- An inexpensive, scalable and easy-to-implement way to nudge more unvaccinated healthcare workers to get their COVID-19 shot is through employers sending targeted emails, patient portal messages, text messages and other communications designed with behavioral science in mind, according to a study published Wednesday in JAMA Network Open.
- Researchers looked at healthcare workers across Geisinger's system in Pennsylvania who received 36 vaccine-related mass emails over five weeks, and 41% had still not scheduled their vaccination. Researchers ran a targeted email experiment on whether they could nudge these holdouts to get the shot.
- Among those unvaccinated workers, an individual email nudge playing up social norms and virus risk caused more than twice as many employees to register for a COVID-19 vaccine compared with employees in the control condition, the study found.
Health systems across the country are grappling with whether to mandate COVID-19 vaccinations among their employees amid rising cases of the delta variant.
A coalition of over 50 medical groups representing an array of different providers issued a joint statement urging healthcare facilities to require COVID-19 vaccines for employees on Monday, and some large systems have already done so.
On the same day, the U.S. Department of Veterans Affairs announced it was mandating the shot for employees, and Justice Department lawyers posted an opinion affirming that federal law doesn't prohibit both public and private sector employers from requiring vaccines.
As healthcare employers decide which path they'll take, they should try nudging some hold-out employees through targeted messaging and easy appointment scheduling, JAMA researchers contend in their report.
Out of 23,700 Geisinger employees who all received the first 36 vaccine-related emails over five weeks, 9,723 did not sign up to get vaccinated, according to the study.
Researchers broke the unvaccinated up into a control group and another group to receive one of two individually addressed emails with three components.
Both emails said Pennsylvania was expanding vaccine eligibility beyond healthcare workers and could reduce employees' access to appointments. The emails sent the the first group framed the decision to be vaccinated by noting that many residents and fellow employees had chosen to get the shot, playing on social norms. The messages sent to the second group compared the vaccine's risk with that of the actual virus.
Both emails then asked employees to either schedule their vaccine appointment through a hyperlinked scheduling portal, or take a hyperlinked survey explaining their reason for declining the shot.
The individual email caused more than twice as many workers to register for a shot compared with those in the control condition during the three-day study, with no significant difference between the first email playing up social norms and the second contrasting risk, according to the report.
Researchers noted that in choosing two different emails, they couldn't exclude the possibility that a general reminder could have the same impact. They also noted the emails may be more effective among recipients who are less hesitant about receiving the vaccine.
"Given the large volume of previous COVID-19 vaccine promotion to healthcare workers, it may seem counterintuitive that a single additional reminder could increase vaccination by late adopters," the study said.
"However, competing demands on attention, behavioral inertia, and unwieldy processes that make it hard to follow through on intentions likely conspire to make a single, timely, targeted reminder helpful," it said.
Among the 1,229 workers who declined to schedule a vaccine appointment and then completed the survey, the most common reasons were unknown vaccine risks (35%) and pregnancy related concerns (13%).