Why Don’t People Follow Through On Their Intent to Vaccinate?

By: Jaclyn Lefkowitz and Jess Leifer (ideas42)

Note: This post first appeared on the ideas42 blog

If you learned there was an easy, low-cost, and effective way to prevent sickness, would you be interested in it? Just one simple method for fewer sick days, fewer trips to the doctor, and better health – the flu shot. Yet less than 1 in 2 Americans get it every year, a rate that has been relatively stable since 2010. For a vaccine that is affordable and widely available, why are the rates so low? While some among us may explicitly choose not to get a vaccine, we suspect there’s more to the story.

In reality, many of us want to be vaccinated, but ultimately don’t follow through with it. This is surprising—we would normally assume that if people want a vaccine they will take action to get it. But it’s not always so simple. Think back to last winter. You may have wanted a flu shot and even researched where and when they were available, how much they cost, and whether you’d need an appointment. But, did you get one? You might have procrastinated – the window to take action is months long, after all – and then decided you didn’t need it anymore, or pushed it off until it was too late. Though information about potential benefits and how to get the vaccine was readily available, it might not have been enough to get you in the door.

While structural and educational improvements are key components of the push towards increasing vaccination rates, research from the behavioral sciences shows that those efforts alone may not get us to where we want to be. We need to focus on strengthening people’s intention to get the vaccine and help them actually follow through. Behavioral scientists have designed three low-cost solutions to help people take action with this in mind:

First, they helped people plan. Researchers sent reminders that included a planning prompt which encouraged people to simply write down the specific time and date they would go to the clinic for a flu vaccine. Adding the planning prompts increased vaccination rates by 4.2 percentage points.

Second, they required people to make a choice. Researchers required people to make what is called an enhanced active choice, a choice between a desirable option and an undesirable option while the implications of each are clearly laid out. In a series of studies, people had to actively select whether they would get a flu shot to reduce their risk of getting the flu, or would choose not get a flu shot, even if it meant increasing their risk. When presented with both the preferable and undesirable options at the same time, 75% of people said they would get a flu shot that fall, as opposed to 42% of people who only saw a standard message about getting a flu shot.

Finally, they offered people an immediate benefit. The benefits of vaccinations (protection from sickness) can feel far off in the future, while the costs of a shot (hassle and physical pain) are immediate. Sure they can protect you months from now, but right now vaccines just feel like painful obligations. Providing a modest financial incentive can counter our tendency to both procrastinate and be overly biased towards the immediate costs or benefits. One study offering students $30 for getting vaccines caused an 11 percentage point increase in the likelihood of vaccination. Raffles or lotteries are an alternative incentive model that can have even stronger results. Research has shown that a $100 lottery can make people 20 percentage points more likely to complete health risk assessments when compared to those who received a guaranteed $25 grocery gift card.

To raise vaccination rates, it’s crucial to design solutions that address action, in addition to increasing motivation. Developing behavioral tools that seek to strengthen the intention to get a vaccine and enable people to actually follow through can do a lot of good at a much lower cost.

Despite their cost-effectiveness and potential for impact, these three behavioral solutions (and others) have yet to be applied at significant scale within healthcare settings. In an effort to bridge the gap between research and practice, ideas42 has joined with the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania (CHIBE) to connect health policymakers and practitioners with useful behavioral science research. Supported by the Robert Wood Johnson Foundation, the new initiative, Behavioral Insights for Health Innovation, will focus on pressing challenges and issues in our healthcare system. Watch out for more on this work in the months ahead as the ideas42 team continues to highlight promising solutions to tough challenges in the health sector.