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The purpose of the study is to evaluate, prospectively, the potential impact on myHealth Rewards wellness program enrollment (prior to the 2020 deadline) of sending different messages via email to Geisinger Health Plan (GHP) members who have not yet enrolled. In particular, this study aims to replicate and extend (with greater sample size and statistical power) the findings from a previous study in which email communication using loss framing language achieved significantly higher click-through rates than a more standard communication, whereas actual enrollment rates were not significantly higher.
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), about 23% of eligible existing GHP members did not enroll during the primary 2019 enrollment period, even after receiving promotional email communications and reminders.
Previous work examining myHealth Rewards found that email communication using loss framing language achieved significantly higher click-through rates than a more standard communication, whereas actual enrollment rates were not statistically significantly higher.
The current study aims to analyze de-identified Geisinger Health Plan (GHP) member data, comparing enrollment status (and secondarily, click-through rates) within the 2020 enrollment period across email conditions to which GHP members will be randomly assigned. The main part of this study will compare the effects of a standard, generic communication vs. communication with loss framing, using a larger sample size for adequate statistical power to detect the original difference in enrollment rates as significant, should that difference be real and reliable. Additional conditions are added after this main comparison in order to compare more precisely other pairs of communications conceived in the original study.
The generic email condition will consist of a standard email of the kind that would typically be sent by GHP to encourage enrollment, which includes the average amount saved, the ease of registration, and a reward incentive. The loss framing condition will highlight that respondents are forfeiting savings unless they take action and register. The two testimonial conditions will have a testimonial from a doctor (medical expert condition) or a customer care specialist (rank-and-file condition) about how the program helped them. The two social norms conditions will show the percentage (percentage condition) or number (number condition) of fellow Geisinger members who already signed up. Emails will go out in three waves. For each wave, Geisinger employees who have not already registered at that time will be randomized into one of two groups:
Wave 1: generic email vs. loss framing email
Wave 2: testimonial (expert) vs. testimonial (rank-and-file)
Wave 3: social norms (percentage) vs. social norms (number)
It is hypothesized that, on average, the loss frame email will increase enrollment compared with the standard email. The other comparisons are exploratory and do not have a priori hypotheses. Findings will help inform how best to increase enrollment in a wellness program through email communication.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard email | This email mentions the cost-saving benefits of enrollment by participants who met their 2018 goals. It also includes the message that registration can be completed quickly (in less than five minutes). Finally, it also includes reward incentive information, wherein registering by a March deadline provides qualified recipients with the potential to win prizes. This information is contained in all other emails. |
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| Loss frame email | In addition to the content of the generic email, the subject line and content of the loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. This email further frames the reward as something recipients will miss out on if they do not sign up. 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. |
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| Testimonial (medical expert) email | In addition to the content of the generic email, the testimonial (medical expert) email includes a testimonial from a doctor, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. This intervention shows proof of other people successfully enrolling and benefitting from the program. Specifically, it is an endorsement from a presumed authority figure. Recipients may be more likely to enroll for this program if they see a physician - who would be seen as an authority on health and wellness - talking about the medical benefits of the program. It is unclear in the current context and population if a message from an expert or rank-and-file employee would be more effective. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Behavioral |
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| Measure | Description | Time Frame |
|---|---|---|
| Rate of Enrollment (14 Days) | Enrollment in the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves. | 14 days |
| Rate of Logging in (14 Days) | Logging into the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves. | 14 days |
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Inclusion Criteria:
Exclusion Criteria:
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The population consists of Geisinger Health System employees who are also Geisinger Health Plan members and are not currently enrolled in myHealth Rewards.
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| Name | Affiliation | Role |
|---|---|---|
| Amir Goren, PhD | Geisinger Clinic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Geisinger | Danville | Pennsylvania | 17822 | United States |
Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings. The PI did not examine or analyze any data from this study prior to this registration.
The data will become available after publication of study results in a scientific journal and will be available as long as the Open Science Framework hosts the data.
The data on the Open Science Framework will be open to anyone requesting that information.
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Eligible participants were sent the Wave 1 emails on February 25, 2020.
