1
|
Griesser A, Mzoughi M, Bidmon S, Cherif E. How do opt-in versus opt-out settings nudge patients toward electronic health record adoption? An exploratory study of facilitators and barriers in Austria and France. BMC Health Serv Res 2024; 24:439. [PMID: 38589922 PMCID: PMC11003073 DOI: 10.1186/s12913-024-10929-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Electronic health records (EHR) are becoming an integral part of the health system in many developed countries, though implementations and settings vary across countries. Some countries have adopted an opt-out policy, in which patients are enrolled in the EHR system following a default nudge, while others have applied an opt-in policy, where patients have to take action to opt into the system. While opt-in systems may exhibit lower levels of active user requests for access, this contrasts with opt-out systems where a notable percentage of users may passively retain access. Thus, our research endeavor aims to explore facilitators and barriers that contribute to explaining EHR usage (i.e., actively accessing the EHR system) in two countries with either an opt-in or opt-out setting, exemplified by France and Austria. METHODS A qualitative exploratory approach using a semi-structured interview guideline was undertaken in both countries: 1) In Austria, with four homogenously composed group discussions, and 2) in France, with 19 single patient interviews. The data were collected from October 2020 to January 2021. RESULTS Influencing factors were categorized into twelve subcategories. Patients have similar experiences in both countries with regard to all facilitating categories, for instance, the role of health providers, awareness of EHR and social norms. However, we highlighted important differences between the two systems regarding hurdles impeding EHR usage, namely, a lack of communication as well as transparency or information security about EHR. CONCLUSION Implementing additional safeguards to enhance privacy protection and supporting patients to improve their digital ability may help to diminish the perception of EHR-induced barriers and improve patients' health and commitment in the long term. PRACTICAL IMPLICATIONS Understanding the differences and similarities will help to develop practical implications to tackle the problem of low EHR usage rates in the long run. This problem is prevalent in countries with both types of EHR default settings.
Collapse
Affiliation(s)
- Anna Griesser
- Department of Marketing and International Management, University of Klagenfurt, Klagenfurt Am Woerthersee, Austria
| | - Manel Mzoughi
- ICD Business School - LARA, Management Department, Lara, France
| | - Sonja Bidmon
- Department of Marketing and International Management, University of Klagenfurt, Universitaetsstraße 65-67, Klagenfurt am Wörthersee, 9020, Austria.
| | - Emna Cherif
- University Clermont Auvergne, IAE Clermont Auvergne School of Management - CleRMa, Research Chair "Health and Territories", Clermont-Ferrand, France
| |
Collapse
|
2
|
Tuckerman J, Riley K, Straube S, Mohammed H, Danchin M, Marshall HS. Interventions for increasing the uptake of immunisations in healthcare workers: A systematic review. Vaccine 2023; 41:5499-5506. [PMID: 37527954 DOI: 10.1016/j.vaccine.2023.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE This systemic review aimed to evaluate the effectiveness of interventions for increasing the uptake of immunisation in healthcare workers (HCWs) compared to no or alternative interventions. METHODS A systematic review was undertaken (until March 2022) using a search strategy established a priori to capture studies that examined the effect of interventions on vaccination levels in HCWs. We included randomised controlled trials (RCT), cluster RCTs, controlled before-after (CBA) studies and interrupted time-series (ITS) studies. We described studies descriptively and synthesized results with a fixed-effect or random-effects model meta-analysis, where appropriate. The risk of bias was assessed for each study; the quality evidence per comparison was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS We identified three RCTs, six cluster RCTs and four ITS studies. There was a diverse range of interventions; many included an educational component. Based on the evidence examined the following may be effective strategies in increasing the proportion of HCWs vaccinated: policy interventions, targeted and multicomponent strategies, tailored programs directed at management, physician delivered education with a vaccine 'champion' and individual decision analysis. Limited eligible studies restricted synthesis and interpretation of findings. No studies evaluated the effectiveness of legislation. Nor did we find studies evaluating the effectiveness of incentives on their own or studies focusing solely on improving access to vaccination. We judged all the studies as either unclear or high risk of bias. CONCLUSION Few robust studies that evaluate interventions to increase vaccination in HCWs are available. A limitation of this systematic review is that interventions are diverse, poorly reported and few were sufficiently alike to combine in an evaluation. More research on the effects of interventions to increase vaccination in HCWs is required, this should address a variety of vaccines and not just influenza vaccination.
Collapse
Affiliation(s)
- Jane Tuckerman
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | - Kathryn Riley
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Hassen Mohammed
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Royal Children's Hospital, Melbourne, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, North Adelaide, Australia; Adelaide Medical School, University of Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, South Australia, Australia
| |
Collapse
|
3
|
Vandenplas Y, Simoens S, Turk F, Vulto AG, Huys I. Applications of Behavioral Economics to Pharmaceutical Policymaking: A Scoping Review with Implications for Best-Value Biological Medicines. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:803-817. [PMID: 35972683 PMCID: PMC9379236 DOI: 10.1007/s40258-022-00751-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Pharmaceutical policies are generally based on the assumption that involved stakeholders make rational decisions. However, behavioral economics has taught us that this is not always the case as people deviate from rational behavior in rather predictable patterns. This scoping review examined to what extent behavioral concepts have already been applied in the pharmaceutical domain and what evidence exists about their effectiveness, with the aim of formulating future applications and research hypotheses on policymaking for best-value biologicals. METHODS A scoping literature review was conducted on the evidence of behavioral applications to pharmaceuticals. Scientific databases (Embase, MEDLINE, APA PsycArticles, and Scopus) were searched up to 20 October, 2021. RESULTS Forty-four full-text scientific articles were identified and narratively described in this article. Pharmaceutical domains where behavioral concepts have been investigated relate to influencing prescribing behavior, improving medication adherence, and increasing vaccination uptake. Multiple behavioral concepts were examined in the identified studies, such as social norms, defaults, framing, loss aversion, availability, and present bias. The effectiveness of the applied interventions was generally positive, but depended on the context. Some of the examined interventions can easily be translated into effective policy interventions for best-value biological medicines. However, some applications require further investigation in a research context. CONCLUSIONS Applications of behavioral economics to pharmaceutical policymaking are promising. However, further research is required to investigate the effect of behavioral applications on policy interventions for a more sustainable market environment for best-value biological medicines.
