A copy of the letter sent to each group is provided in online supplementary material A.
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Our secondary objectives were to examine the differences between staff characteristics and the effects of the interventions on vaccine uptake rates.įront-line staff were allocated to one of four comparator groups: standard group, descriptive norms group, injunctive norms group and combination group.
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Our hypothesis was that the letters would influence staff uptake differently.
#Spss statistics free trial trial#
Our first objective was to assess the effects of the two social norms and any interaction effects on the on-site vaccination rate in a factorial-designed randomised controlled trial (RCT). To compare the effectiveness of different norms, in isolation and combination, the staff were randomly allocated to receive one of four letters: a standard letter encouraging the staff to take up the vaccination (no norms), a letter appealing to descriptive norms, a letter appealing to injunctive norms and a letter that combines these norms. 7 Injunctive norms are based on evidence that people are influenced by the personalised appeals of authority figures. 6 Descriptive norms are based on evidence that people are influenced by comparisons of their behaviour to that of their peers, for example, the bandwagon effect. 5 The social norms we tested included two types: descriptive norms and injunctive norms. Social norms are tacit societal rules that guide how people believe they ought to interact with each other.
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The theories both belong to a set of theories which make appeals to social norms. One letter was a standard reminder to recipients to have the vaccination while the others were based on one of two behavioural theories or on both. 4 Based on these requirements, four letter-based interventions were developed. In coproducing the intervention, UHB stipulated that it needed to be suitable for scale and spread to other hospitals, 3 not run counter to other measures within their planned vaccination campaign and be informed by behavioural science frameworks such as nudge theory. 2 To meet this stretching target, the University Hospitals Birmingham NHS Foundation Trust (UHB) approached the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands for support in designing and evaluating a new intervention as part of their seasonal influenza vaccination campaign. 1 For the 2018/2019 season, NHS England offered a financial reward to trusts that met a 75% vaccination rate for front-line staff. In the 2017/2018 season the target level was 70%, and front-line staff vaccination rates reported across NHS trusts varied from 38.9% to 92.3% with the median trust achieving 70.8%. The NHS incentivises hospitals to maximise vaccination rates by providing payments against achievement of a threshold vaccination rate. The OR for the injunctive norms factor is 1.00 (0.88-1.14) in the absence of the descriptive norms factor and 0.99 (0.87-1.12) in its presence.ConclusionsWe find no evidence that the uptake of the seasonal influenza vaccination is affected by reminders using social norms to motivate uptake.Įvery year the National Health Service (NHS) hospitals and community services in England offer their front-line staff free, onsite influenza vaccination to protect patients from infection, and reduce staff absences in case of an epidemic. The OR for the descriptive norms factor is 1.01 (0.89-1.15) in the absence of the injunctive norms factor and 1.00 (0.88-1.13) in its presence. There were no statistically significant effects of either norm or the interaction. A fourth letter included a combination of the social norms.Main outcome measureThe proportion of hospital staff vaccinated on-site.ResultsVaccine coverage was 43% (812/1885) in the standard letter group, 43% (818/1885) in the descriptive norms group, 43% (814/1885) in the injunctive norms group and 43% (812/1885) in the combination group.
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A third letter highlighted a type of social norm based on an appeal to authority. A second letter highlighted a type of social norm based on peer comparisons. ObjectiveTo evaluate the effectiveness of reminder letters informed by social normative theory (a type of 'nudge theory') on uptake of seasonal influenza vaccination by front-line hospital staff.DesignIndividually randomised controlled trial.SettingA large acute care hospital in England.ParticipantsFront-line staff employed by the hospital (n=7540) were randomly allocated to one of four reminder types in a factorial design.InterventionsThe standard letter included only general information directing the staff to take up the vaccine.