Testing Boosts to Guide Caregivers in 4 French Hospitals: a Comparative and Experimental study

Last registered on October 03, 2025

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Pre-Trial

Trial Information

General Information

Title

Testing Boosts to Guide Caregivers in 4 French Hospitals: a Comparative and Experimental study

RCT ID

AEARCTR-0016901

Initial registration date

September 30, 2025

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

October 03, 2025, 10:23 AM EDT

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

Locations

Country

France

Region

Grand Est, Nouvelle Aquitaine, Auvergne Rhône Alpes

Primary Investigator

Name

Zoé Burtschell

Affiliation

Université Côte d'Azur

Contact Primary Investigator

Other Primary Investigator(s)

Additional Trial Information

Status

On going

Start date

2025-09-25

End date

2026-01-29

Keywords

Behavior, Health

Additional Keywords

Hospital Waste, Sorting, Caregivers, Awarness Campaign, Recyclable Waste

JEL code(s)

Secondary IDs

Prior work

This trial does not extend or rely on any prior RCTs.

Abstract

The objective of this study is to evaluate the impact of displaying awarness posters on waste-sorting behavior of healthcare workers and to identify factors among their behaviors that influence waste sorting practices. Simultaneously, the present study undertakes a comparative analysis of waste management practices among four French hospitals.

Indeed, the research was conducted within the Regional Hospital Group of Mulhouse and the University Hospital Centers of Grenoble, Poitiers and Bordeaux. It is focused on the maternity and pediatry divisions. The sample is composed of healthcare workers, who are divided into 20 groups (with three to six groups per hospital). In order to assess the impact of the study, the groups are randomly assigned to either treatment or a control condition.

The intervention is predicated on principles from behavioral economics. The initiative utilizes "boosts" which entail the disseminating of pertinent information to facilitate decision-making and behavioral patterns among the target population. In practice, five posters are disseminated exclusively to the treatment groups, each containing five distinct pieces of information regarding waste sorting and treatment. The posters are displayed indivudally and are replaced every two weeks. The half of the treatment groups are also subject to "nudges", which consist of guiding and encouraging subjects' behavior without providing information, but with short intuitive messages.

In order to assess the impact of the intervention, two types of measurements were collected: the weight of the domestic waste generated before and after the treatment period and the responses of the hospital staff to a structured survey, which was administered only after the treatment period. The weight results will be analyzed using a Difference-In-Difference (DID) model with the average waste serving as independent variable. The objective of the intervention is to decrease the proportion of domestic waste, thereby ensuring the optimal functionality of available sorting channels. The survey measure will be analyzed with a Randomized Control Trial (RCT) with scores derived from the answers serving as independent variables. The objective of the surveys responses is to facilitate a comparison between the knowledges, perceptions and pretended practices of control and treatment subjects.

External Link(s)

Registration Citation

Citation

Burtschell, Zoé. 2025. "Testing Boosts to Guide Caregivers in 4 French Hospitals: a Comparative and Experimental study." AEA RCT Registry. October 03. https://doi.org/10.1257/rct.16901-1.0

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Experimental Details

Interventions

Intervention(s)

The intervention design is rooted in the "boosts" and "nudges" approaches from behavioral economics. The objective of "boosts" is to furnish individuals with the relevant and actionable information necessary to facilitate the developement of the capacity for autonomous behavioral modification. The term "nudges" is used to describe interventions that aim to modify individual behavior. These nudges differ from information diffusion in that they utilize visual incentives rather than information transmission to achieve their objective. The present study will entail the implementation of an awarness campaign, which will include six "boosts" posters and two "nudges" posters.

Each of the six "boosts" posters is focused on a specific aspect of the waste management process. Collectively, these posters cover the entire chain, from initial sorting practices to final waste treatment. The objective of the "boosts" initiative was to augment the knowledge and awareness of hospital personnel in the treatment group. This was intended to promote more responsible waste-sorting behaviors compared to those in the control group. The objective of the "nudge" intervention was to augment awareness, with the aim of discerning discrepancies between treatment groups that received nudges and those that did not. In any event, the behavioral change will be assessed using two primary indicators: responses to structured surveys and quantitative measurements of waste weight.

Intervention (Hidden)

The posters will be strategically placed in the break room for the "boosts" posters and in places of passage for the "nudges" posters, such as on the toilet or locker room doors. Furthermore, the poster's design was intended to elicit attention through the utilization of specific color combinations, a distinctive writing style, and, notably, the content's message.

