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  • Article
  • Proceedings of the National Academy of Sciences

A 680,000-Person Megastudy of Nudges to Encourage Vaccination in Pharmacies

By: Katherine L. Milkman, Linnea Gandhi, Mitesh S. Patel, Heather N. Graci, Dena M. Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Jake Rothschild, Jonathan E. Bogard, Ilana Brody, Christopher F. Chabris, Edward Chang, Gretchen B. Chapman, Jennifer E. Dannals, Noah J. Goldstein, Amir Goren, Hal Hershfield, Alex Hirsch, Jillian Hmurovic, Samantha Horn, Dean Karlan, Ariella S. Kristal, Cait Lamberton, Michael N. Meyer, Allison H. Oakes, Maurice E. Schweitzer, Maheen Shermohammed, Jaochim H. Talloen, Caleb Warren, Ashley Whillans, Kuldeep N. Yadav, Julian J. Zlatev, Ron Berman, Chalanda N. Evans, Rahul Ladhania, Jens Ludwig, Nina Mazar, Sendhil Mullainathan, Christopher K. Snider, Jann Spiess, Eli Tsukayama, Lyle Ungar, Christophe Van den Bulte, Kevin G. Volpp and Angela L. Duckworth
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Abstract

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-month follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 days apart and communicated to patients that a vaccine was “waiting for you.” Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy.

Keywords

Vaccination; Vaccines; Nudges; Communication Strategy; Communication Technology; Consumer Behavior; Health Care and Treatment

Citation

Milkman, Katherine L., Linnea Gandhi, Mitesh S. Patel, Heather N. Graci, Dena M. Gromet, Hung Ho, Joseph S. Kay, Timothy W. Lee, Jake Rothschild, Jonathan E. Bogard, Ilana Brody, Christopher F. Chabris, Edward Chang, Gretchen B. Chapman, Jennifer E. Dannals, Noah J. Goldstein, Amir Goren, Hal Hershfield, Alex Hirsch, Jillian Hmurovic, Samantha Horn, Dean Karlan, Ariella S. Kristal, Cait Lamberton, Michael N. Meyer, Allison H. Oakes, Maurice E. Schweitzer, Maheen Shermohammed, Jaochim H. Talloen, Caleb Warren, Ashley Whillans, Kuldeep N. Yadav, Julian J. Zlatev, Ron Berman, Chalanda N. Evans, Rahul Ladhania, Jens Ludwig, Nina Mazar, Sendhil Mullainathan, Christopher K. Snider, Jann Spiess, Eli Tsukayama, Lyle Ungar, Christophe Van den Bulte, Kevin G. Volpp, and Angela L. Duckworth. "A 680,000-Person Megastudy of Nudges to Encourage Vaccination in Pharmacies." Proceedings of the National Academy of Sciences 119, no. 6 (February 8, 2022).
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About The Authors

Edward H. Chang

Negotiation, Organizations & Markets
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Ashley V. Whillans

Negotiation, Organizations & Markets
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Julian J. Zlatev

Negotiation, Organizations & Markets
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More from the Authors
  • The Developmental Origins and Behavioral Consequences of Attributions for Inequality By: Antonya Marie Gonzalez, Lucia Macchia and Ashley V. Whillans
  • Policy Stringency and Mental Health During the COVID-19 Pandemic: A Longitudinal Analysis of Data from 15 Countries By: Lara B. Aknin, Bernardo Andretti, Rafael Goldszmidt, John F. Helliwell, Anna Petherick, Jan-Emmanuel De Neve, Elizabeth W. Dunn, Daisy Fancourt, Elkhonon Goldberg, Sarah P. Jones, Ozge Karadag, Elie Karam, Richard Layard, Shekhar Saxena, Emily Thornton, Ashley Whillans and Jamil Zaki
  • Innovation at Moog Inc. By: Brian J. Hall, Ashley V. Whillans, Davis Heniford, Dominika Randle and Caroline Witten
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