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Influenza, HumanNCT04590066

Testing Multiple Behavioral Science Strategies to Increase Flu-Shot Rates at a Large Retail Pharmacy

A study testing Flu shot text messages in people with Influenza, Human, run by University of Pennsylvania at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

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. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Influenza, Human
What is being tested?
Flu shot text messages
Could I receive a placebo?
No, everyone receives an active treatment
How many people
734,383 participants
Where
1 siteUnited States
Study dates
25 Sep 2020to 31 Dec 2020
Phase
Interventional
Are there results?
None posted in the registry

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

Who may be able to join

  • Have agreed to receive SMS messages from the pharmacy
  • Received a flu shot from the pharmacy in the 2019-2020 flu season, as documented in their pharmacy records.

Who cannot join

  • -

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Pennsylvania

    Philadelphia, Pennsylvania, 19104

Other trials in United States

About this study

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, sent automated calls or text messages reminding patients to get a flu vaccination , or provided financial incentives for getting vaccinated. 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 22 different SMS interventions to increase flu vaccinations compared to a holdout control condition 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). Customers of a large retail pharmacy who received a flu shot from the pharmacy last year and receive SMS notifications will be included in this study. We expect this to include approximately 1.2 million 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).

Being tested
Flu shot text messages
Keywords
Influenza vaccination, behavioral science interventions, vaccination promotion
Medical subject headings
Influenza, Human

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Flu shot text messagesBehavioural

    Participants will receive text messages per descriptions listed in the arms.

Study groups in NCT04590066
Study groupRoleWhat they receive
Holdout controlNo interventionParticipants will only receive the standard pharmacy messaging.
Unpacking Risks TreatmentExperimentalParticipants will be asked to think about the risks of catching the flu this flu season and to respond with the location they are most likely to catch the flu out of a list of given options (e.g. at work, at home).
Receives: Behavioral: Flu shot text messages
Unpacking Risks ControlExperimentalParticipants will be asked to think about the risks of catching the flu this flu season and to respond to confirm that they have received the message.
Receives: Behavioral: Flu shot text messages
Active Commitment TreatmentExperimentalParticipants receive a gain framed notification that they are eligible for a flu shot. In addition, participants are told "Many people find it helpful to make a plan to get their shot" and are asked to commit by texting back "I will get a flu shot." Depending on their response, participants receive a general reminder or a commitment reminder 3 days later.
Receives: Behavioral: Flu shot text messages
Active Commitment ControlExperimentalParticipants receive a gain framed notification that they are eligible for a flu shot. Participants receive a general reminder 3 days later.
Receives: Behavioral: Flu shot text messages
Self-Generated Social Norms TreatmentExperimentalParticipants will first receive a message enjoining them to consider 2 peers who would want them to vaccinate. Then they will be asked to do those peers a favor by getting a vaccine at their next opportunity. They will receive a reminder 3 days later.
Receives: Behavioral: Flu shot text messages
Self-Generated Social Norms ControlExperimentalarticipants will be informed of the opportunity to receive a flu vaccine at their appointment. They will receive a reminder 3 days later.
Receives: Behavioral: Flu shot text messages
Foot-in-the-Door TreatmentExperimentalParticipants will first receive a message enjoining them to encourage someone else to receive a flu vaccine this year. They will then be given a message that they might copy-paste to forward to friends, thereby lowering the effort costs of messaging others. They will receive a reminder 3 days later.
Receives: Behavioral: Flu shot text messages
Foot-in-the-Door ControlExperimentalParticipants will be informed of the opportunity to receive a flu vaccine at their appointment. They will receive a reminder 3 days later.
Receives: Behavioral: Flu shot text messages
Prosocial ConditionExperimentalParticipants will receive a message describing the condition-specific benefit of getting a flu shot, and a reminder to ask for their flu shot. The message will also give prosocial reasons for vaccinating (i.e., protecting loved ones; preserving scarce resources).
Receives: Behavioral: Flu shot text messages
Self-Oriented ConditionExperimentalParticipants will receive a message describing the condition-specific benefit of getting a flu shot, and a reminder to ask for their flu shot.
Receives: Behavioral: Flu shot text messages
Prosocial + COVID-19ExperimentalParticipants will receive a message describing the condition-specific benefit of getting a flu shot, and a reminder to ask for their flu shot. The message will also give prosocial reasons for vaccinating (e.g., protecting loved ones; preserving scarce resources). The message will also emphasize the pandemic (e.g., risk of hospital-acquired COVID-19 infection; wasting scarce resources).
Receives: Behavioral: Flu shot text messages
Self-Oriented + COVID-19ExperimentalParticipants will receive a message describing the condition-specific benefit of getting a flu shot, and a reminder to ask for their flu shot. The message will also emphasize the pandemic (e.g., risk of hospital-acquired COVID-19 infection; wasting scarce resources).
Receives: Behavioral: Flu shot text messages
Dynamic + Static NormExperimentalParticipants will receive a text message encouraging them to get a flu shot and informing them that more American adults are getting their flu shot than ever before and how many Americans got their flu shot last year.
Receives: Behavioral: Flu shot text messages
Dynamic NormExperimentalParticipants will receive a text message encouraging them to get a flu shot and informing them that more American adults are getting their flu shot than ever before.
Receives: Behavioral: Flu shot text messages
Dynamic Norms ControlExperimentalParticipants will only receive a text message encouraging them to get a flu shot. They will not receive any norm information.
Receives: Behavioral: Flu shot text messages
Sharing HumorExperimentalParticipants will receive a text message encouraging them to get the flu shot. The message will include a joke about the flu and will encourage participants to share the joke with nurses, doctors, or pharmacists.
Receives: Behavioral: Flu shot text messages
Humor PlaceboExperimentalParticipants will receive a text message encouraging them to get the flu shot. This message will include the same joke but participants will not be encouraged to share it.
Receives: Behavioral: Flu shot text messages
No Humor ConditionExperimentalParticipants will receive a text message encouraging them to get the flu shot.
Receives: Behavioral: Flu shot text messages
Connecting the Past Self to the Future Self TreatmentExperimentalParticipants will receive a text message prompt to recall the negative experience of getting sick. When asked, "Do you wish you could have avoided getting sick by getting a simple shot?", participants will have the chance to respond Y for yes or N for no. Regardless of their response, they will be prompted with a second text message to connect their past experience with present-day opportunities for preventative care (getting a flu shot) to protect the future self from the flu.
Receives: Behavioral: Flu shot text messages
Connecting the Past Self to the Future Self ControlExperimentalIn the first text message, participants will receive a simple text message encouragement to receive a flu shot. In the second text message, they will receive a reminder of the appointment time and provider name.
Receives: Behavioral: Flu shot text messages
Reverse Inference ConditionExperimentalParticipants will receive a text message encouraging them to get a flu shot and informing them that Americans who get flu shots are healthier, wealthier, and more educated.
Receives: Behavioral: Flu shot text messages
Reverse Inference Control ConditionExperimentalParticipants will receive a text message encouraging them to get a flu shot and informing them that Americans who get flu shots are less likely to get the flu.
Receives: Behavioral: Flu shot text messages