Collapse
Affiliation(s)
- Yannick Vandenplas
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Wolf A, Sant'Anna A, Vilhelmsson A. Using nudges to promote clinical decision making of healthcare professionals: A scoping review. Prev Med 2022; 164:107320. [PMID: 36283484 DOI: 10.1016/j.ypmed.2022.107320] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/25/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2022]
Abstract
Nudging has been discussed in the context of policy and public health, but not so much within healthcare. This scoping review aimed to assess the empirical evidence on how nudging techniques can be used to affect the behavior of healthcare professionals (HCPs) in clinical settings. A systematic database search was conducted for the period January 2010-December 2020 using the PRISMA extension for Scoping Review checklist. Two reviewers independently screened each article for inclusion. Included articles were reviewed to extract key information about each intervention, including purpose, target behavior, measured outcomes, key findings, nudging strategies, intervention objectives and their theoretical underpinnings. Two independent dimensions, building on Kahneman's System 1 and System 2, were used to describe nudging strategies according to user action and timing of their implementation. Of the included 51 articles, 40 reported statistically significant results, six were not significant and two reported mixed results. Thirteen different nudging strategies were identified aimed at modifying four types of HPCs' behavior: prescriptions and orders, procedure, hand hygiene, and vaccination. The most common nudging strategy employed were defaults or pre-orders, followed by alerts or reminders, and active choice. Many interventions did not require any deliberate action from users, here termed passive interventions, such as automatically changing prescriptions to their generic equivalent unless indicated by the user. Passive nudges may be successful in changing the target outcome but may go unnoticed by the user. Future work should consider the broader ethical implications of passive nudges.
Collapse
Affiliation(s)
- Axel Wolf
- University of Gothenburg, Centre for Person-Centred Care (GPCC), Sweden; University of Gothenburg, Institute of Health and Care Sciences, Sahlgrenska Academy, Sweden
| | | | - Andreas Vilhelmsson
- Lund University, Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Sweden.
| |
Collapse
|
5
|
Mussio I, de Oliveira ACM. An (un)healthy social dilemma: a normative messaging field experiment with flu vaccinations. HEALTH ECONOMICS REVIEW 2022; 12:41. [PMID: 35917007 PMCID: PMC9344251 DOI: 10.1186/s13561-022-00385-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Influenza seasons can be unpredictable and have the potential to rapidly affect populations, especially in crowded areas. Prior research suggests that normative messaging can be used to increase voluntary provision of public goods, such as the influenza vaccine. We extend the literature by examining the influence of normative messaging on the decision to get vaccinated against influenza. METHODS We conduct a field experiment in conjunction with University Health Services, targeting undergraduate students living on campus. We use four posters, randomized by living area clusters to advertise flu vaccination clinics during the Fall. The wording on the posters is varied to emphasize the individual benefits of the vaccine, the social benefits of the vaccine or both benefits together. We collect survey data for those vaccinated at the vaccination clinics, and for those not vaccinated via an online survey. RESULTS We find that any normative message increases the percentage of students getting the flu vaccine compared with no message. In terms of the likelihood of getting the flu vaccine, emphasizing both the individual and social benefits of vaccination has the largest increase in the vaccination rate (19-20 percentage point increase). However, flu vaccinations did not reach the herd immunity threshold (70% of students vaccinated). CONCLUSIONS This study provides evidence that there is a pro-social component that is relevant in individual vaccination decisions which should be accounted for when designing vaccination campaigns. The results of this normative, pro-social messaging experiment could be extended to other at-risk communities where the number of background risks is much larger. This is especially relevant nowadays, as other seasonal vaccines are being rolled out and younger adults are the ones with the lowest uptake.
Collapse
Affiliation(s)
- Irene Mussio
- Newcastle University Business School (Economics), 5 Barrack Road, Newcastle upon Tyne, NE1 4SE UK
| | - Angela C. M. de Oliveira
- Department of Resource Economics, University of Massachusetts, 203 Stockbridge Hall, 80 Campus Center Way, Amherst, MA 01003 USA
| |
Collapse
|
6
|
Opt-out policy and its improvements promote COVID-19 vaccinations. Soc Sci Med 2022; 307:115120. [PMID: 35792410 PMCID: PMC9217684 DOI: 10.1016/j.socscimed.2022.115120] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022]
Abstract
Rationale Vaccination uptake is a major strategy to prevent infection with SARS-CoV-2 and curb the transmission of COVID-19. However, many people remain unwilling to receive the COVID-19 vaccine. Objective Using default nudges, the present study examines (a) whether opt-out policy and its improvements could increase intention and attitude to get vaccinated and (b) whether these default effects differ across diverse risk-perception groups. Method An online experiment with 1926 unvaccinated Chinese respondents was conducted in February 2021. We measured willingness to be vaccinated after informing opt-in policy, standard opt-out policy, and its five improvements (opt-out education, opt-out opportunity, opt-out social norm, opt-out feedback, and opt-out opportunity). Risk perception of the pandemic of COVID-19 and vaccination were also measured. Results (a) Opt-out policy and its improvement (except the opt-out transparency) increased intentions to be vaccinated. Policies with a vaccination default did not weaken people's attitude toward policy and policymakers compared with the opt-in policy, but participants in the transparent improvement group reported lower freedom of choice than those in the opt-out group. (b) Further latent profile analysis revealed four classes underlying risk perception: risk exaggerators, risk deniers, disease-specific risk perceivers, and vaccine-specific risk perceivers. But there was no conclusive evidence that the effect of risk perception differs as a function of defaults. Conclusions These findings provide new psychological evidence for formulating more targeted vaccination policies and highlight the importance of risk perception to understand vaccination intentions.
