Improving Physician Vaccine Recommendation Using Social Norms, Trust, and Presumptive Language

This research examines vaccination recommendation perceptions and behaviors of physicians and advanced practice providers.

Study Overview

• Status: Completed
• Conditions: Healthy
• Intervention / Treatment: Other: Quantity of vaccination recommendations; Other: Quality of vaccination recommendations; Other: Control

• Study Type: Interventional
• Enrollment (Actual): 447
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Brazil
  • Brasília, Brazil
    • (Any and all facilities) - Participants are recruited via market research company "Survey Healthcare Global"
• United States
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • (Any and all facilities) - The study team ask(s)/(ed) professional contacts, friends, and family members who are employed at various US Institutions to forward the recruitment announcement message via their respective networks
    • Durham, North Carolina, United States, 27710
      • Duke University Health System (all locations)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Participants must be physicians, advanced practice providers, medical students, nurses/nurse practitioners, or medical fellows.
• Must be in a position to be authorized to recommend vaccines to patients in their official professional capacities/responsibilities.

Exclusion Criteria:

• Students or employees under the supervision of the PI who meet inclusion criteria for the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Quantity (present) x Quality (present); Participants will receive a social norm-based message (for quantity) and will learn the AIMS method, a trust-building method using presumptive language (for quality).	Other: Quantity of vaccination recommendations; The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).; Other: Quality of vaccination recommendations; The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).
Experimental: Quantity (present) x Quality (absent); Participants will receive a social norm-based message (for quantity).	Other: Quantity of vaccination recommendations; The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).
Experimental: Quantity (absent) x Quality (present); Participants will learn the AIMS method, a trust-building method using presumptive language (for quality).	Other: Quality of vaccination recommendations; The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).
Experimental: Quantity (absent) x Quality (absent); Control: Participants in this condition will receive general information about vaccines, including vaccine principles, uptake barriers, and guidelines. This information will come directly from the CDC's Advisory Committee on Immunization Practices (ACIP) website.	Other: Control; The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in proportion of patients that receive a vaccine recommendation	Proportion of patients that receive a vaccine recommendation = multiplication of the answer to the following two items: (1) "I (will) check(ed) whether a patient has/had gotten all indicated vaccines", (2) "If I saw/see a patient had not gotten an indicated vaccine, I (will) discuss(ed) getting it." Both items are answered on a scale from 0% (never) to 100% (always).	Day 1, Day 30, Day 60, Day 90
Change in self-reported responsibility perception	Self-reported responsibility perception = answer to the following item: (1) "Recommending indicated vaccines is within the scope of my professional responsibilities". This item is answered on a scale from 0% (completely disagree) to 100% (completely agree).	Day 1, Day 30, Day 60, Day 90
Change in self-reported assessment of patient recommendation acceptance	Self-reported assessment of patient recommendation acceptance = answer to the following item: (1) "If I recommend(ed) an indicated vaccine, my patient (will) accept(ed) that recommendation.". This item is answered on a scale from 0% (never) to 100% (always).	Day 1, Day 30, Day 60, Day 90
Change in self-reported patient trust	Self-reported patient trust = answer to the following item: (1) "Thinking about the last/next 30 days I provided care, I can say that my patients (will) trust(ed) me as their healthcare provider". This item is answered on a scale from 0% (completely disagree) to 100% (completely agree).	Day 1, Day 30, Day 60, Day 90
Change in self-reported utilization of AIMS	Composite score of the following items: (1) "I used/will use direct, declarative language, like: "You're due for your flu shot. We'll do that at the end of this visit"; (2) "If the patient showed/shows hesitancy about getting vaccinated, I (will) ask(ed) about their concerns, and then use(d) active listening to understand their thoughts"; (3) "If the patient showed/shows hesitancy about getting vaccinated, I (will) listen(ed) to the patient's reasoning and then summarize(d) the patient's reasoning back to them to show that I understood/understand"; (4) "If the patient still has concerns, I did/will not continue efforts to convince them." Each item is answered on a scale from 0% (never) to 100% (always).	Day 1, Day 30, Day 60, Day 90
Change in self-reported rate of patient vaccine uptake	Answer to the following item: "Estimate what percentage of your patients is/will be fully vaccinated against […]" This item is answered on a scale from 0% to 100%. The question is being asked 8-10 times with the following name inserted for [...] in the above question: Flu COVID-19 Tetanus, Diphtheria, Pertussis HPV Hepatitis B Meningitis / Meningococcal Shingles Pneumococcal Other (which can be two other diseases that the respondent indicated)	Day 1, Day 30, Day 60, Day 90

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in belief about patient autonomy	Answer to the following item: "I stated / will state the patient's options - to vaccinate or not, and with which vaccine - so that they can make an informed decision." This item is answered on a scale from 0% to 100%.	Day 1, Day 30, Day 60, Day 90
Change in proportion of patients that accept a recommendation	Proportion of patients that accept a recommendation = multiplication of the answer to the following three items: (1) "I (will) check(ed) whether a patient has/had gotten all indicated vaccines", (2) "If I saw/see a patient had not gotten an indicated vaccine, I (will) discuss(ed) getting it."; (3) "If I recommend(ed) an indicated vaccine, my patient (will) accept(ed) that recommendation." All items are answered on a scale from 0% (never) to 100% (always).	Day 1, Day 30, Day 60, Day 90

Collaborators and Investigators

• Sponsor: Duke University
• Investigators: Principal Investigator: Dan Ariely, PhD, Duke University

Study record dates

Study Major Dates

• Study Start (Actual): September 21, 2023
• Primary Completion (Actual): April 24, 2024
• Study Completion (Actual): April 24, 2024

Study Registration Dates

• First Submitted: July 14, 2023
• First Submitted That Met QC Criteria: July 14, 2023
• First Posted (Actual): July 24, 2023

Study Record Updates

• Last Update Posted (Actual): May 1, 2024
• Last Update Submitted That Met QC Criteria: April 30, 2024
• Last Verified: October 1, 2023

More Information

Terms related to this study

• Keywords: Physicians; Trust; Social Norms; Vaccination Recommendation; Presumptive Recommendation
• Other Study ID Numbers: Pro00113696

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

Personal information will be permanently removed from the data no later than two weeks after the distribution of the final study survey, after which study responses will no longer be able to be linked to an individual participant.

What specific individual participant data sets are to be shared: Answers to all questions in all surveys will be shared.

• IPD Sharing Time Frame: After data from the last participant is collected, we'll take 6 months for analysis before data becomes available. Data will be available indefinitely.
• IPD Sharing Access Criteria: Disaggregated data will be uploaded to the Open Science Framework research portal.
• IPD Sharing Supporting Information Type: SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No