Article Text
Abstract
Objective To evaluate the effectiveness of reminder letters informed by social normative theory (a type of ‘nudge theory’) on uptake of seasonal influenza vaccination by front-line hospital staff.
Design Individually randomised controlled trial.
Setting A large acute care hospital in England.
Participants Front-line staff employed by the hospital (n=7540) were randomly allocated to one of four reminder types in a factorial design.
Interventions The standard letter included only general information directing the staff to take up the vaccine. A second letter highlighted a type of social norm based on peer comparisons. A third letter highlighted a type of social norm based on an appeal to authority. A fourth letter included a combination of the social norms.
Main outcome measure The proportion of hospital staff vaccinated on-site.
Results Vaccine coverage was 43% (812/1885) in the standard letter group, 43% (818/1885) in the descriptive norms group, 43% (814/1885) in the injunctive norms group and 43% (812/1885) in the combination group. There were no statistically significant effects of either norm or the interaction. The OR for the descriptive norms factor is 1.01 (0.89–1.15) in the absence of the injunctive norms factor and 1.00 (0.88–1.13) in its presence. The OR for the injunctive norms factor is 1.00 (0.88–1.14) in the absence of the descriptive norms factor and 0.99 (0.87–1.12) in its presence.
Conclusions We find no evidence that the uptake of the seasonal influenza vaccination is affected by reminders using social norms to motivate uptake.
- infection control
- randomised controlled trial
- health policy
- communication
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Footnotes
Contributors RJL, IV and LT first envisioned a study to increase staff vaccination rates. KAS joined the team to write, approve and register the protocol. KR and SG helped coordinate data collection and integration across existing data streams within the hospital. KAS and RJL drafted the manuscript and requested inputs from coauthors as the manuscript evolved. PGN helped plan and conducted the statistical analyses. SIW contributed by helping the team consider additional analysis, and to the revisions of the final manuscript. All authors approved the final manuscript before its submission.
Funding This study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands. This paper presents independent research and the views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Competing interests RJL had financial support from the National Institute of Health Research (NIHR) for the submitted work, all other authors had no support from any organisation for the submitted work.
Patient consent for publication Not required.
Ethics approval Ethical approval for the trial was obtained through the Health Research Authority (Project ID: 250437).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.