Yale School of Management

Nudging Employees to Invest in Their Health

People have the best intentions to do things that will be good for them in the long term, but they often fail to turn those intentions into actions. James Choi, associate professor of finance, studies how to get individuals to act. Much of his research has focused on motivating people to change their financial behavior—for example, to save for retirement by enrolling in their employer-sponsored 401k plans. In a recent study, Choi turned his attention to how to prompt people to invest in their health by getting a flu shot.

"There's an interesting analogy between finance and health," says Choi. "In finance, saving for retirement requires sacrificing pleasure today for future benefit. In health investment, you incur some inconvenience and unpleasantness now to have better future health. It's a similar psychological foundation."

Choi and his co-authors found that participation in free workplace flu vaccination clinics was higher among employees who received a reminder mailing that prompted them to fill in the date and time they planned to get their shot.

"Just prompting people to write down a plan made them more successful in getting a flu shot," says Choi of the low-cost intervention.

The researchers conducted a field experiment in a large utility company that randomly assigned employees to receive different reminder mailings about upcoming flu vaccination clinics. Employees in a control group received a mailing that listed the times and locations of the clinics. A second group of workers received a mailing that also prompted them to write down the date they planned to be vaccinated. A mailing to a third group asked employees to write down both the date and time they would get their shot.

The vaccination rate increased with the specificity of the mailings. The employees who were prompted to write down both the date and time they intended to get their flu shot had the highest vaccination rates—37.3% compared to 33.1% in the control group.

Previous research has shown that prompting people to form a simple plan can make them more likely to succeed in achieving objectives, from getting a mammogram to voting, but it was unclear how much of this effect was due to the social pressure of making a commitment to someone face to face or over the phone. Choi and his coauthors demonstrate that people will follow through on private commitments they've made to themselves.

The paper is part of a growing area of research into nudges, or subtle prompts that encourage desirable outcomes. "What's appealing about nudges is that they are non-coercive," says Choi. "If you mess up and try to push people towards something that's really harmful for them, there's a safety valve: they just won't go along with it." 

Read "Using Implementation Intention Prompts to Enhance Influenza Vaccination Rates" by Katherine L. Milkman, John Beshears, James J. Choi, David Laibson, and Brigitte C. Madrian.