Emails incorporating behavioral insights were not effective in increasing flu shot uptake.

What was the challenge?

Flu causes more than 9 million illnesses and more than 12,000 deaths in the United States annually. The VA provides free flu shots to enrolled Veterans and aims to increase flu vaccination rates nationwide.

What was the program change?

In collaboration with the New York Harbor VA Health Care System, the Office of Evaluation Sciences (OES) designed email messages to send to enrolled Veterans. These included information about how to get a flu shot, and elements, based on evidence from the behavioral sciences, that were designed to increase individuals’ motivation and follow-through.

How did the evaluation work?

Veterans were randomly assigned to an email (treatment) group and a no-email (control) group. The email group received three emails during the flu season. Data from VA electronic health records were used to compare flu shot uptake and timing between the two groups from October 1, 2017, through May 24, 2018.


What was the impact?

There was no significant effect of the emails on either uptake or timing of flu shots.

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Project Type

Program Change and Evaluation


Veterans Affairs




View Analysis Plan (PDF)

View Abstract (PDF)

View Intervention Pack (PDF)