Health Behavior, Health Promotion, Influenza, Vaccination
Conditions
Keywords
Lottery, Financial Incentives
Brief summary
In the current study, the study team will explore whether small incentives are effective at promoting flu vaccine uptake. The study is designed to compare the relative efficacy of incentives of equal perceived expected value (EV) or equal implementation costs, to assess whether people are more likely to get vaccinated in response to lotteries with very high payoffs than to small certain cash payout or slightly higher-probability, more moderate payoffs. In particular, given the potential appeal of official state lottery tickets, one study arm will receive a Pennsylvania scratch-off lottery ticket for getting a flu vaccine. A primary hypothesis is that lotteries will outperform simple reminders (encouraging respondents to get the flu shot at their upcoming appointment) and the standard of care, representing the ambient healthcare system and public health campaigns to increase vaccination.
Detailed description
During the 2021-22 flu season, the study team will contact Geisinger patients who have a primary care or specialist appointment scheduled during flu season and encourage them to get a flu shot. Patients will be randomized into 4 to 9 study arms, depending on a sample size projection completed in August 2021. Arms will test the relative efficacy of a variety of small monetary incentives on flu shot uptake. Incentives may include (a) a $1 Pennsylvania scratch-off lottery ticket (with top prize of $5,000), (b) $1 in cash, (c) entry into a raffle for $5,000 absent upfront odds, (d) entry into a raffle for $5,000, with 1-in-5,000 odds of winning, (d) entry into a raffle for $50, with 1-in-50 odds of winning, and (e) entry into a raffle for $500, with 1-in-500 odds of winning. There will be one no-contact control arm and at least 1 reminder control arm (with additional control arms added given sufficient sample size and additional message versions to be tested). Included in the study will be current Geisinger patients 18+ years of age with no contraindications for flu vaccine who have an appointment scheduled during the study period with a provider who can administer the vaccine. The primary study outcomes will be the rates of flu vaccination and flu diagnosis during the 2021-22 season by targeted patients.
Interventions
BEHAVIORALReminder
Letter, short message service (SMS) text, phone, and/or email
BEHAVIORALFinancial incentive
Letter, SMS, phone, and/or email
BEHAVIORALLottery
Letter, SMS, phone, and/or email
Sponsors
Geisinger Clinic
Massachusetts Institute of Technology
National Institute on Aging (NIA)
National Bureau of Economic Research, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Caregiver)
Masking description
Providers who prescribe vaccination and diagnose conditions will not be randomized to study arms or informed of patient assignment. Although patients will not be explicitly informed of which arm they were randomized to, they will be aware of the messages they receive.
Intervention model description
Eligible patients will be randomly assigned to one of four arms: * Pennsylvania Lottery Scratch-Off Financial Incentive * Certain Cash Payout Financial Incentive * Reminder / Active Control Arm (No Financial Incentive) * No Treatment Control Arm
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Aged 18+ * Pennsylvania mailing address listed * Geisinger primary care provider (PCP) assigned * Upcoming appointment with PCP or select specialist who stocks and can administer the vaccine during the study period
Exclusion criteria
* Has opted out of receiving messages from Geisinger on all modalities being tested
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Flu Vaccination at Appointment | 3 days after patient is randomized | Received flu vaccination at relevant PCP or specialty appointment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Flu Vaccination Within 7 Days | Within 7 days of when patient is randomized | Received flu vaccination |
| Flu Diagnosis | During the 2021-22 flu season (Up to 8 months, from the time the patient is randomized through April 30, 2022) | Received a high confidence flu diagnosis (with positive polymerase chain reaction \[PCR\]/antigen/molecular test) and/or likely flu diagnosis (as assessed via International Classification of Disease \[ICD\] codes or Tamiflu administration or positive PCR/antigen/molecular test) Note that likely flu is a superset of the high confidence flu diagnoses. |
| Flu Complications | During the 2021-22 flu season (Up to 11 months, from the time the patient is randomized through July 31, 2022) | Diagnosed with flu-related complications |
Other
| Measure | Time frame | Description |
|---|---|---|
| Flu Vaccination (Among Subject Cohabitants) Within 28 Days | Within 28 days of when the study subject is randomized | Cohabitant of study subject received flu vaccination |
| Flu Vaccination at Appointment by Gender | 3 days after the patient is randomized. | Received flu vaccination at relevant PCP or specialty appointment. |
| Flu Vaccination at Appointment by Race | 3 days after the patient is randomized. | Received flu vaccination at relevant PCP or specialty appointment. |
| Flu Vaccination at Appointment by Ethnicity | 3 days after the patient is randomized. | Received flu vaccination at relevant PCP or specialty appointment. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive Participants in this arm will receive a message stating that they will receive a PA lottery $1 scratch-off ticket if they get a flu shot at an upcoming appointment. The message will mention that they could win $5,000 (the top prize for the scratch-off game).
