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

      1 , 2 , 2 , 3 , 3 , 4 , 3 , 5 , 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 13 , 14 , 15 , 16 , 7 , 17 , 15 , 7 , 18 , 19 , 10 , 6 , 7 , 7 , 15 , 11 , 10 , 15 , 8 , 20 , 8 , 18 , 21 , 7 , 22 , 23 , 18 , 24 , 2
      American Journal of Health Promotion
      SAGE Publications

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          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.

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          Author and article information

          Contributors
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          Journal
          American Journal of Health Promotion
          Am J Health Promot
          SAGE Publications
          0890-1171
          2168-6602
          March 2023
          October 04 2022
          March 2023
          : 37
          : 3
          : 324-332
          Affiliations
          [1 ]Department of Clinical Transformation and Behavioral Insights, Ascension, St. Louis, MO, USA
          [2 ]Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
          [3 ]Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
          [4 ]Department of Marketing, The University of Chicago Booth School of Business, Chicago, IL, USA
          [5 ]School of Professional Studies, Northwestern University, Evanston, IL, USA
          [6 ]Department of Management, Columbia Business School, Columbia University, New York, NY, USA
          [7 ]Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA
          [8 ]Department of Behavioral Decision Making, Anderson School of Management, University of California, Los Angeles, CA, USA
          [9 ]Department of Family and Community Health, The University of Pennsylvania School of Nursing, Philadelphia, PA, USA
          [10 ]Behavioral and Decision Sciences Program, Geisinger Health System, Danville, PA, USA
          [11 ]Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
          [12 ]Department of Finance, Yale School of Management, Yale University, New Haven, CT, USA
          [13 ]Department of Management and Organization, Anderson School of Management, University of California Los Angeles, Los Angeles, CA, USA
          [14 ]Behavioral Insights Team, Geisinger Health System, Danville, PA, USA
          [15 ]Department of Behavioural Science and Economics, University of Toronto, Toronto, ON, Canada
          [16 ]Department of Marketing, Drexel University, Philadelphia, PA, USA
          [17 ]Department of Finance, Kellogg School of Management, Northwestern University, Evanston, IL, USA
          [18 ]Department of Marketing, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
          [19 ]Department of Finance, Marriott School of Business, Brigham Young University, Provo, UT, USA
          [20 ]Department of Marketing, Eller College of Management, University of Arizona, Tucson, AZ, USA
          [21 ]Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
          [22 ]Center for Health Care Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
          [23 ]Business Administration Division, University of Hawai`i-West O`ahu, Kapolei, HI, USA
          [24 ]Penn Center for Health Incentives and Behavioral Economics, Departments of Medical Ethics and Health Policy and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
          Article
          10.1177/08901171221131021
          36195982
          7911acf6-f367-4d24-965c-c46d4d91f0dd
          © 2023

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