Testing Multiple Behavioral Science Strategies to Increase Flu-Shot Rates
NCT ID: NCT04565353
Last Updated: 2022-02-01
Study Results
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View full resultsBasic Information
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COMPLETED
NA
74811 participants
INTERVENTIONAL
2020-09-20
2021-03-31
Brief Summary
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This research will simultaneously test 19 different SMS interventions to increase flu vaccinations 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). We expect to include at least 80,000 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).
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
HEALTH_SERVICES_RESEARCH
DOUBLE
Study Groups
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Holdout control
Participants will only receive the standard appointment reminders from their providers.
No interventions assigned to this group
Default Reservations Opt-Out Condition
The day before their scheduled appointment, participants receive a text reading: "A flu shot has been reserved for you to receive at your appointment tomorrow. Reply Y if you want this shot held for you, N if you don't." The text will include a picture of a vial that says "Your Flu Shot" on it.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Default Reservations Opt-In Condition
The day before their scheduled appointment, participants receive a text reading: "Reply Y if you would like to receive a flu shot at your appointment tomorrow, N if not." The text will include a picture of vial with no text on it.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Intergroup Competition Treatment Condition
Three days before their scheduled appointment, participants will receive a text message with information about how much "your region" lagged behind "another region" in flu shot rate last year ("your region" and "another region" will depend on the study site and include realistic flu shot rates based on historical CDC data). Participants will receive a reminder message on the day of the appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Intergroup Competition Control Condition
Three days before their scheduled appointment, participants will receive a text message with information about how much "your region" lagged behind the target flu shot rate of 70% last year ("your region" will depend on the study site and include realistic flu shot rates based on historical CDC data). Participants will receive a reminder message on the day of the appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Flu Shot for You Symbolic Condition
Three days before their scheduled appointment, participants will receive a text message encouraging them to get a flu shot. They will also be told that they have the opportunity to dedicate getting the flu shot to someone by texting back the initials of an individual. Participants will receive a reminder message on the day of the appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Flu Shot for You Herd Immunity Condition
Three days before their scheduled appointment, participants will receive a text message encouraging them to get a flu shot. They will also be told that they have the opportunity of getting the flu shot to protect a vulnerable loved one by texting back the initials of an individual. Participants will receive a reminder message on the day of the appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Flu Shot for You Control Condition
Three days before their scheduled appointment, participants will receive a text message encouraging them to get a flu shot. They will also receive a reminder message on the day of the appointment. They will not receive any further information, nor will they be asked to respond with initials of an individual.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Prosocial Condition
The day before their scheduled appointment, participants will receive a message describing the pro-social benefits of getting a flu shot, and a reminder to ask for their flu shot. The described pro-social benefits will vary whether they emphasize the COVID-19 pandemic (e.g., protecting loved ones from the risk of hospital-acquired COVID-19 infection) or not (e.g., protecting loved ones from serious complications from the flu). Participants will also receive a reminder message on the day of the appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Self-Oriented Condition
The day before their scheduled appointment, participants will receive a message describing the self-oriented benefits of getting a flu shot, and a reminder to ask for their flu shot. The described self-oriented benefits will vary whether they emphasize the COVID-19 pandemic (e.g., protecting oneself from the risk of hospital-acquired COVID-19 infection) or not (e.g., protecting oneself from serious complications from the flu).
