ClinicalTrials.gg
RecruitingNCT07838038EMPOWeRUpdated Oct 15, 2026

Effect of Messaging on Pragmatic Outcomes Within an Integrated Healthcare System

An interventional study of Vaccine choice message and Vaccine choice + platform-framed message in Covid-19 Vaccination, sponsored by Kaiser Permanente. Recruiting at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-10-15.

Sponsored by Kaiser Permanente · Not applicable, Interventional, and Health services research

From the registry’s dates

  • Started Sep 2026; still recruiting 1 month later.
Updated Oct 15, 2026Now RecruitingSite recruiting status changed+2 moreGo to Updates ↓
Phase
Not applicable
Study type
Interventional
Enrollment
1,300,000
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

COVID-19 vaccination among patients at high risk for severe disease has declined in the United States since 2022. Prior research, including discrete choice experiments (DCEs), has demonstrated that vaccine preferences are influenced by attributes such as effectiveness, safety, convenience, and protection against severe disease. Although DCEs provide valuable insights into stated vaccine preferences and decision-making, they rely on hypothetical scenarios and cannot directly assess how vaccine attributes influence real-world vaccine uptake. Additional research is needed to understand the relationship between vaccine characteristics and observed COVID-19 vaccination behavior in routine clinical practice.

The EMPOWeR study is a pragmatic randomized controlled trial conducted within Kaiser Permanente Southern California (KPSC) to evaluate the effect of immunization messages and reminders that highlight COVID-19 vaccine choices on vaccine uptake. The primary research questions are:

  1. Does having a choice in COVID-19 vaccine platform affect vaccine uptake among patients at high-risk of severe disease? 1a. Does having a choice in COVID-19 vaccine platform affect vaccine uptake among patients at high-risk of severe disease, when differences in vaccine platform are highlighted? 1b. Does having a choice in COVID-19 vaccine platform affect vaccine uptake among patients at high-risk of severe disease, when a trusted healthcare professional (HCP) endorses both vaccine options? 1c. Does having a choice in COVID-19 vaccine platform affect vaccine uptake among patients at high-risk of severe disease, when vaccine reactogenicity is highlighted?

    A secondary research question is:

  2. Does having a choice in COVID-19 vaccine additionally increase uptake of influenza vaccine?

During the 2026-2027 respiratory virus season, eligible KPSC members who are at high-risk of severe COVID-19 will be randomly assigned to receive a standard reminder message or a reminder message with additional information about available COVID-19 vaccine options.

Read the detailed description

The Effect of Messaging on Pragmatic Outcomes Within an Integrated Healthcare System: A Randomized Trial (EMPOWeR) study is designed to learn whether vaccine reminder messages that highlight a patient's choice of COVID-19 vaccines can help increase vaccine uptake among adults who are at higher risk for serious illness from COVID-19. The study will take place within KPSC, a large integrated health care system in southern California, and will use routine health care messages and reminders for updated COVID-19 immunization .

COVID-19 vaccination rates have declined since 2022, including among older adults and people with medical conditions that increase their risk of severe disease. Concerns about vaccine side effects, trust, and vaccine technologies may influence whether people choose to get vaccinated. The EMPOWeR study will evaluate whether providing information about vaccine choices can encourage individuals at higher risk of severe COVID-19 to receive an updated COVID-19 vaccine.

Adults who are eligible for a COVID-19 vaccine and who meet the study eligibility criteria will be included in the study. Eligible participants include adults enrolled for care at KPSC who are either 65 years of age or adults aged 18 to 64 years with certain health conditions that place them at increased risk for severe COVID-19 illness. Participants will not be asked to attend study visits or complete surveys. The study will use immunization data already collected in electronic health records as part of routine care.

Participants will be randomly assigned to one of five groups. One group will receive a standard COVID-19 vaccine reminder message currently used in routine care. The other four groups will receive messages that provide information about available COVID-19 vaccine options: mRNA and protein-based COVID-19 vaccines. These messages may:

  • Inform participants that they can choose between two different COVID-19 vaccine types.
  • Explain differences between vaccine technologies.
  • Include information that both vaccine options are supported by health care professionals.
  • Provide information about vaccine side effects and vaccine choice.

All messages will be delivered to eligible participants in early October 2026 using the participant's usual communication preferred language (i.e., English or Spanish). Follow-up reminder messages will also be sent later in the vaccination season (in early December 2026).

The main goal of the study is to determine whether these different messages increase receipt of the updated 2026-2027 COVID-19 vaccine. Additional goals include type of COVID-19 vaccine received receipt of an influenza vaccine, receiving influenza and COVID-19 vaccines on the same day, and the time between the reminder message and COVID-19 vaccination.

