The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China

Last registered on December 18, 2016
View Trial History

Pre-Trial

Trial Information

General Information

Title
The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China
RCT ID
AEARCTR-0001138
Initial registration date
December 18, 2016

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
December 18, 2016, 9:23 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country
China
Region
Asia

Primary Investigator

Name
Grant Miller
Affiliation
Stanford Medical School
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Scott Rozelle
PI Affiliation
Freeman Spogli Institute, Stanford University, Stanford, CA, USA
Contact Investigator
PI Name
Alexis Medina
PI Affiliation
Freeman Spogli Institute, Stanford University, Stanford, CA, USA
Contact Investigator
PI Name
Huiping Zhang
PI Affiliation
Economic and Management School, Ningxia University, 750002 Ningxia, China
Contact Investigator
PI Name
Linxiu Zhang
PI Affiliation
Center for Chinese Agricultural Policy, Chinese Academy of Sciences, 100101 Beijing, China
Contact Investigator
PI Name
Yaojiang Shi
PI Affiliation
Northwest Socioeconomic Development Resource Center, Xibei University, 710127 Xi’an, China
Contact Investigator
PI Name
Renfu Luo
PI Affiliation
Center for Chinese Agricultural Policy, Chinese Academy of Sciences, 100101 Beijing, China
Contact Investigator

Additional Trial Information

Status
Completed
Start date
2008-10-01
End date
2011-06-30
Keywords
Education, Health
Additional Keywords
health education, anemia, iron, supplements, rural China, primary school students
JEL code(s)
I12, I15, O15
Secondary IDs
Abstract
This article studies whether or not health education programs targeting childhood anemia are sufficient for changing health behavior and nutrition in rural China. We conducted three different randomized-controlled trials of single and multiple face-to-face education sessions with parents and distributed written health education materials—and compare our results with a simple vitamin distribution program. Across all three studies, we find little evidence of changes in blood hemoglobin concentration or anemia status. In contrast, in our two studies that also examined a multivitamin supplementation intervention, we find meaningful reductions in anemia
External Link(s)
J-PAL Evaluation Summary

Registration Citation

Citation
Luo, Renfu et al. 2016. "The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China." AEA RCT Registry. December 18. https://doi.org/10.1257/rct.1138-1.0
Former Citation
Luo, Renfu et al. 2016. "The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China." AEA RCT Registry. December 18. https://www.socialscienceregistry.org/trials/1138/history/12619
Sponsors & Partners

There is information in this trial unavailable to the public. Use the button below to request access.

Request Information
Experimental Details

Interventions

Intervention(s)
Three separate experiments were conducted in Shaanxi and Ningxia districts to test the effectiveness of information, and nutritional supplements vis-a-vis controls. Entire schools were assigned to treatment or control groups. Fourth grade students in sample schools were tested for anemia and then subjected to the following interventions:
Experiment 1:
Information treatment: parents are mailed general information on anemia, their child's anemia status, and ways to address anemia like including more iron-rich foods in their child's diet or giving their child an iron supplement.
Supplement treatment: teachers were instructed to give each student a daily multivitamin supplement containing iron.
Experiment 2:
Information treatment: similar to experiment 1, except messaging to parents is more intense. The school invited parents to an information session in which a trained health professional shared information on anemia, its cognitive and physiological consequences, and strategies to address it. The recommended strategies were the same as in Experiment 1. The health professional also distributed printed material on anemia: pamphlets to parents and posters to teachers.
Supplement treatment: same as experiment 1.
Experiment 3:
Information treatment: Parents invited to two information sessions at school.
Supplement treatment: None. Only information treatment and control.
Intervention Start Date
2008-10-01
Intervention End Date
2011-06-30

Primary Outcomes

Primary Outcomes (end points)
Student hemoglobin level
Primary Outcomes (explanation)
Hemoglobin levels were measured onsite using a HemoCue Hb 201þ diagnostic machine. Ten percent of all sampled students were retested; if the second measure differed from the original one by more than 0.3 g/dl among three or more students, all sample students in that school were retested. Because students in our sample were aged 8–11 years, the WHO recommended anemia threshold of ‘11.5 g/dl and below for children aged 5–11 years’ was adopted.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
First, a list of all counties in was obtained for the study regions, namely Shaanxi Province or Ningxia Autonomous Region. Second, study counties were randomly selected from those meeting the official criteria for impoverished counties. Third, a list of all primary schools in sample counties was created using official records. Fourth, researchers used official records and their own canvass survey to identify all schools with the following characteristics: (i) six grades (i.e., 'complete' primary schools, or wanxiao), (ii) boarding facilities, and (iii) 400 or more students. Fifth, primary schools were randomly selected from these sampling frames. Finally, only fourth grade students in sample schools were randomly selected for inclusion in the studies.
Experimental Design Details
Randomization Method
Randomization done in office by a computer.
Randomization Unit
Three levels of randomization in order of county, primary schools, and fourth grade students.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
176 schools:
Experiment 1: Control (30), Information(12), Supplementation(24);
Experiment 1: Control (30), Information(15), Supplementation(25);
Experiment 1: Control (25), Information(25)
Sample size: planned number of observations
6,491 students
Sample size (or number of clusters) by treatment arms
Experiment 1: Control (1686), Information(675), Supplementation(1470);
Experiment 1: Control (798), Information(439), Supplementation(417);
Experiment 1: Control (541), Information(475)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Stanford University Institutional Review Board
IRB Approval Date
Details not available
IRB Approval Number
Details not available
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

There is information in this trial unavailable to the public. Use the button below to request access.

Request Information

Intervention

Is the intervention completed?
Yes
Intervention Completion Date
June 30, 2011, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
June 30, 2011, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
6,169 students
Final Sample Size (or Number of Clusters) by Treatment Arms
Control: 2,879 Information: 1,487 Supplement: 1803
Data Publication

Data Publication

Is public data available?
No

There is information in this trial unavailable to the public. Use the button below to request access.

Request Information

Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
THE LIMITS OF HEALTH AND NUTRITION EDUCATION: EVIDENCE FROM THREE RANDOMIZED-CONTROLLED TRIALS IN RURAL CHINA

This article studies whether or not health education programs targeting childhood anemia are sufficient for changing health behavior and nutrition in rural China. We conducted three different randomized-controlled trials of single and multiple face-to-face education sessions with parents and distributed written health education materials—and compare our results with a simple vitamin distribution program. Across all three studies, we find little evidence of changes in blood hemoglobin concentration or anemia status. In contrast, in our two studies that also examined a multivitamin supplementation intervention, we find meaningful reductions in anemia.
Citation
Luo, Renfu, Yaojiang Shi, Linxiu Zhang, Huiping Zhang, Grant Miller, Alexis Medina, and Scott Rozelle. 2012. “The Limits of Health and Nutrition Education: Evidence from Three Randomized-Controlled Trials in Rural China.”CESifo Economic Studies 58(2): 385-404.
URL
https://www.povertyactionlab.org/sites/default/files/publications/827_Grant%20Miller%20limits%20of%20health%20and%20nutrition%20interventions_China_2013.pdf

Reports & Other Materials