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Information Vivid Condition
Three days before their scheduled appointment, participants will receive a message inviting them to watch a 2-minute wellness video and answer some related questions, as well as encouragement to get the flu shot. In this condition, the video will contain vivid information about getting the flu. Participants will also receive a reminder message the day before the appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Information Basic Condition
Three days before their scheduled appointment, participants will receive a message inviting them to watch a 2-minute wellness video and answer some related questions, as well as encouragement to get the flu shot. In this condition, the video will contain basic information about getting the flu. Participants will also receive a reminder message the day before the appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Information Control Condition
Three days before their scheduled appointment, participants will receive a message inviting them to watch a 2-minute wellness video and answer some related questions, as well as encouragement to get the flu shot. In this condition, the video will contain information about exercising. Participants will also receive a reminder message the day before the appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Sharing Humor Condition
The day before their scheduled appointment, 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.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
No Humor Condition
The day before their scheduled appointment, participants will receive a text message encouraging them to get the flu shot.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Healthy Habits Easy Health Behavior Condition
The day before their scheduled appointment, participants will be asked if they have completed a series of easy health behaviors (e.g., whether they walked 500 feet yesterday, at least two serving of fruits and vegetables in the last week, and slept at least 6 hours the previous night). They will then be encouraged to get a flu shot at their appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Healthy Habits Difficult Health Behavior Condition
The day before their scheduled appointment, participants will be asked if they have completed a series of difficult health behaviors (e.g., whether they walked 3 miles yesterday, ate 4-6 servings of fruits and vegetables yesterday, and slept at least 9 hours the previous night). They will then be encouraged to get a flu shot at their appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Healthy Habits Control Condition
The day before their scheduled appointment, participants will receive a text message encouraging them to get a flu shot.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Just-In-Time Reminders 24-Hour Condition
Seventy-two hours before their appointment, participants will receive a text message alerting them to the availability of the flu vaccine at their upcoming appointment. Participants will be told they'll receive a reminder, which they can opt-out from receiving. The text message reminder will be sent 24 hours before their appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Just-In-Time Reminders 15-Minute Condition
Just-In-Time Reminders 15-Minute Condition: Seventy-two hours before their appointment, participants will receive a text message alerting them to the availability of the flu vaccine at their upcoming appointment. Participants will be told they'll receive a reminder, which they can opt-out from receiving. The text message reminder will be sent 15 minutes before their appointment.
Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Interventions
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Flu shot text messages
Participants will receive text messages per descriptions listed in the arms.
Eligibility Criteria
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Inclusion Criteria
* Have a new or routine primary care appointment during the study recruitment period (not a sick visit)
Exclusion Criteria
* Have documentation of already receiving their 2020 influenza vaccination prior to randomization in medical records
* Have opted out of receiving text message appointment reminders
* Have asked not to be contacted for research purposes
* Have an appointment with someone other than their primary care physician
* Have an appointment with someone other than a physician, resident, nurse practitioner, or physician assistant
We will recruit as many patients as possible starting in September 2020. We will stop enrolling participants with appointments scheduled to occur after December 31, 2020 if we have reached 4,000 participants per condition. If we do not have 4,000 participants per condition by December 31, 2020, we will continue enrolling participants until we have reached 4,000 per condition, or until March 31, 2021 (discontinuing enrollment at whichever milestone arrives sooner - 4,000 people enrolled or 3/31/21).
18 Years
ALL
Yes
Sponsors
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Geisinger Clinic
OTHER
University of Pennsylvania
OTHER
Responsible Party
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Locations
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Geisinger Health
Danville, Pennsylvania, United States
University of Pennsylvania Health System
Philadelphia, Pennsylvania, United States
Countries
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References
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Cutrona SL, Golden JG, Goff SL, Ogarek J, Barton B, Fisher L, Preusse P, Sundaresan D, Garber L, Mazor KM. Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial. J Gen Intern Med. 2018 May;33(5):659-667. doi: 10.1007/s11606-017-4266-9. Epub 2018 Jan 30.
Milkman KL, Beshears J, Choi JJ, Laibson D, Madrian BC. Using implementation intentions prompts to enhance influenza vaccination rates. Proc Natl Acad Sci U S A. 2011 Jun 28;108(26):10415-20. doi: 10.1073/pnas.1103170108. Epub 2011 Jun 13.
Regan AK, Bloomfield L, Peters I, Effler PV. Randomized Controlled Trial of Text Message Reminders for Increasing Influenza Vaccination. Ann Fam Med. 2017 Nov;15(6):507-514. doi: 10.1370/afm.2120.
Nowalk MP, Lin CJ, Toback SL, Rousculp MD, Eby C, Raymund M, Zimmerman RK. Improving influenza vaccination rates in the workplace: a randomized trial. Am J Prev Med. 2010 Mar;38(3):237-46. doi: 10.1016/j.amepre.2009.11.011. Epub 2009 Dec 24.
Buttenheim A, Milkman KL, Duckworth AL, Gromet DM, Patel M, Chapman G. Effects of Ownership Text Message Wording and Reminders on Receipt of an Influenza Vaccination: A Randomized Clinical Trial. JAMA Netw Open. 2022 Feb 1;5(2):e2143388. doi: 10.1001/jamanetworkopen.2021.43388.
Provided Documents
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Document Type: Study Protocol
Document Type: Statistical Analysis Plan
Other Identifiers
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843523
Identifier Type: -
Identifier Source: org_study_id
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