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Behavioural interventions to increase adherence to palivizumab prophylaxis in children with CHD
Elif Erolu1, Özgür Kıbrıs2, Yasemin Tosun2
1Department of Pediatric Cardiology, University of Health Sciences Medical School Kartal Kosuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey.
Insights
Nudge interventions significantly improved palivizumab prophylaxis adherence in infants with congenital heart disease (CHD). Default bias and implementation intention strategies proved effective in increasing adherence rates for respiratory syncytial virus (RSV) protection.
Area of Science:
- Pediatrics
- Public Health
- Behavioral Economics
Background:
- Palivizumab prophylaxis is vital for protecting infants with congenital heart disease (CHD) from respiratory syncytial virus (RSV) infections.
- Adherence to prophylaxis programs is essential but can be challenging.
- Nudge interventions, leveraging cognitive biases, offer a potential strategy to improve adherence.
Purpose of the Study:
- To analyze the effectiveness of two distinct nudge interventions in increasing palivizumab prophylaxis adherence among infants with CHD.
- To compare the impact of default bias and implementation intention versus availability bias and social norm strategies on adherence rates.
Main Methods:
- A prospective interventional study involving 229 infants with CHD and their caregivers across five centers in Turkey during the 2020-2021 RSV season.
- Caregivers were randomly allocated to a control group or one of two intervention groups.
- Intervention 1 utilized default bias and implementation intention; Intervention 2 used availability bias and social norm messaging.
Main Results:
- Intervention 1 demonstrated a significantly higher adherence rate (97.3%) compared to the control group (90.9%).
- Both interventions positively impacted adherence during the participants' first prophylaxis season.
- Factors like father's employment and history of ICU admission influenced adherence, with interventions mitigating the negative impact of ICU history.
Conclusions:
- Default bias and implementation intention-based nudge interventions are effective in enhancing palivizumab prophylaxis adherence.
- These findings represent the first prospective interventional study demonstrating the efficacy of cognitive bias-based nudges in this context.
- The study highlights the potential of targeted behavioral strategies to improve adherence to critical infant health programs.
Objectives:
Adherence to palivizumab prophylaxis programmes is crucial to protect infants with CHD against respiratory syncytial virus infections. We analysed the effectiveness of two nudge interventions in increasing adherence.
Methods:
Our study included 229 infants, and their caregivers, from five centers in Turkey in the 2020-2021 respiratory syncytial virus season. We randomly allocated caregivers to a control and two intervention groups. Caregivers in all groups were informed about the prophylaxis programme and provided a schedule. Additionally, caregivers in Intervention 1 were called two days before appointments (default bias) and were asked to plan the appointment day (implementation intention), whereas caregivers in Intervention 2 received biweekly text messages informing them about the programme's benefits (availability bias) and current adherence rate (social norm).
Results:
Caregivers in Intervention 1 had a significantly higher adherence rate than Control (97.3% versus 90.9%) (p = 0.014). Both interventions had a significant effect on participants in their first prophylaxis season (p = 0.031, p = 0.037). Families where the father was employed had a 14.2% higher adherence rate (p = 0.001). Every additional child was associated with a 2.2% decrease in adherence rate (p = 0.02). In control, ICU admission history was associated with an 18.8% lower adherence rate (p = 0.0001), but this association disappeared in intervention groups.
Conclusion:
This is the first prospective interventional study which, in the context of palivizumab prophylaxis, analyses the effectiveness of nudge interventions based on established cognitive biases by comparing randomly generated intervention and control groups. We found that default bias and implementation intention have significant effects on adherence.Clinical trial, in the name and number "Adherence of palivizumab prophylaxis, NCT05778240" registered retrospectively. https://clinicaltrials.gov/ct2/show/NCT05778240.
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