Disclosures: The authors report no relevant financial disclosures.
February 24, 2021
2 min read

Flu shot reminders do not increase uptake among general practice residents

Disclosures: The authors report no relevant financial disclosures.
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A nudge intended to remind general practice residents to receive an influenza vaccine, though deemed “acceptable,” did not increase uptake, according to researchers.

“Most public health policies use education programs to change health care workers’ knowledges and attitudes towards vaccination,” Adriaan Barbaroux, MD, head of a general medicine clinic at Université Cote d’Azur in France, and colleagues wrote in Family Practice. “These programs showed limited impact, suggesting that approaches based exclusively on the provision of information are not enough.”

Scores on a seven-point Likert scale for the acceptability of a nudging procedure to increase influenza vaccine uptake were 6.34 for residents and 6.31 for patients.
Reference: Barbaroux A, et al. Fam Pract. 2021;doi:10.1093/fampra/cmab001.

Aware that vaccination coverage rates of European health care workers are between 6.4% and 30%, Barbaroux and colleagues hypothesized that a nudge encouraging residents to receive their influenza vaccine would be acceptable and increase influenza vaccine uptake. They randomly assigned 161 general practice residents in France into a group that received the nudge (n = 59), a group that did not (n = 36) and, to evaluate the Hawthorne effect, a control group that also did not receive the nudge (n = 66). The residents’ ages ranged from 23 to 35 years, and most (67.5%) were women.

For the first step of the study, nudge recipients received a questionnaire about their vaccination opinions for themselves and patients as well as their professional experiences. They also received a paper form that contained information regarding a free influenza vaccine and contact information for occupational health services. The group that did not receive the nudge were provided with the same questionnaire but no form. For the second step, which occurred 1 month later, the control group received the questionnaire. All three groups then received an explanation of the nudge and filled out a questionnaire about their vaccination status and the acceptability of the nudge.

Adriaan Barbaroux

Barbaroux and colleagues reported that the effectiveness of the nudge “was not verified” in the first two groups.

“Similarly, the Hawthorne effect, which assumed a higher vaccination rate in step one groups than in the control group included in step two, was not demonstrated,” they wrote.

However, all three groups rated the nudging process “acceptable” for residents (mean score on a seven-point Likert scale = 6.34) and patients (mean score on a seven-point Likert scale = 6.31).

“These data highlight the importance of choosing the right nudge for the right population,” the researchers concluded. “Despite nudges’ growing popularity, they are not necessarily effective, which stress the importance for policymakers to match an intervention to the population’s needs.”

When asked whether a similar nudge for a COVID-19 vaccine would be beneficial, Barbaroux told Healio Primary Care that it was unlikely to have an impact.

“The COVID-19 vaccine has a high cognitive salience. Therefore, it doesn’t need a reminder,” he said. “However, reminders can be helpful when health care providers are fully aware of the dangers of flu and COVID-19 .... and are often overwhelmed. Most of the time, when a health care worker is not vaccinated, it’s not because he really refused the vaccine, but because he’s been waiting too long.”