The study is designed to reflect real-world clinical practice. Participants will continue to receive routine medical care, and all vaccines will be provided through standard care processes. Researchers will compare vaccination outcomes across the different message groups to determine which communication approach is most effective for increasing vaccination uptake among high-risk adults.

This study may help health care systems better understand how to communicate with patients about vaccine options and improve vaccination coverage among populations at increased risk for severe COVID-19 illness.

02

Conditions studied

  • Covid-19 Vaccination

Browse trials for

Keywords

  • COVID-19 Vaccination
  • COVID-19 Vaccine Uptake
  • Vaccine Choice
  • Behavioral Intervention
  • High-Risk Adults
  • Patient Preference
  • Pragmatic Trial
  • Implementation Science
  • Health Services Research
03

In context

Patient Preference

112 studies on the registry are indexed under Patient Preference; 28 are open to participants now.

This study's planned enrollment of 1,300,000 is above the median of 134 across 52 interventional studies indexed under Patient Preference.

Browse Patient Preference studies →

Lead sponsor

Kaiser Permanente is the lead sponsor of 393 studies on the registry; 43 are open to participants now.

Of its 7 completed or terminated interventional studies of FDA-regulated products, 3 (43%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

The criteria were revised on the registry on Sep 29, 2026. See what changed

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Aged ≥18 years;
  • Active KPSC member;
  • Continuous membership from 27 August 2025 to 28 September 2026;
  • Members who are aged 65 years and older, or adults aged 18-64 years with at least one of the following health conditions that increases their risk for severe COVID-19 illness, including: a) asthma, b) cancer, c) ischemic stroke, d) intracerebral or subarachnoid hemorrhage, e) , f) chronic kidney disease, g) dialysis, h) bronchiectasis, i) chronic obstructive, pulmonary disease (), j) pulmonary fibrosis, k) cystic fibrosis, l) pulmonary hypertension, m) cirrhosis, n) non-alcoholic fatty liver disease (NALD), o) alcoholic liver disease, p) hepatitis, q) diabetes, r) heart failure, s) coronary artery disease, t) cardiomyopathy, u) , v) obesity, w) essential hypertension, x) primary immunodeficiency and other underlying immunocompromising conditions, y) solid organ or blood stem cell transplant, z) tuberculosis;
  • No documented receipt of updated 2026-27 COVID-19 vaccine as of 28 September 2026;
  • Has valid email information.

Exclusion criteria

Exclusion Criteria:

  • Unable to receive or opted out of email communication.
  • People with unknown or missing sex.
  • People who cannot safely receive a COVID-19 vaccine, including those who had a severe allergic reaction to a previous COVID-19 vaccine or have a to COVID-19 vaccine or a vaccine ingredient, will not be included in the study.
  • People with or terminal illness, advanced illness, receiving hospice or palliative care, or resident in skilled nursing facilities.
  • People who are pregnant or currently breastfeeding.
Terms in these criteria, in plain language(6)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

TIA (transient ischaemic attack)

A “mini-stroke”: temporary stroke-like symptoms caused by reduced blood flow to part of the brain, spinal cord or eye, without signs of a new stroke on a scan.

Stroke symptoms need emergency care at once, even if they go away.

COPD

Chronic obstructive pulmonary disease: long-term lung disease that makes it hard to breathe out, including emphysema and chronic bronchitis.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

05

Study design

Phase
Not applicable
Primary purpose
Health services research
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Care provider, Investigator, Outcomes assessor)
Enrollment
1,300,000 participants (estimated)

Study arms

  • No intervention
    Usual Care

    Standard COVID-19 vaccination reminder message sent as part of usual care.

  • Experimental
    A. Choice-framed

    Intervention arm tests the effects of choice-framed communication to increase patient's awareness of their available choices of COVID-19 vaccines, compared with usual care.

    Behavioral: Vaccine choice message

  • Experimental
    B. Choice + vaccine platform-framed

    Intervention arm tests the effects of choice-framed communication to increase patients' awareness of their available choices of COVID-19 vaccines AND explain differences in vaccine composition and mechanisms of protection by vaccine type, compared with usual care.

    Behavioral: Vaccine choice + platform-framed message

  • Experimental
    C. Choice + HCP trust-framed

    Intervention arm tests the effects of choice-framed communication to increase patients' awareness of their available choices of COVID-19 vaccines AND emphasizes the support of healthcare personnel (HCP) for both vaccine options, compared with usual care.

    Behavioral: Vaccine choice + HCP trust-framed message

  • Experimental
    D. Choice + reactogenicity-framed

    Intervention arm tests the effects of choice-framed communication to increase patients' awareness of their available choices of COVID-19 vaccines AND information about expected side effects, compared with usual care.

