Effect of Targeted Behavioral Science Messages on COVID-19 Vaccination Registration Among Employees of a Large Health System: A Randomized Trial.
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SUBMITTER: Santos HC
PROVIDER: S-EPMC8319759 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeTo evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.DesignRandomized, controlled trial.SettingTwo health systems in the Northeastern US between September 2020 and March 2021.Subjects74,811 adults.InterventionsPatients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content.MeasuresInfluenza vaccination.AnalysisIntention-to-treat.ResultsParticipants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as "reserved for you" and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as "reserved for you." None of the interventions performed worse than control.ConclusionsText messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.
| S-EPMC10798571 | biostudies-literature
Project description:BackgroundThe purpose of the study was to evaluate a 6-month intervention to promote office-employees' walking with pedometers and e-mail messages.MethodsParticipants were recruited by 10 occupational health care units (OHC) from 20 worksites with 2,230 employees. Voluntary and insufficiently physically active employees (N?=?241) were randomized to a pedometer (STEP, N?=?123) and a comparison group (COMP, N?=?118). STEP included one group meeting, log-monitored pedometer-use and six e-mail messages from OHC. COMP participated in data collection. Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) and costs were assessed with questionnaires (0, 2, 6, 12?months), process evaluation and interviews (12?months).ResultsThe intervention reached 29% (N?=?646) of employees in terms of participation willingness. Logistic regression showed that the proportion of walkers tended to increase more in STEP than in COMP at 2?months in "walking for transportation" (Odds ratio 2.12, 95%CI 0.94 to 4.81) and at 6?months in "walking for leisure" (1.86, 95%CI 0.94 to 3.69). Linear model revealed a modest increase in the mean duration of "walking stairs" at 2 and 6?months (Geometric mean ratio 1.26, 95%CI 0.98 to 1.61; 1.27, 0.98 to 1.64). Adoption and implementation succeeded as intended. At 12?months, some traces of the intervention were sustained in 15 worksites, and a slightly higher number of walkers in STEP in comparison with COMP was observed in "walking stairs" (OR 2.24, 95%CI 0.94 to 5.31) and in "walking for leisure" (2.07, 95%CI 0.99 to 4.34). The direct costs of the intervention were 43 Euros per participant.ConclusionsThe findings indicate only modest impact on some indicators of walking. Future studies should invest in reaching the employees, minimizing attrition rate and using objective walking assessment. TRIAL REGISTERATION: ISRCTN79432107.
| S-EPMC3444317 | biostudies-literature
Project description:BackgroundAchieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obtain the COVID-19 vaccine by employees.MethodsThe study was conducted from December 2020 - May 2021 with employees from a VA health care system in Southeastern US. The study used a convergent mixed methods design comprising two main activities: a cross-sectional survey conducted prior to COVID-19 vaccine distribution, and semi-structured interviews conducted 4-6 months after vaccine distribution. Data were collected about participant characteristics, vaccination intention prior to distribution, vaccination decision post-distribution, determinants of vaccination intention and decision, activating factors, sources of information and intervention needs. Data from the survey and interviews were analyzed separately and integrated narratively in the discussion.ResultsPrior to vaccine distribution, 77% of employees wanted to be vaccinated. Post vaccine distribution, we identified 5 distinct decision-making groups: 1) vaccine believers who actively sought vaccination and included those sometimes described as "immunization advocates", 2) go along to get along (GATGA) individuals who got vaccinated but did not actively seek it, 3) cautious acceptors who got the COVID-19 vaccine after some delay, 4) fence sitters who remained uncertain about getting vaccinated, and 5) vaccine refusers who actively rejected the COVID-19 vaccine. Participants identifying with Black or multiple races were more likely to express hesitancy in their vaccination intention.ConclusionThe findings of our study highlight distinct decision-making profiles associated with COVID-19 vaccination among employees of a VA health care system, and provide tailored recommendations to reduce vaccine hesitancy in this population.
| S-EPMC9276645 | biostudies-literature
Project description:We assessed differences in response to a tailored recommendation intervention for HPV vaccine by participants' sociodemographic characteristics in this exploratory sub-analysis of a larger web-based, randomized-controlled trial on tailored messaging among mothers with low intent to vaccinate their 11-14-year-old child against HPV. The intervention consisted of pre-recorded video messages tailored to 1-5 common concerns about HPV vaccine. In these exploratory analyses, we used generalized linear models to assess differences in post-intervention intent across intervention arms, stratified by sociodemographic characteristics among 496 trial participants. We found significantly higher post-intervention intent in the intervention participants versus the control group among mothers: 1) with younger children; 2) with white vs. black children; 3) with Non-Hispanic children; 4) who were younger; 5) with some college or vocational training; with household incomes of ≥$100,000; and 7) with 1-2 children. Our findings of effect modification by certain sociodemographic factors such as age, race/ethnicity, and household income should be considered when designing similar tailored messaging interventions.
