioral and Decision Sciences Program, Geisinger Health System, Danville, PA, USA.
¹¹ 7938Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA.
¹² 6756Department of Finance, Yale School of Management, Yale University, New Haven, CT, USA.
¹³ 8783Department of Management and Organization, Anderson School of Management, University of California Los Angeles, Los Angeles, CA, USA.
¹⁴ 2780Behavioral Insights Team, Geisinger Health System, Danville, PA, USA.
¹⁵ Department of Behavioural Science and Economics, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Marketing, Drexel University, Philadelphia, PA, USA.
¹⁷ Department of Finance, Kellogg School of Management, Northwestern University, Evanston, IL, USA.
¹⁸ Department of Marketing, The Wharton School, 6569University of Pennsylvania, Philadelphia, PA, USA.
¹⁹ Department of Finance, Marriott School of Business, 33865Brigham Young University, Provo, UT, USA.
²⁰ Department of Marketing, Eller College of Management, University of Arizona, Tucson, AZ, USA.
²¹ Center for Digital Health, Perelman School of Medicine, 6569University of Pennsylvania, Philadelphia, PA, USA.
²² Center for Health Care Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
²³ Business Administration Division, University of Hawai`i-West O`ahu, Kapolei, HI, USA.
²⁴ 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.

PMID: 36195982
PMCID: PMC10798571
DOI: 10.1177/08901171221131021

Randomized Controlled Trial

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

Mitesh S Patel et al. Am J Health Promot. 2023 Mar.

. 2023 Mar;37(3):324-332.

doi: 10.1177/08901171221131021. Epub 2022 Oct 4.

Authors

Affiliations

¹ 2974Department of Clinical Transformation and Behavioral Insights, Ascension, St. Louis, MO, USA.
² 6569Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
³ 6569Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
⁴ 3270Department of Marketing, The University of Chicago Booth School of Business, Chicago, IL, USA.
⁵ 5798School of Professional Studies, Northwestern University, Evanston, IL, USA.
⁶ 1812Department of Management, Columbia Business School, Columbia University, New York, NY, USA.
⁷ Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA.
⁸ Department of Behavioral Decision Making, Anderson School of Management, University of California, Los Angeles, CA, USA.
⁹ 6612Department of Family and Community Health, The University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
¹⁰ 2780Behavioral and Decision Sciences Program, Geisinger Health System, Danville, PA, USA.
¹¹ 7938Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA.
¹² 6756Department of Finance, Yale School of Management, Yale University, New Haven, CT, USA.
¹³ 8783Department of Management and Organization, Anderson School of Management, University of California Los Angeles, Los Angeles, CA, USA.
¹⁴ 2780Behavioral Insights Team, Geisinger Health System, Danville, PA, USA.
¹⁵ Department of Behavioural Science and Economics, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Marketing, Drexel University, Philadelphia, PA, USA.
¹⁷ Department of Finance, Kellogg School of Management, Northwestern University, Evanston, IL, USA.
¹⁸ Department of Marketing, The Wharton School, 6569University of Pennsylvania, Philadelphia, PA, USA.
¹⁹ Department of Finance, Marriott School of Business, 33865Brigham Young University, Provo, UT, USA.
²⁰ Department of Marketing, Eller College of Management, University of Arizona, Tucson, AZ, USA.
²¹ Center for Digital Health, Perelman School of Medicine, 6569University of Pennsylvania, Philadelphia, PA, USA.
²² Center for Health Care Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
²³ Business Administration Division, University of Hawai`i-West O`ahu, Kapolei, HI, USA.
²⁴ 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.

PMID: 36195982
PMCID: PMC10798571
DOI: 10.1177/08901171221131021

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.

Keywords: COVID-19; behavioral nudge; influenza; text message; vaccination.

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Figures

**Figure 1.**
CONSORT Diagram. Participants in all arms were identified prior to an upcoming appointment with their primary care clinician and randomly assigned to a usual care control group or one of the 19 intervention arms.

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

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Abstract

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References

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Grants and funding

LinkOut - more resources

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Medical