Social Signaling in Childhood Immunization: Evidence from a Field Experiment in Sierra Leone

Last registered on August 01, 2018

Pre-Trial

Trial Information

General Information

Title
Social Signaling in Childhood Immunization: Evidence from a Field Experiment in Sierra Leone
RCT ID
AEARCTR-0001299
Initial registration date
June 17, 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
June 17, 2016, 6:50 AM EDT

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

Last updated
August 01, 2018, 3:44 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Primary Investigator

Affiliation
Princeton University

Other Primary Investigator(s)

Additional Trial Information

Status
On going
Start date
2016-06-14
End date
2019-05-31
Secondary IDs
Abstract
Can social signaling incentivize caregivers to immunize their children? Working with the Ministry of Health and Sanitation (MoHS) Sierra Leone, I introduce a social incentive in the form of differently colored bracelets that children receive upon coming for immunization visits. The differently colored bracelets make highly salient if the immunization schedule is unfinished and if other children have received immunizations that your child has missed. Different to most incentives that are material or private in nature (e.g. food, cash transfers) the bracelets make the decision to immunize your child observable and allow caregivers to signal to others that they look after their child's health. I implement a field experiment in government clinics to test the effects of the social incentive on timely and complete immunization. I further measure the effect of the bracelets on individuals' knowledge and beliefs about others' immunization choices. I vary the visibility of immunization decisions across treatment arms by implementing different variations of the bracelet scheme. This experimental design allows me to separately identify the extent to which behavior change is driven by (i) the demand for bracelets or reminder effects, (ii) learning from others or (iii) the desire to signal to others.
External Link(s)

Registration Citation

Citation
Karing, Anne. 2018. "Social Signaling in Childhood Immunization: Evidence from a Field Experiment in Sierra Leone." AEA RCT Registry. August 01. https://doi.org/10.1257/rct.1299-4.0
Former Citation
Karing, Anne. 2018. "Social Signaling in Childhood Immunization: Evidence from a Field Experiment in Sierra Leone." AEA RCT Registry. August 01. https://www.socialscienceregistry.org/trials/1299/history/32452
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2016-06-14
Intervention End Date
2018-07-31

Primary Outcomes

Primary Outcomes (end points)
Primary outcome: number of (timely) immunization visits a child made
Secondary outcomes: individual knowledge and beliefs about children's immunization status; take-up and retention of bracelets over time
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Government clinics in the selected districts will be randomly assigned into one of the four intervention arms: 1) Clinic staff distributes two differently colored bracelets. A yellow bracelet is given at the 1st immunization visit. The bracelet will be exchanged for an identical bracelet of the same color (yellow) at the 4th immunization visit. The yellow bracelet will be exchanged for a green bracelet when a child comes for the 5th immunization visit on time. The bracelets show whether a child has come for all immunizations on time (~fully informative bracelets).
2) Clinic staff distributes two differently colored bracelets. A yellow bracelet is given at the 1st immunization visit. The yellow bracelet will be exchanged for a green bracelet when a child comes for the 4th immunization visit on time. The bracelet will be exchanged for an identical bracelet of the same color at the 5th immunization visit. The bracelets show whether a child has completed four out of the five required immunization visits on time (~partially informative bracelets).
3) Clinic staff distributes two differently colored bracelets. A yellow or green bracelet is given at the 1st immunization visit. The caregiver can choose the color. No color change takes place for later vaccine visits. The bracelet will be exchanged for an identical bracelet of the same color at the 4th and 5th immunization visit irrespective of whether a child came timely for immunization (~uninformative bracelets).
4) Status quo. No bracelets are given.

Clinic staff and caregivers in all four intervention arms will be sensitized on the importance of immunization and enumerators will visit clinics at the same frequency across arms to collect data from administrative records and survey individuals.
Experimental Design Details
Randomization Method
The randomization was conducted using a computer random number generator.
Randomization Unit
Clinics
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
120 clinics
Sample size: planned number of observations
12000 children observed from administrative records, 6000 individual survey respondents
Sample size (or number of clusters) by treatment arms
30 clinics yellow bracelets for 1st and green bracelets for 5th immunization visit, 30 clinics yellow bracelets for 1st and green bracelets for 4th immunization visit, 30 clinics yellow and green bracelets for 1st immunization visit, 30 clinics control.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Sierra Leone Ethics and Scientific Review Committee
IRB Approval Date
2016-05-16
IRB Approval Number
N/A
IRB Name
Human Subjects Committee for Innovations for Poverty Action IRB-USA
IRB Approval Date
2016-05-12
IRB Approval Number
13983
IRB Name
Committee for Protection of Human Subjects (CPHS) UC Berkeley
IRB Approval Date
2016-06-14
IRB Approval Number
2016-03-8471

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials