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

NCT ID: NCT04590066

Last Updated: 2021-02-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

734383 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-25

Study Completion Date

2020-12-31

Brief Summary

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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).

Detailed Description

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Conditions

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Influenza, Human

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will be randomly assigned to the different arms.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Caregivers Outcome Assessors
As treated participants will receive text messages, there is no scope for blinding. Care providers will not be made aware of subjects' participation in the study, or assigned treatment arms. The study team will only receive data on subjects' assigned arms and outcomes at the end of the study.

Study Groups

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Holdout control

Participants will only receive the standard pharmacy messaging.

Group Type NO_INTERVENTION

No interventions assigned to this group

Unpacking Risks Treatment

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).

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Unpacking Risks Control

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Active Commitment Treatment

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Active Commitment Control

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

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Self-Generated Social Norms Treatment

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Self-Generated Social Norms Control

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

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Foot-in-the-Door Treatment

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Foot-in-the-Door Control

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

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Prosocial Condition

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).

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Self-Oriented Condition

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

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Prosocial + COVID-19

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).

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Self-Oriented + COVID-19

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).

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Dynamic + Static Norm

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Dynamic Norm

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Dynamic Norms Control

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

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Sharing Humor

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Humor Placebo

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

No Humor Condition

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

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Connecting the Past Self to the Future Self Treatment

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Connecting the Past Self to the Future Self Control

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Reverse Inference Condition

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

Participants will receive text messages per descriptions listed in the arms.

Reverse Inference Control Condition

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.

Group Type EXPERIMENTAL

Flu shot text messages

Intervention Type BEHAVIORAL

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.

Intervention Type BEHAVIORAL

Eligibility Criteria

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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

\-
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Pennsylvania

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

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.

Reference Type BACKGROUND
PMID: 29383550 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 21670283 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 29133488 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 20036102 (View on PubMed)

Other Identifiers

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843523-Trial B

Identifier Type: -

Identifier Source: org_study_id

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