How postcard reminders empowered seniors to stay up-to-date on vaccinations

Adults in the USA are falling short on important vaccinations, particularly seniors over 65 years who should receive immunizations for four potentially life-threatening diseases: influenza, tetanus (Td/Tdap), pneumococcal pneumonia, and herpes zoster (shingles). An alarmingly low 43% of adults and 59% of children received their flu vaccine during the 2016-2017 period – underscoring an urgent need for actionable strategies to ensure vulnerable populations have access to life-saving vaccines.

Through a collaborative study carried out during the 2017-2018 influenza season in Louisiana, the Office of Evaluation Sciences and the Louisiana Department of Health evaluated the effectiveness of behavior-oriented interventions such as vaccination reminder postcards. Their findings reinforce prior research that suggests reminders can be effective for changing health behaviors; they saw an average increase in four recommended vaccine uptakes among participants who received this type of reminder.

These results point towards the effectiveness of reminders as an influential tool for changing patient conduct; however, more research is needed to verify its long-term efficacy.

Barriers to Vaccine Uptake in Louisiana

Vaccination rates are lower than recommended due to multiple factors, including financial and accessibility challenges as well as reluctance or refusal among some individuals. In the search for solutions, researchers have proposed a ‘5C’ psychological model of vaccine acceptance that leverages constraints and collective responsibility. This decision-science approach focuses on guiding behavior for optimal outcomes “without trying to change beliefs and attitudes.”

The Louisiana Department of Health is up against multiple challenges that may prevent individuals from getting vaccinated. Low public awareness, lack of strong provider recommendations, and insufficient access to vaccine providers are all key factors preventing people from protecting their health with vaccines. To tackle this issue, a postcard was sent out during flu season – an effort that proved effective in reducing the wide gap between those who intend to be vaccinated versus those who actually make it happen.

Healthcare Organizations Can Use Reminders As Valuable Tool

McCaul et al. (2002) and Yokum et al.(2018) both discovered that sending reminder letters could be an effective way to encourage greater take-up of the flu vaccine, particularly when it comes to elderly individuals or Medicare beneficiaries. McCaul’s research demonstrated a rise in uptake from 20% to 8.6 percentage points following such reminders; Yokum achieved increases between 0.4 – 0.9 percentage points above baseline amongst their sample group of 25.9%.

Proven through empirical research, reminder-based interventions are an effective and reliable way to improve healthcare compliance. Specifically in the context of flu vaccines, sending out reminders has been seen to increase uptake amongst elderly individuals or Medicare beneficiaries. Reminders can successfully reduce forgetfulness and complacency regarding recommended vaccine schedules. This indicates that strategically implemented reminders could be a valuable tool for improving overall adherence rates and securing healthier futures.

The postcard design also encourages recipients to keep the Centers for Disease Control and Prevention’s (CDC) vaccine sequence recommendation in mind and to proactively “contact their healthcare provider” for further information. Through this simple method of communication, it has been found that individuals are more likely to follow through with getting vaccinated.

The Block-Randomized Stepped Wedge Design

To evaluate the effects of a postcard reminder intervention, this unique study utilized a block-randomized stepped wedge design. Each individual was randomly assigned to receive treatment in one predefined month from October, November, December 2017, and January 2018, with individuals receiving their respective treatments at different times over that period. Vaccination history for each participant played an important role as it helped decide when and how they would react to postcards throughout the course of the trial. This method allows the researchers to determine more precisely how effective this particular strategy is in improving adherence rates over time.

The Louisiana Department of Health and the CDC sent externally informed postcard reminders to 208,867 residents aged 65–70 in order to increase vaccination rates. At the end of a four-month trial period, it was determined that 563 additional vaccinations had been received due to this reminder – representing an increased share of recommended vaccines by 0.27 percentage points compared with control groups who did not receive them.

This study showcases the efficacy of a vaccination reminder postcards intervention sent by mail in boosting vaccine uptake among elderly populations due to one or more vaccinations. In particular, this tactic proved to be notably effective when implemented early during flu season; primarily leading to higher uptake of both the flu and shingles vaccines, but not tetanus or pneumonia vaccinations.