Abstract
Background
Messages aimed at increasing uptake of vaccines have been modestly successful, perhaps in part because they often focus on why individuals should receive a vaccine. Construal Level Theory posits that messages emphasizing “how” to get a vaccine may be more effective at encouraging vaccination than emphasizing “why.” This message framing may be particularly important for COVID-19 booster acceptance.
Objective
To determine if pre-visit patient portal messages designed using Construal Level Theory increase rates of COVID-19 booster vaccination.
Design and Interventions
This 3-arm randomized trial was conducted across three large, diverse primary care clinics in Massachusetts between February and May 2022, testing the impact of “how” versus “why” framed pre-visit messages versus no messages (“usual care”). Messages were sent by patient portal two business days before a visit.
Participants
Adults with upcoming primary care visits who had electronic health record evidence of receiving their initial COVID-19 vaccination series but not a booster dose.
Main Measures
Receipt of a COVID-19 booster vaccination after the message was sent through the visit date (primary outcome) or 6 weeks (secondary outcome).
Key Results
A total of 3665 patients were randomized (mean age: 53.5 years (SD: 17.3), 59% female, 65.2% White, 26.6% Hispanic), with 1249 to “how” 1199 to “why,” and 1217 to usual care arms. Except for clinic and preferred language, characteristics were well balanced across arms. Rates of COVID-19 booster were 13.6% (usual care), 11.7% (“how”) (odds ratio (OR) “how” vs usual care: 0.87, 95%CI: 0.67–1.14), and 13.7% (“why”) (“why” vs usual care: OR: 1.01, 95%CI: 0.81–1.28). At 6 weeks, “why” outperformed “how” for vaccination (OR: 1.26, 95%CI: 1.06–1.49), with no difference versus usual care.
Conclusions
We found no differences on visit booster receipt after single pre-visit portal messages designed using Construal Level Theory. Further studies to identify effective messaging interventions are needed, especially as additional doses are recommended.
Clinical Trial Registration
This trial is registered at clinicaltrials.gov, ID: NCT04871776. Initial release occurred 04/30/2021.
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Funding
This research was supported by the National Institute on Aging of the National Institutes of Health under Award Number P30AG064199 to BWH (Choudhry PI). Dr. Lauffenburger (K01HL141538) and Dr. Haff (K23HL161480) were also supported in part by career development grants from the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Dr. Choudhry serves as a consultant to Veracity Healthcare Analytics and holds equity in RxAnte and DecipherHealth; unrelated to the current work, Dr. Choudhry has also received unrestricted grant funding payable to Brigham and Women’s Hospital from Humana. The remainder of the authors report no conflicts of interest.
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Haff, N., Choudhry, N.K., Bhatkhande, G. et al. “How” Versus “Why” Messaging to Increase Uptake of Booster Vaccination Against COVID-19: Results of a Pragmatic Randomized Trial. J GEN INTERN MED 39, 611–618 (2024). https://doi.org/10.1007/s11606-023-08492-x
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DOI: https://doi.org/10.1007/s11606-023-08492-x