Abstract
IMPORTANCE: Influenza vaccination coverage in the US is low, due largely to vaccine hesitancy. Personalized messages from trusted physicians may raise vaccination rates. OBJECTIVE: To evaluate the effects of physician-created videos and infographics containing physician photographs on influenza vaccination rates. DESIGN, SETTING, AND PARTICIPANTS: This 3-arm randomized clinical trial included patients from 6 months to older than 65 years of age served by 21 primary care physicians in 21 practices at UCLA Health who were listed in the electronic health record as not receiving influenza vaccination between October 31, 2023, and April 1, 2024. INTERVENTION: Patients within each physician patient population were randomized to receive usual care or a physician-created video or an infographic with their physician's photograph encouraging receipt of influenza vaccinations. Primary care physicians used a suggested script to create a brief video with their smartphone or a video conference recording, or an infographic containing their photograph and a similar script was created, both encouraging patients to receive influenza vaccinations. The video or infographic was sent via the patient portal up to 3 times (October, November, and December). MAIN OUTCOMES AND MEASURES: All analyses used the evaluable patient population. The primary outcome was end-of-season influenza vaccination rates by Aril 1, 2024. A secondary outcome was timely vaccination by December 31, 2023. RESULTS: Among 22 233 patients, 3200 were children younger than 18 years (14.4%), 14 704 were adults 18 to 64 years of age (66.1%), and 4329 were adults 65 years or older (19.5%); 13 973 (62.8%) were female. Overall, 18 878 patients (84.9%) had private insurance. The rates of influenza vaccination across the entire study population by April 1, 2024, were 3479 of 7417 (46.9%) for usual care, 3557 of 7410 (48.0%) for the video arm, and 3518 of 7406 (47.5%) for the infographic arm. Neither intervention had significantly higher rates of vaccination than usual care (adjusted risk ratio, 1.03 [95% CI, 1.00-1.06] for the video group; adjusted risk ratio, 1.02 [95% CI, 0.99-1.06] for the infographic group). In the post hoc analysis, children in both intervention arms had higher vaccination rates by April 1, 2024: 618 of 1058 children in the video group (58.4%) (P < .001) and 598 of 1085 children in the infographics group (55.1%), each compared with 576 of 1057 (54.5%) in the usual care group (P = .04). CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, neither physician-created videos nor infographics increased influenza overall vaccination rates by April 1, 2024. However, among children, both interventions were effective by end of influenza season. Messages personalized by physicians may represent a potential strategy to improve influenza vaccination among children, but further innovations are needed across the entire age spectrum. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06062264.