For vaccine text-message campaigns, researchers confirm success is all about timing

Textual content-message “nudges” despatched out to unvaccinated Rhode Islanders in late spring 2021 did not enhance COVID-19 vaccine uptake, in line with a brand new research led by researchers at Brown College’s Coverage Lab.

However the researchers posit that the messages’ ineffectiveness was principally attributable to their timing: By the point unvaccinated folks within the Ocean State acquired the nudges, all state residents ages 16 and up had been eligible to get a shot for at the very least 4 weeks.

The research was printed on Wednesday, April 6, in Nature, simply seven months after researchers on the College of California Los Angeles printed an influential study that discovered that textual content messages have been efficient at boosting vaccination charges early in 2021.

However the Coverage Lab’s research — which analyzes the outcomes of a textual content message marketing campaign it carried out in partnership with the Rhode Island Division of Well being — is way from a repudiation of these outcomes, the authors mentioned. Slightly, it presents vital extra info on when text-message vaccination campaigns work and after they do not — takeaways that researchers say could possibly be useful to well being officers throughout america as they work to maintain People wholesome and out of hospitals by selling COVID-19 and influenza vaccine uptake.

“On the one hand, you could possibly say, ‘What a bummer that these nudges do not work a month after vaccinations turn into obtainable to all adults,'” mentioned Kevin Wilson, affiliate director of knowledge science on the Coverage Lab and a co-author of the research. “However alternatively, we now have extra info that may assist people who find themselves pondering critically about how and when to make public well being interventions. We have unlocked one other piece of the puzzle.”

Collaborating to enhance public well being

Wilson mentioned working with RIDOH on the text-message marketing campaign was the newest in a sequence of collaborations with state well being leaders. Because the Coverage Lab’s founding in 2019, it has labored with the Government Workplace of Well being and Human Providers, which homes RIDOH, to raised perceive the effectiveness of behavioral interventions focusing on the opioid epidemic, and to assist develop instruments that might enhance the state’s Medicaid and Supplemental Diet Help applications. Initially of the COVID-19 pandemic, Coverage Lab workers collaborated with the state to design protected, environment friendly PCR testing services and helped leaders survey native residents to grasp what behaviors they have been implementing to maintain their households protected, together with social distancing, masking and testing.

In Could 2021, RIDOH and the Coverage Lab labored collectively to achieve out to greater than 140,000 Rhode Island residents who had been eligible to obtain the COVID-19 vaccine for at the very least 4 weeks however had not but acquired a shot, in line with state data. After creating eight totally different textual content messages with details about the vaccine, the researchers and well being officers despatched the messages to many of the unvaccinated residents over the course of 13 days. Some unvaccinated residents have been a part of a management group that did not obtain any messages.

Wilson mentioned they crafted the messages utilizing findings from earlier research on People’ behaviors in the course of the COVID-19 pandemic. One message touted the vaccine’s security and one other described its potential to stop hospitalization, he mentioned, interesting to folks’s issues about their very own well being. Different messages appealed to folks’s instincts to guard their family members (“Maintain your loved ones protected”) and emphasised entry (“You do not want an appointment, insurance coverage or different paperwork”).

“At this juncture, Rhode Islanders may simply stroll into any CVS or Walgreens with out an appointment, an ID or an insurance coverage coverage and get the vaccine totally free,” Wilson mentioned. “We thought, what if not everybody is aware of that is attainable? Somebody who needs the vaccine however does not know the way quick and straightforward it’s is precisely the form of particular person you’d wish to attain.”

However ultimately, the textual content messages had no significant impact on vaccine uptake. No single message appeared to compel a big variety of unvaccinated Rhode Islanders to go to a clinic within the following days and weeks. Even the textual content message that had the most important optimistic impact on uptake, which described how the vaccine may stop “unhealthy COVID-19 outcomes,” confirmed an impact so small as to be statistically indistinguishable from the management group: It drove 2.2% of recipients to get a vaccine, in comparison with 2% of those that did not obtain any message.

Nathaniel Rabb, a mission supervisor on the Coverage Lab and a Class of 2014 Brown graduate, mentioned all of the messages contained what researchers name “possession language,” or phrases and phrases that talk on to the message’s recipient (“a vaccine is obtainable for you”). He mentioned the usage of possession language had beforehand been proven to assist drive flu vaccine turnout.

“Possession language could possibly be a means of reducing by way of the notion that getting a vaccine is difficult,” Rabb mentioned. “It conveys this message of, ‘We will make this straightforward for you. There is no crimson tape. We have got a vaccine prepared, put aside, only for you.'”

Wilson mentioned the usage of possession language labored properly within the research carried out by UCLA researchers in January 2021. These researchers labored with a Los Angeles well being system to ship COVID-19 vaccine reminders to about 93,000 individuals who have been among the many very first sufferers to turn into eligible for the shot. The authors reported {that a} text-message reminder containing possession language boosted appointment and vaccine charges inside the well being system by 6.83 share factors inside six days.

That marketing campaign’s success as in comparison with the Rhode Island marketing campaign, Wilson mentioned, factors to the significance of timing when sending out vaccine reminders.

“To start with of 2021, the vaccines have been nonetheless a novelty,” Wilson mentioned. “Everybody who needed a vaccine was strategizing get one as early as attainable. I keep in mind pals frantically calling me, saying, ‘You have to log in to the appointment system at precisely 12:00 and fill out the shape as shortly as attainable!’ I’d have been ecstatic to get a textual content message with a hyperlink that confirmed me precisely the place to go and what to do. However three months later, it is going to be tougher to get good outcomes from a textual content marketing campaign. There’s an abundance of vaccines, there’s much less urgency, and the quantity of people that may get vaccinated has shrunk.”

Rabb mentioned the research confirms that it is essential for public well being officers to kick off text-message campaigns on the proper “inflection level,” when there’s an elevated demand for vaccinations. There is a cause why text-message campaigns for the flu shot work higher in October than in February, he mentioned: It is a key juncture at which kids return to high school, physicians emphasize the significance of immunization, and the flu season begins.

Rabb mentioned discovering that inflection level could possibly be trickier for COVID-19, which hasn’t but turn into endemic or reliably seasonal. However he predicts {that a} good time to start out a textual content marketing campaign would possibly come when kids youthful than 5 turn into eligible for a shot, or when weak adults are suggested to obtain one other booster.

However even when the “proper” timing does not turn into clear, Wilson mentioned, there’s little hurt in sending “nudges” to the unvaccinated. Earlier research have proven that text-message campaigns don’t have any destructive impact on vaccination charges, which means that the worst they’ll do is encourage no new vaccine uptake. Plus, the campaigns are eminently inexpensive: In Could 2021, RIDOH spent lower than a penny per message despatched.

“Many states have the info which are essential to make these sorts of interventions,” Wilson mentioned. “I hope public well being leaders who see this research take into account making an attempt these types of low-cost messaging campaigns, so long as the timing is correct.”