Note: $1 scratch-off products vary over time; at study implementation, an active game with top prize of $5,000 (or the next-highest top prize) will be selected and will define the prize in the raffle absent upfront odds
Reminder: Letter, short message service (SMS) text, phone, and/or email
Financial incentive: Letter, SMS, phone, and/or email
Lottery: Letter, SMS, phone, and/or email | 14,394 |
| Certain Cash Payout Financial Incentive Participants in this arm will receive a message stating that they will receive $1 in cash if they get a flu shot at an upcoming appointment.
Reminder: Letter, short message service (SMS) text, phone, and/or email
Financial incentive: Letter, SMS, phone, and/or email | 14,394 |
| Reminder / Active Control (No Financial Incentive) Participants in this arm will receive a message stating that they can get a flu shot at an upcoming appointment. These participants will not be offered a financial incentive for getting a flu shot.
Reminder: Letter, short message service (SMS) text, phone, and/or email | 14,394 |
| No Treatment Control No additional contact beyond standard Geisinger flu shot communications | 14,399 |
| Total | 57,581 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Protocol Violation | 0 | 0 | 1 | 1 |
Baseline characteristics
| Characteristic | Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Certain Cash Payout Financial Incentive | Reminder / Active Control (No Financial Incentive) | No Treatment Control | Total |
|---|---|---|---|---|---|
| Age, Customized <18 | 0 Participants | 0 Participants | 1 Participants | 1 Participants | 2 Participants |
| Age, Customized 18-65 | 11051 Participants | 11105 Participants | 11097 Participants | 11066 Participants | 44319 Participants |
| Age, Customized 65+ | 3343 Participants | 3289 Participants | 3296 Participants | 3332 Participants | 13260 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 643 Participants | 659 Participants | 701 Participants | 661 Participants | 2664 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 13670 Participants | 13649 Participants | 13624 Participants | 13656 Participants | 54599 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 81 Participants | 86 Participants | 69 Participants | 82 Participants | 318 Participants |
| Race/Ethnicity, Customized American Indian or Alaska Native | 42 Participants | 29 Participants | 30 Participants | 29 Participants | 130 Participants |
| Race/Ethnicity, Customized Asian | 135 Participants | 112 Participants | 130 Participants | 148 Participants | 525 Participants |
| Race/Ethnicity, Customized Black or African American | 595 Participants | 609 Participants | 615 Participants | 595 Participants | 2414 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 50 Participants | 51 Participants | 56 Participants | 53 Participants | 210 Participants |
| Race/Ethnicity, Customized Unknown | 113 Participants | 109 Participants | 115 Participants | 117 Participants | 454 Participants |
| Race/Ethnicity, Customized White | 13459 Participants | 13484 Participants | 13448 Participants | 13457 Participants | 53848 Participants |
| Sex: Female, Male Female | 8370 Participants | 8306 Participants | 8313 Participants | 8344 Participants | 33333 Participants |
| Sex: Female, Male Male | 6024 Participants | 6088 Participants | 6081 Participants | 6055 Participants | 24248 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
Flu Vaccination at Appointment
Received flu vaccination at relevant PCP or specialty appointment.