| S-EPMC8192722 | biostudies-literature
Project description:The behavioral immune system is considered to be a psychological adaptation that decreases the risk of infection. Research suggests that, in the current environment, this system can produce attitudes with negative health consequences, such as increased vaccine hesitancy. In three studies, we investigated whether two facets of the behavioral immune system-germ aversion (i.e., aversion to potential pathogen transmission) and perceived infectability (i.e., perceived susceptibility to disease)-predicted intentions to accept COVID-19 and influenza vaccination during the pandemic. The behavioral immune system mechanisms were measured before the COVID-19 pandemic in one study, and during the pandemic in two. In contrast to previous research, those with higher germ aversion during the pandemic perceived vaccines to be safer and had higher intentions to accept vaccination. Germ aversion before the pandemic was not associated with vaccination intentions. Individuals who perceived themselves as more susceptible to disease were slightly more willing to accept vaccination. We conjecture that high disease threat reverses the relationship between the behavioral immune system response and vaccination. As the associations were weak, individual differences in germ aversion and perceived infectability are of little practical relevance for vaccine uptake.
| S-EPMC8486622 | biostudies-literature
Project description:A fundamental challenge complicates news decisions about covering vaccine side effects: although serious vaccine side effects are rare, less severe ones do occur occasionally. The study was designed to test whether a side effect message could induce vaccine hesitancy and whether that could be countered by pro-vaccine messages about vaccine safety. A large (N = 2,345), nationally representative experiment was conducted by randomly exposing participants to one of six videos about the measles, mumps, and rubella (MMR) vaccine edited from news programs produced during the 2019 measles outbreak in the United States. The design was a 2x3 factorial crossing the presence or absence of a hesitancy-inducing narrative message with a pro-vaccine science-supporting message (i.e., no message, science-supporting expert message, or pro-vaccine narrative message), leading to a total of six conditions. A general linear model was used to assess the effects of these videos on respondents' (1) vaccine risk perceptions, (2) policy views on vaccination, (3) willingness to encourage others to vaccinate their children, and (4) intention to send a pro-vaccine letter to their state representative. Findings indicated that the science-supporting expert message about vaccine safety led to higher pro-vaccine evaluations relative to other conditions [e.g., b = -0.17, p < .001, a reduction in vaccine risk perceptions of 0.17 as compared to the control]. There was also suggestive evidence that the hesitancy-inducing narrative may limit the effectiveness of a science-supporting expert message, although this finding was not consistent across different outcomes. When shown alone the hesitancy-inducing narrative did not shift views and intentions, but more research is needed to ascertain whether exposure to such messages can undercut the pro-vaccine influence of science-supporting (expert) ones. All in all, however, it is clear that science-supporting messages are effective and therefore worthwhile in combating vaccine misinformation.
| S-EPMC7990169 | biostudies-literature
Project description:BACKGROUND:Patient reminders for influenza vaccination, delivered via electronic health record (EHR) patient portal messages and interactive voice response (IVR) calls, offer an innovative approach to improving patient care. OBJECTIVE:To test the effectiveness of portal and IVR outreach in improving rates of influenza vaccination. DESIGN:Randomized controlled trial of EHR portal messages and IVR calls promoting influenza vaccination. PARTICIPANTS:Adults with no documented influenza vaccination 2 months after the start of influenza season (2014-2015). INTERVENTION:Using a factorial design, we assigned 20,000 patients who were active portal users to one of four study arms: (a) receipt of a portal message promoting influenza vaccines, (b) receipt of IVR call with similar content, (c) both a and b, or (d) neither (usual care). We randomized 10,000 non-portal users to receipt of IVR call or usual care. In all intervention arms, information on pneumococcal vaccination was included if the targeted patient was overdue for pneumococcal vaccine. MAIN MEASURES:EHR-documented influenza vaccination during the 2014-2015 influenza season, measured April 2015. KEY RESULTS:Among portal users, 14.0% (702) of those receiving both portal messages and calls, 13.4% (669) of message recipients, 12.8% (642) of call recipients, and 11.6% (582) of those with usual care received vaccines. On multivariable analysis of portal users, those receiving portal messages alone (OR 1.20, 95% CI 1.06-1.35) or IVR calls alone (OR 1.15 95% CI 1.02-1.30) were more likely than usual care recipients to be vaccinated. Those receiving both messages and calls were also more likely than the usual care group to be vaccinated (ad hoc analysis, using a Bonferroni correction: OR 1.29, 97.5% CI 1.13, 1.48). Among non-portal users, 8.5% of call recipients and 8.6% of usual care recipients received influenza vaccines (p?=?NS). Pneumococcal vaccination rates showed no significant improvement. CONCLUSIONS:Our outreach achieved a small but significant improvement in influenza vaccination rates. Registration: ClinicalTrials.gov Identifier NCT02266277 ( https://clinicaltrials.gov/ct2/show/NCT02266277 ).
