Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States: Decentralized Randomized Controlled Trial

Nell J. Marshall; Jennifer L. Lee; Jessica Schroeder; Wei Nchih Lee; Jermyn See; Mohammad Madjid; Mrudula R. Munagala; John D. Piette; Litjen Tan; Orly Vardeny; Michael Greenberg; Jan Liska; Monica Mercer; Sandrine Samson

doi:10.2196/38710

Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States: Decentralized Randomized Controlled Trial

Nell J. Marshall, Jennifer L. Lee, Jessica Schroeder, Wei Nchih Lee, Jermyn See, Mohammad Madjid, Mrudula R. Munagala, John D. Piette, Litjen Tan, Orly Vardeny, Michael Greenberg, Jan Liska, Monica Mercer, Sandrine Samson

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

BACKGROUND: Seasonal influenza affects 5% to 15% of Americans annually, resulting in preventable deaths and substantial economic impact. Influenza infection is particularly dangerous for people with cardiovascular disease, who therefore represent a priority group for vaccination campaigns.

OBJECTIVE: We aimed to assess the effects of digital intervention messaging on self-reported rates of seasonal influenza vaccination.

METHODS: This was a randomized, controlled, single-blind, and decentralized trial conducted at individual locations throughout the United States over the 2020-2021 influenza season. Adults with self-reported cardiovascular disease who were members of the Achievement mobile platform were randomized to receive or not receive a series of 6 patient-centered digital intervention messages promoting influenza vaccination. The primary end point was the between-group difference in self-reported vaccination rates at 6 months after randomization. Secondary outcomes included the levels of engagement with the messages and the relationship between vaccination rates and engagement with the messages. Subgroup analyses examined variation in intervention effects by race. Controlling for randomization group, we examined the impact of other predictors of vaccination status, including cardiovascular condition type, vaccine drivers or barriers, and vaccine knowledge.

RESULTS: Of the 49,138 randomized participants, responses on the primary end point were available for 11,237 (22.87%; 5575 in the intervention group and 5662 in the control group) participants. The vaccination rate was significantly higher in the intervention group (3418/5575, 61.31%) than the control group (3355/5662, 59.25%; relative risk 1.03, 95% CI 1.004-1.066; P=.03). Participants who were older, more educated, and White or Asian were more likely to report being vaccinated. The intervention was effective among White participants (P=.004) but not among people of color (P=.42). The vaccination rate was 13 percentage points higher among participants who completed all 6 intervention messages versus none, and at least 2 completed messages appeared to be needed for effectiveness. Participants who reported a diagnosis of COVID-19 were more likely to be vaccinated for influenza regardless of treatment assignment.

CONCLUSIONS: This personalized, evidence-based digital intervention was effective in increasing vaccination rates in this population of high-risk people with cardiovascular disease.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04584645; https://clinicaltrials.gov/ct2/show/NCT04584645.

Original language	English (US)
Article number	e38710
Journal	Journal of medical Internet research
Volume	24
Issue number	10
DOIs	https://doi.org/10.2196/38710
State	Published - Oct 1 2022
Externally published	Yes

Bibliographical note

Funding Information:
This study was funded by Sanofi. This sponsor was involved in the intervention development, study design, data interpretation, and writing of the report and was kept informed during data collection and data analysis. Sanofi produces one of the influenza vaccines available in the United States, but participants were not instructed to get a specific type of influenza vaccine. The senior (SS) and corresponding (NJM) authors had full access to all of the data in the study and had final responsibility for the decision to submit for publication. The authors thank Patricia A. French, BS, of Left Lane Communications for assistance in the drafting and editing of the manuscript.

Publisher Copyright:
© 2022 Journal of Medical Internet Research. All rights reserved.

Keywords

cardiovascular disease
digital intervention
digital messaging
immunization
influenza
mHealth
mobile health
public health
randomized trial
vaccination
Single-Blind Method
Influenza Vaccines/therapeutic use
Cardiovascular Diseases/prevention & control
United States
Humans
Influenza, Human/epidemiology
Vaccination
COVID-19
Text Messaging
Adult

PubMed: MeSH publication types

Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2196/38710

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Marshall, N. J., Lee, J. L., Schroeder, J., Lee, W. N., See, J., Madjid, M., Munagala, M. R., Piette, J. D., Tan, L., Vardeny, O., Greenberg, M., Liska, J., Mercer, M., & Samson, S. (2022). Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States: Decentralized Randomized Controlled Trial. Journal of medical Internet research, 24(10), Article e38710. https://doi.org/10.2196/38710

Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States: Decentralized Randomized Controlled Trial. / Marshall, Nell J.; Lee, Jennifer L.; Schroeder, Jessica et al.
In: Journal of medical Internet research, Vol. 24, No. 10, e38710, 01.10.2022.