    Behavioral: Vaccine choice + reactogenicity-framed message

Interventions

  • BehavioralVaccine choice message

    A message communicating available choices of COVID-19 vaccines.

  • BehavioralVaccine choice + platform-framed message

    A message communicating available choices of COVID-19 vaccines and differences in vaccine composition and mechanisms of protection by vaccine type.

  • BehavioralVaccine choice + HCP trust-framed message

    A message communicating available choices of COVID-19 vaccines and emphasizes the support of healthcare personnel (HCP) for both vaccine options.

  • BehavioralVaccine choice + reactogenicity-framed message

    A message communicating available choices of COVID-19 vaccines and expected side effects of available vaccines.

06

What researchers measure

Primary outcomes

  1. Proportion of participants with documented receipt of the updated 2026-27 COVID-19 vaccine

    Kaiser Permanente Southern California's electronic health record tracks the type of vaccine, dose, and date each patient receives. Immunization data will be retrieved from participants' electronic health records to ascertain COVID-19 immunization status during the study period.

    Time frame: up to 4 months after intervention

Secondary outcomes

  1. Type of COVID-19 vaccine received

    The brand of COVID-19 vaccines received will be retrieved from participants' electronic health records to ascertain the type of COVID-19 immunizations received during the study period.

    Time frame: up to 4 months after intervention

  2. Receipt of the 2026-27 influenza vaccine

    Influenza vaccines received will be retrieved from participants' electronic health records to ascertain influenza immunization status during the study period.

    Time frame: up to 4 months after intervention

  3. Co-administration of COVID-19 vaccine and influenza vaccine

    The date of influenza and COVID-19 vaccines received will be retrieved from participants' electronic health records and used to ascertain the number of participants who received an influenza and COVID-19 vaccine on the same day.

    Time frame: up to 4 months after intervention

  4. Time to immunization (in days) with an updated 2026-27 COVID-19 vaccine

    The date of COVID-19 immunization will be retrieved from the participants' electronic health records and used to determine the number of days between message transmission and vaccination.

    Time frame: up to 4 months after intervention

07

Study locations

1 of 1 sites recruiting
08

References and documents

Individual participant data

Plan to share: No — The individual-level data that will be analyzed for this study will not be publicly available due to privacy concerns. Individual requests to access the study data can be made to the study PI.

No publications or documents are linked to this record.

09

Updates

2 registry updates since Sep 25, 2026
Status
Not yet recruiting→Recruiting
changed Oct 15, 2026
Sites
Kaiser Permanente Southern California, Department of Research & Evaluation is now Recruiting
Oct 15, 2026
Start date
Sep 28, 2026→Sep 29, 2026 (actual)
Oct 15, 2026
Eligibility
1 inclusion criterion edited; 1 exclusion criterion edited, 2 added
What changed in the criteria
Inclusion criteria
  • EditedContinuous membership from 27 August 2025 to 2728 September 2026;
Exclusion criteria
  • AddedPeople with unknown or missing sex.
  • AddedPeople with metastatic or terminal illness, advanced illness, receiving hospice or palliative care, or resident in skilled nursing facilities.
  • EditedPeople who are pregnant or currently breastfeeding will not be included.
Sep 29, 2026
Show all 2 updates
  1. Oct 15, 2026
    Not yet recruiting→Recruiting
    Kaiser Permanente Southern California, Department of Research & Evaluation is now Recruiting
    Start date Sep 28, 2026→Sep 29, 2026 (now actual)
  2. Sep 29, 2026
    Eligibility 1 inclusion criterion edited; 1 exclusion criterion edited, 2 added
    What changed in the criteria
    Inclusion criteria
    • EditedContinuous membership from 27 August 2025 to 2728 September 2026;
    Exclusion criteria
    • AddedPeople with unknown or missing sex.
    • AddedPeople with metastatic or terminal illness, advanced illness, receiving hospice or palliative care, or resident in skilled nursing facilities.
    • EditedPeople who are pregnant or currently breastfeeding will not be included.

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

10

Registry details

Key details

Study ID
NCT07838038
Lead sponsor
Kaiser Permanente
Collaborators
Sanofi
Responsible party
Sponsor
First posted
Sep 24, 2026
Start date
Sep 29, 2026
Primary completion
Jan 31, 2027 (estimated)
Completion
Jun 30, 2027 (estimated)
Last update
Oct 15, 2026

Study contacts

Annette Regan, PhD
Contact
annette.k.regan@kp.org
626-760-2482
Zendi S Yha, BS
Contact
zendi.s.yha@kp.org
626-372-5637
Annette Regan, PhD
principal investigator · Kaiser Permanente

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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