Hospitals and health systems looking at low employee COVID-19 vaccination rates in spite of awareness and education campaigns may find more success by replacing their mass emails with individualized messages, according to Geisinger Health System.
The insight comes in the wake of a newly published study in which the health system said it was able to double the number of holdouts who registered for a vaccine by individually addressing thousands of emails containing behavioral science-informed messages.
“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 Pennsylvania health system’s team wrote in JAMA Network Open. “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.”
Prior to the intervention, Geisinger had already sent its employees 36 vaccine-related mass emails over the course of five weeks, the researchers wrote. Nearly 10,000 employees, about 41% of its total healthcare workforce, still had not registered to receive a shot.
Geisinger randomized the holdouts into three groups. Two of these would receive the intervention—an individually addressed email explaining that vaccine availability would soon become scarcer as the state of Pennsylvania opened up eligibility beyond healthcare workers.
The messages then veered, with one group receiving a message that highlighted the choice other employees and individuals made to be vaccinated (speaking to social norms) and the other weighing the risks of vaccination against COVID-19 infection (asking recipients to reframe the risks).
The third randomized group served as a delayed control, randomly receiving one of the two targeted messages three days later.
Registrations among employees in the first two groups were significantly higher during the three days after delivery compared to the control group, although there was no significant difference between the two intervention messages. Specifically, 6.47% of participants in the social norms group registered, versus 6.9% of the reframing risks group and 3.17% in the control.
Just over 1,200 of the employees who declined to register completed a survey on why they did not want the vaccine. Unknown vaccine risks (35%) and pregnancy-related concerns (13%) were the top two responses.
Targeted emails, text messages and even patient portal messages like these are an inexpensive and easily scalable way to encourage vaccination among healthcare workers and the general public alike, the researchers wrote.
Still, the design of this study leaves some questions about how much of an impact the behaviorial science-based content included in the emails may have had, the researchers noted.
“By choosing to compare two behaviorally informed emails, we are unable to exclude the possibility that a plain reminder might have had the same effect,” they wrote.
The intervention also occurred earlier during the pandemic when vaccines were still relatively difficult to come by in the U.S. Vaccine sentiment polling conducted by the Kaiser Family Foundation has suggested that as U.S. adults who were on the fence have gradually decided to seek out a shot, a large proportion of the remaining unvaccinated population is comprised of those who are staunch in their refusal to get vaccinated.
The Geisinger data come at a time when healthcare worker and employee vaccination is at the forefront of industry and public debate.
Dozens of healthcare professional organizations including the American Hospital Association have come out in favor of hospital policies requiring that all staff receive COVID-19 vaccination as a condition of employment. A growing number of health systems and government agencies alike are beginning to take this approach—sometimes to the ire of their staff.
However, a segment of healthcare providers are holding back on a mandate, either due to the lack of regulatory clearance or the threat of labor shortages such a requirement would likely incur. Hospitals and health systems falling into these camps have said they would primarily be relying on advocacy and educational campaigns to win over unvaccinated staff until full FDA approval or when the circumstances around COVID-19 have changed.