Building informed trust: Developing an educational tool for injection practices and health insurance in Cambodia
Last registered on November 17, 2017

Pre-Trial

Trial Information
General Information
Title
Building informed trust: Developing an educational tool for injection practices and health insurance in Cambodia
RCT ID
AEARCTR-0002584
Initial registration date
November 16, 2017
Last updated
November 17, 2017 10:22 AM EST
Location(s)
Primary Investigator
Affiliation
UNC Eshelman School of Pharmacy
Other Primary Investigator(s)
Additional Trial Information
Status
On going
Start date
2012-09-01
End date
2018-10-31
Secondary IDs
Abstract
Unnecessary injections increase the risk of blood borne infections as well as pose an avoidable financial burden on patients. Perceptions in rural Cambodia that non-illicit medical drug injections are the best quality of medical care have resulted in a high proportion of the population seeking these injections across medical conditions. As private providers have a higher propensity to offer injections, patients pursue more expensive care contributing to greater financial burden on patients. This study aimed to use an educational intervention to improve participant knowledge about injections and health insurance in order to build informed trust in safer injection practices and health insurance. Using a quasi-experimental study design, villages in rural Cambodia were randomly assigned to an intervention or control arm. Community educational workshops were implemented to improve participant knowledge about injections and health insurance. Pre-and post-intervention assessments were used to record the resulting changes in knowledge and trust in providers. Statistical analysis of these survey results from the two study arms showed increases of 16.8% and 15.6% in study participant knowledge regarding injections and health insurance, respectively. Trust in health insurance increased by 12.9%. However, trust in health care providers proved to be resilient with small to no change. These results show that knowledge about injection safety and health insurance, as well as trust in health insurance, can be increased through information dissemination in rural Cambodia. However, health information campaigns may not easily influence people’s trust in healthcare providers. Education of the general populace about safe injection practices and health insurance can contribute toward the country’s efforts to reach universal health coverage.
External Link(s)
Registration Citation
Citation
Ozawa, Sachiko. 2017. "Building informed trust: Developing an educational tool for injection practices and health insurance in Cambodia." AEA RCT Registry. November 17. https://www.socialscienceregistry.org/trials/2584/history/23264
Experimental Details
Interventions
Intervention(s)
The intervention consisted of community workshops aimed at providing participants with knowledge on injection risks and the importance of health insurance as well as trust in the health system, thereby decreasing their demand for inappropriate injections and increasing their demand for health insurance.
Intervention Start Date
2012-09-01
Intervention End Date
2013-10-31
Primary Outcomes
Primary Outcomes (end points)
We aimed to measure changes in knowledge and trust due to the intervention.
Primary Outcomes (explanation)
For knowledge, we measured (1) injection knowledge measured by 16 true-false questions and (2) health insurance knowledge measured by 14 true-false questions. For trust, measurements included (1) provider trust assessed by 10 scoring (scale) questions for both public providers and (2) private providers; and (3) insurer trust assessed by 12 scoring (scale) questions.

The same standardized metrics were used pre- and post- intervention to assess the changes due to the intervention.
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
We conducted a quasi-experimental study with an intervention arm and a control arm. Sixteen villages in two operational districts (eight in each operational district) were randomly selected based on the size of village population, health center coverage (one village per vicinity of a health center), and distance between the village and the nearest health center. These villages were then equally assigned to be intervention and control villages. We randomly recruited at least 30 participants per selected intervention and control village. In order to avoid conflict of interests and ethical issues, participants were 18 years or older, and neither a medical practitioner nor staff of health insurance organizations.
Experimental Design Details
Surveys were conducted among all study participants in the 16 intervention and control villages. In the intervention villages, one survey was conducted before the workshop and another 4-5 days after the workshop. In control villages, two surveys were similarly completed 4-5 days apart. The surveys and workshops were pre-tested in a non-study village in Thmar Pouk operational district in order to improve the questionnaire, the workshop plans, and the surveyors’ skills in administering the questionnaire and facilitating the workshops. A structured survey questionnaire was administered to each willing participant. Consent was obtained for every study participant. The questionnaire included questions on trust, knowledge and behavior around injections, and health insurance.
Randomization Method
List of all villages in provinces based on the size of village population, health center coverage (one village per vicinity of a health center), and distance between the village and the nearest health center. Randomly selected via random number generator.
Randomization Unit
16 villages with 30 individuals per village.
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
8 villages and 240 people in the intervention and 8 villages and 240 people in the control. 480 participants total.
Sample size: planned number of observations
480 participants with 2 surveys (pre- and post- intervention) recorded for each participant (total of 960 surveys).
Sample size (or number of clusters) by treatment arms
8 control villages and 8 intervention villages. 240 control participants and 240 intervention participants.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
National Ethics Committee for Health Research in Cambodia
IRB Approval Date
2012-08-31
IRB Approval Number
148 NECHR
IRB Name
Johns Hopkins School of Public Health Institutional Review Board
IRB Approval Date
2012-07-12
IRB Approval Number
IRB00003710
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
No
Is data collection complete?
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports and Papers
Preliminary Reports
Relevant Papers