Health PromotionNCT04289623
Assessing the Impact of myHealth Rewards Program-related Communications on Enrollment: Replication
An observational study of Health Promotion and Wellness Program, run by Geisinger Clinic at 1 site in United States.
Trial summary
The purpose of the study is to evaluate, prospectively, the potential impact on myHealth Rewards wellness program enrollment (prior to the 2020 deadline) of sending different messages via email to Geisinger Health Plan (GHP) members who have not yet enrolled. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Health Promotion, Wellness Program
- What is being tested?
- Email, Loss frame and Testimonial (medical expert)
- Type of treatment
- Lifestyle or therapy programme
- How many people
- 13,546 participants
- Where
- 1 siteUnited States
- Study dates
- 25 Feb 2020to 10 Mar 2020
- Phase
- Observational
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Study population: The population consists of Geisinger Health System employees who are also Geisinger Health Plan members and are not currently enrolled in myHealth Rewards.
Who may be able to join
- Geisinger Health Plan members
- Geisinger Health System employees who have not yet enrolled in myHealth Rewards
Who cannot join
- Enrollment in myHealth Rewards before the email launch date for each wave
- Do not have an email address on file
Trial locations and contacts
1 site in 1 country.
About this study
The purpose of the study is to evaluate, prospectively, the potential impact on myHealth Rewards wellness program enrollment (prior to the 2020 deadline) of sending different messages via email to Geisinger Health Plan (GHP) members who have not yet enrolled. In particular, this study aims to replicate and extend (with greater sample size and statistical power) the findings from a previous study in which email communication using loss framing language achieved significantly higher click-through rates than a more standard communication, whereas actual enrollment rates were not significantly higher.
Read the detailed description
The myHealth Rewards wellness program managed by GHP rewards those GHP members who carry their insurance through employment at Geisinger with reduced health insurance premiums over the course of the following year, if members register for the program and have their health measures on file by the enrollment deadline and are then able to meet their health goals by the respective due date. In spite of the potential savings to health plan members and the wellness program's potential to motivate engagement in healthy activities (with consequent improvement in health outcomes), about 23% of eligible existing GHP members did not enroll during the primary 2019 enrollment period, even after receiving promotional email communications and reminders.
Previous work examining myHealth Rewards found that email communication using loss framing language achieved significantly higher click-through rates than a more standard communication, whereas actual enrollment rates were not statistically significantly higher.
The current study aims to analyze de-identified Geisinger Health Plan (GHP) member data, comparing enrollment status (and secondarily, click-through rates) within the 2020 enrollment period across email conditions to which GHP members will be randomly assigned. The main part of this study will compare the effects of a standard, generic communication vs. communication with loss framing, using a larger sample size for adequate statistical power to detect the original difference in enrollment rates as significant, should that difference be real and reliable. Additional conditions are added after this main comparison in order to compare more precisely other pairs of communications conceived in the original study.
The generic email condition will consist of a standard email of the kind that would typically be sent by GHP to encourage enrollment, which includes the average amount saved, the ease of registration, and a reward incentive. The loss framing condition will highlight that respondents are forfeiting savings unless they take action and register. The two testimonial conditions will have a testimonial from a doctor (medical expert condition) or a customer care specialist (rank-and-file condition) about how the program helped them. The two social norms conditions will show the percentage (percentage condition) or number (number condition) of fellow Geisinger members who already signed up. Emails will go out in three waves. For each wave, Geisinger employees who have not already registered at that time will be randomized into one of two groups:
Wave 1: generic email vs. loss framing email
Wave 2: testimonial (expert) vs. testimonial (rank-and-file)
Wave 3: social norms (percentage) vs. social norms (number)
It is hypothesized that, on average, the loss frame email will increase enrollment compared with the standard email. The other comparisons are exploratory and do not have a priori hypotheses. Findings will help inform how best to increase enrollment in a wellness program through email communication.