Time frame: 3 days after patient is randomized
Population: All enrolled patients were included in analyses, except the two patients who were inadvertently enrolled at age 17.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment | No Shot at Appointment | 10461 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment | Shot at Appointment | 3933 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment | Shot at Appointment | 3883 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment | No Shot at Appointment | 10511 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment | No Shot at Appointment | 10394 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment | Shot at Appointment | 3999 Participants |
| No Treatment Control | Flu Vaccination at Appointment | No Shot at Appointment | 10746 Participants |
| No Treatment Control | Flu Vaccination at Appointment | Shot at Appointment | 3652 Participants |
Comparison: Null hypothesis: There is no difference in vaccination rates between patients sent messages offering a scratch-off lottery ticket and patients sent messages offering $1 cash in exchange for vaccination; Alternative hypothesis: the vaccination rate is higher in patients sent messages offering scratch-off tickets compared to those sent messages offering $1 cash.p-value: 0.506Regression, Linear
Comparison: Null hypothesis: There is no difference in vaccination rates between patients sent messages offering a scratch-off lottery ticket in exchange for vaccination and those sent active control messages; Alternative hypothesis: the vaccination rate is higher in patients sent messages offering scratch-off tickets compared to those sent active control messages.p-value: 0.378Regression, Linear
Comparison: Null hypothesis: There is no difference in vaccination rates between patients sent messages offering a scratch-off lottery ticket in exchange for vaccination and those sent no study messages; Alternative hypothesis: the vaccination rate is higher in patients sent messages offering scratch-off tickets compared to those who were not sent messages.p-value: <0.001Regression, Linear
Comparison: Null hypothesis: There is no difference in vaccination rates between patients sent active control messages and those sent no study messages; Alternative hypothesis: the vaccination rate is higher in patients sent active control messages compared to those who were not sent messages.p-value: <0.001Regression, Linear
Comparison: Null hypothesis: There is no difference in vaccination rates between patients sent messages offering $1 cash in exchange for vaccination and those sent active control messages; Alternative hypothesis: the vaccination rate is higher in patients sent messages offering $1 cash compared to those sent active control messages.p-value: 0.121Regression, Linear
Comparison: Null hypothesis: There is no difference in vaccination rates between patients sent messages offering $1 cash in exchange for vaccination and those sent no study messages; Alternative hypothesis: the vaccination rate is higher in patients sent messages offering $1 cash compared to those who were not sent messages.p-value: 0.002Regression, Linear
Secondary
Flu Complications
Diagnosed with flu-related complications
Time frame: During the 2021-22 flu season (Up to 11 months, from the time the patient is randomized through July 31, 2022)
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Complications | No flu complications | 12537 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Complications | Flu complications | 1857 Participants |
| Certain Cash Payout Financial Incentive | Flu Complications | Flu complications | 1781 Participants |
| Certain Cash Payout Financial Incentive | Flu Complications | No flu complications | 12613 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Complications | No flu complications | 12593 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Complications | Flu complications | 1800 Participants |
| No Treatment Control | Flu Complications | Flu complications | 1793 Participants |
| No Treatment Control | Flu Complications | No flu complications | 12605 Participants |
Secondary
Flu Diagnosis
Received a high confidence flu diagnosis (with positive polymerase chain reaction \[PCR\]/antigen/molecular test) and/or likely flu diagnosis (as assessed via International Classification of Disease \[ICD\] codes or Tamiflu administration or positive PCR/antigen/molecular test) Note that likely flu is a superset of the high confidence flu diagnoses.
