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A behavioral economics intervention to increase pertussis vaccination among infant caregivers: A randomized
Alison M Buttenheim1, Alexander G Fiks2, Randall C Burson3
1Department of Family and Community Health, University of Pennsylvania School of Nursing, 416 Fagin Hall, 435 Curie Blvd, Philadelphia, PA 19104, USA.
Insights
Retail pharmacy vouchers and PSAs did not increase Tdap vaccination among infant caregivers. Barriers like convenience and perceived risk remain significant challenges for Tdap vaccine uptake.
Area of Science:
- Public Health
- Vaccinology
- Behavioral Economics
Background:
- Pertussis (whooping cough) incidence has tripled recently, posing a significant risk to infants.
- Cocooning, vaccinating infant caregivers with the Tdap vaccine, is crucial for infant protection.
- Low Tdap vaccine coverage among adult caregivers necessitates effective intervention strategies.
Purpose of the Study:
- To evaluate the feasibility and impact of behavioral economics-informed interventions to boost Tdap vaccination rates in infant caregivers.
- To assess the effectiveness of retail pharmacy vouchers and public service announcements (PSAs) in increasing Tdap vaccine uptake.
Main Methods:
- A randomized controlled feasibility trial was conducted with adult caregivers attending newborn well-child visits.
- Participants were assigned to conditions involving Tdap vaccine vouchers (discounted vs. free) and PSA exposure (video vs. none).
- Tdap vaccination status was determined by voucher redemption tracking and follow-up phone interviews.
Main Results:
- Only one participant redeemed a retail pharmacy Tdap vaccine voucher, indicating low uptake.
- Significant barriers to vaccination persisted, including delayed vaccination, inconvenient pharmacy locations, and misconceptions about pertussis.
- Interventions leveraging retail pharmacy vouchers during newborn visits were not effective in promoting Tdap vaccination.
Conclusions:
- Retail pharmacy vouchers are an ineffective strategy for increasing Tdap vaccination among infant caregivers.
- Alternative approaches prioritizing convenience and immediate vaccination opportunities are required.
- Addressing perceived risks and logistical barriers is essential for improving Tdap vaccine coverage.
Objectives:
The incidence of pertussis has tripled in the past five years. Infants can be protected by "cocooning," or vaccinating household contacts with the Tdap vaccine. However, Tdap coverage for adult caregivers of infants is low. This study evaluated the feasibility and impact of interventions informed by behavioral economics (retail pharmacy vouchers for Tdap vaccines and a celebrity public service announcement) to increase Tdap vaccination among caregivers of young infants.
Methods:
We conducted a randomized controlled feasibility trial among adults attending newborn well-child visits at an urban Philadelphia pediatric primary care clinic who were not previously vaccinated with Tdap. Participants were randomized to one of four conditions: ($5-off Tdap voucher vs. free voucher)×(watching a 1min video public service announcement (PSA) about Tdap vaccination vs. no PSA). Tdap vaccination was assessed by tracking voucher redemption and following up with participants by phone.
Results:
Ninety-five adult caregivers of 74 infants were enrolled in the study (mean age 29.3 years; 61% male; relationship to newborn: 54% father, 33% mother, 13% grandparent or other; caregiver insurance status: 35% Medicaid, 34% private insurance, 32% uninsured). Only 1 subject redeemed the retail pharmacy Tdap voucher. Follow-up interviews suggest that, even with the voucher, significant barriers to vaccination remained including: delaying planned vaccination, perceived inconvenient pharmacy locations, and beliefs about pertussis risk and severity.
Conclusions:
Despite leveraging existing infrastructure for adult vaccination, results suggest that retail pharmacy vouchers delivered during a newborn visit are not an effective strategy for promoting Tdap. Alternate approaches are needed that prioritize convenience and provide an immediate opportunity to vaccinate when motivation is high.
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