Effect of Messaging on Pragmatic Outcomes Within an Integrated Healthcare System: a Randomized Trial (EMPOWeR)
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 1,300,000
- 试验地点
- 1
- 主要终点
- Proportion of participants with documented receipt of the updated 2026-27 COVID-19 vaccine
研究概览
简要总结
COVID-19 vaccination among patients at high risk for severe disease has declined in the United States since 2022. Prior research, including discrete choice experiments (DCEs), has demonstrated that vaccine preferences are influenced by attributes such as effectiveness, safety, convenience, and protection against severe disease. Although DCEs provide valuable insights into stated vaccine preferences and decision-making, they rely on hypothetical scenarios and cannot directly assess how vaccine attributes influence real-world vaccine uptake. Additional research is needed to understand the relationship between vaccine characteristics and observed COVID-19 vaccination behavior in routine clinical practice.
The EMPOWeR study is a pragmatic randomized controlled trial conducted within Kaiser Permanente Southern California (KPSC) to evaluate the effect of immunization messages and reminders that highlight COVID-19 vaccine choices on vaccine uptake. The primary research questions are:
- Does having a choice in COVID-19 vaccine platform affect vaccine uptake among patients at high-risk of severe disease? 1a. Does having a choice in COVID-19 vaccine platform affect vaccine uptake among patients at high-risk of severe disease, when differences in vaccine platform are highlighted? 1b. Does having a choice in COVID-19 vaccine platform affect vaccine uptake among patients at high-risk of severe disease, when a trusted healthcare professional (HCP) endorses both vaccine options? 1c. Does having a choice in COVID-19 vaccine platform affect vaccine uptake among patients at high-risk of severe disease, when vaccine reactogenicity is highlighted?
A secondary research question is: 2. Does having a choice in COVID-19 vaccine additionally increase uptake of influenza vaccine?
During the 2026-2027 respiratory virus season, eligible KPSC members who are at high-risk of severe COVID-19 will be randomly assigned to receive a standard reminder message or a reminder message with additional information about available COVID-19 vaccine options.
详细描述
The Effect of Messaging on Pragmatic Outcomes Within an Integrated Healthcare System: A Randomized Trial (EMPOWeR) study is designed to learn whether vaccine reminder messages that highlight a patient's choice of COVID-19 vaccines can help increase vaccine uptake among adults who are at higher risk for serious illness from COVID-19. The study will take place within KPSC, a large integrated health care system in southern California, and will use routine health care messages and reminders for updated COVID-19 immunization .
COVID-19 vaccination rates have declined since 2022, including among older adults and people with medical conditions that increase their risk of severe disease. Concerns about vaccine side effects, trust, and vaccine technologies may influence whether people choose to get vaccinated. The EMPOWeR study will evaluate whether providing information about vaccine choices can encourage individuals at higher risk of severe COVID-19 to receive an updated COVID-19 vaccine.
Adults who are eligible for a COVID-19 vaccine and who meet the study eligibility criteria will be included in the study. Eligible participants include adults enrolled for care at KPSC who are either 65 years of age or adults aged 18 to 64 years with certain health conditions that place them at increased risk for severe COVID-19 illness. Participants will not be asked to attend study visits or complete surveys. The study will use immunization data already collected in electronic health records as part of routine care.
Participants will be randomly assigned to one of five groups. One group will receive a standard COVID-19 vaccine reminder message currently used in routine care. The other four groups will receive messages that provide information about available COVID-19 vaccine options: mRNA and protein-based COVID-19 vaccines. These messages may:
- Inform participants that they can choose between two different COVID-19 vaccine types.
- Explain differences between vaccine technologies.
- Include information that both vaccine options are supported by health care professionals.
- Provide information about vaccine side effects and vaccine choice.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Triple (Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Aged ≥18 years;
- •Active KPSC member;
- •Continuous membership from 27 August 2025 to 27 September 2026;
- •Members who are aged 65 years and older, or adults aged 18-64 years with at least one of the following health conditions that increases their risk for severe COVID-19 illness, including: a) asthma, b) cancer, c) ischemic stroke, d) intracerebral or subarachnoid hemorrhage, e) transient ischemic attack, f) chronic kidney disease, g) dialysis, h) bronchiectasis, i) chronic obstructive, pulmonary disease (COPD), j) pulmonary fibrosis, k) cystic fibrosis, l) pulmonary hypertension, m) cirrhosis, n) non-alcoholic fatty liver disease (NALD), o) alcoholic liver disease, p) autoimmune hepatitis, q) diabetes, r) heart failure, s) coronary artery disease, t) cardiomyopathy, u) HIV, v) obesity, w) essential hypertension, x) primary immunodeficiency and other underlying immunocompromising conditions, y) solid organ or blood stem cell transplant, z) tuberculosis;
- •No documented receipt of updated 2026-27 COVID-19 vaccine as of 28 September 2026;
- •Has valid email information.
排除标准
- •Unable to receive or opted out of email communication.
- •People who cannot safely receive a COVID-19 vaccine, including those who had a severe allergic reaction to a previous COVID-19 vaccine or have a contraindication to COVID-19 vaccine or a vaccine ingredient, will not be included in the study.
- •People who are pregnant or breastfeeding will not be included.
研究组 & 干预措施
Usual Care
Standard COVID-19 vaccination reminder message sent as part of usual care.
A. Choice-framed
Intervention arm tests the effects of choice-framed communication to increase patient's awareness of their available choices of COVID-19 vaccines, compared with usual care.
干预措施: Vaccine choice message (Behavioral)
B. Choice + vaccine platform-framed
Intervention arm tests the effects of choice-framed communication to increase patients' awareness of their available choices of COVID-19 vaccines AND explain differences in vaccine composition and mechanisms of protection by vaccine type, compared with usual care.
干预措施: Vaccine choice + platform-framed message (Behavioral)
C. Choice + HCP trust-framed
Intervention arm tests the effects of choice-framed communication to increase patients' awareness of their available choices of COVID-19 vaccines AND emphasizes the support of healthcare personnel (HCP) for both vaccine options, compared with usual care.
干预措施: Vaccine choice + HCP trust-framed message (Behavioral)
D. Choice + reactogenicity-framed
Intervention arm tests the effects of choice-framed communication to increase patients' awareness of their available choices of COVID-19 vaccines AND information about expected side effects, compared with usual care.
干预措施: Vaccine choice + reactogenicity-framed message (Behavioral)
结局指标
主要结局
Proportion of participants with documented receipt of the updated 2026-27 COVID-19 vaccine
时间窗: up to 4 months after intervention
Kaiser Permanente Southern California's electronic health record tracks the type of vaccine, dose, and date each patient receives. Immunization data will be retrieved from participants' electronic health records to ascertain COVID-19 immunization status during the study period.
次要结局
- Type of COVID-19 vaccine received(up to 4 months after intervention)
- Receipt of the 2026-27 influenza vaccine(up to 4 months after intervention)
- Co-administration of COVID-19 vaccine and influenza vaccine(up to 4 months after intervention)
- Time to immunization (in days) with an updated 2026-27 COVID-19 vaccine(up to 4 months after intervention)