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When individuals with an upcoming doctor’s appointment get a text reminder of getting a flu vaccination, it increases the likelihood that they will get immunized if they arrive in, particularly if the message states that the shot is”reserved” to them, new evidence shows.
“Our take home message is that text message reminders are effective for increasing vaccination uptake — and the best ones communicate to patients that a vaccine is reserved for you,” said Dena M. Gromet, PhD.
“This strategy capitalizes on a well-studied behavioral science phenomenon: A reserved vaccine feels like it belongs to you, so it feels like a loss to give it up,” additional Gromet, executive director of Behavior Change for Good Initiative at the University of Pennsylvania at Philadelphia.
The research was published online April 29 in PNAS.
Could Work for COVID-19
The researchers focused on which message approaches worked best for primary care offices offering the influenza vaccine — but the strategy also could employ to COVID-19 vaccinations, a study author and other experts said.
“Although uptake of the COVID-19 vaccine comes with a unique set of challenges,” Gromet said,”we expect that for those who are open to getting vaccinated but haven’t followed through, these types of reminders will be an effective nudge toward vaccination.”
It is a”very interesting study with significant implications for boosting vaccination rates, such as for COVID-19,” David Kaelber, MD, told Medscape Medical News when requested to comment.
Dr David Kaelber
“I would expect a similar effect if this strategy were applied to COVID-19 vaccinations as well,” added Kaelber, professor of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences at Case Western Reserve University in Cleveland, Ohio.
Dr Julie C. Jacobson Vann
Along with lead writer Katherine Milkman, PhD, and colleagues, Gromet researched 19 possible text message scripts, combinations, and time to increase uptake of vaccination. They compared vaccination rates among messages delivered to 37,304 patients at two associations versus individuals who did not get such reminders.
Based on additional research,”this seems to be a reasonable approach to also increase vaccination rates for COVID-19,” Julie C. Jacobson Vann, PhD, MS, RN, from the University of North Carolina at Chapel Hill School of Nursing, stated in an email.
Stick With Your Style
In addition to a larger obligation to follow through when they believe a vaccine is reserved to them, patients also responded best to text messages across the lines of communications that are typical by their doctor’s office.
In other words, it’s best to refrain from trying to be especially creative or funny.
“We were surprised to find in our post-hoc analyses that more interactive and informal messages did not perform as well,” Gromet explained. “In fact, some of our most clever interventions were among the least effective.”
A message with a picture of a dog telling a cat a joke regarding spreading the flu, by way of example, did not work particularly well.
A Messaging “Megastudy”
Gromet and colleagues ran a megastudy, a field experiment in which different groups of scientists examine multiple interventions in the same population and about the exact same outcome. In this case, they analyzed 47,306 patients coming to Penn Medicine or Geisinger Health to get a new or regular main care appointment in the autumn 2020.
They randomly assigned patients to one of those 19 text messaging approaches or to the management group. None had received a flu shot , in accordance with their electronic health record.
Average age was 52 years, 43percent were male, and 70% were white. Although digital health records suggested that none of the patients had received a flu shot, 47% had received one during the last flu season.
“I think many of us have a sense that automated texting/messaging about immunizations outside of or in conjunction with an in-person visit should improve immunization rates some,” Kaelber said. “What is great about this study is that it looks at many different ways to do this and therefore is prescriptive about ways to text/message that are more or less effective.”
Clinically Effective and Cost-effective?
All 19 text messaging plans improved vaccination rates by an average 2.1 percentage points. “Although the average 2.1 percentage point difference in influenza vaccination rates between the text message participants and comparison participants is small, the overall effect has the potential to be substantial if applied to large populations,” Jacobson Vann said.
The most effective approach was a two-pronged approach: One message sent 72 hours prior to a consultation noting that”it’s flu season,””a flu vaccine is available for you,” and”a vaccine reminder” will be transmitted prior to the appointment. Another text sent 24 hours in advance simply stated that”this is a reminder that a flu vaccine has been reserved for your appointment.”
This intervention has been associated with a 4.6 percentage point increase in alcoholism in the cost of sending two text messages, or less than 10 cents, the investigators note.
The researchers also calculated a much more conservative estimate and discovered this strategy associated with a 2.8 percentage point boost in vaccination, or a 6.7% increase.
“Even though a 6.7% improvement in vaccination rates might not seem like too much, at the population level, considering everyone who should receive a vaccine like the influenza vaccine or the COVID-19 vaccine, this increase in vaccination rates will result in millions and millions of more people being vaccinated,” Kaelber said.
Gromet and colleagues also conducted a similar study with Walmart pharmacy sufferers. Preliminary findings contain a similar top-performing message that the flu vaccine has been”waiting for you.”
“We’re eager for opportunities to test messages specifically for COVID-19 vaccinations and to examine other types of nudges that could help encourage vaccination,” Gromet added.
PNAS. Published online April 29, 2021. Full text
Gromet, Kaelber, and Jacobson Vann disclosed no relevant financial relationships. The National Institute on Aging, the Bill and Melinda Gates Foundation, the Flu Lab, and the Penn Center for Precision Medicine Accelerator Fund supported the analysis. The AKO Foundation, John Alexander, Mark J. Leder, and Warren G. Lichtenstein provided additional aid.
Damian McNamara is a staff journalist located in Miami. He covers a wide selection of medical specialties, including infectious diseases, gastroenterology, and critical maintenance. Follow Damian on Twitter: @MedReporter.