• Nancy Haff, Niteesh K Choudhry, Gauri Bhatkhande, Punam A Keller, Ted Robertson, Rebecca Oran, Daniel Horn, Katherine L Crum, Theresa Oduol, Kaitlin Hanken, and Julie C Lauffenburger.
• Center for Healthcare Delivery Sciences (C4HDS) and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, USA. nhaff@mgb.org.
• J Gen Intern Med. 2024 Mar 1; 39 (4): 611618611-618.

BackgroundMessages aimed at increasing uptake of vaccines have been modestly successful, perhaps in part because they often focus on why individuals should receive a vaccine. Construal Level Theory posits that messages emphasizing "how" to get a vaccine may be more effective at encouraging vaccination than emphasizing "why." This message framing may be particularly important for COVID-19 booster acceptance.ObjectiveTo determine if pre-visit patient portal messages designed using Construal Level Theory increase rates of COVID-19 booster vaccination.Design And InterventionsThis 3-arm randomized trial was conducted across three large, diverse primary care clinics in Massachusetts between February and May 2022, testing the impact of "how" versus "why" framed pre-visit messages versus no messages ("usual care"). Messages were sent by patient portal two business days before a visit.ParticipantsAdults with upcoming primary care visits who had electronic health record evidence of receiving their initial COVID-19 vaccination series but not a booster dose.Main MeasuresReceipt of a COVID-19 booster vaccination after the message was sent through the visit date (primary outcome) or 6 weeks (secondary outcome).Key ResultsA total of 3665 patients were randomized (mean age: 53.5 years (SD: 17.3), 59% female, 65.2% White, 26.6% Hispanic), with 1249 to "how" 1199 to "why," and 1217 to usual care arms. Except for clinic and preferred language, characteristics were well balanced across arms. Rates of COVID-19 booster were 13.6% (usual care), 11.7% ("how") (odds ratio (OR) "how" vs usual care: 0.87, 95%CI: 0.67-1.14), and 13.7% ("why") ("why" vs usual care: OR: 1.01, 95%CI: 0.81-1.28). At 6 weeks, "why" outperformed "how" for vaccination (OR: 1.26, 95%CI: 1.06-1.49), with no difference versus usual care.ConclusionsWe found no differences on visit booster receipt after single pre-visit portal messages designed using Construal Level Theory. Further studies to identify effective messaging interventions are needed, especially as additional doses are recommended.Clinical Trial RegistrationThis trial is registered at clinicaltrials.gov, ID: NCT04871776 . Initial release occurred 04/30/2021.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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