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

doi:10.1073/pnas.2101165118

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.

Authors

Katherine L Milkman¹, Mitesh S Patel², Linnea Gandhi³, Heather N Graci⁴, Dena M Gromet⁴, Hung Ho³, Joseph S Kay⁴, Timothy W Lee⁴, Modupe Akinola⁵, John Beshears⁶, Jonathan E Bogard⁷, Alison Buttenheim⁸, Christopher F Chabris^{9

10}, Gretchen B Chapman¹¹, James J Choi¹², Hengchen Dai¹³, Craig R Fox¹³, Amir Goren⁹, Matthew D Hilchey¹⁴, Jillian Hmurovic¹⁵, Leslie K John⁶, Dean Karlan¹⁶, Melanie Kim¹⁴, David Laibson¹⁷, Cait Lamberton¹⁸, Brigitte C Madrian¹⁹, Michelle N Meyer^{9

20}, Maria Modanu⁵, Jimin Nam²¹, Todd Rogers²², Renante Rondina¹⁴, Silvia Saccardo¹¹, Maheen Shermohammed⁹, Dilip Soman¹⁴, Jehan Sparks⁷, Caleb Warren²³, Megan Weber⁷, Ron Berman¹⁸, Chalanda N Evans²⁴, Christopher K Snider²⁵, Eli Tsukayama²⁶, Christophe Van den Bulte¹⁸, Kevin G Volpp²⁷, Angela L Duckworth^{3

28}

Affiliations

¹ Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104; kmilkman@wharton.upenn.edu.
² Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104.
³ Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104.
⁴ Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104.
⁵ Management Division, Columbia Business School, Columbia University, New York, NY 10027.
⁶ Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA 02163.
⁷ Department of Behavioral Decision Making, Anderson School of Management, University of California Los Angeles, Los Angeles, CA 90095.
⁸ Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104.
⁹ Behavioral Insights Team, Steele Institute for Health Innovation, Geisinger Health System, Danville, PA 17822.
¹⁰ Autism and Developmental Medicine Institute, Geisinger Health System, Lewisburg, PA 17837.
¹¹ Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213.
¹² Yale School of Management, Yale University, New Haven, CT 06511.
¹³ Department of Management and Organizations, Anderson School of Management, University of California Los Angeles, Los Angeles, CA 90095.
¹⁴ Behavioural Economics in Action at Rotman, Rotman School of Management, University of Toronto, Toronto, ON M5S 3E6, Canada.
¹⁵ Wharton Risk Management and Decision Processes Center, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104.
¹⁶ Department of Finance, Kellogg School of Management, Northwestern University, Evanston, IL 60208.
¹⁷ Department of Economics, Harvard University, Cambridge, MA 02138.
¹⁸ Department of Marketing, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104.
¹⁹ Department of Finance, Marriott School of Business, Brigham Young University, Provo, UT 84602.
²⁰ Center for Translational Bioethics and Health Care Policy, Geisinger Health System, Danville, PA 17822.
²¹ Marketing Unit, Harvard Business School, Harvard University, Boston, MA 02163.
²² Harvard Kennedy School of Government, Harvard University, Cambridge, MA 02138.
²³ Department of Marketing, Eller College of Management, University of Arizona, Tucson, AZ 85721.
²⁴ Penn Medicine Nudge Unit, Penn Medicine, Philadelphia, PA 19104.
²⁵ Center for Health Care Innovation, Penn Medicine, Philadelphia, PA 19104.
²⁶ Business Administration Division, University of Hawai`i-West O`ahu, Kapolei, HI 96707.
²⁷ Penn Center for Health Incentives and Behavioral Economics, Departments of Medical Ethics and Health Policy and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104.
²⁸ Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104.

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.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
COVID-19 / prevention & control*
COVID-19 Vaccines*
Female
Humans
Influenza Vaccines*
Influenza, Human / prevention & control*
Male
Middle Aged
Office Visits / statistics & numerical data*
Physicians, Primary Care
Reminder Systems
Text Messaging
Vaccination / psychology
Vaccination / statistics & numerical data*

Substances

COVID-19 Vaccines
Influenza Vaccines

Abstract

Publication types

MeSH terms

Substances

Grants and funding