Behavioral Nudges Increase COVID-19 Vaccinations

Dai, H., Saccardo, S., Han, M.A., Roh L., Raja, N., Vangala, S., Modi, H., Pandya, S., Sloyan, M., Croymans, D.M. (2021) Behavioural nudges increase COVID-19 vaccinations. Nature. https://www.nature.com/articles/s41586-021-03843-2

106 Pages Posted: 5 Apr 2021 Last revised: 3 Sep 2021

See all articles by Hengchen Dai

Hengchen Dai

University of California, Los Angeles (UCLA) - Anderson School of Management

Silvia Saccardo

Carnegie Mellon University, Department of Social and Decision Sciences

Maria Han

University of California, Los Angeles (UCLA) - UCLA Health System

Lily Roh

University of California, Los Angeles (UCLA) - UCLA Health System

Naveen Raja

University of California, Los Angeles (UCLA) - UCLA Health System

Sitaram Vangala

University of California, Los Angeles (UCLA) - UCLA Health System

Hardikkumar Modi

University of California, Los Angeles (UCLA) - UCLA Health System

Shital Pandya

University of California, Los Angeles (UCLA) - UCLA Health System

Michael Sloyan

University of California, Los Angeles (UCLA) - UCLA Health System

Daniel Croymans

University of California, Los Angeles (UCLA) - UCLA Health System

Date Written: July 21, 2021

Abstract

Enhancing vaccine uptake is a critical public health challenge. Overcoming vaccine hesitancy and failure to follow through on vaccination intentions requires effective communication strategies. Here we present two sequential randomized controlled trials to test the effect of behavioural interventions on the uptake of COVID-19 vaccines. We designed text-based reminders that make vaccination salient and easy, and delivered them to participants drawn from a healthcare system one day (first randomized controlled trial) (n = 93,354 participants; clinicaltrials number NCT04800965) and eight days (second randomized controlled trial) (n = 67,092 individuals; clinicaltrials number NCT04801524) after they received a notification of vaccine eligibility. The first reminder boosted appointment and vaccination rates within the healthcare system by 6.07 (84%) and 3.57 (26%) percentage points, respectively; the second reminder increased those outcomes by 1.65 and 1.06 percentage points, respectively. The first reminder had a greater effect when it was designed to make participants feel ownership of the vaccine dose. However, we found no evidence that combining the first reminder with a video-based information intervention designed to address vaccine hesitancy heightened its effect. We performed online studies (n = 3,181 participants) to examine vaccination intentions, which revealed patterns that diverged from those of the first randomized controlled trial; this underscores the importance of pilot-testing interventions in the field. Our findings inform the design of behavioural nudges for promoting health decisions, and highlight the value of making vaccination easy and inducing feelings of ownership over vaccines.

Note: *The first two authors contributed equally to this work. Trial Registration: clinicaltrials.gov numbers: NCT04800965 and NCT04801524

Funding Statement: Funding support for this research was provided by UCLA Health, Anderson School of Management, and Carnegie Mellon University.

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: This research was approved by the UCLA Institutional Review Board, which granted a waiver of informed consent.

Keywords: vaccination, COVID-19, nudges, RCT, psychological ownership, information intervention

JEL Classification: I12

Suggested Citation

Dai, Hengchen and Saccardo, Silvia and Han, Maria and Roh, Lily and Raja, Naveen and Vangala, Sitaram and Modi, Hardikkumar and Pandya, Shital and Sloyan, Michael and Croymans, Daniel, Behavioral Nudges Increase COVID-19 Vaccinations (July 21, 2021). Dai, H., Saccardo, S., Han, M.A., Roh L., Raja, N., Vangala, S., Modi, H., Pandya, S., Sloyan, M., Croymans, D.M. (2021) Behavioural nudges increase COVID-19 vaccinations. Nature. https://www.nature.com/articles/s41586-021-03843-2, Available at SSRN: https://ssrn.com/abstract= or http://dx.doi.org/10.2139/ssrn.3817832

Hengchen Dai (Contact Author)

University of California, Los Angeles (UCLA) - Anderson School of Management ( email )

110 Westwood Plaza
Los Angeles, CA 90095-1481
United States

Silvia Saccardo

Carnegie Mellon University, Department of Social and Decision Sciences ( email )

Pittsburgh, PA 15213-3890
United States

Maria Han

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Lily Roh

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Naveen Raja

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Sitaram Vangala

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Hardikkumar Modi

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Shital Pandya

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Michael Sloyan

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

Daniel Croymans

University of California, Los Angeles (UCLA) - UCLA Health System ( email )

10833 Le Conte Avenue
17-165 CHS
Los Angeles, CA 90095-1730
United States

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