Behavioural nudges increase COVID-19 vaccinations

  1. Hengchen Dai
  2. Silvia Saccardo
  3. Maria A. Han
  4. Lily Roh
  5. Naveen Raja
  6. Sitaram Vangala
  7. Hardikkumar Modi
  8. Shital Pandya
  9. Michael Sloyan
  10. Daniel M. Croymans

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Abstract

Enhancing vaccine uptake is a critical public health challenge 1 . Overcoming vaccine hesitancy 2,3 and failure to follow through on vaccination intentions 3 requires effective communication strategies 3,4 . Here we present two sequential randomized controlled trials to test the effect of behavioural interventions on the uptake of COVID-19 vaccines. We designed text-based reminders that make vaccination salient and easy, and delivered them to participants drawn from a healthcare system one day (first randomized controlled trial) ( n  = 93,354 participants; clinicaltrials number NCT04800965) and eight days (second randomized controlled trial) ( n  = 67,092 individuals; clinicaltrials number NCT04801524) after they received a notification of vaccine eligibility. The first reminder boosted appointment and vaccination rates within the healthcare system by 6.07 (84%) and 3.57 (26%) percentage points, respectively; the second reminder increased those outcomes by 1.65 and 1.06 percentage points, respectively. The first reminder had a greater effect when it was designed to make participants feel ownership of the vaccine dose. However, we found no evidence that combining the first reminder with a video-based information intervention designed to address vaccine hesitancy heightened its effect. We performed online studies ( n  = 3,181 participants) to examine vaccination intentions, which revealed patterns that diverged from those of the first randomized controlled trial; this underscores the importance of pilot-testing interventions in the field. Our findings inform the design of behavioural nudges for promoting health decisions 5 , and highlight the value of making vaccination easy and inducing feelings of ownership over vaccines.

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  1. Version published to 10.1038/s41586-021-03843-2
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    SciScore for 10.1101/2021.04.12.21254876: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This research was approved by the UCLA Institutional Review Board, which granted a waiver of informed consent.
    Consent: This research was approved by the UCLA Institutional Review Board, which granted a waiver of informed consent.
    RandomizationWe randomly assigned patients at a 4:1 ratio to either the Text Message Arm, where patients received a text message at 3pm PST on the first reminder date encouraging them to schedule a vaccination appointment, or a Holdout arm with no text message.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableThese patients were on average 72.8 years old (s.d. = 10.1), 43.0% of them were male, 55.5% were non-Hispanic white, 4.4% preferred Spanish, and 51.2% received the flu shot in the 2019-2020 or 2020-2021 flu season.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04800965Enrolling by invitationText-based Interventions to Promote COVID-19 Vaccinations
    NCT04801524Enrolling by invitationText-based Reminders to Promote COVID-19 Vaccinations

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.04.12.21254876v1 on medRxiv