Improving Physician Vaccine Recommendation Using Social Norms, Trust, and Presumptive Language

Study Overview
=================
Brief Summary
-----------------
This research examines vaccination recommendation perceptions and behaviors of physicians and advanced practice providers.

Official Title
-----------------
Improving Physician Vaccine Recommendation Using Social Norms, Trust, and Presumptive Language

Conditions
-----------------
Healthy

Intervention / Treatment
-----------------
* Other: Quantity of vaccination recommendations
* Other: Quality of vaccination recommendations
* Other: Control


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Participants must be physicians, advanced practice providers, medical students, nurses/nurse practitioners, or medical fellows. Must be in a position to be authorized to recommend vaccines to patients in their official professional capacities/responsibilities. Exclusion Criteria: Students or employees under the supervision of the PI who meet inclusion criteria for the study

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Quantity (present) x Quality (present)<br>Participants will receive a social norm-based message (for quantity) and will learn the AIMS method, a trust-building method using presumptive language (for quality). | Other: Quantity of vaccination recommendations<br>* The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).<br>Other: Quality of vaccination recommendations<br>* The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).<br>|
| Experimental: Quantity (present) x Quality (absent)<br>Participants will receive a social norm-based message (for quantity). | Other: Quantity of vaccination recommendations<br>* The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).<br>|
| Experimental: Quantity (absent) x Quality (present)<br>Participants will learn the AIMS method, a trust-building method using presumptive language (for quality). | Other: Quality of vaccination recommendations<br>* The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).<br>|
| Experimental: Quantity (absent) x Quality (absent)<br>Control: Participants in this condition will receive general information about vaccines, including vaccine principles, uptake barriers, and guidelines. This information will come directly from the CDC's Advisory Committee on Immunization Practices (ACIP) website. | Other: Control<br>* The survey contains a messaging intervention using a 2x2 randomized factorial design, where the investigators attempt to increase the quantity and/or quality of physician and APP vaccination recommendations (Quantity (present vs. absent) x Quality (present vs. absent)).<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in proportion of patients that receive a vaccine recommendation | Proportion of patients that receive a vaccine recommendation = multiplication of the answer to the following two items: (1) I (will) check(ed) whether a patient has/had gotten all indicated vaccines, (2) If I saw/see a patient had not gotten an indicated vaccine, I (will) discuss(ed) getting it. Both items are answered on a scale from 0% (never) to 100% (always). | Day 1, Day 30, Day 60, Day 90 | 
| Change in self-reported responsibility perception | Self-reported responsibility perception = answer to the following item: (1) Recommending indicated vaccines is within the scope of my professional responsibilities. This item is answered on a scale from 0% (completely disagree) to 100% (completely agree). | Day 1, Day 30, Day 60, Day 90 | 
| Change in self-reported assessment of patient recommendation acceptance | Self-reported assessment of patient recommendation acceptance = answer to the following item: (1) If I recommend(ed) an indicated vaccine, my patient (will) accept(ed) that recommendation.. This item is answered on a scale from 0% (never) to 100% (always). | Day 1, Day 30, Day 60, Day 90 | 
| Change in self-reported patient trust | Self-reported patient trust = answer to the following item: (1) Thinking about the last/next 30 days I provided care, I can say that my patients (will) trust(ed) me as their healthcare provider. This item is answered on a scale from 0% (completely disagree) to 100% (completely agree). | Day 1, Day 30, Day 60, Day 90 | 
| Change in self-reported utilization of AIMS | Composite score of the following items: (1) I used/will use direct, declarative language, like: You're due for your flu shot. We'll do that at the end of this visit; (2) If the patient showed/shows hesitancy about getting vaccinated, I (will) ask(ed) about their concerns, and then use(d) active listening to understand their thoughts; (3) If the patient showed/shows hesitancy about getting vaccinated, I (will) listen(ed) to the patient's reasoning and then summarize(d) the patient's reasoning back to them to show that I understood/understand; (4) If the patient still has concerns, I did/will not continue efforts to convince them. Each item is answered on a scale from 0% (never) to 100% (always). | Day 1, Day 30, Day 60, Day 90 | 
| Change in self-reported rate of patient vaccine uptake | Answer to the following item: Estimate what percentage of your patients is/will be fully vaccinated against […] This item is answered on a scale from 0% to 100%. The question is being asked 8-10 times with the following name inserted for [...] in the above question: Flu COVID-19 Tetanus, Diphtheria, Pertussis HPV Hepatitis B Meningitis / Meningococcal Shingles Pneumococcal Other (which can be two other diseases that the respondent indicated) | Day 1, Day 30, Day 60, Day 90 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in belief about patient autonomy | Answer to the following item: I stated / will state the patient's options - to vaccinate or not, and with which vaccine - so that they can make an informed decision. This item is answered on a scale from 0% to 100%. | Day 1, Day 30, Day 60, Day 90 | 
| Change in proportion of patients that accept a recommendation | Proportion of patients that accept a recommendation = multiplication of the answer to the following three items: (1) I (will) check(ed) whether a patient has/had gotten all indicated vaccines, (2) If I saw/see a patient had not gotten an indicated vaccine, I (will) discuss(ed) getting it.; (3) If I recommend(ed) an indicated vaccine, my patient (will) accept(ed) that recommendation. All items are answered on a scale from 0% (never) to 100% (always). | Day 1, Day 30, Day 60, Day 90 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Trust, Presumptive Recommendation, Physicians, Vaccination Recommendation, Social Norms