Research output: Contribution to journal › Article › peer-review

Marshall, NJ, Lee, JL, Schroeder, J, Lee, WN, See, J, Madjid, M, Munagala, MR, Piette, JD, Tan, L, Vardeny, O, Greenberg, M, Liska, J, Mercer, M & Samson, S 2022, 'Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States: Decentralized Randomized Controlled Trial', Journal of medical Internet research, vol. 24, no. 10, e38710. https://doi.org/10.2196/38710

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title = "Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States: Decentralized Randomized Controlled Trial",

abstract = "BACKGROUND: Seasonal influenza affects 5% to 15% of Americans annually, resulting in preventable deaths and substantial economic impact. Influenza infection is particularly dangerous for people with cardiovascular disease, who therefore represent a priority group for vaccination campaigns.OBJECTIVE: We aimed to assess the effects of digital intervention messaging on self-reported rates of seasonal influenza vaccination.METHODS: This was a randomized, controlled, single-blind, and decentralized trial conducted at individual locations throughout the United States over the 2020-2021 influenza season. Adults with self-reported cardiovascular disease who were members of the Achievement mobile platform were randomized to receive or not receive a series of 6 patient-centered digital intervention messages promoting influenza vaccination. The primary end point was the between-group difference in self-reported vaccination rates at 6 months after randomization. Secondary outcomes included the levels of engagement with the messages and the relationship between vaccination rates and engagement with the messages. Subgroup analyses examined variation in intervention effects by race. Controlling for randomization group, we examined the impact of other predictors of vaccination status, including cardiovascular condition type, vaccine drivers or barriers, and vaccine knowledge.RESULTS: Of the 49,138 randomized participants, responses on the primary end point were available for 11,237 (22.87%; 5575 in the intervention group and 5662 in the control group) participants. The vaccination rate was significantly higher in the intervention group (3418/5575, 61.31%) than the control group (3355/5662, 59.25%; relative risk 1.03, 95% CI 1.004-1.066; P=.03). Participants who were older, more educated, and White or Asian were more likely to report being vaccinated. The intervention was effective among White participants (P=.004) but not among people of color (P=.42). The vaccination rate was 13 percentage points higher among participants who completed all 6 intervention messages versus none, and at least 2 completed messages appeared to be needed for effectiveness. Participants who reported a diagnosis of COVID-19 were more likely to be vaccinated for influenza regardless of treatment assignment.CONCLUSIONS: This personalized, evidence-based digital intervention was effective in increasing vaccination rates in this population of high-risk people with cardiovascular disease.TRIAL REGISTRATION: ClinicalTrials.gov NCT04584645; https://clinicaltrials.gov/ct2/show/NCT04584645.",

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author = "Marshall, {Nell J.} and Lee, {Jennifer L.} and Jessica Schroeder and Lee, {Wei Nchih} and Jermyn See and Mohammad Madjid and Munagala, {Mrudula R.} and Piette, {John D.} and Litjen Tan and Orly Vardeny and Michael Greenberg and Jan Liska and Monica Mercer and Sandrine Samson",

note = "Funding Information: This study was funded by Sanofi. This sponsor was involved in the intervention development, study design, data interpretation, and writing of the report and was kept informed during data collection and data analysis. Sanofi produces one of the influenza vaccines available in the United States, but participants were not instructed to get a specific type of influenza vaccine. The senior (SS) and corresponding (NJM) authors had full access to all of the data in the study and had final responsibility for the decision to submit for publication. The authors thank Patricia A. French, BS, of Left Lane Communications for assistance in the drafting and editing of the manuscript. Publisher Copyright: {\textcopyright} 2022 Journal of Medical Internet Research. All rights reserved.",

year = "2022",

month = oct,

day = "1",

doi = "10.2196/38710",

language = "English (US)",

volume = "24",

journal = "Journal of medical Internet research",

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T1 - Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States

T2 - Decentralized Randomized Controlled Trial

AU - Marshall, Nell J.

AU - Lee, Jennifer L.

AU - Schroeder, Jessica

AU - Lee, Wei Nchih

AU - See, Jermyn

AU - Madjid, Mohammad

AU - Munagala, Mrudula R.

AU - Piette, John D.

AU - Tan, Litjen

AU - Vardeny, Orly

AU - Greenberg, Michael

AU - Liska, Jan

AU - Mercer, Monica

AU - Samson, Sandrine

N1 - Funding Information: This study was funded by Sanofi. This sponsor was involved in the intervention development, study design, data interpretation, and writing of the report and was kept informed during data collection and data analysis. Sanofi produces one of the influenza vaccines available in the United States, but participants were not instructed to get a specific type of influenza vaccine. The senior (SS) and corresponding (NJM) authors had full access to all of the data in the study and had final responsibility for the decision to submit for publication. The authors thank Patricia A. French, BS, of Left Lane Communications for assistance in the drafting and editing of the manuscript. Publisher Copyright: © 2022 Journal of Medical Internet Research. All rights reserved.

