A 680,000-person megastudy of nudges to encourage vaccination in pharmacies.

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-mo 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 d 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.

A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor's appointment.

Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment (N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findings suggest that text messages sent prior to a primary care visit can boost vaccination rates by an average of 5%. Overall, interventions performed better when they were 1) framed as reminders to get flu shots that were already reserved for the patient and 2) congruent with the sort of communications patients expected to receive from their healthcare provider (i.e., not surprising, casual, or interactive). The best-performing intervention in our study reminded patients twice to get their flu shot at their upcoming doctor's appointment and indicated it was reserved for them. This successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.

On Skinner's pendulum: A framework for assessing s-frame hope.

Unsatisfied with the effects of behavioral economics' i-frame, "technology of behavior," Chater & Loewenstein call for a pendulum swing back to the s-frame, suggesting that such an approach offers a more hopeful path toward societal well-being. In this commentary, I offer a framework to think about this pendulum swing, as well as the scope - and limits - of this hope.

A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit.

PURPOSE: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates. DESIGN: Randomized, controlled trial. SETTING: Two health systems in the Northeastern US between September 2020 and March 2021. SUBJECTS: 74,811 adults. INTERVENTIONS: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content. MEASURES: Influenza vaccination. ANALYSIS: Intention-to-treat. RESULTS: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as "reserved for you" and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as "reserved for you." None of the interventions performed worse than control. CONCLUSIONS: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.

What matters when it comes to measuring Age-Friendly Health System transformation.

Thousands of health systems are now recognized as "Age-Friendly Health Systems," making this model one of the most widely disseminated - and most promising- models to redesign care delivery for older adults. Sustaining these gains will require demonstrating the impact on care delivery and outcomes of older adults. We propose a new measurement model to more tightly link Age-Friendly Health System transformation to outcomes within each "M" (What Matters, Medications, Mobility, and Mentation). We evaluated measures based on the following characteristics: (1) conceptual responsiveness to changes brought about by practicing "4Ms" care; (2) degree to which they represent outcomes that matter to older adults; and (3) how they can be feasibly, reliably, and validly measured. We offer specific examples of how novel measures are currently being used where available. Finally, we present measures that could capture system-level effects across "M"s. We tie these suggestions together into a conceptual measurement model for AFHS transformation, with the intent to spur discussion, debate, and iterative improvement in measures over time.

When Does Sharing Stigmatize? Saving Money (vs. Seeking Variety) Through Access-Based Consumption.

Access-based services allow financially-constrained individuals to consume a variety of goods and services without the cost of sole ownership. But might there be dangers in communicating about access-based consumption in terms of its affordability, particularly among this segment of consumers? To answer this question, we investigate the effects of framing access-based consumption in terms of two primary benefits: affordability and variety. Results from four studies suggest that although affordability might rationally be of most interest to financially-constrained individuals, framing access-based consumption's benefits in terms of affordability undermines the happiness they may extract from their consumption relative to framing in terms of variety. This difference emerges because communications focused on affordability re-affirm the negative self-identity financially-constrained individuals perceive as a result of their financial situation. Given these findings, we make clear recommendations for communications related to the access-based economy and this vulnerable set of people.

Behavioral Economics to Enhance Food Is Medicine Programs.

This Viewpoint highlights ways in which behavioral economics could enhance Food Is Medicine programs in the US.

Measuring Empathetic Care: Development and Validation of a Self-Report Scale.

PURPOSE: This study describes the development of a self-report survey measure of empathetic care. Empathetic care is defined as caregiving that supports clients' socioemotional capabilities and addresses their emotional needs. It is distinct from instrumental care, which involves assisting with physical needs such as activities of daily living. DESIGN AND METHOD: Based on a literature review, structured interviews, and focus groups, we identify three dimensions of empathetic care: extra-role behavior, emotional support, and relational richness. We then developed a large pool of items that could tap into these dimensions and administered versions of the survey to nearly 300 health care paraprofessionals. RESULTS: After performing exploratory factor analyses on a larger survey of 138 paraprofessionals, a 10-item, three-factor measure, the Empathetic Care Scale (ECS), was developed that predicts decisions on consequential allocation scenarios. A second sample of 125 paraprofessionals provided data for a confirmatory factor analysis; results suggested that the ECS has desirable psychometric properties and evidence of convergent and discriminant validity. Further samples demonstrated acceptable levels of test-retest reliability and no social desirability bias. IMPLICATIONS: This study provides a short self-report measure that can be used to gauge care workers' individual levels of empathetic care. Future research can use this measure to explore relationships between ECS responses and previously proposed but untested outcomes such as patient well-being and employee burnout or turnover rates.