Collapse
|
7
|
Rauprich O, Möllenkamp M, Reimann J, Huster S, Schreyögg J, Marckmann G. [Effectiveness and Ethical Evaluation of Nudging to Promote the Self-Management in Diabetes Mellitus Type 2]. DAS GESUNDHEITSWESEN 2022; 84:1059-1066. [PMID: 35738300 PMCID: PMC9671667 DOI: 10.1055/a-1709-0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hintergrund
Nudges bieten vielfältige Möglichkeiten zur
Förderung von gesundheitsbezogenem Verhalten im Alltag, die klassische
Public Health-Maßnahmen ergänzen können. Vor diesem
Hintergrund führten wir vorläufige Untersuchungen zur
Wirksamkeit und zu ethischen Aspekten verschiedener Nudges zur Förderung
des Selbstmanagements von Patienten mit Diabetes mellitus Typ 2 im Kontext von
Disease-Management-Programmen (DMPs) durch.
Methodik
Die ethische Bewertung der Nudges erfolgte im systematischen
Rahmen von Marckmann et al. (2015) zur Public Health-Ethik. Die bisherige
Evidenz zur Wirksamkeit von Nudges wurde mittels einer narrativen
Literaturübersicht zusammenfassend dargestellt.
Ergebnisse
Zielvereinbarungen mit Umsetzungsplänen, Erinnerungen,
Feedback, Sammeltermine bei Ärzten, Peer Mentoring sowie
Verhaltensverträge sind Nudging-Interventionen mit
mäßiger Eingriffstiefe in die Persönlichkeitsrechte der
Patienten und ethisch relativ unproblematischen Voraussetzungen, die sich in
verschiedenen Kontexten bewährt haben. Automatische Einschreibungen zu
Patientenschulungen, Einbindung der Lebenspartner, Konfrontation mit sozialen
Normen und Verwendung von Schockbildern können ebenfalls wirksam sein,
greifen jedoch tiefer in die Freiheit und Privatsphäre der Patienten ein
und unterliegen stärkeren ethischen Voraussetzungen und
Beschränkungen. Die Evidenzlage ist insbesondere bei Maßnahmen
zur sozialen Unterstützung durch Angehörige und Peers noch
unzureichend.
Schlussfolgerungen
Nudging bietet ein breites Spektrum gezielter
Interventionen zur Förderung des Selbstmanage-ments von Patienten mit
chronischen Erkrankungen, dessen Potenzial bislang noch zu wenig erschlossen
wurde. Besonders vielversprechende Maßnahmen sollten in Pilotstudien auf
ihre Akzeptanz, Wirksamkeit und Kosteneffektivität im Rahmen von DMPs
evaluiert werden.
Collapse
Affiliation(s)
- Oliver Rauprich
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Germany
| | - Meilin Möllenkamp
- Lehrstuhl für Management im Gesundheitswesen, Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
| | - Jennifer Reimann
- Institut für Sozial- und Gesundheitsrecht, Ruhr-Universitat Bochum, Bochum, Germany
| | - Stefan Huster
- Institut für Sozial- und Gesundheitsrecht, Ruhr-Universitat Bochum, Bochum, Germany
| | - Jonas Schreyögg
- Lehrstuhl für Management im Gesundheitswesen, Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
| | - Georg Marckmann
- Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Germany
| |
Collapse
|
8
|
Tentori K, Pighin S, Giovanazzi G, Grignolio A, Timberlake B, Ferro A. Nudging COVID-19 Vaccine Uptake by Changing the Default: A Randomized Controlled Trial. Med Decis Making 2022; 42:837-841. [PMID: 35658775 DOI: 10.1177/0272989x221101536] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although vaccination against SARS-CoV-2 is considered the central strategy against the pandemic, uptake lags behind target rates. METHOD To explore whether this rate could be enhanced by a nudging strategy that exploits the status quo bias, we conducted a randomized controlled trial in northern Italy comparing vaccination acceptance among 2000 adults, ages 50 to 59 years, who were either invited to set an appointment (opt-in group) or assigned an individual appointment (opt-out group). RESULTS Results indicate a difference of 3.2 percentage points, which represents a 32% relative increase in the vaccination rate for the opt-out group compared with the opt-in group. CONCLUSIONS A significant portion of those who remain unvaccinated may not hold strong beliefs against vaccination but rather tend to inaction and may therefore be nudged toward vaccination with a reduction of action required. HIGHLIGHTS Reluctant adults (50-59 years), who had not yet received vaccines against COVID-19, were sent letters announcing appointment availabilityIn an RCT, the status quo option in the notices influenced the rate of vaccine acceptanceNudging via pre-scheduled appointments encouraged vaccine uptake more than invitations to schedule didSwitching the default option yielded a 32% relative increase (13.1% vs. 9.9%) in vaccination.
