Lottery Incentive Nudges to Increase Influenza Vaccinations
Study Details
Study Description
Brief Summary
In the current study, the study team will explore whether small incentives are effective at promoting flu vaccine uptake. The study is designed to compare the relative efficacy of incentives of equal perceived expected value (EV) or equal implementation costs, to assess whether people are more likely to get vaccinated in response to lotteries with very high payoffs than to small certain cash payout or slightly higher-probability, more moderate payoffs. In particular, given the potential appeal of official state lottery tickets, one study arm will receive a Pennsylvania scratch-off lottery ticket for getting a flu vaccine. A primary hypothesis is that lotteries will outperform simple reminders (encouraging respondents to get the flu shot at their upcoming appointment) and the standard of care, representing the ambient healthcare system and public health campaigns to increase vaccination.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
During the 2021-22 flu season, the study team will contact Geisinger patients who have a primary care or specialist appointment scheduled during flu season and encourage them to get a flu shot.
Patients will be randomized into 4 to 9 study arms, depending on a sample size projection completed in August 2021. Arms will test the relative efficacy of a variety of small monetary incentives on flu shot uptake. Incentives may include (a) a $1 Pennsylvania scratch-off lottery ticket (with top prize of $5,000), (b) $1 in cash, (c) entry into a raffle for $5,000 absent upfront odds, (d) entry into a raffle for $5,000, with 1-in-5,000 odds of winning, (d) entry into a raffle for $50, with 1-in-50 odds of winning, and (e) entry into a raffle for $500, with 1-in-500 odds of winning. There will be one no-contact control arm and at least 1 reminder control arm (with additional control arms added given sufficient sample size and additional message versions to be tested).
Included in the study will be current Geisinger patients 18+ years of age with no contraindications for flu vaccine who have an appointment scheduled during the study period with a provider who can administer the vaccine. The primary study outcomes will be the rates of flu vaccination and flu diagnosis during the 2021-22 season by targeted patients.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Pennsylvania (PA) Lottery Scratch-Off Financial Incentive Participants in this arm will receive a message stating that they will receive a PA lottery $1 scratch-off ticket if they get a flu shot at an upcoming appointment. The message will mention that they could win $5,000 (the top prize for the scratch-off game). Note: $1 scratch-off products vary over time; at study implementation, an active game with top prize of $5,000 (or the next-highest top prize) will be selected and will define the prize in the raffle absent upfront odds |
Behavioral: Reminder
Letter, short message service (SMS) text, phone, and/or email
Behavioral: Financial incentive
Letter, SMS, phone, and/or email
Behavioral: Lottery
Letter, SMS, phone, and/or email
|
| Experimental: Certain Cash Payout Financial Incentive Participants in this arm will receive a message stating that they will receive $1 in cash if they get a flu shot at an upcoming appointment. |
Behavioral: Reminder
Letter, short message service (SMS) text, phone, and/or email
Behavioral: Financial incentive
Letter, SMS, phone, and/or email
|
| Experimental: Reminder / Active Control (No Financial Incentive) Participants in this arm will receive a message stating that they can get a flu shot at an upcoming appointment. These participants will not be offered a financial incentive for getting a flu shot. |
Behavioral: Reminder
Letter, short message service (SMS) text, phone, and/or email
|
| No Intervention: No Treatment Control No additional contact beyond standard Geisinger flu shot communications |
Outcome Measures
Primary Outcome Measures
- Flu vaccination at appointment [3 days after patient is randomized]
Received flu vaccination at relevant PCP or specialty appointment.
Secondary Outcome Measures
- Flu vaccination within 7 days [Within 7 days of when patient is randomized]
Received flu vaccination
- Flu diagnosis [During the 2021-22 flu season (Up to 8 months, from the time the patient is randomized through April 30, 2022)]
Received a "high confidence flu" diagnosis (with positive polymerase chain reaction [PCR]/antigen/molecular test) and/or "likely flu" diagnosis (as assessed via International Classification of Disease [ICD] codes or Tamiflu administration or positive PCR/antigen/molecular test) Note that "likely flu" is a superset of the "high confidence flu" diagnoses.
- Flu complications [During the 2021-22 flu season (Up to 11 months, from the time the patient is randomized through July 31, 2022)]
Diagnosed with flu-related complications
- Flu vaccination (among subject cohabitants) within 28 days [Within 28 days of when the study subject is randomized]
Cohabitant of study subject received flu vaccination
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Aged 18+
-
Pennsylvania mailing address listed
-
Geisinger primary care provider (PCP) assigned
-
Upcoming appointment with PCP or select specialist who stocks and can administer the vaccine during the study period
Exclusion Criteria:
- Has opted out of receiving messages from Geisinger on all modalities being tested
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Geisinger Clinic | Danville | Pennsylvania | United States | 17822 |
Sponsors and Collaborators
- National Bureau of Economic Research, Inc.
- Geisinger Clinic
- Massachusetts Institute of Technology
- National Institute on Aging (NIA)
Investigators
- Principal Investigator: Michelle N Meyer, PhD JD, Geisinger Clinic
- Principal Investigator: Christopher F Chabris, PhD, Geisinger Clinic
Study Documents (Full-Text)
More Information
Publications
None provided.- 2021-0484
- P30AG034532