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Opt-out nudge reduces number of unvaccinated medical residents by 81% for influenzaOpt-out Nudges Increase Influenza Vaccination Rates Among Medical Residents

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Key Takeaway
Consider using opt-out nudges to increase influenza vaccination rates among medical residents.

This randomized controlled trial enrolled 260 medical residents across four hospitals in France to evaluate the impact of an opt-out nudge on influenza vaccination rates. The study compared a group receiving the nudge against a control group.

The primary outcome showed that 5% of residents in the nudge group were not vaccinated, compared to 27% in the control group. This represents an 81% reduction in the number of unvaccinated residents. Secondary outcomes indicated that the nudge was viewed as very acceptable by residents, particularly when they were directly exposed to it. Furthermore, residents reported that the nudge did not reduce their feeling of autonomy.

No adverse events, serious adverse events, or discontinuations were reported. While the study suggests a causal link between the nudge and increased vaccination rates, the specific p-values or confidence intervals for the primary outcome were not reported. The results suggest that nudging can complement other interventions aimed at promoting vaccination among healthcare professionals.

How this fits prior evidence

This finding addresses a gap in behavioral interventions for healthcare workers. While previous coverage noted that many healthcare students lack knowledge that antibiotics do not speed recovery from colds and flu, this study provides a specific behavioral strategy to improve vaccination rates among medical residents. It complements the need for targeted interventions in the clinical environment.

Researchers conducted a study in four French hospitals to see how a simple communication method, called an opt-out nudge, affected flu vaccination rates. The study included 260 medical residents. In the group that received the nudge, only 5% of the residents were unvaccinated. In the control group, 27% of the residents were not vaccinated.

Beyond just the numbers, the study looked at how the residents felt about the nudge. The participants reported that they found the nudge very acceptable, especially when they were directly exposed to it. They also reported that the nudge did not make them feel like they were losing their personal autonomy or freedom of choice.

This study suggests that nudges can be a helpful tool to encourage vaccinations. While the results were positive for this specific group of medical residents, the findings are specific to this setting. You should talk with a healthcare provider to discuss the best ways to manage your own vaccination schedule.

What this means for you:
An opt-out nudge significantly increased flu vaccination rates without reducing the participants' sense of autonomy.

Common questions

What is an opt-out nudge?

An opt-out nudge is a way of presenting a choice where the person is automatically included in a program unless they specifically say no. In this study, it was used to encourage flu vaccinations. The results showed that only 5% of residents in the nudge group were unvaccinated, compared to 27% in the control group.

Did the residents feel forced by the nudge?

No, the residents did not feel forced. The study found that the residents found the nudge very acceptable, especially when they were exposed to it. They also reported that the nudge did not reduce their feeling of autonomy or their ability to make their own choices.

How much did the nudge improve vaccination rates?

The nudge led to a significant increase in vaccination rates. In the study, the number of unvaccinated residents dropped from 27% in the control group to 5% in the nudge group. This represents an 81% reduction in the number of residents who were not vaccinated.

Study Details

Study typeRct
EvidenceLevel 2
PublishedAug 2026
View Original Abstract ↓
Nudging has been proposed as an effective tool for promoting influenza vaccination among healthcare workers. To be successful, nudges must be considered acceptable. This paper evaluated the effectiveness and the acceptability of a nudge promoting influenza vaccination among medical residents in four hospitals in France. The hypotheses were that exposure to an opt-out nudge would increase vaccination rates and that participants would express more acceptability and a higher feeling of autonomy when exposed to the nudge. It was also expected that the feeling of autonomy would be positively correlated with nudge acceptability and with nudge effectiveness. The study's subjects were 260 medical residents. At the end of the study, 5% of residents in the nudge group reported they had not been vaccinated versus 27% in the control group, suggesting that applying the nudge to all residents could have reduced the number of unvaccinated residents by 81%. Residents found the nudge very acceptable, especially when they had been exposed to it. Residents felt that the nudge did not reduce their autonomy. The feeling of autonomy was associated with the nudge's acceptability and effectiveness. These data suggest that nudging can complement other interventions promoting vaccination, but policymakers should consider its ethical implications.
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