ORIGINAL RESEARCH article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
This article is part of the Research TopicNudge Theory: Advancing Health Promotion and Disease PreventionView all 7 articles
Nudging healthcare workers: assessing the impact of pre-booked appointments on influenza vaccination uptake
Provisionally accepted
- 1University of Padua, Department of Medicine, Padua, Italy
- 2Healthcare Profession Department, Padua University Hospital, Padua, Italy
- 3Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy
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Background: Influenza vaccination coverage among healthcare workers in Italy remains low compared with international benchmarks. Evidence on effective and scalable interventions in hospital settings is limited. Methods: We conducted a clustered quasi-experimental study in a large Italian university hospital, comparing the 2024/25 campaign to 2023/24. Hospital cost centers (n=277) were non-randomly allocated to intervention (personalized letter with a pre-scheduled on-site appointment; 130 centers, 2,967 healthcare workers) or control (standard information; 147 centers, 1,577 healthcare workers). Administrative records provided uptake. We estimated Difference-in-Differences models at the cost-center level, weighting by center size and clustering standard errors at cost-center level, with subgroup analyzes by profession, gender, and age Results: Overall coverage increased from 16.0% in 2023/24 to 25.2% in 2024/25. The DiD analysis indicated a significant effect of invitation letters (+4.0 percentage points). Stratification showed heterogeneous responses: the intervention was particularly effective among nurses, female workers, and mid-aged staff, while no effect was observed among physicians, the youngest, and the oldest age groups. Conclusions Personalized invitation letters with pre-scheduled appointments represent a simple, scalable, and resource-efficient strategy to increase influenza vaccination uptake among HCWs. However, the effect was not homogeneous across subgroups, highlighting the importance of tailoring communication strategies to different professional and demographic profiles.
Keywords: influenza vaccination, vaccination uptake, Healthcare workers, coverage, invitation letter
Received: 23 Sep 2025; Accepted: 06 Nov 2025.
Copyright: © 2025 Daicampi, Cesaro, Kolmykova, Degan and Baldo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Elisabetta Cesaro, elisabetta.cesaro@studenti.unipd.it
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