Nudging towards COVID-19 and influenza vaccination in children with medically at-risk conditions

Background Non-coercive ‘nudge’ interventions have shown the potential to promote health behaviours. This study aimed to evaluate the impact of nudge interventions on COVID-19/influenza vaccine uptake among children with medically at-risk conditions. Methods Randomized controlled trials (RCTs) were conducted, and participants were randomized (1:1) to standard care or intervention. The multicomponent nudge interventions included three text messages with video links, developed using the MINDSPACE framework. Results In the COVID-19 RCT, 554 were randomized to intervention and 552 to standard care, with 15.3% opting out of text messages. Over 3 months, eight children in the intervention group (1.4%) and nine in the standard care group (1.6%) received at least one dose of COVID-19 vaccine (odds ratio (OR): 0.89; 95% confidence interval (CI): 0.34–2.35). In the influenza RCT, 564 were randomized to intervention and 567 to standard care. There was no difference in the percentage vaccinated against influenza between the intervention (25.7%) and standard care (23.8%) groups (OR: 1.11; 95% CI: 0.85–1.45). Conclusions The nudge interventions were ineffective at increasing COVID-19/influenza vaccine uptake. The study included mostly unvaccinated children, and low vaccination rates during the study likely impacted the evaluation results. Nudges may need to evolve with changes to public trust in technology and communications.