Collapse
Affiliation(s)
- Katya Tentori
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy.,Centre for Medical Sciences (CISMed), University of Trento, Trento, Italy
| | - Stefania Pighin
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | - Giulia Giovanazzi
- Provincial Authority for Health Services (APSS), Autonomous Province of Trento, Italy
| | - Andrea Grignolio
- International MD Program, Vita-Salute San Raffaele University, Milan, Italy.,Interdepartmental Center for Research Ethics and Integrity, National Research Council (CNR)
| | - Benjamin Timberlake
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy
| | - Antonio Ferro
- Provincial Authority for Health Services (APSS), Autonomous Province of Trento, Italy
| |
Collapse
|
9
|
Sani T, Morelli I, Sarti D, Tassinari G, Capalbo M, Espinosa E, Gasperini B, Prospero E. Attitudes of Healthcare Workers toward Influenza Vaccination in the COVID-19 Era. Vaccines (Basel) 2022; 10:vaccines10060883. [PMID: 35746492 PMCID: PMC9231023 DOI: 10.3390/vaccines10060883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/21/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022] Open
Abstract
Healthcare workers (HCWs) are reluctant to participate in the influenza vaccination program, despite their high risk to contract and diffuse influenza due to professional exposure. The onset of the COVID-19 pandemic could raise HCW flu vaccination adherence. The aim of this study was to assess HCW attitudes toward influenza vaccination in the COVID-19 era. A multicenter observational study was carried out in three Italian hospitals (two in Pesaro and one in Fano, Marche region, Italy). Data about HCW influenza vaccination between 2013 and 2021 were extracted from the vaccination registers. An online questionnaire was sent to HCWs from July to October 2020 to assess their opinion about influenza vaccination in terms of knowledge, attitude, and practice during the COVID-19 pandemic. The number of flu-vaccinated HCWs increased from 3.7% in the 2013−2014 flu season to 53.6% in the 2020−2021 flu season (p < 0.001). About 15% (n = 324) of HCWs responded to the online questionnaire, and 30.5% of them declared that they had changed their minds on flu vaccination after the COVID-19 pandemic, deciding to get vaccinated. The COVID-19 pandemic significantly increased HCWs’ attitudes toward flu vaccination. However, flu vaccination adherence remained low and should be improved.
Collapse
Affiliation(s)
- Tommaso Sani
- School of Nursing, Università Politecnica delle Marche, Via Lombroso, 61122 Pesaro, Italy; (T.S.); (I.M.)
| | - Ilaria Morelli
- School of Nursing, Università Politecnica delle Marche, Via Lombroso, 61122 Pesaro, Italy; (T.S.); (I.M.)
| | - Donatella Sarti
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy; (D.S.); (E.P.)
| | - Giovanni Tassinari
- General Direction, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61122 Pesaro, Italy; (G.T.); (M.C.)
| | - Maria Capalbo
- General Direction, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61122 Pesaro, Italy; (G.T.); (M.C.)
| | - Emma Espinosa
- Geriatric Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61032 Fano, Italy;
| | - Beatrice Gasperini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy; (D.S.); (E.P.)
- Geriatric Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61032 Fano, Italy;
- Correspondence: ; Tel.: +39-0712-206036; Fax: +39-0712-206032
| | - Emilia Prospero
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy; (D.S.); (E.P.)
| |
Collapse
|
10
|
Walsh D, Foster J. Where does research design fall short? Mental health related‐stigma as example. JOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR 2022. [DOI: 10.1111/jtsb.12337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel Walsh
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | - Juliet Foster
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| |
Collapse
|
11
|
Omer SB, Benjamin RM, Brewer NT, Buttenheim AM, Callaghan T, Caplan A, Carpiano RM, Clinton C, DiResta R, Elharake JA, Flowers LC, Galvani AP, Lakshmanan R, Maldonado YA, McFadden SM, Mello MM, Opel DJ, Reiss DR, Salmon DA, Schwartz JL, Sharfstein JM, Hotez PJ. Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA. Lancet 2021; 398:2186-2192. [PMID: 34793741 PMCID: PMC8592561 DOI: 10.1016/s0140-6736(21)02507-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022]
Abstract
Since the first case of COVID-19 was identified in the USA in January, 2020, over 46 million people in the country have tested positive for SARS-CoV-2 infection. Several COVID-19 vaccines have received emergency use authorisations from the US Food and Drug Administration, with the Pfizer-BioNTech vaccine receiving full approval on Aug 23, 2021. When paired with masking, physical distancing, and ventilation, COVID-19 vaccines are the best intervention to sustainably control the pandemic. However, surveys have consistently found that a sizeable minority of US residents do not plan to get a COVID-19 vaccine. The most severe consequence of an inadequate uptake of COVID-19 vaccines has been sustained community transmission (including of the delta [B.1.617.2] variant, a surge of which began in July, 2021). Exacerbating the direct impact of the virus, a low uptake of COVID-19 vaccines will prolong the social and economic repercussions of the pandemic on families and communities, especially low-income and minority ethnic groups, into 2022, or even longer. The scale and challenges of the COVID-19 vaccination campaign are unprecedented. Therefore, through a series of recommendations, we present a coordinated, evidence-based education, communication, and behavioural intervention strategy that is likely to improve the success of COVID-19 vaccine programmes across the USA.
Collapse
Affiliation(s)
- Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, CT, USA; Infectious Diseases Section, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, USA; Yale School of Nursing, Yale University, Orange, CT, USA.
| | | | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, and Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, A&M University, College Station, TX, USA
| | - Arthur Caplan
- Langone School of Medicine, New York University, New York, NY, USA
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Renee DiResta
- Stanford Internet Observatory, Stanford University, Stanford, CA, USA
| | - Jad A Elharake
- Yale Institute for Global Health, Yale University, New Haven, CT, USA; Infectious Diseases Section, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Lisa C Flowers
- Department of Obstetrics & Gynecology, Emory University, Atlanta, GA, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale University, New Haven, CT, USA
| | | | | | - SarahAnn M McFadden
- Yale Institute for Global Health, Yale University, New Haven, CT, USA; Infectious Diseases Section, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Michelle M Mello
- School of Medicine, Stanford University, Stanford, CA, USA; Stanford Law School, Stanford University, Stanford, CA, USA; Freeman Spogli Institute for International Studies, Stanford University, Stanford, CA, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; UC Hastings College of Law, University of California, San Francisco, CA, USA
| | - Dorit R Reiss
- UC Hastings College of Law, University of California, San Francisco, CA, USA
| | - Daniel A Salmon
- Institute for Vaccine Safety, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jason L Schwartz
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Joshua M Sharfstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Peter J Hotez
- Hagler Institute for Advanced Study at Texas A&M University, A&M University, College Station, TX, USA; Scowcroft Institute of International Affairs, Bush School of Government and Public Service Texas, A&M University, College Station, TX, USA; Texas Children's Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Biology, Baylor University, Waco, TX, USA; James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA
| |
Collapse
|
12
|
Vilhelmsson A, Sant'Anna A, Wolf A. Nudging healthcare professionals to improve treatment of COVID-19: a narrative review. BMJ Open Qual 2021; 10:e001522. [PMID: 34887299 PMCID: PMC8662583 DOI: 10.1136/bmjoq-2021-001522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/25/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Andreas Vilhelmsson
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Occupational and Environmental Medicine, Lund University Faculty of Medicine, Lund, Sweden
| | | | - Axel Wolf
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
13
|
Silva MT, Galvao TF, Chapman E, da Silva EN, Barreto JOM. Dissemination interventions to improve healthcare workers' adherence with infection prevention and control guidelines: a systematic review and meta-analysis. Implement Sci 2021; 16:92. [PMID: 34689810 PMCID: PMC8542414 DOI: 10.1186/s13012-021-01164-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/09/2021] [Indexed: 01/04/2023] Open
Abstract
Background The COVID-19 pandemic has challenged health systems worldwide since 2020. At the frontline of the pandemic, healthcare workers are at high risk of exposure. Compliance with infection prevention and control (IPC) should be encouraged at the frontline. This systematic review aimed to assess the effects of dissemination interventions to improve healthcare workers’ adherence with IPC guidelines for respiratory infectious diseases in the workplace. Methods We searched CENTRAL, MEDLINE, Embase, and the Cochrane COVID-19 Study Register. We included randomized controlled trials (RCTs) and cluster RCTs that assessed the effect of any dissemination strategy in any healthcare settings. Certainty of evidence was assessed using the GRADE approach. We synthesized data using random-effects model meta-analysis in Stata 14.2. Results We identified 14 RCTs conducted from 2004 to 2020 with over 65,370 healthcare workers. Adherence to IPC guidelines was assessed by influenza vaccination uptake, hand hygiene compliance, and knowledge on IPC. The most assessed intervention was educational material in combined strategies (plus educational meetings, local opinion leaders, audit and feedback, reminders, tailored interventions, monitoring the performance of the delivery of health care, educational games, and/or patient-mediated interventions). Combined dissemination strategies compared to usual routine improve vaccination uptake (risk ratio [RR] 1.59, 95% confidence interval [CI] 1.54 to 1.81, moderate-certainty evidence), and may improve hand hygiene compliance (RR 1.70; 95% CI 1.03 to 2.83, moderate-certainty). When compared to single strategies, combined dissemination strategies probably had no effect on vaccination uptake (RR 1.01, 95% CI 0.95 to 1.07, low-certainty), and hand hygiene compliance (RR 1.16, 95% CI 0.99 to 1.36, low-certainty). Knowledge of healthcare workers on IPC improved when combined dissemination strategies were compared with usual activities, and the effect was uncertain in comparison to single strategy (very low-certainty evidence). Conclusions Combined dissemination strategies increased workers’ vaccination uptake, hand hygiene compliance, and knowledge on IPC in comparison to usual activities. The effect was negligible when compared to single dissemination strategies. The adoption of dissemination strategies in a planned and targeted way for healthcare workers may increase adherence to IPC guidelines and thus prevent dissemination of infectious disease in the workplace. Trial registration Protocol available at http://osf.io/aqxnp.
Collapse
Affiliation(s)
| | - Tais Freire Galvao
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
| | | | | | | |
Collapse
|
14
|
Barbaroux A, Benoit L, Raymondie RA, Milhabet I. Nudging health care workers towards a flu shot: reminders are accepted but not necessarily effective. A randomized controlled study among residents in general practice in France. Fam Pract 2021; 38:410-415. [PMID: 33506858 DOI: 10.1093/fampra/cmab001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A nudge corresponds to any procedure that influences choice architecture, without using persuasion or financial incentives. Nudges are effective in increasing vaccination with heterogeneous levels of acceptability. OBJECTIVE To evaluate the effectiveness and acceptability of a nudge promoting influenza vaccination for general practice trainees, also called residents. METHODS The hypothesis was that a reminder would be efficient and accepted and that prior exposure to a nudge increases its acceptability. Residents were randomly divided into three parallel experimental arms: a nudge group, a no-nudge group and a control group in order to evaluate the Hawthorne effect. The nudge consisted of providing a paper form for the free delivery of the vaccine and contacts for occupational health services. RESULTS The analysis included 161 residents. There was a strong consensus among the residents that it is very acceptable to nudge their peers and patients. Acceptability was better with residents exposed to the nudge and with residents included in step 1 (Hawthorne effect). The nudge did not increase vaccination coverage. CONCLUSION The failure of this nudge highlights the importance of matching an intervention to the population's needs. The experimental approach is innovative in this context and deserves further attention. CLINICALTRIALS.GOV PRE-REGISTRATION NCT03768596.
Collapse
Affiliation(s)
- Adriaan Barbaroux
- Département d'enseignement et de recherche en médecine générale, Université Cote d'Azur, RETINES, HEALTHY, Nice, France.,Université Cote d'Azur, LAPCOS, Nice, France
| | - Laurie Benoit
- Département d'enseignement et de recherche en médecine générale, Université Cote d'Azur, RETINES, HEALTHY, Nice, France
| | | | | |
Collapse
|
15
|
Healthcare Workers' Willingness to Receive Influenza Vaccination in the Context of the COVID-19 Pandemic: A Survey in Southern Italy. Vaccines (Basel) 2021; 9:vaccines9070766. [PMID: 34358182 PMCID: PMC8310353 DOI: 10.3390/vaccines9070766] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
This cross-sectional survey was designed to evaluate hospital healthcare workers’ (HCWs) willingness to receive the influenza vaccination during the COVID-19 pandemic and to identify the related determinants, since it is plausible that the two epidemics will coexist in future winters. Overall, 68% out of 490 participants expressed their willingness to receive influenza vaccination in the 2020/21 season, with 95% of those ever and 45.8% of those never vaccinated in the previous six influenza seasons. Belief that influenza vaccine is useful in distinguishing influenza symptoms from those of COVID-19 and that the influenza vaccine is useful to prevent influenza in hospital settings, willingness to receive COVID-19 vaccination, having no concern about influenza vaccine side effects, concern about the possibility to transmit influenza to hospitalized patients, and influenza vaccination in previous years were all predictors of willingness to receive influenza vaccination. In the context of the COVID-19 pandemic, a relevant increase in the willingness to undergo influenza vaccination was reported. Therefore, interventions focused primarily on enabling factors are needed to promote the adherence to influenza vaccination in future seasons among HCWs.
