A Large Scale Examination of Digital Textual Nudges on Uptake Rates of Medical Checkups

Background: Textual messages are often used by healthcare authorities in order to increase compliance rates with different medical recommendations, as in the case of vaccinations against Covid-19. The effectiveness of different types of message framings have been examined over the past three decades. Of the most influential and widely-used frames are those that involve gains and losses, physician recommendation and implementation intentions.Methods: Using a large scale field study (n=113,048) held in Israel together with Maccabi Healthcare Services (MHS), we revisit the effect of these prominent types of frames on uptake rates of medical checkups. MHS invited members aged 50-74, via email or text message, to take their personally recommended medical actions from the following list of checkups: HPV, mammography, abdominal aortic aneurysm, fecal occult blood test and pneumococcal vaccination. Each member was randomly assigned to receive one of six types of framed messages: Control (neutral and informative), gains, losses, physician recommendation, implementation intentions, and empowerment.Findings: No significant effect of message framing on uptake rates was found. We identify two suggestive findings: (1) shorter subject lines are positively correlated with opening rates, and (2) emails outperform text messages.Interpretation: In our study, no evidence was found for an effect of the above commonly-used frames on uptake rates. In order to increase compliance rates of the general population, public health officials should consider alternative message framings. In addition, media channels and subject line length should be given careful thought.Funding: This research was based on internal funding of MHS. The author(s) received no financial support for the research and/or publication of this article.Declaration of Interest: This research was based on internal funding of MHS. AM and AS certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The following authors were full time employees of MHS during the research period or part of it: SR, YC, ES, TL, NAB, TA.Ethical Approval: This research has been approved by the Helsinki Committee of MHS (study number 0099-20-MHS), and by the Ethical Research and the Protection of Human ParticipantsCommittee, The Faculty of Social Sciences, University of Haifa (approval number 369/21).