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May 4, 2021 – When people who have an appointment with a doctor receive a text message reminding them about the flu shot, it increases the likelihood that they will be vaccinated when they enter, especially if the message indicates that the shot is “reserved” for them. , reveal new evidence.
“Our message to take home is that text message reminders are effective in increasing vaccine uptake and that they best communicate to patients that a vaccine is‘ reserved for you, ’” said Dena M. Gromet , PhD.
“This strategy takes advantage of a well-studied behavioral science phenomenon: a reserved vaccine seems to belong to you, and so it’s a loss to give it up,” added Gromet, executive director of the University of Pennsylvania’s Behavior Change for Good Initiative. in Philadelphia.
He to study was published online on April 29 a PNAS.
It could work for COVID-19
Researchers focused on which message tactics worked best for primary care offices offering the flu vaccine, but the strategy could also be applied to COVID-19 vaccinations, according to an author of the study. study and other experts.
“While the adoption of the COVID-19 vaccine poses a unique set of challenges,” Gromet said, “we hope that for those who are open to getting vaccinated but have not followed it, these types of reminders will be an effective push towards vaccination “.
This is a “very interesting study with significant implications for increasing vaccination rates, as for COVID-19,” David Kaelber, MD, told Medscape when asked to comment.
“I would expect a similar effect if this strategy were also applied to COVID-19 vaccines,” added Kaelber, a professor of Internal Medicine, Pediatrics and Population and Quantitative Health Sciences at Case Western Reserve University in Cleveland.
Together with lead author Katherine Milkman, PhD and colleagues, Gromet studied 19 possible text message scripts, combinations, and timing to increase vaccine adoption. They compared vaccination rates between messages sent to 37,304 patients from two institutions against people who did not receive these reminders.
Based on other research, “this appears to be a reasonable approach to increase COVID-19 vaccination rates as well,” said Julie C. Jacobson Vann, a doctor from the University of North Carolina at Chapel Hill School of Nursing.
Follow your style
In addition to a greater obligation to comply when they believe a vaccine is reserved for them, patients also responded better to text messages by following the typical lines of communication in their doctor’s office.
In other words, it’s best to avoid trying to be especially creative or funny.
“We were surprised to see in our post-hoc analyzes that the more interactive and informal messages didn’t work so well,” Gromet said. “In fact, some of our smartest interventions were among the least effective.”
A message with a photo of a dog telling a cat a joke about transmitting the flu, for example, didn’t work particularly well.
A messaging “Megastudy.”
Gromet and his colleagues conducted a megastudio, a field experiment where different teams of scientists tested several interventions in the same population and in the same result. In this case, they evaluated 47,306 patients attending Penn Medicine or Geisinger Health for a new or routine primary care appointment in the fall of 2020.
They randomly assigned patients to one of 19 text messaging strategies or to the control group. None of them had already received an influenza vaccine, according to their electronic health record.
The median age was 52 years, 43% were male, and 70% were white. Although electronic medical records indicate that none of the patients had yet received a flu vaccine, 47% had received it during the previous flu season.
“I think a lot of us believe that automatic texting / messaging about vaccines outside or in conjunction with a face-to-face visit should improve some vaccination rates,” Kaelber said. “What’s fantastic about this study is that it looks at a lot of different ways of doing it, and so it’s prescriptive about ways to send text messages / messages that are more or less effective.”
Clinically effective and cost effective?
All 19 text messaging strategies increased vaccination rates by an average of 2.1 percentage points. “Although the average difference of 2.1 percentage points in grip vaccination rates between text message participants and comparison participants are small, the overall effect can be substantial if applied to large populations, ”said Jacobson Vann.
The most effective approach was a two-pronged approach: a message sent 72 hours before the appointment stating that “it’s flu season,” “a flu vaccine is available,” and that it would send “a vaccine reminder “before appointment. A second 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 was associated with a 4.6 percentage point increase in vaccination at the expense of sending two text messages, or less than 10 cents, the researchers note.
The researchers also calculated a more conservative estimate and found this strategy associated with a 2.8 percentage point increase in vaccination or a 6.7% increase.
“While a 6.7% improvement in vaccination rates may not seem like much, at the population level, considering everyone should receive a vaccine like the flu vaccine or the COVID-19 vaccine, this increase in vaccination rates will result in millions and millions more people being vaccinated, ”Kaelber said.
Next steps
Gromet and colleagues also conducted a similar study with patients at Walmart Pharmacy. Preliminary conclusions include a similar message with better performance than the flu vaccine “was waiting for you.”
“We look forward to opportunities to test specific messages for COVID-19 vaccines and examine other types of impulses that may help encourage vaccination,” Gromet added.
Drs. Gromet, Kaelber and Jacobson Vann had no relevant financial relationships to disclose. The study was supported by the National Institute on Aging, the Bill and Melinda Gates Foundation, the Influenza Laboratory, and the Penn Center for Precision Medicine Accelerator Fund. The AKO Foundation, John Alexander, Mark J. Leder, and Warren G. Lichtenstein provided additional support.
PNAS. Published online April 29, 2021.
Damian McNamara is a staff Miami-based journalist. It covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.
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