Collapse
|
16
|
Sant'Anna A, Vilhelmsson A, Wolf A. Nudging healthcare professionals in clinical settings: a scoping review of the literature. BMC Health Serv Res 2021; 21:543. [PMID: 34078358 PMCID: PMC8170624 DOI: 10.1186/s12913-021-06496-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare organisations are in constant need of improvement and change. Nudging has been proposed as a strategy to affect people's choices and has been used to affect patients' behaviour in healthcare settings. However, little is known about how nudging is being interpreted and applied to change the behaviour of healthcare professionals (HCPs). The objective of this review is to identify interventions using nudge theory to affect the behaviour of HCPs in clinical settings. METHODS A scoping review. We searched PubMed and PsycINFO for articles published from 2010 to September 2019, including terms related to "nudging" in the title or abstract. Two reviewers screened articles for inclusion based on whether the articles described an intervention to change the behaviour of HCPs. Two reviewers extracted key information and categorized included articles. Descriptive analyses were performed on the data. RESULTS Search results yielded 997 unique articles, of which 25 articles satisfied the inclusion criteria. Five additional articles were selected from the reference lists of the included articles. We identified 11 nudging strategies: accountable justification, goal setting, suggested alternatives, feedback, information transparency, peer comparison, active choice, alerts and reminders, environmental cueing/priming, defaults/pre-orders, and education. These strategies were employed to affect the following 4 target behaviours: vaccination of staff, hand hygiene, clinical procedures, prescriptions and orders. To compare approaches across so many areas, we introduced two independent dimensions to describe nudging strategies: synchronous/asynchronous, and active/passive. CONCLUSION There are relatively few studies published referring to nudge theory aimed at changing HCP behaviour in clinical settings. These studies reflect a diverse set of objectives and implement nudging strategies in a variety of ways. We suggest distinguishing active from passive nudging strategies. Passive nudging strategies may achieve the desired outcome but go unnoticed by the clinician thereby not really changing a behaviour and raising ethical concerns. Our review indicates that there are successful active strategies that engage with clinicians in a more deliberate way. However, more research is needed on how different nudging strategies impact HCP behaviour in the short and long term to improve clinical decision making.
Collapse
Affiliation(s)
| | - Andreas Vilhelmsson
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 100, 40530, Gothenburg, SE, Sweden
| | - Axel Wolf
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 100, 40530, Gothenburg, SE, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| |
Collapse
|
17
|
De Sarro C, Papadopoli R, Cautela V, Nobile CGA, Pileggi C, Pavia M. Vaccination coverage among health-care workers: pre-post intervention study to assess impact of an on-site vaccination-dedicated clinic. Expert Rev Vaccines 2021; 20:753-759. [PMID: 33896347 DOI: 10.1080/14760584.2021.1915776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Several studies have revealed low vaccinations coverage among health-care workers (HCWs) for all vaccinations. The aim of our study was to evaluate the impact of the implementation of an on-site vaccination-dedicated clinic on the vaccination coverage rates of HCWs. RESEARCH DESIGN AND METHODS A quasi-experimental pre-post intervention study was carried out among undergraduate and postgraduate students attending medical and health-care professions schools. RESULTS We enrolled 804 students, 404 in the control and 400 in the experimental group. A significantly higher increase of vaccination coverage in the experimental group than in the control group for all the investigated vaccinations (p < 0.001) was found. The odds of adherence to vaccinations in the experimental group, compared to the control group, ranged from 6.9-fold (95% CI 3.51-13.44) to 18.9-fold (95% CI 10.85-32.96). The increase in the coverage rate in the control group was between 2.5% and 3.5%, whereas in the experimental group, higher increases were found, ranging from 34.8% to 71%. CONCLUSIONS The extraordinary increase in the adherence to HCWs recommended vaccinations found in the study seems to indicate a significant role of enabling factors in the complex process of decision-making and implementation of health-related behaviors.
Collapse
Affiliation(s)
- Caterina De Sarro
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro (Italy)
| | - Rosa Papadopoli
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro (Italy)
| | - Vincenza Cautela
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro (Italy)
| | | | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro (Italy)
| | - Maria Pavia
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples (Italy)
| |
Collapse
|
18
|
Promoting Influenza Vaccination among Staff of Nursing Homes According to Behavioral Insights: Analyzing the Choice Architecture during a Nudge-Based Intervention. Vaccines (Basel) 2020; 8:vaccines8040600. [PMID: 33053868 PMCID: PMC7712811 DOI: 10.3390/vaccines8040600] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Influenza vaccination uptake in nursing home (NH) workers is uncommon. The aim of this study was to understand the choice architecture of influenza vaccination acceptance or refusal among them and to promote vaccination acceptance using the nudge approach. (2) Methods: In autumn 2019, a nudge intervention with a contextual qualitative analysis of choice architecture of vaccination was performed among the staff of eight Tuscan NHs. In summer 2020, a cross-sectional study including the staff of 111 NHs (8 in the nudge, 103 in the comparison group) was conducted to assess the impact of the nudge intervention in promoting vaccination uptake. (3) Results: Macro-categories of motivations for vaccination uptake that emerged from the qualitative analysis were risk perception, value dimension, and trust, while those regarding refusal were risk perception, distrust, value dimension, and reasons related to one’s health. Considering the cross-sectional study, influenza vaccination uptake in the 2018–2019 season was similar in the two groups (23.6% vs. 22.2% respectively, in the nudge and comparison group), but significantly different in the 2019–2020 season: 28% in the nudge vs. 20% in the comparison group. Also, the intention to get the vaccine in the 2020–2021 season was significantly different in the two groups: 37.9% in the nudge and 30.8% in the comparison group. (4) Conclusions: Nudge interventions-simple, fast, low cost-could be effective in promoting vaccination acceptance among NH workers and the analysis of choice architecture could be useful in improving tailored, new nudge interventions aimed at modifying irrational biased and cognitive errors.