- Conditions
- Health Promotion, Wellness Program
- Being tested
- Email, Loss frame, Testimonial (medical expert), Testimonial (rank-and-file), Social norms (percentage)
- Keywords
- Prospect theory, Social norms, Social proof, Authority
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
EmailBehavioural
Email
Loss frameBehavioural
Also called Endowment effect
Email
Testimonial (medical expert)Behavioural
Also called Authority
Email
Testimonial (rank-and-file)Behavioural
Also called Social proof
Email
Social norms (percentage)Behavioural
Also called Social proof
Email
Social norms (number)Behavioural
Also called Social proof
Email
| Study group | Role | What they receive |
|---|---|---|
| Standard email | This email mentions the cost-saving benefits of enrollment by participants who met their 2018 goals. It also includes the message that registration can be completed quickly (in less than five minutes). Finally, it also includes reward incentive information, wherein registering by a March deadline provides qualified recipients with the potential to win prizes. This information is contained in all other emails. Receives: Behavioral: Email | |
| Loss frame email | In addition to the content of the generic email, the subject line and content of the loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. This email further frames the reward as something recipients will miss out on if they do not sign up.
This intervention frames the status quo as a state from which recipients, via inaction, are slated to forfeit a sizable and precise monetary amount to which they should otherwise feel entitled (via loss aversion and the endowment effect). People tend to be risk-seeking in the domain of losses; therefore, this intervention is hypothesized to increase enrollment in the hope of achieving zero loss by meeting program goals, as opposed to a sure loss via inaction. Receives: Behavioral: Email; Behavioral: Loss frame | |
| Testimonial (medical expert) email | In addition to the content of the generic email, the testimonial (medical expert) email includes a testimonial from a doctor, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress.
This intervention shows proof of other people successfully enrolling and benefitting from the program. Specifically, it is an endorsement from a presumed authority figure. Recipients may be more likely to enroll for this program if they see a physician - who would be seen as an authority on health and wellness - talking about the medical benefits of the program. It is unclear in the current context and population if a message from an expert or rank-and-file employee would be more effective. Receives: Behavioral: Email; Behavioral: Testimonial (medical expert) | |
| Testimonial (rank-and-file) email | In addition to the content of the generic email, the testimonial (rank-and-file) email includes a testimonial from a customer care specialist, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress.
This intervention shows proof of other people successfully enrolling and benefitting from the program. Specifically, it is an endorsement from a peer (relative to most Geisinger employees). Recipients may be more likely to enroll for this program if they see a rank-and-file employee talking about the program as this person would be more relatable (relative to a doctor). It is unclear in the current context and population if a message from an expert or rank-and-file employee would be more effective. Receives: Behavioral: Email; Behavioral: Testimonial (rank-and-file) | |
| Social norms (percentage) email | In addition to the content of the generic email, the social norms (percentage) email will include communication about the percentage of benefit-eligible employees who had already registered for myHealth Rewards.
This message sets up a descriptive norm, showing that a majority of people are doing a certain behavior. When people see a behavior as the norm, they are more likely to follow it. The use of percentages makes it clear that this behavior is indeed being done by most people in the group. It is unclear in the current context and population if a message using percentages or numbers would be more effective. Receives: Behavioral: Email; Behavioral: Social norms (percentage) | |
| Social norms (number) email | In addition to the content of the generic email, the social norms (number) email will include communication about the number of benefit-eligible employees who had already registered for myHealth Rewards.
This message sets up a descriptive norm, showing that a large number of people are doing a certain behavior. When people see a behavior as the norm, they are more likely to follow it. While the use of numbers does not indicate that this behavior is being done by a majority, using a large number can be more convincing just in showing sheer quantity. Receives: Behavioral: Email; Behavioral: Social norms (number) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Rate of Enrollment (14 Days)
Enrollment in the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves.
Measured: 14 days
Rate of Logging in (14 Days)
Logging into the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves.
Measured: 14 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Feb 2020
- Study start25 Feb 2020
- Primary completion10 Mar 2020
- Study completion10 Mar 2020
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Health PromotionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case-control
- Time perspective
- Prospective
- Enrolment
- 13,546 participants (actual)
Sponsor and investigators
- Lead sponsor
- Geisinger Clinic
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Amir Goren, PhD, Principal investigator, Geisinger Clinic
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04289623
- Sponsor's protocol ID
- 2020-0218
- Status last verified
- Jun 2021
- First submitted
- 27 Feb 2020
- Last updated
- 9 Jul 2021
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings. The PI did not examine or analyze any data from this study prior to this registration.
