Nudging toward vaccination: a systematic review

Area of Science:

• Public Health
• Behavioral Science
• Health Promotion

Background:

• Vaccine hesitancy and declining vaccine coverage pose significant global health threats.
• Novel strategies are urgently needed to enhance vaccine confidence and uptake.
• Nudging, defined as modifying decision-making contexts, has shown potential in health promotion.

Purpose of the Study:

• To systematically review evidence on the effectiveness of nudging interventions in addressing vaccine hesitancy.
• To determine if nudging can mitigate vaccine hesitancy and improve vaccination rates.
• To synthesize findings on the value and impact of nudges for vaccine promotion.

Main Methods:

• Systematic review of articles identified through Medical Subject Headings and non-MeSH terms in nine databases.
• Inclusion of 15,177 titles, assessed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Evaluation of 48 included articles from high-income countries using the Mixed Methods Appraisal Tool and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

Main Results:

• Nudging interventions include reminders, framing/messaging adjustments, messenger changes, social norms, emotional appeals, incentives, and default options.
• Promising evidence supports nudges involving incentives for parents/healthcare workers, enhanced information salience, and trusted messengers.
• Intervention effectiveness varies significantly by context, with mixed evidence for some approaches, indicating a need for further research and adaptation strategies.

Conclusions:

• Nudging interventions demonstrate potential for increasing vaccine confidence and uptake.
• Further research is essential to establish clear, evidence-based recommendations for nudging strategies.
• The COVID-19 pandemic underscores the critical need for accelerated research into nudging for vaccination.