Time frame: During the 2021-22 flu season (Up to 8 months, from the time the patient is randomized through April 30, 2022)
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Diagnosis | Flu diagnosis | 117 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Diagnosis | No flu diagnosis | 14277 Participants |
| Certain Cash Payout Financial Incentive | Flu Diagnosis | No flu diagnosis | 14262 Participants |
| Certain Cash Payout Financial Incentive | Flu Diagnosis | Flu diagnosis | 132 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Diagnosis | No flu diagnosis | 14298 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Diagnosis | Flu diagnosis | 95 Participants |
| No Treatment Control | Flu Diagnosis | Flu diagnosis | 133 Participants |
| No Treatment Control | Flu Diagnosis | No flu diagnosis | 14265 Participants |
Secondary
Flu Vaccination Within 7 Days
Received flu vaccination
Time frame: Within 7 days of when patient is randomized
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination Within 7 Days | No Shot Within 7 Days | 10119 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination Within 7 Days | Shot Within 7 Days | 4275 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination Within 7 Days | No Shot Within 7 Days | 10104 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination Within 7 Days | Shot Within 7 Days | 4290 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination Within 7 Days | Shot Within 7 Days | 4386 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination Within 7 Days | No Shot Within 7 Days | 10007 Participants |
| No Treatment Control | Flu Vaccination Within 7 Days | Shot Within 7 Days | 4055 Participants |
| No Treatment Control | Flu Vaccination Within 7 Days | No Shot Within 7 Days | 10343 Participants |
Other Pre-specified
Flu Vaccination (Among Subject Cohabitants) Within 28 Days
Cohabitant of study subject received flu vaccination
Time frame: Within 28 days of when the study subject is randomized
Other Pre-specified
Flu Vaccination at Appointment by Ethnicity
Received flu vaccination at relevant PCP or specialty appointment.
Time frame: 3 days after the patient is randomized.
Population: All enrolled patients were included in analyses, except the two patients who were inadvertently enrolled at age 17.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Hispanic or Latino | No Shot at Appointment | 511 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Hispanic or Latino | Shot at Appointment | 132 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Not Hispanic or Latino | No Shot at Appointment | 9889 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Not Hispanic or Latino | Shot at Appointment | 3781 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Unknown | No Shot at Appointment | 61 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Unknown | Shot at Appointment | 20 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Unknown | Shot at Appointment | 14 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Not Hispanic or Latino | Shot at Appointment | 3727 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Hispanic or Latino | No Shot at Appointment | 517 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Not Hispanic or Latino | No Shot at Appointment | 9922 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Hispanic or Latino | Shot at Appointment | 142 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Ethnicity | Unknown | No Shot at Appointment | 72 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Ethnicity | Hispanic or Latino | Shot at Appointment | 175 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Ethnicity | Not Hispanic or Latino | No Shot at Appointment | 9812 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Ethnicity | Not Hispanic or Latino | Shot at Appointment | 3812 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Ethnicity | Unknown | Shot at Appointment | 12 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Ethnicity | Unknown | No Shot at Appointment | 57 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Ethnicity | Hispanic or Latino | No Shot at Appointment | 525 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Ethnicity | Unknown | No Shot at Appointment | 63 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Ethnicity | Unknown | Shot at Appointment | 19 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Ethnicity | Hispanic or Latino | Shot at Appointment | 130 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Ethnicity | Not Hispanic or Latino | Shot at Appointment | 3503 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Ethnicity | Hispanic or Latino | No Shot at Appointment | 530 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Ethnicity | Not Hispanic or Latino | No Shot at Appointment | 10153 Participants |
Other Pre-specified
Flu Vaccination at Appointment by Gender
Received flu vaccination at relevant PCP or specialty appointment.
Time frame: 3 days after the patient is randomized.
