Personalized Nudging to Increase Influenza Vaccinations

NCT06566534 | Completed

• 1 other identifier: 2024-0561
• Study Type: interventional
• Target: 77,482
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to prospectively test whether personalized, message-based nudges can increase flu vaccination compared with nudges that are not personalized or no nudges.

Conditions

Influenza, Human

Keywords

vaccination; health promotion; health behavior; reminder systems; behavioral economics; behavioral risk assessment; machine learning; personalization; nudges

Outcome Measures

Primary Outcomes (1)

• Number of Patients With Flu Shot Receipt Between Enrollment Date and Target Appointment Date

  Our field experiment will be conducted with Geisinger Health patients via SMS messages sent prior to their first flu shot-eligible appointment during the study period, referred to as the "target appointment." The key dependent variable is whether patients receive a flu shot at or before their target appointment (as recorded in their electronic health records). If patients cancel or do not show up for their target appointment after they have been randomized to a treatment and then schedule a new appointment during the study period, their new flu-shot eligible appointment becomes the target appointment and the outcome window extends from three days prior to the original appointment through the date of the appointment. Patients who miss their target appointment and do not reschedule within the study period will still be included in the analysis. Their outcome window is from three days prior to the original appointment through the date of the original canceled appointment.

  Between the enrollment date and target appointment date (at least 4 days and up to 4 months)

Other Outcomes (4)

• Number of Patients With Flu Shot Receipt On or Before December 31, 2024

  Up to 4 months after randomization

• Number of Patients with Flu Shot Receipt Between Enrollment Date and First Eligible Appointment

  4 Days

• Number of Patients with Flu Diagnosis (encounter diagnosis or flu test)

  Up to 8 months after randomization

Study Arms (4)

Passive Control

NO INTERVENTION

Patients randomized to this arm will receive no special communications, beyond what Geisinger sends out as standard practice.

Active Control

EXPERIMENTAL

Patients will receive a simple message encouraging them to get a flu shot at their appointment.

Behavioral: Reminder

Best Nudge

EXPERIMENTAL

Patients will receive the nudge found to be numerically most effective in the megastudy, including language that a flu vaccine is "reserved" for them at their upcoming appointment.

Behavioral: Reminder

Personalized Nudge

EXPERIMENTAL

Patients will receive the nudge predicted to be most effective for them on the basis of the machine learning-derived treatment assignment trees.

Behavioral: Reminder

Interventions

Reminder BEHAVIORAL

Flu shot messages via SMS

Active Control; Best Nudge; Personalized Nudge

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18+
• Has not received the 2024 flu vaccine according to the Geisinger electronic health record (EHR) prior to randomization
• Has a non-acute, flu-shot eligible, in-person Geisinger appointment scheduled with enough time to be randomized
• Has a Geisinger primary care provider

You may not qualify if:

• Cannot be contacted by SMS (e.g., due to insufficient/missing contact information in the EHR or because they opted out)
• Appointment type or department not approved for outreach by Geisinger leadership at the time of outreach
• Has an allergy to flu vaccines according to any EHR allergy table known to the study team
• Has a health maintenance modifier indicating they are permanently discontinued from receiving a seasonal flu shot
• Shares a phone number with someone who has already been enrolled

Sponsors & Collaborators

• Geisinger Clinic: lead
• Massachusetts Institute of Technology: collaborator
• University of Michigan: collaborator
• Abdul Latif Jameel Poverty Action Lab: collaborator

Study Sites (1)

Geisinger Clinic

Danville, Pennsylvania, 17822, United States

Location

Related Publications (2)

• Milkman KL, Patel MS, Gandhi L, Graci HN, Gromet DM, Ho H, Kay JS, Lee TW, Akinola M, Beshears J, Bogard JE, Buttenheim A, Chabris CF, Chapman GB, Choi JJ, Dai H, Fox CR, Goren A, Hilchey MD, Hmurovic J, John LK, Karlan D, Kim M, Laibson D, Lamberton C, Madrian BC, Meyer MN, Modanu M, Nam J, Rogers T, Rondina R, Saccardo S, Shermohammed M, Soman D, Sparks J, Warren C, Weber M, Berman R, Evans CN, Snider CK, Tsukayama E, Van den Bulte C, Volpp KG, Duckworth AL. A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor's appointment. Proc Natl Acad Sci U S A. 2021 May 18;118(20):e2101165118. doi: 10.1073/pnas.2101165118.

  PMID: 33926993 BACKGROUND

• Patel MS, Milkman KL, Gandhi L, Graci HN, Gromet D, Ho H, Kay JS, Lee TW, Rothschild J, Akinola M, Beshears J, Bogard JE, Buttenheim A, Chabris C, Chapman GB, Choi JJ, Dai H, Fox CR, Goren A, Hilchey MD, Hmurovic J, John LK, Karlan D, Kim M, Laibson D, Lamberton C, Madrian BC, Meyer MN, Modanu M, Nam J, Rogers T, Rondina R, Saccardo S, Shermohammed M, Soman D, Sparks J, Warren C, Weber M, Berman R, Evans CN, Lee SH, Snider CK, Tsukayama E, Van den Bulte C, Volpp KG, Duckworth AL. A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit. Am J Health Promot. 2023 Mar;37(3):324-332. doi: 10.1177/08901171221131021. Epub 2022 Oct 4.

  PMID: 36195982 BACKGROUND

Related Links

• Centers for Disease Control and Prevention. (2020). Disease Burden of Influenza.

MeSH Terms

Conditions

Influenza, Human; Health Behavior

Condition Hierarchy (Ancestors)

Respiratory Tract Infections; Infections; Orthomyxoviridae Infections; RNA Virus Infections; Virus Diseases; Respiratory Tract Diseases; Behavior

Study Officials

• Christopher F Chabris, PhD

  Geisinger Clinic

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Although patients will not be explicitly informed of which arm they were randomized to, they will be aware of the messages they receive. The care provider will be provided an information sheet describing the intervention, but they will not be explicitly told which patients are enrolled or their randomized arm assignment.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: August 20, 2024
• First Posted: August 22, 2024
• Study Start: September 9, 2024
• Primary Completion: December 31, 2024
• Study Completion: December 31, 2024
• Last Updated: January 16, 2025

Record last verified: 2025-01

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ANALYTIC CODE
• Time Frame: By the paper's online publication date. Data will remain available for as long as the Open Science Framework hosts it.
• Access Criteria: The data on the Open Science Framework will be open to anyone requesting that information.

Locations

US (1)