Abstract
Background
Vaccine hesitancy, especially related to COVID-19 vaccinations among Veterans, may limit uptake. Behaviorally informed text-based messages have the potential to improve uptake of COVID-19 vaccinations.
Objective
To evaluate the impact of two different behaviorally informed text message nudges on COVID-19 vaccine scheduling and completion, compared to standard control message.
Design
Prospective, three-arm patient-level randomized quality improvement trial.
Participants
Between March and May 2021, 20,523 Veterans were eligible for the initial series of COVID-19 vaccination, enrolled at two large Veterans Health Administration sites.
Intervention
Arm 1 (Control): standard scheduling message; Arm 2 (Social Good): standard message plus behaviorally informed text message “When you get a vaccine now, you help protect yourself, your family, and your community”; and Arm 3 (Scarcity): standard plus behaviorally informed text message “Only a limited number of vaccine appointments are available.”
Main Measures
Outcomes were vaccine scheduling and/or completion rate within 7 days of receipt of text message (primary), and within 14 days and 30 days after receipt of text message (secondary).
Key Results
Veterans had an overall rate of 19% of scheduling or receiving a vaccination in 7 days. In our adjusted intention-to-treat analysis, we found no difference between intervention social good or scarcity (aOR 0.98, 95% CI, 0.88–1.09, for both arms) compared to standard scheduling message. We found no statistical differences in our secondary outcomes.
Conclusions
During the initial phases of vaccine roll-out, two behaviorally informed text messages did not increase COVID-19 vaccination rates among Veterans compared to a standard scheduling message.


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Acknowledgements
This work was made possible through operational support and funding from VA Puget Sound Health Care System Leadership. Additionally, this work was funded by the Primary Care Analytics Team through the Veterans Health Administration Office of Primary Care. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US government, the Department of Veterans Affairs, and the University of Washington.
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Reddy, A., Geyer, J., Wheat, C. et al. Behaviorally Informed Text Message Nudges to Schedule COVID-19 Vaccinations: A Randomized Controlled Trial. J GEN INTERN MED 40, 1078–1084 (2025). https://doi.org/10.1007/s11606-024-09170-2
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DOI: https://doi.org/10.1007/s11606-024-09170-2