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Last Published November 03, 2025 10:29 AM November 27, 2025 12:05 PM
Intervention (Public) Using data from an independent audit of government, private, and non-profit health centres using standard patients, we designed two information provision interventions: Intervention 1) providing objective quality signals to individuals. Delivered to participants through a short video – a voiced over animated presentation comparing provider quality – and report cards with comparative ratings of types of providers (government, public, non-profit). Intervention 2) objective quality signals + addressing errors in conceptual frameworks of healthcare. Intervention 2 will include all the information components, but the video will include an additional section addressing misconceptions about healthcare providers, focusing on private clinics’ tendency to overtreatment, lower medical accuracy, and higher costs. Using data from an independent audit of government, private, and non-profit health centres using standard patients, we designed three information provision interventions: Intervention 1) providing objective quality signals to individuals. Delivered to participants through a short video – a voiced over animated presentation comparing provider quality – and report cards with comparative ratings of types of providers (government, public, non-profit). Intervention 2) objective quality signals + addressing errors in conceptual frameworks of healthcare. Intervention 2 will include all the information components, but the video will include an additional section addressing misconceptions about healthcare providers, focusing on private clinics’ tendency to overtreatment, lower medical accuracy, and higher costs. Intervention 3) A final intervention is a simple screen where we reveal which providers performed best within each category according to SP study results. We do not compare how they did *across* provider types.
Experimental Design (Public) Sample and Recruitment: We will conduct a randomized controlled trial with 1,500 participants in Gulu, Uganda. Participating adults will be eligible if 1) they had sought care within the past 12 months; 2) they had sought care from private healthcare providers within the past 12 months; 3) they are able to give a mobile phone contact number (essential for a part of the primary outcome, and enabling future follow-up data collection if desired). We will recruit individuals who have recently used private health facilities in Gulu. In a recent pilot, conducted in a busy market location and a well-off neighbourhood of Gulu, 92% of respondents sought care in past 12 months and 2/3 of those had used private providers. We will recruit in central locations in the city. Participants will be screened for eligibility and invited to participate in a 35 minute survey. To avoid interviewing the same individuals, enumerators will work in teams under the guidance of a supervisor and recruitment sites will be split between the teams. Randomization: After completing the baseline portion of the survey and the belief elicitation module, participants will be randomly assigned to one of three groups with equal probability (n=500 per arm): - Control group: Receives no additional information - Treatment 1 (Objective Quality Information): Receives objective information on provider quality based on standardized patient audits conducted earlier this year - Treatment 2 (Conceptual Framework Correction): Receives treatment 1 and additional information addressing common misconceptions about healthcare quality signals Sample and Recruitment: We will conduct a randomized controlled trial with 1,600 participants in Gulu, Uganda. Participating adults will be eligible if 1) they had sought care within the past 12 months; 2) they had sought care from private healthcare providers within the past 12 months; 3) they are able to give a mobile phone contact number (essential for a part of the primary outcome, and enabling future follow-up data collection if desired). We will recruit individuals who have recently used private health facilities in Gulu. In a recent pilot, conducted in a busy market location and a well-off neighbourhood of Gulu, 92% of respondents sought care in past 12 months and 2/3 of those had used private providers. We will recruit in central locations in the city. Participants will be screened for eligibility and invited to participate in a 35 minute survey. To avoid interviewing the same individuals, enumerators will work in teams under the guidance of a supervisor and recruitment sites will be split between the teams. Randomization: After completing the baseline portion of the survey and the belief elicitation module, participants will be randomly assigned to one of four groups: - Control group (T0): Receives no additional information; views a placebo video of unrelated results from the SP study. n=300 - Best performer group (T1): Received the placebo video; in addition, learns only information on which providers did best in the SP study, by category. This group tests if preferred provider can be shifted *within* provider, if not between types. n=300 - Objective Quality Information (T2): Receives objective information on provider quality based on standardized patient audits conducted earlier this year. n=500 - Conceptual Framework Correction (T3): Receives treatment T2 and additional information addressing common misconceptions about healthcare quality signals. n=500
Planned Number of Observations 1,500 1,600
Sample size (or number of clusters) by treatment arms 500 control individuals, 500 treatment 1, 500 treatment 2. 300 T0, 300 T1, 500 T2, 500 T3.
Secondary Outcomes (End Points) Marginal preferences for providers characterised by: 1) overtreatment, 2) low cost, 3) higher diagnostic effort, 4) better patient manner, 5) nicer facility conditions, 6) less time at facility
Secondary Outcomes (Explanation) Preference parameters are elicited using a discrete choice experiment (DCE). Each subject will complete 4 choice sets in their DCE, with each choice set containing two alternatives for the six attributes. 8 choice sets (16 pairs) in 2 blocks were selected to ensure d-efficiency of the design and randomly assigned to participants. A logit model will be estimated to obtain preference estimates for the different provider attributes. In addition, the coefficient estimates on the attributes will be compared between the treatment groups - the DCE will be conducted after the intervention to test if preference parameters shift in response to the information videos. We will use treatment groups T0 and T1 (600 obs) to estimate the untreated population preference model, as they receive no information about the performance of private providers versus others. We will then compare these parameters to T2 and T3 group parameters.
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