Informing facility selection through a web-based user ratings system: A randomized controlled trial among mothers in urban Lao PDR

Last registered on December 03, 2024
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Pre-Trial

Trial Information

General Information

Title
Informing facility selection through a web-based user ratings system: A randomized controlled trial among mothers in urban Lao PDR
RCT ID
AEARCTR-0014923
Initial registration date
November 28, 2024

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 03, 2024, 1:36 PM EST

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

Locations

Country
Lao People's Democratic Republic
Region
Vientianne Province

Primary Investigator

Name
Günther Fink
Affiliation
Swiss Tropical and Public Health Institute
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Other Primary Investigator(s)

PI Name
Emma Clarke-Deelder
PI Affiliation
Swiss TPH and University of Basel
Contact Investigator
PI Name
Amit Aryal
PI Affiliation
Swiss TPH and University of Basel
Contact Investigator

Additional Trial Information

Status
On going
Start date
2024-03-01
End date
2025-12-31
Keywords
Behavior, Health
Additional Keywords
care seeking; digital platforms; user ratings; quality of care
JEL code(s)
I11, I12
Secondary IDs
NCT06304831
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Background:
Despite increasing options for public and private health care providers in Lao PDR, choosing a high-quality health provider or a facility is difficult because timely and reliable information about providers is not readily available. Additionally, only 28% describe their recent visit to a health care provider as high-quality suggesting that while there are increasing options for care, people may need support to find providers that meet their quality needs. In order to inform efforts to improve people's access to high-quality care, there is a need for evidence on mechanisms to empower people to identify and use high-quality care. Rapid adoption of mobile phones in Lao PDR, particularly in urban areas, offer opportunities to enhance people's access to timely quality information about health care facilities.
Methods:
An unblinded randomized controlled trial (RCT) design will be performed. Mothers with at least one child under 2 years old awill be invited to participate in the study during in-person visits by the research staff. The control and intervention groups will have an equal number of randomly assigned participants. The intervention group will receive a URL to the consisting of facility ratings for pediatric health care services every two weeks via a WhatsApp message; the control group will not receive anything. We will also use WhatsApp to administer bi-weekly surveys among both groups to assess quality of health care received in the past 2 weeks. The webpage shared with the intervention group via WhatsApp will display the results from these surveys and the pilot study. Research staff will conduct baseline and endline surveys that are three months apart to all participants during in-person visits.
Objectives:
The primary outcome will be the proportion of mothers that changed their preferred health care facility for non-urgent child health care services between the baseline and endline surveys. Secondary outcomes will include changes in preferred providers for urgent health care services, satisfaction with recent health care visits, the number and types of health care providers used in the past 3 months, the use of digital information services to inform health facility choices, and confidence in ability to identify the best paediatric care providers.
External Link(s)

Registration Citation

Citation
Aryal, Amit, Emma Clarke-Deelder and Günther Fink. 2024. "Informing facility selection through a web-based user ratings system: A randomized controlled trial among mothers in urban Lao PDR ." AEA RCT Registry. December 03. https://doi.org/10.1257/rct.14923-1.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
Participants will be randomly assigned to one of two groups: 1) a control group that will not receive any information about providers and 2) an intervention group that will receive biweekly updates about quality ratings based on reviews collected from mothers of young children in the study areas.
Intervention Start Date
2024-03-11
Intervention End Date
2024-10-23

Primary Outcomes

Primary Outcomes (end points)
Our primary outcome will be the proportion of mothers that changed their preferred health care facility for non-urgent child care services between baseline and endline surveys.
Primary Outcomes (explanation)
Non-urgent care is defined as children with mild fever of 38 degrees along with cough. During the baseline and endline surveys, participants will be asked to specify their preferred location for child care as follows: "If your child is sick tomorrow with mild fever of 38 degrees Celsius and cough, which hospital, clinic or health center will you take your child to?" The primary outcome will be a binary indicator for participants changing their preferred location between baseline and endline.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary outcomes are 1) change in preferred providers for urgent health care services, 2) satisfaction with recent health care visits, 3) the number and types of health care providers used in the past 3 months, 4) the use of digital information services to inform health facility choices, and 5) confidence in ability to identify the best paediatric care providers.
Secondary Outcomes (explanation)
Secondary outcomes will look at the potential impact of having more information for facility choice - we hypothesize that the information treatment will encourage mothers to try out different facilities and to be happier with the chosen facility over time.

Experimental Design

Experimental Design
This study is an unblinded randomized control experiment with two arms (treatment and control).

All women 18 years of age or older, enrolled in VITERBI with at least one child less than two years old, living in one of two urban districts (Sikhottabong or Chathabouly), able to read, have exclusive access to a mobile phone, have a WhatsApp account, understand and sign the Informed Consent Form (ICF) will be eligible to participate in the stud
Experimental Design Details
Not available
Randomization Method
A simple random number draw generated by the ODK package installed on the tablets will be used to assign participants to treatment and control with equal probability.
Randomization Unit
Individual (mother of young child)
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
NA (not clustered)
Sample size: planned number of observations
660 participants for main outcomes - up to
Sample size (or number of clusters) by treatment arms
330 treated, 330 control mothers
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The study is powered to detect a 12% percentage point change in the outcome with 80% power and α = 0.05, assuming 10% attrition between baseline and endline.
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
EKNZ
IRB Approval Date
2023-09-08
IRB Approval Number
AO_2023-00063
IRB Name
National Ethics Committee for Health Research (Laos)
IRB Approval Date
2023-09-09
IRB Approval Number
540
Analysis Plan