A cluster randomised trial of digital messaging nudges to improve influenza vaccination uptake in China
As an effective strategy for preventing influenza, vaccination uptake remains suboptimal. This cluster randomised trial evaluated digital messaging nudges on influenza vaccination among children aged 6-35 months and their parents in China. During 2024-25 flu season, 36 community health centres were randomly assigned to one of six arms by message framing (gain vs. loss) and evidence type (statistical vs. narrative), and standard message and no-message control, with 2,011 parents of age-eligible children enroled. For childhood vaccination, loss-framed narrative arm achieved the highest uptake (24.0% vs. control 9.4%; adjusted RR 2.50, 95% CI 1.27-4.94), and effects sustained at five-month follow-up. Loss-framed statistical arm (16.9% vaccination uptake) was significantly effective only at one-month follow-up (RR 2.73; 95% CI 1.50-4.99), with effects attenuating rapidly. Both standard and gain-framed messages had no significant effect on childhood vaccination. Loss-framed narrative digital nudges offer a scalable strategy to improve childhood vaccination. Clinical trial registration: ChiCTR2400092213.
Authors
- Zhijie An (ORCID: https://orcid.org/0000-0002-1552-6684)
- Lixin Hao
- Lance E. Rodewald (ORCID: https://orcid.org/0000-0003-2593-542X)
- Zhiyuan Hou (ORCID: https://orcid.org/0000-0003-3413-0076)
- Yang Zhou (ORCID: https://orcid.org/0000-0002-4379-3456)
- Qing Hou (ORCID: https://orcid.org/0000-0002-2500-8362)
- Wenwen Gu (ORCID: https://orcid.org/0000-0002-6169-5315)
- Yan Liu (ORCID: https://orcid.org/0000-0002-2566-6867)
- Qian Wang (ORCID: https://orcid.org/0000-0002-7613-1408)
- Zundong Yin
- Yujuan Jia (ORCID: https://orcid.org/0000-0002-5313-5780)
- Hanqing He (ORCID: https://orcid.org/0000-0003-0863-5177)
- Wenzhou Yu (ORCID: https://orcid.org/0000-0002-8357-4485)
- Hui Xu (ORCID: https://orcid.org/0000-0003-2555-7844)
- Linling Ding
Institutions
- Chinese Center For Disease Control and Prevention (CN)
- Fudan University (CN)
- National Health and Family Planning Commission (CN)
- Hangzhou Center for Disease Control and Prevention (CN)
- Chinese Preventive Medicine Association (CN)
- Zhejiang Center for Disease Control and Prevention (CN)
Publication Details
- Journal
- npj Digital Medicine
- Published
- 2025-11-27
- DOI
- https://doi.org/10.1038/s41746-025-02137-5
- Citations
- 1
- Primary Topic
- Vaccine Coverage and Hesitancy
- Type
- article
- Field-Weighted Citation Impact
- 2.17
Funders
- Fudan University
- Chinese Center for Disease Control and Prevention