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| ID | Title | Description |
|---|---|---|
| FG000 | Standard Email | This email mentions the cost-saving benefits of enrollment by participants who met their 2018 goals. It also includes the message that registration can be completed quickly (in less than five minutes). Finally, it also includes reward incentive information, wherein registering by a March deadline provides qualified recipients with the potential to win prizes. This information is contained in all other emails. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Wave 1 Emails |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 17, 2021 |
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| Testimonial (rank-and-file) email | In addition to the content of the generic email, the testimonial (rank-and-file) email includes a testimonial from a customer care specialist, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. This intervention shows proof of other people successfully enrolling and benefitting from the program. Specifically, it is an endorsement from a peer (relative to most Geisinger employees). Recipients may be more likely to enroll for this program if they see a rank-and-file employee talking about the program as this person would be more relatable (relative to a doctor). It is unclear in the current context and population if a message from an expert or rank-and-file employee would be more effective. |
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| Social norms (percentage) email | In addition to the content of the generic email, the social norms (percentage) email will include communication about the percentage of benefit-eligible employees who had already registered for myHealth Rewards. This message sets up a descriptive norm, showing that a majority of people are doing a certain behavior. When people see a behavior as the norm, they are more likely to follow it. The use of percentages makes it clear that this behavior is indeed being done by most people in the group. It is unclear in the current context and population if a message using percentages or numbers would be more effective. |
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| Social norms (number) email | In addition to the content of the generic email, the social norms (number) email will include communication about the number of benefit-eligible employees who had already registered for myHealth Rewards. This message sets up a descriptive norm, showing that a large number of people are doing a certain behavior. When people see a behavior as the norm, they are more likely to follow it. While the use of numbers does not indicate that this behavior is being done by a majority, using a large number can be more convincing just in showing sheer quantity. |
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| Loss frame | Behavioral |
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| Testimonial (medical expert) | Behavioral |
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| Testimonial (rank-and-file) | Behavioral |
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| Social norms (percentage) | Behavioral |
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| Social norms (number) | Behavioral |
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| FG001 | Loss Frame Email | In addition to the content of the generic email, the subject line and content of the loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. This email further frames the reward as something recipients will miss out on if they do not sign up. |
| FG002 | Testimonial (Medical Expert) Email | In addition to the content of the generic email, the testimonial (medical expert) email includes a testimonial from a doctor, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. |
| FG003 | Testimonial (Rank-and-file) Email | In addition to the content of the generic email, the testimonial (rank-and-file) email includes a testimonial from a customer care specialist, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. |
| FG004 | Social Norms (Percentage) Email | In addition to the content of the generic email, the social norms (percentage) email will include communication about the percentage of benefit-eligible employees who had already registered for myHealth Rewards. |
| FG005 | Social Norms (Number) Email | In addition to the content of the generic email, the social norms (number) email will include communication about the number of benefit-eligible employees who had already registered for myHealth Rewards. |
| COMPLETED |
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| NOT COMPLETED |
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| Wave 2 Emails |
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The baseline outcome measure was not applicable, since enrollment and login in response to the email was the outcome. There was no previous email, and participants were selected for not having enrolled in the year of the study period. The participants who were sent the standard email and the loss frame email but did not respond to the intervention were pooled into one group and randomly assigned to either receive the testimonial (medical expert) email or the testimonial (rank-and-file) email.
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| ID | Title | Description |
|---|---|---|
| BG000 | Standard Email | This email mentions the cost-saving benefits of enrollment by participants who met their 2018 goals. It also includes the message that registration can be completed quickly (in less than five minutes). Finally, it also includes reward incentive information, wherein registering by a March deadline provides qualified recipients with the potential to win prizes. This information is contained in all other emails. |
| BG001 | Loss Frame Email | In addition to the content of the generic email, the subject line and content of the loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. This email further frames the reward as something recipients will miss out on if they do not sign up. |
| BG002 | Testimonial (Medical Expert) Email | In addition to the content of the generic email, the testimonial (medical expert) email includes a testimonial from a doctor, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. |
| BG003 | Testimonial (Rank-and-file) Email | In addition to the content of the generic email, the testimonial (rank-and-file) email includes a testimonial from a customer care specialist, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. |
| BG004 | Social Norms (Percentage) Email | In addition to the content of the generic email, the social norms (percentage) email will include communication about the percentage of benefit-eligible employees who had already registered for myHealth Rewards. |
| BG005 | Social Norms (Number) Email | In addition to the content of the generic email, the social norms (number) email will include communication about the number of benefit-eligible employees who had already registered for myHealth Rewards. |
| BG006 | Total | Total of all reporting groups |
| Units | Counts |
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| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | |||||
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| Age, Categorical | Count of Participants | Participants |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Primary | Rate of Enrollment (14 Days) | Enrollment in the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves. | A planned Wave 3 of the study was not conducted due to COVID-19-related changes in the program being offered as part of the intervention. | Posted | Count of Participants | Participants | 14 days |
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| Primary | Rate of Logging in (14 Days) | Logging into the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves. | A planned Wave 3 of the study was not conducted due to COVID-19-related changes in the program being offered as part of the intervention. | Posted | Count of Participants | Participants | 14 days |
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No adverse events were evaluated.
