Testing Multiple Behavioral Science Strategies to Increase Flu-Shot Rates at a Large Retail Pharmacy

University of Pennsylvania

Status: Completed

Conditions: Influenza, Human

Treatments: Behavioral: Flu shot text messages

Study type: Interventional

Funder types: Other

Identifiers

NCT04590066

843523-Trial B

Details and patient eligibility

About

This research aims to identify which behavioral science strategies are most effective at increasing flu vaccination rates overall and based on patients' individual characteristics. Past behavioral science interventions have shown promise in increasing flu vaccinations. For example, successful interventions have encouraged people to make concrete plans for when they will get a flu vaccination, sent automated calls or text messages reminding patients to get a flu vaccination , or provided financial incentives for getting vaccinated. Although these results are promising, these studies have been conducted in isolation on different populations, which makes it difficult to compare their interventions' effectiveness or to have enough power to reliably detect differing responses to interventions based on individual characteristics.

This research will simultaneously test 22 different SMS interventions to increase flu vaccinations compared to a holdout control condition in a "mega-study" and apply machine learning to identify which interventions work best for whom. The interventions are designed by behavioral science experts from the Behavior Change for Good Initiative (BCFG), Penn Medicine Nudge Unit (PMNU), and Geisinger Behavioral Insights Team (BIT). Customers of a large retail pharmacy who received a flu shot from the pharmacy last year and receive SMS notifications will be included in this study. We expect this to include approximately 1.2 million participants.

The specific aims of this research are to identify (1) which behavioral science strategies effectively increase flu vaccination rates overall, and (2) which strategies are most effective for different subgroups (e.g., based on age, gender, race).

Enrollment: 734,383 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

1. Have agreed to receive SMS messages from the pharmacy
2. Received a flu shot from the pharmacy in the 2019-2020 flu season, as documented in their pharmacy records.

Exclusion criteria

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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734,383 participants in 23 patient groups

Holdout control

No Intervention group

Description:

Participants will only receive the standard pharmacy messaging.

Unpacking Risks Treatment

Experimental group

Description:

Participants will be asked to think about the risks of catching the flu this flu season and to respond with the location they are most likely to catch the flu out of a list of given options (e.g. at work, at home).

Treatment:

Behavioral: Flu shot text messages

Unpacking Risks Control

Experimental group

Description:

Participants will be asked to think about the risks of catching the flu this flu season and to respond to confirm that they have received the message.

Treatment:

Behavioral: Flu shot text messages

Active Commitment Treatment

Experimental group

Description:

Participants receive a gain framed notification that they are eligible for a flu shot. In addition, participants are told "Many people find it helpful to make a plan to get their shot" and are asked to commit by texting back "I will get a flu shot." Depending on their response, participants receive a general reminder or a commitment reminder 3 days later.

Treatment:

Behavioral: Flu shot text messages

Active Commitment Control

Experimental group

Description:

Participants receive a gain framed notification that they are eligible for a flu shot. Participants receive a general reminder 3 days later.

Treatment:

Behavioral: Flu shot text messages

Self-Generated Social Norms Treatment

Experimental group

Description:

Participants will first receive a message enjoining them to consider 2 peers who would want them to vaccinate. Then they will be asked to do those peers a favor by getting a vaccine at their next opportunity. They will receive a reminder 3 days later.

Treatment:

Behavioral: Flu shot text messages

Self-Generated Social Norms Control

Experimental group

Description:

articipants will be informed of the opportunity to receive a flu vaccine at their appointment. They will receive a reminder 3 days later.

Treatment:

Behavioral: Flu shot text messages

Foot-in-the-Door Treatment

Experimental group

Description:

Participants will first receive a message enjoining them to encourage someone else to receive a flu vaccine this year. They will then be given a message that they might copy-paste to forward to friends, thereby lowering the effort costs of messaging others. They will receive a reminder 3 days later.