Concurrently, the design of the measurement tools (waste weight and survey) aimed to optimize participation and data quality by minimizing the burden on hospital staff. The survey was intentionally brief, comprising straightforward inquiries to promote completion. It was administered only after the intervention to avert a decline in respondents following the intervention due to excessive solicitation. The domestic waste weight data was derived from a meticulous decision-making process that had previously undergone rigorous testing and approval in a prior intervention. The solution entailed the implementation of automatic scales equipped with the capacity to record the weight of any object placed upon them. These scales were installed in the waste disposal rooms, enabling caregivers to weight garbage bags by placing them on the scale prior to disposal.

Intervention Start Date

2025-10-20

Intervention End Date

2025-12-28

Primary Outcomes

Primary Outcomes (end points)

The primary outcome variables are the scores derived from the survey responses and the average weight of domestic waste bags.

The survey scores were determined by aggregating the points allocated to each question that was evaluated. The initial categorization of these inquiries was predicated on their pertinence to the study's objective, with due consideration given to the significance of the concepts addressed and their frequency in the intervention presentations. The questions were assigned a specific point value based on this hierarchy, with a maximum total score of 100. Questions that were deemed non-evaluable, including those pertaining to socio-demographic characteristics or subjective perceptions, were excluded from the scoring process.

The weight of domestic waste bags was measured using specially designed electronic scales that automatically recorded the weight of any object placed on them. The scales were installed either within or in close proximity to the waste disposal rooms and programmed to record measurements at four-second intervals. Subsequent to the installation, the hospital staff was instructed to place all domestic waste bags on the scale prior to their disposal. This directive was reinforced through the implementation of visual cues, including the display of posters above the scales, in addition to verbal reminders.

Following the conclusion of one week of data collection, the measurements were retrieved via an SD card and exported to an Excel file. The dataset comprised the date and time of each recording, the measured weight (in kilograms), the ambient temperature, and the battery level of the device. The subsequent data cleaning and processing entailed the identification of individual weighting events and the calculation of the average weight per weighting. The final dataset will be analyzed using Stata software, employing regression models and statistical tests based on the average recorded weight of domestic waste bags.

Primary Outcomes (explanation)

The primary objective of the survey component was to maximize response rate among caregivers. The distribution of the questionnaire was facilitated by a QR code, a technological mechanism that enabled the supervision of the completeness of the responses, that is to say, it made sure that each question was answered, as well as the accuracy of the multiple-choice and single-choice formats. The survey was developed and administered using the Sphinx software, which enabled real-time monitoring of the number of responses overall and per hospital. The functionality in question facilitated the identification of facilities exhibiting low participation rates, thereby enabling the subsequent implementation of follow-up measures.

With regard to the measurement of waste weight, the responsibility for informing hospital personnel of the designated weighting period prior to its commencement and for disseminating reminders throughout the data collection phase was incumbent upon the managers of each facility. This communication was imperative, as two preliminary tests of the weighting system conducted prior to the intervention yielded an insufficient number of recorded weightings. The predominant rationale identified pertained to a deficiency in the effective transmission of clear information among caregivers, thereby underscoring the significance of managerial engagement in the data collection process.

Secondary Outcomes

Secondary Outcomes (end points)

Secondary Outcomes (explanation)

Experimental Design

The experiment is meticulously designed to encompass four distinct strata, which are representative of the four hospitals under consideration. Within each stratum, 20 clusters have been meticulously delineated, corresponding to geographically distinct services within each hospital. The number of clusters per hospital ranges from three to six, ensuring a comprehensive and balanced representation of the hospital's services and resources. The experimental design incorporates randomization across the 20 hospital workers' group, with half of the subjects assigned to the treatment group and the other half to the control group. The randomization method employed was based on a random selection of clusters from each stratum, with half of the clusters assigned to the treatment group. Pre- and post-intervention measurements were obtained for all 20 clusters, while the intervention itself was implemented exclusively in the 10 clusters assigned to the treatment group.

Experimental Design Details

The process of establishing the various groups was executed in conjunction with the respective hospital managers. The primary objective of the study was to form as many groups as possible within each facility, while adhering to specific conditions. The stipulated conditions indicated that each group was required to have its own designated waste disposal area to ensure clear differentiation between the treatment and control group. Furthermore, a unique transmission period was allocated to each group, contingent upon specific constraints, with the objective of impeding caregivers from the control group from participating in the presentations designated for the treatment group.

Randomization Method

The randomization of the 20 groups was conducted using Stata.

Randomization Unit

The level of randomization is the groups of healthcare staff working in identified services.

Was the treatment clustered?

Yes

Experiment Characteristics

Sample size: planned number of clusters

The number of cluster is 20 groups of healthcare workers.

Sample size: planned number of observations

The number of observation corresponding to the number of healthcare workers envolved in the sample. The exact number is not know for now but will be more than 2000 healthcare workers.

Sample size (or number of clusters) by treatment arms

There is 10 groups of "boosts" treatment with 7 groups of "nudges" groups and 10 groups of control.

Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Supporting Documents and Materials

IRB