Testing Multiple Behavioral Science Strategies to Increase Flu-Shot Rates
Testing Multiple Behavioral Science Strategies to Increase Flu-Shot Rates
This research aims to identify which behavioral science strategies are most effective at
 increasing flu vaccination rates overall and based on patients' individual characteristics.
 Past behavioral science interventions have shown promise in increasing flu vaccinations. For
 example, successful interventions have encouraged people to make concrete plans for when they
 will get a flu vaccination (Milkman et al. 2011), sent automated calls or text messages
 reminding patients to get a flu vaccination (Cutrona et al. 2018; Regan et al. 2017), or
 provided financial incentives for getting vaccinated (Nowalk et al. 2010). Although these
 results are promising, these studies have been conducted in isolation on different
 populations, which makes it difficult to compare their interventions' effectiveness or to
 have enough power to reliably detect differing responses to interventions based on individual
 characteristics.

 This research will simultaneously test 19 different SMS interventions to increase flu
 vaccinations in a "mega-study" and apply machine learning to identify which interventions
 work best for whom. The interventions are designed by behavioral science experts from the
 Behavior Change for Good Initiative (BCFG), Penn Medicine Nudge Unit (PMNU), and Geisinger
 Behavioral Insights Team (BIT). We expect to include at least 80,000 participants.

 The specific aims of this research are to identify (1) which behavioral science strategies
 effectively increase flu vaccination rates overall, and (2) which strategies are most
 effective for different subgroups (e.g., based on age, gender, race).
Penn Medicine and Geisinger patients will be included if they:

 Inclusion Criteria:

 -  Have a cell phone number recorded in a Penn Medicine or Geisinger database

 -  Have a new or routine primary care appointment during the study recruitment period
 (not a sick visit)

 Exclusion Criteria:

 -  Have documentation of allergy or adverse event to influenza vaccination in medical
 records

 -  Have documentation of already receiving their 2020 influenza vaccination prior to
 randomization in medical records

 -  Have opted out of receiving text message appointment reminders

 -  Have asked not to be contacted for research purposes

 -  Have an appointment with someone other than their primary care physician

 -  Have an appointment with someone other than a physician, resident, nurse practitioner,
 or physician assistant

 We will recruit as many patients as possible starting in September 2020. We will stop
 enrolling participants with appointments scheduled to occur after December 31, 2020 if we
 have reached 4,000 participants per condition. If we do not have 4,000 participants per
 condition by December 31, 2020, we will continue enrolling participants until we have
 reached 4,000 per condition, or until March 31, 2021 (discontinuing enrollment at whichever
 milestone arrives sooner - 4,000 people enrolled or 3/31/21).