Table 4.
Behavioural insights informed changes to the flu invitation letter and rationale
| Changes to letter | Behavioural rationale |
|---|---|
| Formatting | |
| Reduced in length and made simpler. | Simplification: Reduces the cognitive effort required to process the information and identify the action required [25]. |
| We have formatted text to highlight the key points of note/ actions required. | Salience: Reduces cognitive effort to identify action required [26–28]. |
| Provider letterhead plus NHS logo | Messenger effect: NHS is a trusted brand when it comes to medical/ health issues. (BCT 9.1 Credible Source [24]) |
| Phrasing | |
| Your child’s annual flu vaccination is now due | Stating ‘due’ creates a sense of urgency. |
| This vaccination programme is in place to help protect your child against flu. | Gain-framed message: evidence indicates gain-framed messages may be more effective than loss-framed for preventative behaviours (BCT 13.2 Framing [24]) |
| Flu can be an unpleasant illness and sometimes causes serious complications. | Information about Health Consequences and Salience of Consequences: highlighting the negative effects of flu (BCT 5.1 Information about Health Consequences and 5.2 Salience of consequences [24]) |
| Please complete the enclosed consent form (one for each child) and return to the school [by/ within] [INSERT DATE or TIME FRAME] | Action orientated: providing clear action focused instruction including telephone number to make the behaviour easy to perform and providing child’s name to increase personal salience (BCT 4.1 Instruction on how to perform a behaviour [24]) |
| The vaccination is free … | Framing/ Reducing friction: to perform the behaviour: Reduces friction costs by eliminating the barrier of cost since there is anecdotal evidence that parents do not realise it is free or annual. Note: the evidence on use of ‘free’ is mixed as this can be deemed as less valuable, particularly by some cultures. (BCT 13.2 Framing, 6.3 Information about others’ approval [24]) |
| … and will be given by a quick and simple spray up the nose | Framing effect: Encouraging uptake of this method because it is appealing and not painful (compared to traditional ideas of a vaccination being an invasive injection) (BCT 13.2 Framing [24]) |
| Last year, most children offered the vaccine in schools had the immunisation. | Social norms (BCT 6.2 Social comparison [24]) |