Time for a “B.O.O.S.T.E.R.”! Promising Messages and Practices to Promote the Latest COVID-19 Shot

By: Jack Stevens, PhD, Nationwide Children’s Hospital

Researchers from University of Maryland, Yale University, and York University estimated that maximizing uptake of the new COVID-19 bivalent booster could:

(a) save tens of thousands of American lives;

(b) prevent hundreds of thousands of hospitalizations; and

(c) avert tens of billions of dollars in direct medical expenses.1

Minimal research has been conducted on strategies to encourage COVID-19 boosters.  However,  based upon relevant studies for other purposes, there are promising messages and practices that might increase vaccinations.  Here are some approaches that you can consider:

• Be presumptive.  Use an “announcement” communication style to indicate that these vaccinations represent recommended health care.2

“There is a COVID-19 booster vaccination that will be given today.”

• Offer normative information by highlighting groups of individuals who have already engaged in this preventative behavior.3

“Millions of Americans have already received the latest COVID-19 booster shot” or “Many of my other patients have recently received this booster.”

• Offer boosters during non-well visits when medically acceptable for certain patients.4   Administering a booster during a sick visit, an emergency department encounter, or inpatient hospital stay eliminates the need for a separate trip to receive this shot.   

“Let’s save you another trip and give you the COVID-19 booster now.”

•  Say “a booster shot has been reserved for you” or “claim your dose” in your oral, written, and electronic messages.5-6  Instilling a sense of ownership has been shown to increase rates of other vaccinations.

• Tell potential recipients who are least interested in vaccination about benefits to them and their loved ones.7 Highlighting the societal benefits of boosters may not be convincing. 

“Catching COVID-19 can seriously disrupt your life. It can take you from work, education, family, and friends. Vaccination reduces the chances of your falling ill.”

• Ease the vaccination process for physicians. Specifically, use of standing orders and greater involvement of non-physicians (e.g., medical assistants) are associated with increased rates of other vaccinations.8-9

• Remind interested patients that they can proactively ask for a booster. During busy health care encounters, patients may sometimes not be offered this shot.  Posters in waiting areas and electronic messages from patient portals can convey this opportunity.10-11

On posters or through electronic messages: “Don’t forget to ask for your COVID-19 booster!”

References 

1. Commonwealth Fund.   A fall COVID-19 booster campaign could save thousands of lives, billions of dollars.   https://www.commonwealthfund.org/blog/2022/fall-covid-19-booster-campaign-could-save-thousands-of-lives-billions-of-dollars.  Accessed October 6, 2022

2. Brewer NT, Hall ME, Malo TL.  Announcements versus conversations to improve HPV vaccination coverage:  A randomized trial.   Pediatrics. 2017; 139(1): e20161764.

3. Brewer NT, Chapman BG, Rothman AJ, et al.    Increasing vaccination: putting psychological science into action.   Psychological Science in the Public Interest.  2017; 18(3): 149-207.

4. Bryan MA, Hofstetter AM, Opel DJ, et al.  Vaccine administration in children’s hospitals.  Pediatrics. 2022; 149(2): e2021053925.

5. Dai H, Saccardo S, Han MA, et al.   Behavioural nudges increase COVID-19 vaccinations.  Nature. 2021; 597: 404. 

6. Patel MS, Milkman KL, Gandhi L, et al.   A randomized trial of behavioral nudges delivered through text messages to increase influenza vaccination among patients with an upcoming primary care visit.  American Journal of Health Promotion.  2022; 8901171221131021

7. Freeman D, Loe BS, Yu LM, et al.   Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): A single-blind, parallel-group, randomized controlled trial.   Lancet Public Health. 2021; 6: e416-427.

8. Cataldi J, O’Leary ST, Lindley MC, et al.   Use of standing orders for vaccinations among pediatricians.  Pediatrics.  2020; 145(5): e20191855.

9. Kim RH, Day SC, Small DS, et al.  Variations in influenza vaccination by clinic appointment time and an active choice intervention in the electronic health record to increase influenza vaccination.   JAMA Network Open.  2018; 1(5): e181770.

10. Rutten LJ, Zhu X, Leppin AL, et al.   Evidence-based strategies for clinical organizations to address COVID-19 vaccine hesitancy.  Mayo Clinic Proceedings.  2021; 96(3): 699-707.

11. Lieu TA, Elkin EP, Escobar PR, et al.  Effect of electronic and mail outreach from primary care physicians for COVID-19 vaccination of Black and Latino older adults:  A randomized clinical trial.   JAMA Network Open.  2022; 5(6):e2217004.

About the Author

Jack Stevens, PhD, is a psychologist with Nationwide Children’s Hospital and an Associate Professor of Pediatrics at the Ohio State University. Dr. Stevens collaborates with Health Impact Ohio on a Centers for Disease Control and Prevention-funded project involving Community Health Workers for COVID Response and Resilient Communities. Part of this initiative features implementing promising approaches to encourage COVID-19 vaccinations and boosters among Ohio residents of all ages.