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Stigma barriers to information diffusion: an experiment with refugee mental health care-seeking

Last registered on January 03, 2023
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Pre-Trial

Trial Information

General Information

Title
Stigma barriers to information diffusion: an experiment with refugee mental health care-seeking
RCT ID
AEARCTR-0010702
Initial registration date
December 27, 2022

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
January 03, 2023, 5:27 PM EST

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

Locations

Country
Jordan
Region

Primary Investigator

Name
Emma Smith
Affiliation
Harvard University
Contact Primary Investigator

Other Primary Investigator(s)

Additional Trial Information

Status
In development
Start date
2023-01-02
End date
2023-11-30
Keywords
Behavior, Crime, Violence, & Conflict, Health
Additional Keywords
networks, refugees, mental health
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
This study uses a randomized controlled trial to study the take-up of mental health services in the context of a "sender" who has private information about an available mental health service, and a "recipient" who may be in need and with whom the sender may share the information. The study is conducted with a sample of Syrian refugees living in Jordan. In this setting there is a large mental health burden, with roughly 50% of the adult population having symptoms aligned with clinical depression (Stillman et al. 2022). Senders are invited to share with their friends mental health awareness information advertising a free counseling helpline. The sender's choice to share is observed by the researcher, as is the recipient's decision of whether to take-up the helpline. I consider first what constrains sharing of information, and second how message recipients are impacted, both in their probability of using the helpline as well as their perceptions about their own fit for the service relative to the reputational costs of using it.

Citations
Stillman, Sarah, Rozo, Sandra V, Tamim, Abdulrazzak, Palmer, I Bailey, Smith, Emma and Miguel, Edward, (2022), The Syrian refugee life study: first glance, Oxford Review of Economic Policy, 38, issue 3, p. 625-653.
External Link(s)

Registration Citation

Citation
Smith, Emma. 2023. "Stigma barriers to information diffusion: an experiment with refugee mental health care-seeking." AEA RCT Registry. January 03. https://doi.org/10.1257/rct.10702-1.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
The intervention consists of a mental health awareness campaign, delivered over WhatsApp over the course of 8 days. The mental health awareness campaign includes information on identifying psychological distress, self-care tips, and information about a free helpline service. The campaign content was designed and piloted locally by the International Rescue Committee in Jordan.
Intervention Start Date
2023-01-09
Intervention End Date
2023-02-17

Primary Outcomes

Primary Outcomes (end points)
Sender follow-through
Take-up of helpline
Recipient's perceived mental health benefit relative to reputational cost
Recipient’s mental health stigma
Primary Outcomes (explanation)
Sender follow-through is defined two ways:
- A sender-level binary variable indicating whether the sender shared the content with at least 1 recipient.
- A recipient-level binary variable indicating if the sender sent at least 1 message to the recipient.
Take-up of helpline: Constructed two ways. First as the number of helpline caller phone numbers that match the recipient phone numbers in each arm, collected via the sender survey and recipient surveys.
Mental health benefit relative to reputational cost: The respondent's predicted benefit to self of using mental health services, minus the respondent's predicted reputational cost to self of using mental health services, with both component variables and the final variable normalized relative to the control group.
Recipient’s mental health stigma : Recipient’s willingness to share her experience publicly to be used for future IRC content. Normalized score of not willing at, willing when anonymous, to willingness when not anonymous.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
“Senders” will be invited to share mental health awareness content with their friends. Conditional on stating their willingness to do this, the senders are randomized to either a control group, which receives no information until after the study, or a treatment group. The treatment group senders receive the intervention information (the mental health awareness campaign) over WhatsApp over the course of 8 days. Each time they are requested to share the information with their friends, who have been identified prior to the randomization. Each treatment sender will be randomized to one of three different message framings.

The intended recipients of the messages form the recipient sample. They are surveyed 3 weeks after the intervention ends, and asked about mental health care-seeking and stigma attitudes.
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer.
Randomization Unit
Senders
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
900 senders
Sample size: planned number of observations
3600 recipients and 900 senders
Sample size (or number of clusters) by treatment arms
225 senders control, 675 senders treatment. 225 senders per message framing in the treatment group.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Sender follow-through (binary variable): 10.4 percentage point difference in follow-through assuming 50% follow-through in the benchmark framing (standard deviation .5). Follow-through measured at the recipient and sender levels. Take-up of helpline (binary variable): 5.0 percentage point difference in follow-through. Baseline mental health care-seeking in this population is 7% with a standard deviation of 25 percentage points. Measured at the recipient level.
Supporting Documents and Materials

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IRB

Institutional Review Boards (IRBs)

IRB Name
Harvard University-Area Committee on the Use of Human Subjects
IRB Approval Date
2022-04-04
IRB Approval Number
IRB20-1023
Analysis Plan