We only received aggregate information about email engagement with no individual-level information collected (including those for adverse events).
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Standard Email | This email mentions the cost-saving benefits of enrollment by participants who met their 2018 goals. It also includes the message that registration can be completed quickly (in less than five minutes). Finally, it also includes reward incentive information, wherein registering by a March deadline provides qualified recipients with the potential to win prizes. This information is contained in all other emails. | 0 | 0 | 0 | 0 | 0 | 0 |
| EG001 | Loss Frame Email | In addition to the content of the generic email, the subject line and content of the loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. This email further frames the reward as something recipients will miss out on if they do not sign up. | 0 | 0 | 0 | 0 | 0 | 0 |
| EG002 | Testimonial (Medical Expert) Email | In addition to the content of the generic email, the testimonial (medical expert) email includes a testimonial from a doctor, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. | 0 | 0 | 0 | 0 | 0 | 0 |
| EG003 | Testimonial (Rank-and-file) Email | In addition to the content of the generic email, the testimonial (rank-and-file) email includes a testimonial from a customer care specialist, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. | 0 | 0 | 0 | 0 | 0 | 0 |
| EG004 | Social Norms (Percentage) Email | In addition to the content of the generic email, the social norms (percentage) email will include communication about the percentage of benefit-eligible employees who had already registered for myHealth Rewards. | 0 | 0 | 0 | 0 | 0 | 0 |
| EG005 | Social Norms (Number) Email | In addition to the content of the generic email, the social norms (number) email will include communication about the number of benefit-eligible employees who had already registered for myHealth Rewards. | 0 | 0 | 0 | 0 | 0 | 0 |
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For this study, we only received data about engagement with the email. Individual patients were not identified and demographic information such as age, sex, or gender were not collected.
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Amir Goren, PhD | Geisinger Clinic | 5702144395 | agoren@geisinger.edu |
| Jun 17, 2021 |
| Prot_SAP_000.pdf |
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| Never Enrolled |
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We conducted a logistic regression among the never enrolled group with the standard email as the reference group.
| Regression, Logistic |
| .287 |
We used an a priori threshold of p < .05. |
| Odds Ratio (OR) |
| 0.82 |
| 2-Sided |
| 95 |
| 0.56 |
| 1.19 |
| Superiority |
| We conducted a logistic regression among the previously enrolled group with the rank-and-file email as the reference group. | Regression, Logistic | .590 | We used an a priori threshold of p < .05. | Odds Ratio (OR) | 1.05 | 2-Sided | 95 | 0.87 | 1.27 | Superiority |
| We conducted a logistic regression among the never enrolled group with the rank-and-file email as the reference group. | Regression, Logistic | .035 | We used an a priori threshold of p < .05. | Odds Ratio (OR) | 1.86 | 2-Sided | 95 | 1.05 | 3.32 | Superiority |
In addition to the content of the generic email, the testimonial (medical expert) email includes a testimonial from a doctor, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. |
| OG003 | Testimonial (Rank-and-file) Email | In addition to the content of the generic email, the testimonial (rank-and-file) email includes a testimonial from a customer care specialist, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. |
| OG004 | Social Norms (Percentage) Email | In addition to the content of the generic email, the social norms (percentage) email will include communication about the percentage of benefit-eligible employees who had already registered for myHealth Rewards. |
| OG005 | Social Norms (Number) Email | In addition to the content of the generic email, the social norms (number) email will include communication about the number of benefit-eligible employees who had already registered for myHealth Rewards. |
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