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Whether participants receive a flu shot vaccination at our pharmacy partner by December 31, 2020

    The primary outcome measure is whether participants receive a flu shot at our retail pharmacy partner by December 31, 2020 (as recorded in their pharmacy records) after receiving the SMS intervention on September 25, 2020.

    Participants who receive a flu shot before September 25, 2020 when they received the SMS intervention will be excluded from the analyses.

    Measured: 98 days

Secondary outcomes (1)
  1. Whether participants receive a flu shot vaccination at our pharmacy partner by October 31, 2020

    The secondary outcome measure is whether participants receive a flu shot at our retail pharmacy partner by October 31, 2020 (as recorded in their pharmacy records) after receiving the SMS intervention on September 25, 2020.

    Participants who receive a flu shot before they receive the SMS intervention on September 25, 2020 will be excluded from the analyses.

    Measured: 37 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Oct 2020
  2. Study start25 Sep 2020
  3. Primary completion31 Dec 2020
  4. Study completion31 Dec 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Model description
Participants will be randomly assigned to the different arms.
Masking
Double blind
Who is masked
Care provider, Outcomes assessor
Enrolment
734,383 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04590066
Sponsor's protocol ID
843523-Trial B
Status last verified
Jan 2021
First submitted
2 Oct 2020
Last updated
1 Feb 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Cutrona SL, Golden JG, Goff SL, Ogarek J, Barton B, Fisher L, Preusse P, Sundaresan D, Garber L, Mazor KM. Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial. J Gen Intern Med. 2018 May;33(5):659-667. doi: 10.1007/s11606-017-4266-9. Epub 2018 Jan 30.

    PubMed 29383550
  • Milkman KL, Beshears J, Choi JJ, Laibson D, Madrian BC. Using implementation intentions prompts to enhance influenza vaccination rates. Proc Natl Acad Sci U S A. 2011 Jun 28;108(26):10415-20. doi: 10.1073/pnas.1103170108. Epub 2011 Jun 13.

    PubMed 21670283
  • Regan AK, Bloomfield L, Peters I, Effler PV. Randomized Controlled Trial of Text Message Reminders for Increasing Influenza Vaccination. Ann Fam Med. 2017 Nov;15(6):507-514. doi: 10.1370/afm.2120.

    PubMed 29133488
  • Nowalk MP, Lin CJ, Toback SL, Rousculp MD, Eby C, Raymund M, Zimmerman RK. Improving influenza vaccination rates in the workplace: a randomized trial. Am J Prev Med. 2010 Mar;38(3):237-46. doi: 10.1016/j.amepre.2009.11.011. Epub 2009 Dec 24.

    PubMed 20036102

Questions about this trial

What is this clinical trial studying?

A study testing Flu shot text messages in people with Influenza, Human, run by University of Pennsylvania 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 1 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 1 Feb 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Whether participants receive a flu shot vaccination at our pharmacy partner by December 31, 2020 (time frame: 98 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04590066, which also lists 4 linked publications.

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 1 Feb 2021.

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