A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor's appointment

Katherine L Milkman, Mitesh S Patel, Linnea Gandhi, Heather N Graci, Dena M Gromet, Hung Ho, Joseph S Kay, Timothy W Lee, Modupe Akinola, John Beshears, Jonathan E Bogard, Alison Buttenheim, Christopher F Chabris, Gretchen B Chapman, James J Choi, Hengchen Dai, Craig R Fox, Amir Goren, Matthew D Hilchey, Jillian Hmurovic, Leslie K John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C Madrian, Michelle N Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N Evans, Christopher K Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin G Volpp, Angela L Duckworth, Katherine L Milkman, Mitesh S Patel, Linnea Gandhi, Heather N Graci, Dena M Gromet, Hung Ho, Joseph S Kay, Timothy W Lee, Modupe Akinola, John Beshears, Jonathan E Bogard, Alison Buttenheim, Christopher F Chabris, Gretchen B Chapman, James J Choi, Hengchen Dai, Craig R Fox, Amir Goren, Matthew D Hilchey, Jillian Hmurovic, Leslie K John, Dean Karlan, Melanie Kim, David Laibson, Cait Lamberton, Brigitte C Madrian, Michelle N Meyer, Maria Modanu, Jimin Nam, Todd Rogers, Renante Rondina, Silvia Saccardo, Maheen Shermohammed, Dilip Soman, Jehan Sparks, Caleb Warren, Megan Weber, Ron Berman, Chalanda N Evans, Christopher K Snider, Eli Tsukayama, Christophe Van den Bulte, Kevin G Volpp, Angela L Duckworth

Abstract

Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment (N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findings suggest that text messages sent prior to a primary care visit can boost vaccination rates by an average of 5%. Overall, interventions performed better when they were 1) framed as reminders to get flu shots that were already reserved for the patient and 2) congruent with the sort of communications patients expected to receive from their healthcare provider (i.e., not surprising, casual, or interactive). The best-performing intervention in our study reminded patients twice to get their flu shot at their upcoming doctor's appointment and indicated it was reserved for them. This successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.

Keywords: COVID-19; field experiment; influenza; nudge; vaccination.

Conflict of interest statement

Competing interest statement: K.G.V. is a part-owner of VAL Health, a behavioral economics consulting firm.

Copyright © 2021 the Author(s). Published by PNAS.

Figures

Fig. 1.
Fig. 1.
Regression-estimated increase in flu vaccinations induced by each of our 19 interventions compared to a usual care control at Penn Medicine and Geisinger. Whiskers depict 95% CIs. As indicated in parentheses, some messages were sent at 6 PM, 1 and/or 3 d before an appointment, while others were sent a predetermined number of hours before an appointment (e.g., 72 h).

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Source: PubMed

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