Health Promotion, Wellness Programs
Conditions
Keywords
Prospect theory
Brief summary
The purpose of the study is to evaluate, prospectively, the potential impact of different email message conditions (no email, standard promotional email, social norms, and loss framing) on enrollment in a wellness program (myHealth Rewards) by Geisinger Health Plan (GHP) members.
Detailed description
The myHealth Rewards wellness program managed by GHP rewards those GHP members who carry their insurance through employment at Geisinger with reduced health insurance premiums over the course of the following year, if members register for the program and have their health measures on file by the enrollment deadline and are then able to meet their health goals by the respective due date. In spite of the potential savings to health plan members and the wellness program's potential to motivate engagement in healthy activities (with consequent improvement in health outcomes), over 20% of eligible GHP members have not yet enrolled in 2019, even after receiving promotional email communications and reminders. Therefore, the current study was developed to test whether different versions of emails are more effective than a standard reminder email or no-email condition in increasing myHealth Rewards login and enrollment rates. The standard email reminder mentions the average premium savings, the ease of the registration process, and the deadline for registering and having health measures on file, plus it provides links for registering and finding free health screenings where health measures can be collected and registered at one convenient time and location. The social norms email notes that a majority (78%) of GHP members' colleagues had enrolled in 2018, it provides a testimonial from a medical director at Geisinger's Commonwealth School of Medicine, stating the ways in which myHealth Rewards helped that doctor personally, and it emphasizes the simplicity and ease of taking the first step toward enrollment. The loss framing email suggests that GHP members are currently throwing away a precise monetary amount in savings by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. It is hypothesized that, on average, each of the emails will increase enrollment compared with no email. Among GHP members who never enrolled in the past, it is hypothesized that the standard email reminder will not be as effective as the social norms and loss framing emails. Therefore, email conditions will be compared separately among those who did and did not register in 2018. Findings will help inform how best to increase enrollment in a wellness program among health plan members who have already received past promotional communications and who may or may not have participated in the past.
Interventions
BEHAVIORALSocial norms
This intervention introduces recipients to descriptive social norms specifying that a majority of their colleagues have signed up for the program, which sets a normative standard against which recipients are expected to compare themselves and to change their behavior accordingly (i.e., when they realize that their behavior is discrepant from that of relevant others). The personal testimonial from a Geisinger medical director serves as a personal exemplar intended to further enhance the effect of the social norms with an implicit indication that the intended behavior is desirable and feasible.
BEHAVIORALLoss framing
This intervention frames the status quo as a state from which recipients, via inaction, are slated to forfeit a sizable and precise monetary amount to which they should otherwise feel entitled (via loss aversion and the endowment effect). People tend to be risk-seeking in the domain of losses; therefore, this intervention is hypothesized to increase enrollment in the hope of achieving zero loss by meeting program goals, as opposed to a sure loss via inaction.
BEHAVIORALEmail reminder
This intervention is a standard email reminder that mentions the average premium savings, the speed and ease of starting the process, and the deadline for registering and having health measures on file, plus it provides two button links for registering and finding screenings.
Sponsors
Geisinger Clinic
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Geisinger employees who are benefits subscribers
Exclusion criteria
* Those who had already registered for myHealth Rewards in 2019, up through May 6, 2019 * New Geisinger employees hired between December 1, 2018 and May 6, 2019 * Existing Geisinger employees who transitioned from non-subscribers in 2018 to subscribers in 2019
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Enrollment (7 Days) | 7 days, from May 7 through 13, 2019 | Enrollment in the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention (i.e., when the emails are first sent). |
| Logging in (7 Days) | 7 days, from May 7 through 13, 2019 | Logging into the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| No Email No email will be sent out to this subset of GHP members during the week that the other emails are sent. | 1,422 |
| Standard Email Reminder The standard email reminder mentions the average premium savings, the speed and ease of starting the process, and the deadline for registering and having health measures on file, plus it provides two button links for registering and finding free health screenings where health measures can be collected and registered at one convenient time and location. | 1,425 |
| Social Norms Email The social norms email notes that a majority (78%) of GHP members' colleagues had enrolled in 2018, it provides a testimonial from a medical director at Geisinger's Commonwealth School of Medicine, stating the ways in which myHealth Rewards helped that doctor personally, and it emphasizes the simplicity and ease of taking the first step toward enrollment. | 1,425 |
| Loss Framing The loss framing email suggests that GHP members are currently throwing away a precise dollar amount (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. | 1,425 |
| Total | 5,697 |
Baseline characteristics
| Characteristic | Total | Standard Email Reminder | Social Norms Email | Loss Framing | No Email |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | NA Participants | NA Participants | NA Participants | NA Participants | NA Participants |
| Age, Categorical >=65 years | NA Participants | NA Participants | NA Participants | NA Participants | NA Participants |
| Age, Categorical Between 18 and 65 years | NA Participants | NA Participants | NA Participants | NA Participants | NA Participants |
| Race and Ethnicity Not Collected | 0 Participants | — | — | — | — |
| Region of Enrollment United States | 5697 participants | 1425 participants | 1425 participants | 1425 participants | 1422 participants |
| Sex: Female, Male Female | NA Participants | NA Participants | NA Participants | NA Participants | NA Participants |
| Sex: Female, Male Male | NA Participants | NA Participants | NA Participants | NA Participants | NA Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Enrollment (7 Days)
Enrollment in the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention (i.e., when the emails are first sent).
