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; Katherine L. Milkman; Linnea Gandhi; Heather N. Graci; Dena Gromet; Hung Ho; Joseph S. Kay; Timothy W. Lee; Jake Rothschild; Modupe Akinola; John Beshears; Jonathan E. Bogard; Alison Buttenheim; Christopher Chabris; Gretchen B. Chapman; James J. Choi; Hengchen Dai; Craig R. Fox; Amir Goren; Matthew D. Hilchey; Jillian Hmurovic; Leslie K. John; Dean Karlan; Melanie Kim; David Laibson; Cait Lamberton; Brigitte C. Madrian; Michelle N. Meyer; Maria Modanu; Jimin Nam; Todd Rogers; Renante Rondina; Silvia Saccardo; Maheen Shermohammed; Dilip Soman; Jehan Sparks; Caleb Warren; Megan Weber; Ron Berman; Chalanda N. Evans; Seung Hyeong Lee; Christopher K. Snider; Eli Tsukayama; Christophe Van den Bulte; Kevin G. Volpp; Angela L. Duckworth

doi:10.1177/08901171221131021

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, Katherine L. Milkman, Linnea Gandhi, Heather N. Graci, Dena Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Jake Rothschild, Modupe Akinola, John Beshears, Jonathan E. Bogard, Alison Buttenheim, Christopher Chabris, Gretchen B. Chapman, James J. Choi, Hengchen Dai, Craig R. Fox, Amir Goren, Matthew D. HilcheyJillian Hmurovic, Leslie K. John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C. Madrian, Michelle N. Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N. Evans, Seung Hyeong Lee, Christopher K. Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin G. Volpp, Angela L. Duckworth

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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.

Original language	English (US)
Pages (from-to)	324-332
Number of pages	9
Journal	American Journal of Health Promotion
Volume	37
Issue number	3
DOIs	https://doi.org/10.1177/08901171221131021
State	Published - Mar 2023

Keywords

COVID-19
behavioral nudge
influenza
text message
vaccination

ASJC Scopus subject areas

Health(social science)
Public Health, Environmental and Occupational Health

Access to Document

10.1177/08901171221131021

Cite this

Patel, M. S., Milkman, K. L., Gandhi, L., Graci, H. N., Gromet, D., Ho, H., Kay, J. S., Lee, T. W., Rothschild, J., Akinola, M., Beshears, J., Bogard, J. E., Buttenheim, A., Chabris, C., Chapman, G. B., Choi, J. J., Dai, H., Fox, C. R., Goren, A., ... Duckworth, A. L. (2023). A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit. American Journal of Health Promotion, 37(3), 324-332. https://doi.org/10.1177/08901171221131021

Patel, MS, Milkman, KL, Gandhi, L, Graci, HN, Gromet, D, Ho, H, Kay, JS, Lee, TW, Rothschild, J, Akinola, M, Beshears, J, Bogard, JE, Buttenheim, A, Chabris, C, Chapman, GB, Choi, JJ, Dai, H, Fox, CR, Goren, A, Hilchey, MD, Hmurovic, J, John, LK, Karlan, D, Kim, M, Laibson, D, Lamberton, C, Madrian, BC, Meyer, MN, Modanu, M, Nam, J, Rogers, T, Rondina, R, Saccardo, S, Shermohammed, M, Soman, D, Sparks, J, Warren, C, Weber, M, Berman, R, Evans, CN, Lee, SH, Snider, CK, Tsukayama, E, Van den Bulte, C, Volpp, KG & Duckworth, AL 2023, 'A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit', American Journal of Health Promotion, vol. 37, no. 3, pp. 324-332. https://doi.org/10.1177/08901171221131021

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title = "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.",

keywords = "COVID-19, behavioral nudge, influenza, text message, vaccination",

author = "Patel, {Mitesh S.} and Milkman, {Katherine L.} and Linnea Gandhi and Graci, {Heather N.} and Dena Gromet and Hung Ho and Kay, {Joseph S.} and Lee, {Timothy W.} and Jake Rothschild and Modupe Akinola and John Beshears and Bogard, {Jonathan E.} and Alison Buttenheim and Christopher Chabris and Chapman, {Gretchen B.} and Choi, {James J.} and Hengchen Dai and Fox, {Craig R.} and Amir Goren and Hilchey, {Matthew D.} and Jillian Hmurovic and John, {Leslie K.} and Dean Karlan and Melanie Kim and David Laibson and Cait Lamberton and Madrian, {Brigitte C.} and Meyer, {Michelle N.} and Maria Modanu and Jimin Nam and Todd Rogers and Renante Rondina and Silvia Saccardo and Maheen Shermohammed and Dilip Soman and Jehan Sparks and Caleb Warren and Megan Weber and Ron Berman and Evans, {Chalanda N.} and Lee, {Seung Hyeong} and Snider, {Christopher K.} and Eli Tsukayama and {Van den Bulte}, Christophe and Volpp, {Kevin G.} and Duckworth, {Angela L.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2022.",

year = "2023",

month = mar,

doi = "10.1177/08901171221131021",

language = "English (US)",

volume = "37",

pages = "324--332",

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T1 - A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit

AU - Patel, Mitesh S.

AU - Milkman, Katherine L.

AU - Gandhi, Linnea

AU - Graci, Heather N.

AU - Gromet, Dena

AU - Ho, Hung

AU - Kay, Joseph S.

AU - Lee, Timothy W.

AU - Rothschild, Jake

AU - Akinola, Modupe

AU - Beshears, John

AU - Bogard, Jonathan E.

AU - Buttenheim, Alison

AU - Chabris, Christopher

AU - Chapman, Gretchen B.

AU - Choi, James J.

AU - Dai, Hengchen

AU - Fox, Craig R.

AU - Goren, Amir

AU - Hilchey, Matthew D.

AU - Hmurovic, Jillian

AU - John, Leslie K.

AU - Karlan, Dean

AU - Kim, Melanie

AU - Laibson, David

AU - Lamberton, Cait

AU - Madrian, Brigitte C.

AU - Meyer, Michelle N.

AU - Modanu, Maria

AU - Nam, Jimin

AU - Rogers, Todd

AU - Rondina, Renante

AU - Saccardo, Silvia

AU - Shermohammed, Maheen

AU - Soman, Dilip

AU - Sparks, Jehan

AU - Warren, Caleb

AU - Weber, Megan

AU - Berman, Ron

AU - Evans, Chalanda N.

AU - Lee, Seung Hyeong

AU - Snider, Christopher K.

AU - Tsukayama, Eli

AU - Van den Bulte, Christophe

AU - Volpp, Kevin G.

AU - Duckworth, Angela L.

PY - 2023/3

Y1 - 2023/3

N2 - 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.

AB - 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.

KW - COVID-19

KW - behavioral nudge

KW - influenza

KW - text message

KW - vaccination

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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

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Keywords

ASJC Scopus subject areas

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