Andraweera Prabha H, Wang Bing, Danchin Margie, Blyth Christopher C, Vlaev Ivo, Ong Jason J, Dodd Jodie, Couper Jennifer, Sullivan Thomas R, Cuthbert Alana R, Karnon Jonathan, Spurrier Nicola, Cusack Michael, Mordaunt Dylan, Simatos Dimi, Dekker Gus, Carlson Samantha, Tuckerman Jane, Wood Nicholas, Whop Lisa, Koch Joanne, Herewane Kirsty, Pidd Deborah, Rak Ashleigh, Marshall Helen S
Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, SA Health, Adelaide, South Australia, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, SA Health, Adelaide, South Australia, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
Vaccine. 2025 Aug 30;62:127477. doi: 10.1016/j.vaccine.2025.127477. Epub 2025 Jul 9.
Influenza and COVID-19 vaccine uptake among pregnant women is sub-optimal. We assessed the effectiveness of a multi-component behavioural nudge intervention to improve COVID-19 and influenza vaccine uptake among pregnant women.
A 'nudge' was developed that comprised three SMS text message reminders with a social norming message, links to vaccine safety information, videos of health professionals and consumers recommending vaccination in pregnancy and a pledge to get vaccinated. In separate RCTs, pregnant women who had not received an influenza vaccine during the 2023 influenza season, or received ≤2 doses of a COVID-19 vaccine, were randomised (1:1) to standard care or intervention at four hospitals in Australia.
A total of 1090 and 1068 pregnant women were randomised to the COVID-19 and influenza RCTs, respectively. The nudges resulted in a 1.6 % increase in COVID-19 vaccine uptake and 1.7 % increase in influenza vaccine uptake among pregnant women. However, there was no significant difference in the percentage of pregnant women in the intervention (2.7 %) and the standard care (1.1 %) groups receiving one dose of a COVID-19 vaccine from randomisation until delivery (odds ratio, 2.40; 95 % confidence interval [CI], 0.91 to 6.30, P = 0.08). Similarly, there was no significant difference in the percentage of pregnant women in the intervention (58.0 %) and the standard care (56.3 %) groups receiving the influenza vaccine from the time of randomisation until delivery (odds ratio, 1.07; 95 % CI, 0.84 to 1.38, P = 0.58). Less than 2 % of women had viewed the video content of the nudges in both RCTs.
The nudges delivered via SMS resulted in small increases in COVID-19 and influenza vaccination uptake among pregnant women. Considering the very low cost of bulk SMS, these nudges may be cost-effective interventions at a population level.