Collapse
|
19
|
Cappa F, Rosso F, Giustiniano L, Porfiri M. Nudging and citizen science: The effectiveness of feedback in energy-demand management. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2020; 269:110759. [PMID: 32425166 DOI: 10.1016/j.jenvman.2020.110759] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
Nudging is a framework for directing individuals toward better behavior, both for personal and societal benefits, through heuristics that drive the decision-making process but without preventing any available choice. Considering the Grand Challenges that our society faces today, nudging represents an effective framework to tackle some of these pressing issues. In this work, we assessed the effectiveness of informational nudges in the form of detailed, customized feedback, within an energy-demand-management project. The project aligns energy production and demand, thereby reducing greenhouse gases and pollutant emissions to mitigate climate change. We also offered evidence that this kind of feedback is efficacious in involving individuals as citizen scientists, who volunteer their efforts toward the success of the environmentally-related aim of the project. The results of this research - based on surveys, electroencephalography measurements and online participation measures - indicate that feedback can be an effective tool to steer participants' behavior under the libertarian paternalistic view of nudging, increase their motivation to contribute to citizen science, and improve their awareness about environmentally-related issues. In so doing, we provide evidence that nudging and citizen science can be jointly adopted toward the mitigation of pressing environmental issues.
Collapse
Affiliation(s)
- Francesco Cappa
- LUISS Guido Carli University, Department of Business and Management, Viale Pola 12, 00198, Rome, Italy.
| | - Federica Rosso
- Sapienza University of Rome, Department of Civil, Construction and Environmental Engineering, Via Eudossiana 18, 00184, Rome, Italy
| | - Luca Giustiniano
- LUISS Guido Carli University, Department of Business and Management, Viale Pola 12, 00198, Rome, Italy
| | - Maurizio Porfiri
- New York University Tandon School of Engineering, Department of Mechanical and Aerospace Engineering and Department of Biomedical Engineering, 6 MetroTech Center Brooklyn, New York, 11201, USA
| |
Collapse
|
20
|
Frascella B, Oradini-Alacreu A, Balzarini F, Signorelli C, Lopalco PL, Odone A. Effectiveness of email-based reminders to increase vaccine uptake: a systematic review. Vaccine 2020; 38:433-443. [DOI: 10.1016/j.vaccine.2019.10.089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/25/2019] [Accepted: 10/27/2019] [Indexed: 01/08/2023]
|
21
|
Sadness, but not all negative emotions, heightens addictive substance use. Proc Natl Acad Sci U S A 2019; 117:943-949. [PMID: 31888990 DOI: 10.1073/pnas.1909888116] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Do negative feelings in general trigger addictive behavior, or do specific emotions play a stronger role? Testing these alternative accounts of emotion and decision making, we drew on the Appraisal Tendency Framework to predict that sadness, specifically, rather than negative mood, generally, would 1) increase craving, impatience, and actual addictive substance use and 2) do so through mechanisms selectively heightened by sadness. Using a nationally representative, longitudinal survey, study 1 (n = 10,685) revealed that sadness, but not other negative emotions (i.e., fear, anger, shame), reliably predicted current smoking as well as relapsing 20 years later. Study 2 (n = 425) used an experimental design, and found further support for emotion specificity: Sadness, but not disgust, increased self-reported craving relative to a neutral state. Studies 3 and 4 (n = 918) introduced choice behavior as outcome variables, revealing that sadness causally increased impatience for cigarette puffs. Moreover, study 4 revealed that the effect of sadness on impatience was more fully explained by concomitant appraisals of self-focus, which are specific to sadness, than by concomitant appraisals of negative valence, which are general to all negative emotions. Importantly, study 4 also examined the topography of actual smoking behavior, finding that experimentally induced sadness (as compared to neutral emotion) causally increased the volume and duration of cigarette puffs inhaled. Together, the present studies provide support for a more nuanced model regarding the effects of emotion on tobacco use, in particular, as well as on addictive behavior, in general.
Collapse
|
22
|
Schmidtke KA, Nightingale PG, Reeves K, Gallier S, Vlaev I, Watson SI, Lilford RJ. Randomised controlled trial of a theory-based intervention to prompt front-line staff to take up the seasonal influenza vaccine. BMJ Qual Saf 2019. [PMID: 31383723 DOI: 10.1136/bmjqs-2019-009775.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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.
Collapse
Affiliation(s)
- Kelly Ann Schmidtke
- Department of Psychology, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Peter G Nightingale
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Katharine Reeves
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Suzy Gallier
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, West Midlands, UK
| | - Samuel I Watson
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Richard J Lilford
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| |
Collapse
|
23
|
Schmidtke KA, Nightingale PG, Reeves K, Gallier S, Vlaev I, Watson SI, Lilford RJ. Randomised controlled trial of a theory-based intervention to prompt front-line staff to take up the seasonal influenza vaccine. BMJ Qual Saf 2019; 29:189-197. [PMID: 31383723 PMCID: PMC7061920 DOI: 10.1136/bmjqs-2019-009775] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022]
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.
