Personally addressed emails designed with behavioral science can increase COVID-19 vaccine registration among vaccine-hesitant healthcare workers

Behavioral scientists at Geisinger’s Steele Institute for Health Innovation report findings from randomized trial

Peer-Reviewed Publication

GEISINGER HEALTH SYSTEM

DANVILLE, Pa. – A research letter published today in JAMA Network Open reports that individually addressed email reminders designed with behavioral science increased registration for a COVID-19 vaccination more than two-fold among healthcare workers who had not received a vaccine, compared with those who did not receive an email.

In one of the first real-world tests of an intervention to increase COVID-19 vaccination, members of the Behavioral Insights Team at Geisinger’s Steele Institute for Health Innovation used a combination of behavioral science principles, such as highlighting how many people have already been vaccinated, comparing the risk of a vaccine to that of COVID-19, and embedding a link to the registration portal, to develop the email messages.

The rate of COVID-19 vaccination is slowing in the United States, with some states having vaccination rates far below the target of 70%. Meanwhile, the increasing prevalence of the Delta variant, the threat of other COVID-19 variants, and the possibility that some or all vaccinated people will need to return for a booster shot highlight the importance of testing ways to increase vaccination.

“The evidence for easily scalable interventions for COVID-19 vaccination, like a well-designed email, has largely been limited to laboratory experiments that only measure intentions for getting a vaccine, which may or may not translate into actual behavior,” said Henri Santos, Ph.D., staff scientist in Geisinger’s Behavioral Insights Team and first author of the paper. “Although we focused on encouraging vaccination among healthcare workers—one of the first groups to gain access to COVID-19 vaccines—these messages could be adapted by other organizations and sent to other kinds of employees, students, or patients.”

Employees of Geisinger, a large, integrated health system in central and northeast Pennsylvania, began to access COVID-19 vaccines in mid-December. Between then and when the project was conducted in mid-January, the health system sent at least 36 COVID-19 vaccine-related emails to employees. At that point, employees were randomly assigned to one of three groups: one receiving an individually addressed “social norms” email, another receiving an individually addressed “reframing risks” email, or a delayed control group who received one of the two emails three days later. Those who received the social norms email were told that millions of U.S. residents and most of their fellow employees had been vaccinated or had scheduled a vaccination. Those who received the reframing risks email were presented with a comparison of the side effects of a vaccine against the much more serious known and unknown complications of COVID-19. Both emails were sent from the chief of infectious diseases and requested that the employee make a yes-or-no decision about receiving a vaccine.

Both the social norms and reframing risks emails led to more than twice as many registrations within three days (6.5% and 6.9% of recipients, respectively) compared with the delayed control group who had not yet received an email (3.2%)—an average absolute increase in vaccination registration of 3.5 percentage points. However, there was no significant difference between those who received the social norms and reframing risks emails.

“Like many lightweight behavioral interventions—sometimes called ‘nudges’—tested in the real world, ours had a modest impact, increasing the vaccination rate in our sample by 3.5 percentage points,” said Michelle Meyer, faculty co-director of the Behavioral Insights Team, assistant professor in Geisinger’s Research Institute, and the senior author of the paper. “On the other hand, these emails can be quickly sent to large numbers of people for free, and in some places, 3.5 percentage points might be the difference between reaching and failing to reach herd immunity. Our results suggest that some people who have been hesitant about the vaccine, even after a great deal of prior communication, can still be reached, at virtually no cost.”

About Geisinger
Geisinger is committed to making better health easier for the more than 1 million people it serves. Founded more than 100 years ago by Abigail Geisinger, the system now includes nine hospital campuses, a health plan with more than half a million members, a Research Institute, and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,600 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2021.18702

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Effect of Targeted Behavioral Science Messages on COVID-19 Vaccination Registration Among Employees of a Large Health System

ARTICLE PUBLICATION DATE

28-Jul-2021