Can Behavioral Science Reduce Healthcare Worker Vaccine Hesitancy?

Individually addressed email reminders driven by behavioral science may be effective at reducing healthcare worker vaccine hesitancy, according to a research letter published in JAMA Network Open. The emails more than doubled COVID-19 vaccine registration compared to workers who did not receive an email.

Researchers from the Behavioral Insights Team at Geisinger Health System’s Steel Institute for Health Innovation targeted over 9,600 employees of a large Pennsylvania health system who had not scheduled their vaccination after the health system had sent mass emails to employees over the past five weeks.

The remaining unvaccinated employees were split into three groups: a delayed control group, a social norm group, and a reframing risk group.

Both the social norm and reframing risk groups received emails explaining that vaccine eligibility would soon be expanded beyond healthcare workers and appointments will be harder to obtain. Both emails also asked employees to either schedule an appointment through a hyperlink in the email or fill out an online form explaining their reasoning behind not getting the vaccine.

The social norm group received an email that pointed out that many US residents and fellow healthcare employees chose to get vaccinated. The reframing risks group received an email that explained the risks of contracting COVID-19 compared to the proven effectiveness and lower risks relating to the vaccine.

Both emails yielded more than twice as many registrations in three days compared to the control group, of which 3.5 percent registered for a vaccine appointment within the three-day window. The social norms email led to 6.5 percent of recipients setting up a vaccine appointment, and the reframing risks email convinced 6.9 percent of recipients.

“Like many lightweight behavioral interventions—sometimes called ‘nudges’—tested in the real world, ours had a modest impact, increasing the vaccination rate in our sample by 3.5 percentage points,” Michelle Meyer, senior author of the research letter and faculty co-director of the Behavioral Insights Team remarked in a press release.

“On the other hand, these emails can be quickly sent to large numbers of people for free, and in some places, 3.5 percentage points might be the difference between reaching and failing to reach herd immunity. Our results suggest that some people who have been hesitant about the vaccine, even after a great deal of prior communication, can still be reached, at virtually no cost.”

No substantial differences were observed between the two email approaches, but both were largely effective and could be applied to other settings, such as schools.

Researchers cited behavioral science techniques such as active choice, emphasis on scarcity, social norms, risk recalibration, and appeal to authority as the driving influencers of reducing vaccine hesitancy.

“Given the large volume of previous COVID-19 vaccine promotion to [healthcare workers], it may seem counterintuitive that a single additional reminder could increase vaccination by late adopters,” the research letter pointed out.

“However, competing demands on attention, behavioral inertia, and unwieldy processes that make it hard to follow through on intentions likely conspire to make a single, timely, targeted reminder helpful.”

Vaccine hesitancy among healthcare workers remains high, and some health systems are turning to vaccine mandates to reach reluctant healthcare workers. AMA recently announced its support for COVID-19 vaccine mandates for healthcare workers, a sentiment echoed by dozens of other healthcare organizations.

But some leaders are concerned about exacerbating existing hospital staffing shortages. Texas-based health system Houston Methodist faced backlash after enforcing a vaccine mandate. Over 150 employees were fired or resigned after refusing vaccination.

The Patient-Centered Outcomes Research Institute (PCORI) recently approved $11 million to fund studies aimed at reducing vaccine hesitancy among long-term care workers as vaccination rates slow nationwide.