Dataset Information

A 680,000-person megastudy of nudges to encourage vaccination in pharmacies.

ABSTRACT: Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was "waiting for you." Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy.

SUBMITTER: Milkman KL

PROVIDER: S-EPMC8833156 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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A 680,000-person megastudy of nudges to encourage vaccination in pharmacies.

Milkman Katherine L KL Gandhi Linnea L Patel Mitesh S MS Graci Heather N HN Gromet Dena M DM Ho Hung H Kay Joseph S JS Lee Timothy W TW Rothschild Jake J Bogard Jonathan E JE Brody Ilana I Chabris Christopher F CF Chang Edward E Chapman Gretchen B GB Dannals Jennifer E JE Goldstein Noah J NJ Goren Amir A Hershfield Hal H Hirsch Alex A Hmurovic Jillian J Horn Samantha S Karlan Dean S DS Kristal Ariella S AS Lamberton Cait C Meyer Michelle N MN Oakes Allison H AH Schweitzer Maurice E ME Shermohammed Maheen M Talloen Joachim J Warren Caleb C Whillans Ashley A Yadav Kuldeep N KN Zlatev Julian J JJ Berman Ron R Evans Chalanda N CN Ladhania Rahul R Ludwig Jens J Mazar Nina N Mullainathan Sendhil S Snider Christopher K CK Spiess Jann J Tsukayama Eli E Ungar Lyle L Van den Bulte Christophe C Volpp Kevin G KG Duckworth Angela L AL

Proceedings of the National Academy of Sciences of the United States of America 20220201 6

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested incr ...[more]

PMID: 35105809

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Project description:Background/Objectives: Antimicrobial resistance (AMR) is a global public health concern exacerbated by inappropriate antimicrobial prescribing practices, particularly in low-resource settings such as Uganda. The research aimed to develop a culturally sensitive behavioral intervention, leveraging a "nudge" strategy, to improve healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016) in five Ugandan hospitals. This intervention formed part of broader antimicrobial stewardship initiatives led by the United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program. Methods: This study employed a mixed-methods approach, combining formative research and behavioral intervention. Guided by the Deloitte Behavioral Insights Framework, the research team conducted key informant interviews to identify prescribing barriers and motivators and developed three suitable behavioral interventions: perceived monitoring, ward leaderboards, and educational workshops. The study evaluated the interventions' impact through point prevalence surveys (PPS), using the World Health Organization PPS methodology at three stages: pre-intervention, immediate post-intervention, and one-month post-intervention. Results: Key behavioral themes across individual, social, environmental, and organizational elements informed the intervention design and implementation. The behavioral intervention package increased antimicrobial prescription compliance with the UCG 2016 from 27% at baseline to 50% immediately post-intervention, though these effects diminished at one-month post-intervention. Conclusions: Our study addresses an existing gap in behavioral nudges-based operational research on antimicrobial prescribing in low- and middle-income countries. These results showed an immediate improvement in adherence to the UCG 2016 among healthcare providers in Ugandan hospitals, though the effect was attenuated at one-month follow-up. Despite the attenuation, behavior change presents a feasible, cost-effective, and sustainable approach to improving antimicrobial prescribing practices and addressing AMR.

Dataset Information

A 680,000-person megastudy of nudges to encourage vaccination in pharmacies.

Publications

A 680,000-person megastudy of nudges to encourage vaccination in pharmacies.

Similar Datasets

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