PY - 2022/10/1

Y1 - 2022/10/1

N2 - BACKGROUND: Seasonal influenza affects 5% to 15% of Americans annually, resulting in preventable deaths and substantial economic impact. Influenza infection is particularly dangerous for people with cardiovascular disease, who therefore represent a priority group for vaccination campaigns.OBJECTIVE: We aimed to assess the effects of digital intervention messaging on self-reported rates of seasonal influenza vaccination.METHODS: This was a randomized, controlled, single-blind, and decentralized trial conducted at individual locations throughout the United States over the 2020-2021 influenza season. Adults with self-reported cardiovascular disease who were members of the Achievement mobile platform were randomized to receive or not receive a series of 6 patient-centered digital intervention messages promoting influenza vaccination. The primary end point was the between-group difference in self-reported vaccination rates at 6 months after randomization. Secondary outcomes included the levels of engagement with the messages and the relationship between vaccination rates and engagement with the messages. Subgroup analyses examined variation in intervention effects by race. Controlling for randomization group, we examined the impact of other predictors of vaccination status, including cardiovascular condition type, vaccine drivers or barriers, and vaccine knowledge.RESULTS: Of the 49,138 randomized participants, responses on the primary end point were available for 11,237 (22.87%; 5575 in the intervention group and 5662 in the control group) participants. The vaccination rate was significantly higher in the intervention group (3418/5575, 61.31%) than the control group (3355/5662, 59.25%; relative risk 1.03, 95% CI 1.004-1.066; P=.03). Participants who were older, more educated, and White or Asian were more likely to report being vaccinated. The intervention was effective among White participants (P=.004) but not among people of color (P=.42). The vaccination rate was 13 percentage points higher among participants who completed all 6 intervention messages versus none, and at least 2 completed messages appeared to be needed for effectiveness. Participants who reported a diagnosis of COVID-19 were more likely to be vaccinated for influenza regardless of treatment assignment.CONCLUSIONS: This personalized, evidence-based digital intervention was effective in increasing vaccination rates in this population of high-risk people with cardiovascular disease.TRIAL REGISTRATION: ClinicalTrials.gov NCT04584645; https://clinicaltrials.gov/ct2/show/NCT04584645.

AB - BACKGROUND: Seasonal influenza affects 5% to 15% of Americans annually, resulting in preventable deaths and substantial economic impact. Influenza infection is particularly dangerous for people with cardiovascular disease, who therefore represent a priority group for vaccination campaigns.OBJECTIVE: We aimed to assess the effects of digital intervention messaging on self-reported rates of seasonal influenza vaccination.METHODS: This was a randomized, controlled, single-blind, and decentralized trial conducted at individual locations throughout the United States over the 2020-2021 influenza season. Adults with self-reported cardiovascular disease who were members of the Achievement mobile platform were randomized to receive or not receive a series of 6 patient-centered digital intervention messages promoting influenza vaccination. The primary end point was the between-group difference in self-reported vaccination rates at 6 months after randomization. Secondary outcomes included the levels of engagement with the messages and the relationship between vaccination rates and engagement with the messages. Subgroup analyses examined variation in intervention effects by race. Controlling for randomization group, we examined the impact of other predictors of vaccination status, including cardiovascular condition type, vaccine drivers or barriers, and vaccine knowledge.RESULTS: Of the 49,138 randomized participants, responses on the primary end point were available for 11,237 (22.87%; 5575 in the intervention group and 5662 in the control group) participants. The vaccination rate was significantly higher in the intervention group (3418/5575, 61.31%) than the control group (3355/5662, 59.25%; relative risk 1.03, 95% CI 1.004-1.066; P=.03). Participants who were older, more educated, and White or Asian were more likely to report being vaccinated. The intervention was effective among White participants (P=.004) but not among people of color (P=.42). The vaccination rate was 13 percentage points higher among participants who completed all 6 intervention messages versus none, and at least 2 completed messages appeared to be needed for effectiveness. Participants who reported a diagnosis of COVID-19 were more likely to be vaccinated for influenza regardless of treatment assignment.CONCLUSIONS: This personalized, evidence-based digital intervention was effective in increasing vaccination rates in this population of high-risk people with cardiovascular disease.TRIAL REGISTRATION: ClinicalTrials.gov NCT04584645; https://clinicaltrials.gov/ct2/show/NCT04584645.

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KW - digital intervention

KW - digital messaging

KW - immunization

KW - influenza

KW - mHealth

KW - mobile health

KW - public health

KW - randomized trial

KW - vaccination

KW - Single-Blind Method

KW - Influenza Vaccines/therapeutic use

KW - Cardiovascular Diseases/prevention & control

KW - United States

KW - Humans

KW - Influenza, Human/epidemiology

KW - Vaccination

KW - COVID-19

KW - Text Messaging

KW - Adult

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Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States: Decentralized Randomized Controlled Trial

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

Publisher link

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