Study at a glance
From the registry record, last updated by the sponsor on 9 Jul 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Assessing the Impact of myHealth Rewards Program-related Communications on Enrollment: Replication
- ClinicalTrials.gov ID
- NCT04289623
- Acronym / sponsor ID
- 2020-0218
- Conditions
- Health Promotion, Wellness Program
- Keywords
- Prospect theory, Social norms, Social proof, Authority
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 13,546 participants (actual)
- Lead sponsor
- Geisinger ClinicUniversity, hospital or other
- Study start
- 25 Feb 2020 (actual)
- Primary completion
- 10 Mar 2020 (actual)
- Study completion
- 10 Mar 2020 (actual)
- First posted
- 28 Feb 2020 (actual)
- Results
- Posted 9 Jul 2021
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of the study is to evaluate, prospectively, the potential impact on myHealth Rewards wellness program enrollment (prior to the 2020 deadline) of sending different messages via email to Geisinger Health Plan (GHP) members who have not yet enrolled. In particular, this study aims to replicate and extend (with greater sample size and statistical power) the findings from a previous study in which email communication using loss framing language achieved significantly higher click-through rates than a more standard communication, whereas actual enrollment rates were not significantly higher.
Detailed description
The myHealth Rewards wellness program managed by GHP rewards those GHP members who carry their insurance through employment at Geisinger with reduced health insurance premiums over the course of the following year, if members register for the program and have their health measures on file by the enrollment deadline and are then able to meet their health goals by the respective due date. In spite of the potential savings to health plan members and the wellness program's potential to motivate engagement in healthy activities (with consequent improvement in health outcomes), about 23% of eligible existing GHP members did not enroll during the primary 2019 enrollment period, even after receiving promotional email communications and reminders.
Previous work examining myHealth Rewards found that email communication using loss framing language achieved significantly higher click-through rates than a more standard communication, whereas actual enrollment rates were not statistically significantly higher.
The current study aims to analyze de-identified Geisinger Health Plan (GHP) member data, comparing enrollment status (and secondarily, click-through rates) within the 2020 enrollment period across email conditions to which GHP members will be randomly assigned. The main part of this study will compare the effects of a standard, generic communication vs. communication with loss framing, using a larger sample size for adequate statistical power to detect the original difference in enrollment rates as significant, should that difference be real and reliable. Additional conditions are added after this main comparison in order to compare more precisely other pairs of communications conceived in the original study.
The generic email condition will consist of a standard email of the kind that would typically be sent by GHP to encourage enrollment, which includes the average amount saved, the ease of registration, and a reward incentive. The loss framing condition will highlight that respondents are forfeiting savings unless they take action and register. The two testimonial conditions will have a testimonial from a doctor (medical expert condition) or a customer care specialist (rank-and-file condition) about how the program helped them. The two social norms conditions will show the percentage (percentage condition) or number (number condition) of fellow Geisinger members who already signed up. Emails will go out in three waves. For each wave, Geisinger employees who have not already registered at that time will be randomized into one of two groups:
Wave 1: generic email vs. loss framing email
Wave 2: testimonial (expert) vs. testimonial (rank-and-file)
Wave 3: social norms (percentage) vs. social norms (number)
It is hypothesized that, on average, the loss frame email will increase enrollment compared with the standard email. The other comparisons are exploratory and do not have a priori hypotheses. Findings will help inform how best to increase enrollment in a wellness program through email communication.