Population: All enrolled patients were included in analyses, except the two patients who were inadvertently enrolled at age 17.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Gender | Female | No Shot at Appointment | 6207 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Gender | Female | Shot at Appointment | 2163 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Gender | Male | No Shot at Appointment | 4254 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Gender | Male | Shot at Appointment | 1770 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Gender | Female | Shot at Appointment | 2174 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Gender | Male | No Shot at Appointment | 4379 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Gender | Male | Shot at Appointment | 1709 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Gender | Female | No Shot at Appointment | 6132 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Gender | Male | No Shot at Appointment | 4288 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Gender | Female | Shot at Appointment | 2206 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Gender | Male | Shot at Appointment | 1793 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Gender | Female | No Shot at Appointment | 6106 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Gender | Male | Shot at Appointment | 1598 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Gender | Female | Shot at Appointment | 2054 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Gender | Female | No Shot at Appointment | 6290 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Gender | Male | No Shot at Appointment | 4456 Participants |
Other Pre-specified
Flu Vaccination at Appointment by Race
Received flu vaccination at relevant PCP or specialty appointment.
Time frame: 3 days after the patient is randomized.
Population: All enrolled patients were included in analyses, except the two patients who were inadvertently enrolled at age 17.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | Native Hawaiian or Other Pacific Islander | No Shot at Appointment | 37 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | Black or African American | Shot at Appointment | 99 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | Asian | Shot at Appointment | 43 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | White | Shot at Appointment | 3741 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | Black or African American | No Shot at Appointment | 496 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | Unknown | Shot at Appointment | 28 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | Asian | No Shot at Appointment | 92 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | Unknown | No Shot at Appointment | 85 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | Native Hawaiian or Other Pacific Islander | Shot at Appointment | 13 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | American Indian or Alaska Native | No Shot at Appointment | 33 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | American Indian or Alaska Native | Shot at Appointment | 9 Participants |
| Pennsylvania (PA) Lottery Scratch-Off Financial Incentive | Flu Vaccination at Appointment by Race | White | No Shot at Appointment | 9718 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | Unknown | No Shot at Appointment | 90 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | American Indian or Alaska Native | Shot at Appointment | 6 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | American Indian or Alaska Native | No Shot at Appointment | 23 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | Asian | No Shot at Appointment | 78 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | Asian | Shot at Appointment | 34 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | Black or African American | No Shot at Appointment | 521 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | Black or African American | Shot at Appointment | 88 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | Native Hawaiian or Other Pacific Islander | No Shot at Appointment | 42 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | Native Hawaiian or Other Pacific Islander | Shot at Appointment | 9 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | Unknown | Shot at Appointment | 19 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | White | No Shot at Appointment | 9757 Participants |
| Certain Cash Payout Financial Incentive | Flu Vaccination at Appointment by Race | White | Shot at Appointment | 3727 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | Black or African American | Shot at Appointment | 106 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | Asian | No Shot at Appointment | 89 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | Native Hawaiian or Other Pacific Islander | No Shot at Appointment | 36 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | White | No Shot at Appointment | 9649 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | Native Hawaiian or Other Pacific Islander | Shot at Appointment | 20 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | White | Shot at Appointment | 3798 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | American Indian or Alaska Native | No Shot at Appointment | 18 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | Unknown | No Shot at Appointment | 93 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | American Indian or Alaska Native | Shot at Appointment | 12 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | Unknown | Shot at Appointment | 22 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | Asian | Shot at Appointment | 41 Participants |
| Reminder / Active Control (No Financial Incentive) | Flu Vaccination at Appointment by Race | Black or African American | No Shot at Appointment | 509 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | Unknown | Shot at Appointment | 21 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | Black or African American | Shot at Appointment | 80 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | Unknown | No Shot at Appointment | 96 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | American Indian or Alaska Native | No Shot at Appointment | 21 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | American Indian or Alaska Native | Shot at Appointment | 8 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | Native Hawaiian or Other Pacific Islander | No Shot at Appointment | 37 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | White | Shot at Appointment | 3480 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | White | No Shot at Appointment | 9976 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | Black or African American | No Shot at Appointment | 515 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | Native Hawaiian or Other Pacific Islander | Shot at Appointment | 16 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | Asian | Shot at Appointment | 47 Participants |
| No Treatment Control | Flu Vaccination at Appointment by Race | Asian | No Shot at Appointment | 101 Participants |