Postcards incorporating behavioral insights were not more effective than a basic informational postcard.

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 St. Cloud VA Health Care System, the Office of Evaluation Sciences (OES) designed three different postcards to send to enrolled Veterans: a basic informational postcard, which provided details on how to get a flu shot, and two postcards informed by insights from the behavioral sciences — one designed to increase motivation, the other designed to facilitate implementation.

How did the evaluation work?

Veterans were randomly assigned to receive one of three postcards: a basic informational postcard, a motivation postcard, or an implementation postcard. Data from VA electronic health records were used to compare flu shot uptake and timing among the three groups between September 14, 2017, and May 1, 2018.


What was the impact?

There were no significant differences among the three postcards in 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)