Study design
- Observational model
- Case-control
- Time perspective
- Prospective
- Number of arms
- 6
| Arm | Type | Receives |
|---|---|---|
| Standard email | – | Behavioral: EmailThis email mentions the cost-saving benefits of enrollment by participants who met their 2018 goals. It also includes the message that registration can be completed quickly (in less than five minutes). Finally, it also includes reward incentive information, wherein registering by a March deadline provides qualified recipients with the potential to win prizes. This information is contained in all other emails. |
| Loss frame email | – | Behavioral: Email, Behavioral: Loss frameIn addition to the content of the generic email, the subject line and content of the loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. This email further frames the reward as something recipients will miss out on if they do not sign up. This intervention frames the status quo as a state from which recipients, via inaction, are slated to forfeit a sizable and precise monetary amount to which they should otherwise feel entitled (via loss aversion and the endowment effect). People tend to be risk-seeking in the domain of losses; therefore, this intervention is hypothesized to increase enrollment in the hope of achieving zero loss by meeting program goals, as opposed to a sure loss via inaction. |
| Testimonial (medical expert) email | – | Behavioral: Email, Behavioral: Testimonial (medical expert)In addition to the content of the generic email, the testimonial (medical expert) email includes a testimonial from a doctor, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. This intervention shows proof of other people successfully enrolling and benefitting from the program. Specifically, it is an endorsement from a presumed authority figure. Recipients may be more likely to enroll for this program if they see a physician - who would be seen as an authority on health and wellness - talking about the medical benefits of the program. It is unclear in the current context and population if a message from an expert or rank-and-file employee would be more effective. |
| Testimonial (rank-and-file) email | – | Behavioral: Email, Behavioral: Testimonial (rank-and-file)In addition to the content of the generic email, the testimonial (rank-and-file) email includes a testimonial from a customer care specialist, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. This intervention shows proof of other people successfully enrolling and benefitting from the program. Specifically, it is an endorsement from a peer (relative to most Geisinger employees). Recipients may be more likely to enroll for this program if they see a rank-and-file employee talking about the program as this person would be more relatable (relative to a doctor). It is unclear in the current context and population if a message from an expert or rank-and-file employee would be more effective. |
| Social norms (percentage) email | – | Behavioral: Email, Behavioral: Social norms (percentage)In addition to the content of the generic email, the social norms (percentage) email will include communication about the percentage of benefit-eligible employees who had already registered for myHealth Rewards. This message sets up a descriptive norm, showing that a majority of people are doing a certain behavior. When people see a behavior as the norm, they are more likely to follow it. The use of percentages makes it clear that this behavior is indeed being done by most people in the group. It is unclear in the current context and population if a message using percentages or numbers would be more effective. |
| Social norms (number) email | – | Behavioral: Email, Behavioral: Social norms (number)In addition to the content of the generic email, the social norms (number) email will include communication about the number of benefit-eligible employees who had already registered for myHealth Rewards. This message sets up a descriptive norm, showing that a large number of people are doing a certain behavior. When people see a behavior as the norm, they are more likely to follow it. While the use of numbers does not indicate that this behavior is being done by a majority, using a large number can be more convincing just in showing sheer quantity. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
- Study population
- The population consists of Geisinger Health System employees who are also Geisinger Health Plan members and are not currently enrolled in myHealth Rewards.
Key inclusion criteria (2 listed)
- Geisinger Health Plan members
- Geisinger Health System employees who have not yet enrolled in myHealth Rewards
Key exclusion criteria (2 listed)
- Enrollment in myHealth Rewards before the email launch date for each wave
- Do not have an email address on file
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| EmailEmail | Behavioural | Loss frame email, Social norms (number) email, Social norms (percentage) email, Standard email, Testimonial (medical expert) email, Testimonial (rank-and-file) email |
| Loss frameAlso: Endowment effectEmail | Behavioural | Loss frame email |
| Testimonial (medical expert)Also: AuthorityEmail | Behavioural | Testimonial (medical expert) email |
| Testimonial (rank-and-file)Also: Social proofEmail | Behavioural | Testimonial (rank-and-file) email |
| Social norms (percentage)Also: Social proofEmail | Behavioural | Social norms (percentage) email |
| Social norms (number)Also: Social proofEmail | Behavioural | Social norms (number) email |
Primary outcome
Rate of Enrollment (14 Days)
Time frame: 14 days
Enrollment in the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves.
Rate of Logging in (14 Days)
Time frame: 14 days
Logging into the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves.
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Jul 2021.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Individual participant dataSharing planned: Yes. Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings. The PI did not examine or analyze any data from this study prior to this registration.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Amir Goren, PhD principal investigator
Geisinger Clinic
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Health Promotion and Wellness Program, run by Geisinger Clinic at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 9 Jul 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 9 Jul 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Rate of Enrollment (14 Days) (time frame: 14 days). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jul 2021.