Treatment:

Behavioral: Flu shot text messages

Foot-in-the-Door Control

Experimental group

Description:

Participants will be informed of the opportunity to receive a flu vaccine at their appointment. They will receive a reminder 3 days later.

Treatment:

Behavioral: Flu shot text messages

Prosocial Condition

Experimental group

Description:

Participants will receive a message describing the condition-specific benefit of getting a flu shot, and a reminder to ask for their flu shot. The message will also give prosocial reasons for vaccinating (i.e., protecting loved ones; preserving scarce resources).

Treatment:

Behavioral: Flu shot text messages

Self-Oriented Condition

Experimental group

Description:

Participants will receive a message describing the condition-specific benefit of getting a flu shot, and a reminder to ask for their flu shot.

Treatment:

Behavioral: Flu shot text messages

Prosocial + COVID-19

Experimental group

Description:

Participants will receive a message describing the condition-specific benefit of getting a flu shot, and a reminder to ask for their flu shot. The message will also give prosocial reasons for vaccinating (e.g., protecting loved ones; preserving scarce resources). The message will also emphasize the pandemic (e.g., risk of hospital-acquired COVID-19 infection; wasting scarce resources).

Treatment:

Behavioral: Flu shot text messages

Self-Oriented + COVID-19

Experimental group

Description:

Participants will receive a message describing the condition-specific benefit of getting a flu shot, and a reminder to ask for their flu shot. The message will also emphasize the pandemic (e.g., risk of hospital-acquired COVID-19 infection; wasting scarce resources).

Treatment:

Behavioral: Flu shot text messages

Dynamic + Static Norm

Experimental group

Description:

Participants will receive a text message encouraging them to get a flu shot and informing them that more American adults are getting their flu shot than ever before and how many Americans got their flu shot last year.

Treatment:

Behavioral: Flu shot text messages

Dynamic Norm

Experimental group

Description:

Participants will receive a text message encouraging them to get a flu shot and informing them that more American adults are getting their flu shot than ever before.

Treatment:

Behavioral: Flu shot text messages

Dynamic Norms Control

Experimental group

Description:

Participants will only receive a text message encouraging them to get a flu shot. They will not receive any norm information.

Treatment:

Behavioral: Flu shot text messages

Sharing Humor

Experimental group

Description:

Participants will receive a text message encouraging them to get the flu shot. The message will include a joke about the flu and will encourage participants to share the joke with nurses, doctors, or pharmacists.

Treatment:

Behavioral: Flu shot text messages

Humor Placebo

Experimental group

Description:

Participants will receive a text message encouraging them to get the flu shot. This message will include the same joke but participants will not be encouraged to share it.

Treatment:

Behavioral: Flu shot text messages

No Humor Condition

Experimental group

Description:

Participants will receive a text message encouraging them to get the flu shot.

Treatment:

Behavioral: Flu shot text messages

Connecting the Past Self to the Future Self Treatment

Experimental group

Description:

Participants will receive a text message prompt to recall the negative experience of getting sick. When asked, "Do you wish you could have avoided getting sick by getting a simple shot?", participants will have the chance to respond Y for yes or N for no. Regardless of their response, they will be prompted with a second text message to connect their past experience with present-day opportunities for preventative care (getting a flu shot) to protect the future self from the flu.

Treatment:

Behavioral: Flu shot text messages

Connecting the Past Self to the Future Self Control

Experimental group

Description:

In the first text message, participants will receive a simple text message encouragement to receive a flu shot. In the second text message, they will receive a reminder of the appointment time and provider name.

Treatment:

Behavioral: Flu shot text messages

Reverse Inference Condition

Experimental group

Description:

Participants will receive a text message encouraging them to get a flu shot and informing them that Americans who get flu shots are healthier, wealthier, and more educated.

Treatment:

Behavioral: Flu shot text messages

Reverse Inference Control Condition

Experimental group

Description:

Participants will receive a text message encouraging them to get a flu shot and informing them that Americans who get flu shots are less likely to get the flu.

Treatment:

Behavioral: Flu shot text messages