title: A behavioral economics intervention to increase pertussis vaccination among infant caregivers: A randomized feasibility trial.
abstract: OBJECTIVE
  The incidence of pertussis has tripled in the past five years. Infants can be protected by "cocooning," or vaccinating household contacts with the Tdap vaccine. However, Tdap coverage for adult caregivers of infants is low. This study evaluated the feasibility and impact of interventions informed by behavioral economics (retail pharmacy vouchers for Tdap vaccines and a celebrity public service announcement) to increase Tdap vaccination among caregivers of young infants.
  
  
  METHODS
  We conducted a randomized controlled feasibility trial among adults attending newborn well-child visits at an urban Philadelphia pediatric primary care clinic who were not previously vaccinated with Tdap. Participants were randomized to one of four conditions: ($5-off Tdap voucher vs. free voucher)×(watching a 1min video public service announcement (PSA) about Tdap vaccination vs. no PSA). Tdap vaccination was assessed by tracking voucher redemption and following up with participants by phone.
  
  
  RESULTS
  Ninety-five adult caregivers of 74 infants were enrolled in the study (mean age 29.3 years; 61% male; relationship to newborn: 54% father, 33% mother, 13% grandparent or other; caregiver insurance status: 35% Medicaid, 34% private insurance, 32% uninsured). Only 1 subject redeemed the retail pharmacy Tdap voucher. Follow-up interviews suggest that, even with the voucher, significant barriers to vaccination remained including: delaying planned vaccination, perceived inconvenient pharmacy locations, and beliefs about pertussis risk and severity.
  
  
  CONCLUSIONS
  Despite leveraging existing infrastructure for adult vaccination, results suggest that retail pharmacy vouchers delivered during a newborn visit are not an effective strategy for promoting Tdap. Alternate approaches are needed that prioritize convenience and provide an immediate opportunity to vaccinate when motivation is high.
authors.affiliation: Department of Family and Community Health, University of Pennsylvania School of Nursing, 416 Fagin Hall, 435 Curie Blvd, Philadelphia, PA 19104, USA. Electronic address: abutt@nursing.upenn.edu.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Buttenheim
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia, CHOP North Room 1546, 34th & Civic Center Blvd, Philadelphia, PA 19104, USA. Electronic address: fiks@email.chop.edu.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Fiks
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Blockley Hall 333, 423 Guardian Drive, Philadelphia, PA 19104, USA. Electronic address: Randall.Burson@uphs.upenn.edu.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Burson
authors.affiliation: Department of Family and Community Health, University of Pennsylvania School of Nursing, 416 Fagin Hall, 435 Curie Blvd, Philadelphia, PA 19104, USA. Electronic address: eiwang@sas.upenn.edu.
authors.forename: Eileen
authors.initials: E
authors.lastname: Wang
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, 3535 Market Street, Room 1579, Philadelphia, PA 19104, USA. Electronic address: coffin@email.chop.edu.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.affiliation: Massachusetts General Hospital, Harvard University School of Medicine, 15 Parkman Street, Boston, MA 02114-3117, USA. Electronic address: jmetlay@partners.org.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, CHOP North Room 1511, 34th & Civic Center Blvd, Philadelphia, PA 19104, USA. Electronic address: feemster@email.chop.edu.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Feemster
mesh_terms: D000328:Adult; D017028:Caregivers; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000627:therapeutic use*; D060909:Economics, Behavioral; D005240:Feasibility Studies; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015143:Philadelphia; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*; D014917:Whooping Cough / Q000517:prevention & control*
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines
keywords: Behavioral economics; Diphtheria-tetanus-pertussis vaccine; Infant; Pharmacy; Vaccination; Whooping cough