Time frame: 7 days, from May 7 through 13, 2019
Population: We planned a priori to specifically compare the conditions within two groups: employees who previously enrolled and employees who never enrolled.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| No Email | Enrollment (7 Days) | Previously Enrolled | 29 Participants |
| No Email | Enrollment (7 Days) | Never Enrolled | 4 Participants |
| Standard Email Reminder | Enrollment (7 Days) | Never Enrolled | 8 Participants |
| Standard Email Reminder | Enrollment (7 Days) | Previously Enrolled | 126 Participants |
| Social Norms Email | Enrollment (7 Days) | Previously Enrolled | 88 Participants |
| Social Norms Email | Enrollment (7 Days) | Never Enrolled | 6 Participants |
| Loss Framing | Enrollment (7 Days) | Previously Enrolled | 145 Participants |
| Loss Framing | Enrollment (7 Days) | Never Enrolled | 13 Participants |
Comparison: We conducted a logistic regression with the three email conditions as dummy variables with no email as the reference group (among employees who previously enrolled in the program).p-value: <0.00195% CI: [4, 9.18]Regression, Logistic
Comparison: We conducted a logistic regression with the three email conditions as dummy variables with no email as the reference group (among employees who previously enrolled in the program).p-value: <0.00195% CI: [3.36, 7.76]Regression, Logistic
Comparison: We conducted a logistic regression with the three email conditions as dummy variables with no email as the reference group (among employees who previously enrolled in the program).p-value: <0.00195% CI: [2.17, 5.17]Regression, Logistic
Comparison: We conducted a logistic regression with the three email conditions as dummy variables with no email as the reference group (among employees who never enrolled in the program).p-value: 0.03895% CI: [1.16, 11.71]Regression, Logistic
Comparison: We conducted a logistic regression with the three email conditions as dummy variables with no email as the reference group (among employees who never enrolled in the program).p-value: 0.25695% CI: [0.63, 7.54]Regression, Logistic
Comparison: We conducted a logistic regression with the three email conditions as dummy variables with no email as the reference group (among employees who never enrolled in the program).p-value: 0.53195% CI: [0.43, 5.89]Regression, Logistic
Comparison: We conducted a logistic regression with the two experimental conditions as dummy variables with the standard email as the reference group (among employees who previously enrolled in the program).p-value: 0.20295% CI: [0.91, 1.54]Regression, Logistic
Comparison: We conducted a logistic regression with the two experimental conditions as dummy variables with the standard email as the reference group (among employees who previously enrolled in the program).p-value: 0.00595% CI: [0.49, 0.88]Regression, Logistic
Comparison: We conducted a logistic regression with the two experimental conditions as dummy variables with the standard email as the reference group (among employees who never enrolled in the program).p-value: 0.27695% CI: [0.69, 4.16]Regression, Logistic
Comparison: We conducted a logistic regression with the two experimental conditions as dummy variables with the standard email as the reference group (among employees who never enrolled in the program).p-value: 0.59295% CI: [0.25, 2.16]Regression, Logistic
Primary
Logging in (7 Days)
Logging into the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention.
Time frame: 7 days, from May 7 through 13, 2019
Population: There was no login data for participants in the No email group, as the website link was provided by the email. In addition, we planned a priori to specifically compare the conditions within two groups: employees who previously enrolled and employees who never enrolled.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| No Email | Logging in (7 Days) | Previously Enrolled | 0 Participants |
| No Email | Logging in (7 Days) | Never Enrolled | 0 Participants |
| Standard Email Reminder | Logging in (7 Days) | Never Enrolled | 25 Participants |
| Standard Email Reminder | Logging in (7 Days) | Previously Enrolled | 182 Participants |
| Social Norms Email | Logging in (7 Days) | Previously Enrolled | 117 Participants |
| Social Norms Email | Logging in (7 Days) | Never Enrolled | 19 Participants |
| Loss Framing | Logging in (7 Days) | Previously Enrolled | 222 Participants |
| Loss Framing | Logging in (7 Days) | Never Enrolled | 42 Participants |
p-value: 0.0295% CI: [1.04, 1.65]Regression, Logistic
Comparison: We conducted a logistic regression with the two experimental conditions as dummy variables with the standard email as the reference group (among employees who previously enrolled).p-value: <0.00195% CI: [0.44, 0.75]Regression, Logistic
Comparison: We conducted a logistic regression with the two experimental conditions as dummy variables with the standard email as the reference group (among employees who never enrolled).p-value: 0.35995% CI: [0.41, 1.38]Regression, Logistic
p-value: 0.03595% CI: [1.05, 2.9]Regression, Logistic