Dataset Information

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.

SUBMITTER: Patel MS

PROVIDER: S-EPMC10798571 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Patel Mitesh S MS Milkman Katherine L KL Gandhi Linnea L Graci Heather N HN Gromet Dena D Ho Hung H Kay Joseph S JS Lee Timothy W TW Rothschild Jake J Akinola Modupe M Beshears John J Bogard Jonathan E JE Buttenheim Alison A Chabris Christopher C Chapman Gretchen B GB Choi James J JJ Dai Hengchen H Fox Craig R CR Goren Amir A Hilchey Matthew D MD Hmurovic Jillian J John Leslie K LK Karlan Dean D Kim Melanie M Laibson David D Lamberton Cait C Madrian Brigitte C BC Meyer Michelle N MN Modanu Maria M Nam Jimin J Rogers Todd T Rondina Renante R Saccardo Silvia S Shermohammed Maheen M Soman Dilip D Sparks Jehan J Warren Caleb C Weber Megan M Berman Ron R Evans Chalanda N CN Lee Seung Hyeong SH Snider Christopher K CK Tsukayama Eli E Van den Bulte Christophe C Volpp Kevin G KG Duckworth Angela L AL

American journal of health promotion : AJHP 20221004 3

<h4>Purpose</h4>To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.<h4>Design</h4>Randomized, controlled trial.<h4>Setting</h4>Two health systems in the Northeastern US between September 2020 and March 2021.<h4>Subjects</h4>74,811 adults.<h4>Interventions</h4>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. ...[more]

PMID: 36195982

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Project description:ImportanceInfluenza vaccination is associated with a reduced risk of mortality in patients with diabetes, but vaccination rates remain suboptimal.ObjectiveTo assess the effect of electronic nudges on influenza vaccination uptake according to diabetes status.Design, setting, and participantsThe NUDGE-FLU (Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake) trial was a nationwide clinical trial of Danish citizens 65 years or older that randomized participants at the household level to usual care or 9 different electronic nudge letters during the 2022 to 2023 influenza season. End of follow-up was January 1, 2023. This secondary analysis of the NUDGE-FLU trial was performed from May to July 2023.InterventionNine different electronic nudge letters designed to boost influenza vaccination were sent in September to October 2022. Effect modification by diabetes status was assessed in a pooled analysis of all intervention arms vs usual care and for individual letters.Main outcomes and measuresThe primary end point was receipt of a seasonal influenza vaccine.ResultsThe trial included 964 870 participants (51.5% female; mean [SD] age, 73.8 [6.3] years); 123 974 had diabetes. During follow-up, 83.5% with diabetes vs 80.2% without diabetes received a vaccine (P < .001). In the pooled analysis, nudges improved vaccination uptake in participants without diabetes (80.4% vs 80.0%; difference, 0.37 percentage points; 99.55% CI, 0.08 to 0.66), whereas there was no evidence of effect in those with diabetes (83.4% vs 83.6%; difference, -0.19 percentage points; 99.55% CI, -0.89 to 0.51) (P = .02 for interaction). In the main results of NUDGE-FLU, 2 of the 9 behaviorally designed letters (cardiovascular benefits letter and a repeated letter) significantly increased uptake of influenza vaccination vs usual care; these benefits similarly appeared attenuated in participants with diabetes (cardiovascular gain letter: 83.7% vs 83.6%; difference, 0.04 percentage points; 99.55% CI, -1.52 to 1.60; repeated letter: 83.5% vs 83.6%; difference, -0.15 percentage points; 99.55% CI, -1.71 to 1.41) vs those without diabetes (cardiovascular gain letter: 81.1% vs 80.0%; difference, 1.06 percentage points; 99.55% CI, 0.42 to 1.70; repeated letter: 80.9% vs 80.0%; difference, 0.87 percentage points; 99.55% CI, 0.22 to 1.52) (P = .07 for interaction).Conclusions and relevanceIn this exploratory subgroup analysis, electronic nudges improved influenza vaccination uptake in persons without diabetes, whereas there was no evidence of an effect in persons with diabetes. Trials are needed to investigate the effect of digital nudges specifically tailored to individuals with diabetes.Trial registrationClinicalTrials.gov Identifier: NCT05542004.

Project description:BackgroundIncreasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders' acceptability of interventions.MethodsA systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers' behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools.ResultsTwenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants' perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals.ConclusionThere is limited reporting of stakeholders' experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants' acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up.Trial registrationPROSPERO registration: CRD42019108658.

Dataset Information

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

Purpose

Design

Setting

Subjects

Interventions

Measures

Analysis

Results

Conclusions

Publications

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

Similar Datasets

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