| S-EPMC5910339 | biostudies-literature
Project description:BACKGROUND:Although there is a rise in the use of mobile health (mHealth) tools to support chronic disease management, evidence derived from theory-driven design is lacking. OBJECTIVE:The objective of this study was to determine the impact of an mHealth app that incorporated theory-driven trigger messages. These messages took different forms following the Fogg behavior model (FBM) and targeted self-efficacy, knowledge, and self-care. We assess the feasibility of our app in modifying these behaviors in a pilot study involving individuals with diabetes. METHODS:The pilot randomized unblinded study comprised two cohorts recruited as employees from within a health care system. In total, 20 patients with type 2 diabetes were recruited for the study and a within-subjects design was utilized. Each participant interacted with an app called capABILITY. capABILITY and its affiliated trigger (text) messages integrate components from social cognitive theory (SCT), FBM, and persuasive technology into the interactive health communications framework. In this within-subjects design, participants interacted with the capABILITY app and received (or did not receive) text messages in alternative blocks. The capABILITY app alone was the control condition along with trigger messages including spark and facilitator messages. A repeated-measures analysis of variance (ANOVA) was used to compare adherence with behavioral measures and engagement with the mobile app across conditions. A paired sample t test was utilized on each health outcome to determine changes related to capABILITY intervention, as well as participants' classified usage of capABILITY. RESULTS:Pre- and postintervention results indicated statistical significance on 3 of the 7 health survey measures (general diet: P=.03; exercise: P=.005; and blood glucose: P=.02). When only analyzing the high and midusers (n=14) of capABILITY, we found a statistically significant difference in both self-efficacy (P=.008) and exercise (P=.01). Although the ANOVA did not reveal any statistically significant differences across groups, there is a trend among spark conditions to respond more quickly (ie, shorter log-in lag) following the receipt of the message. CONCLUSIONS:Our theory-driven mHealth app appears to be a feasible means of improving self-efficacy and health-related behaviors. Although our sample size is too small to draw conclusions about the differential impact of specific forms of trigger messages, our findings suggest that spark triggers may have the ability to cue engagement in mobile tools. This was demonstrated with the increased use of capABILITY at the beginning and conclusion of the study depending on spark timing. Our results suggest that theory-driven personalization of mobile tools is a viable form of intervention. TRIAL REGISTRATION:ClinicalTrials.gov NCT04132089; http://clinicaltrials.gov/ct2/show/NCT004122089.
| S-EPMC7105932 | biostudies-literature
Project description:Effective COVID-19 vaccine distribution requires prioritizing locations that are accessible to high-risk target populations. However, little is known about the vaccination location preferences of individuals with underlying chronic conditions. Using data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we grouped 162,744 respondents into high-risk and low-risk groups for COVID-19 and analyzed the odds of previous influenza vaccination at doctor's offices, health departments, community settings, stores, or hospitals. Individuals at high risk for severe COVID-19 were more likely to be vaccinated in doctor's offices and stores and less likely to be vaccinated in community settings.
| S-EPMC8345551 | biostudies-literature
Project description:OBJECTIVES:To evaluate whether the updated 2013 US Preventive Services Task Force (USPSTF) hepatitis C virus (HCV) screening recommendations, related Affordable Care Act provisions, and the impending availability of efficacious therapies were associated with increased screening in an integrated health system. STUDY DESIGN:We analyzed 665,339 records of adult patients visiting Kaiser Permanente Mid-Atlantic States clinics from 2003 to 2014. METHODS:We used Cox proportional hazards to estimate time to HCV screening and confirmation after June 1, 2013, compared with prior. RESULTS:HCV screening steadily increased over time, but it jumped 29% (P <.01) from 2013 to 2014 versus 4% (P <.01) from 2012 to 2013. The adjusted hazard ratio for HCV screening since June 2013 was 2.40 (95% CI, 2.34-2.47) times higher than it was pre-intervention among the birth cohort (those born 1945-1965) and 2.00 (95% CI, 1.96-2.04) times higher in those born in other years, representing a 1.20-fold (95% CI, 1.17-1.24) greater increase in the screening rate among the birth cohort. We also identified variability in those thought to be at higher risk of HCV infection. CONCLUSIONS:HCV screening has been increasing in our healthcare system, more so since June 2013 and among the birth cohort. The availability of efficacious therapies and coverage policies coincident with the USPSTF recommendations may have facilitated access to screening and treatment in ways that were absent at the time of the 2012 CDC recommendations. Health systems must also be poised to make resources available to clinicians and patients in order to incentivize screening. Future research should inform a better understanding of incentives and barriers to screening and linkage to care from all stakeholder perspectives.
| S-EPMC6132051 | biostudies-literature