Collapse
Affiliation(s)
- Kelly Ann Schmidtke
- Department of Psychology, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Peter G Nightingale
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Katharine Reeves
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Suzy Gallier
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, West Midlands, UK
| | - Samuel I Watson
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Richard J Lilford
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| |
Collapse
|
24
|
Mirzaei Alavijeh M, Vaezi M, Jalilian F. Hepatitis B Vaccine Acceptability among Nurses: A Theory Based Conceptualization. Middle East J Dig Dis 2018; 11:45-51. [PMID: 31049182 PMCID: PMC6488493 DOI: 10.15171/mejdd.2018.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/10/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis B is the most common occupational disease in health care providers. It can be followed by several complications. The aim of this study was to determine the cognitive determinants of hepatitis B (HB) vaccination Acceptability among nurses based on the Health Belief Model (HBM). METHODS This cross-sectional study was conducted among 330 nurses in educational hospitals of Kermanshah city, during 2016. Samples were randomly selected with the proportional to size among different educational hospitals in Kermanshah. A structured questionnaire was applied for collecting data and data were analyzed using SPSS software version 16 by using bivariate correlations and logistic regression statistical tests. RESULTS The mean age of the respondents was 30.5 years [SD: 6.62]. About, 58.5% of the participants reported to have completed (three times) vaccination of HB. Female nurses were more likely to be fully vaccinated against HB than male nurses, with adjusted odds ratio estimate of 2.507 [95% CI: 1.523-4.125] and those who had family or friends with a history of HB with odds ratio estimate of 3.706 [95% CI: 1.317-10.425], making these the most influential predictive determinants for full uptake (three time) of HB vaccination. Among the HBM variables: perceived threat with odds ratio estimate of 1.264 [95% CI: 1.160-1.376], perceived self-efficacy with odds ratio estimate of 1.179 [95% CI: 1.020-1.363], and cues to action with odds ratio estimate of 1.335 [95% CI: 1.015-1.756], were the more influential predictors of full uptake (three time) of HB vaccination. CONCLUSION To development uptake vaccination programs promotion in addition to focusing on male nurses, using the results of the predictive constructs include; perceived threat perceived self-efficacy suggested. Based on our result, it seems that development and implementation of health promotion programs to increase threat about side effect of HB and self-efficacy regarding HB vaccination uptake may be usefulness of the findings to promotion of vaccination of HB.
Collapse
Affiliation(s)
- Mehdi Mirzaei Alavijeh
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoumeh Vaezi
- Faculty of Medicine, Kateb University, Kabul, Afghanistan
| | - Farzad Jalilian
- Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
25
|
Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest 2018; 18:149-207. [DOI: 10.1177/1529100618760521] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
Collapse
Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
| | | | | | - Julie Leask
- Faculty of Nursing and Midwifery, University of Sydney
- Faculty of Medicine, University of Sydney
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
| |
Collapse
|
26
|
Vallée-Tourangeau G, Promberger M, Moon K, Wheelock A, Sirota M, Norton C, Sevdalis N. Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers: Development and validation of two short scales. Vaccine 2017; 36:6540-6545. [PMID: 28958815 DOI: 10.1016/j.vaccine.2017.08.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/10/2017] [Accepted: 08/10/2017] [Indexed: 11/16/2022]
Abstract
Healthcare workers (HCWs) are an important priority group for vaccination against influenza, yet, flu vaccine uptake remains low among them. Psychosocial studies of HCWs' decisions to get vaccinated have commonly drawn on subjective expected utility models to assess predictors of vaccination, assuming HCWs' choices result from a rational information-weighing process. By contrast, we recast those decisions asa commitment to vaccination and we aimed to understand why HCWs may want to (rather than believe they need to) get vaccinated against the flu. This article outlines the development and validation of a 9-item measure of cognitive empowerment towards flu vaccination (MoVac-flu scale) and an 11-item measure of cognitive empowerment towards vaccination advocacy. Both scales were administered to 784 frontline NHS HCWs with direct patient contact between June 2014 and July 2015. The scales exhibited excellent reliability and a clear unidimensional factor structure. An examination of the nomological network of the cognitive empowerment construct in relation to HCWs' vaccination against the flu revealed that this construct was distinct from traditional measures of risk perception and the strongest predictor of HCWs' decisions to vaccinate. Similarly, cognitive empowerment in relation to vaccination advocacy was a strong predictor of HCWs' engagement with vaccination advocacy. These findings suggest that the cognitive empowerment construct has important implications for advancing our understanding of HCWs' decisions to vaccinate as well as their advocacy behavior.
Collapse
Affiliation(s)
| | - Marianne Promberger
- Kingston Business School, Kingston University London, Kingston upon Thames, UK
| | - Karis Moon
- Kingston Business School, Kingston University London, Kingston upon Thames, UK
| | | | | | | | | |
Collapse
|
27
|
Exploring and Promoting Prosocial Vaccination: A Cross-Cultural Experiment on Vaccination of Health Care Personnel. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6870984. [PMID: 27725940 PMCID: PMC5048021 DOI: 10.1155/2016/6870984] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/18/2016] [Indexed: 11/30/2022]
Abstract
Influenza vaccination for health care personnel (HCP) is recommended particularly because it indirectly protects patients from contracting the disease. Vaccinating can therefore be interpreted as a prosocial act. However, HCP vaccination rates are often far too low to prevent nosocomial infections. Effective interventions are needed to increase HCP's influenza vaccine uptake. Here we devise a novel tool to experimentally test interventions that aim at increasing prosocially motivated vaccine uptake under controlled conditions. We conducted a large-scale and cross-cultural experiment with participants from countries with either a collectivistic (South Korea) or an individualistic (USA) cultural background. Results showed that prosocially motivated vaccination was more likely in South Korea compared to the US, mediated by a greater perception of vaccination as a social act. However, changing the default of vaccination, such that participants had to opt out rather than to opt in, increased vaccine uptake in the US and therefore compensated for the lower level of prosocial vaccination. In sum, the present study provides both a novel method to investigate HCP influenza vaccination behavior and interventions to increase their vaccine uptake.
Collapse
|