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Comparing cash transfers and other demand-side incentives for health screenings in Armenia

Last registered on January 18, 2019
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Pre-Trial

Trial Information

General Information

Title
Comparing cash transfers and other demand-side incentives for health screenings in Armenia
RCT ID
AEARCTR-0003776
Initial registration date
January 15, 2019

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 18, 2019, 3:24 AM EST

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

Locations

Country
Armenia
Region

Primary Investigator

Name
Damien de Walque
Affiliation
The World Bank
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Marianna Koshkakaryan
PI Affiliation
The World Bank
Contact Investigator
PI Name
Adanna Chukwuma
PI Affiliation
The World Bank
Contact Investigator

Additional Trial Information

Status
In development
Start date
2019-03-31
End date
2020-03-31
Keywords
Health
Additional Keywords
health screenings, incentives, diabetes, hypertension, cash transfers, social norms
JEL code(s)
I12
Secondary IDs
Abstract
Despite repeated efforts both on the supply side (improving facility equipment and supplies, and financial incentives to providers) and on the demand side (communication campaign including mass-media outreach), screening rates for diabetes and hypertension are still lagging in the Armenian population. Hypertension and diabetes are among the top drivers of preventable death and disability due to non-communicable diseases in Armenia. The focus of this evaluation will be on increasing screening rates for diabetes and hypertension for males and females ages 35-68. Current screening rates are: diabetes mellitus, females 48.1%, males 30.9%; hypertension, females 75.4%; males 48.3%.

We will evaluate different types of demand-side incentives to increase the take-up of the screenings. We will compare regular incentives for patients to come for screenings, including personal invitations, personal invitations mentioning that peers have tested, a labeled but unconditional cash transfer (in the form of “cash like” pharmacy voucher) and a conditional cash transfer, also in the form of a pharmacy voucher.
External Link(s)

Registration Citation

Citation
Chukwuma, Adanna, Damien de Walque and Marianna Koshkakaryan. 2019. "Comparing cash transfers and other demand-side incentives for health screenings in Armenia." AEA RCT Registry. January 18. https://doi.org/10.1257/rct.3776-1.1
Former Citation
Chukwuma, Adanna, Damien de Walque and Marianna Koshkakaryan. 2019. "Comparing cash transfers and other demand-side incentives for health screenings in Armenia." AEA RCT Registry. January 18. https://www.socialscienceregistry.org/trials/3776/history/202607
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
Treatment group 1 Personal invitation to come to the health clinic for diabetes and hypertension screening
Treatment group 2 Personal invitation to come to the health clinic for diabetes and hypertension screening with added mention about screening among peers.

Treatment group 3 Personal invitation to come to the health clinic for diabetes and hypertension screening + cash-like incentive conditional on taking the screening test
Treatment group 4 Personal invitation to come to the health clinic for diabetes and hypertension screening + pharmacy voucher incentive given with the invitation, labeled as an unconditional “encouragement”.
Intervention Start Date
2019-03-31
Intervention End Date
2019-12-31

Primary Outcomes

Primary Outcomes (end points)
Screening rates for diabetes mellitus among individuals 35-68
Screening rates for hypertension among individuals 35-68
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
In addition to the screening rates for diabetes mellitus and hypertension, we will also seek informed consent from participants to anonymously used the results of the screening to examine whether it varies by study group.
Secondary Outcomes (explanation)
We do not expect the interventions to have an impact of the results of the screenings, i.e. whether individuals test positive for diabetes or hypertension, but if we observe differences this might provide information about the composition of people likely to react to the testing incentives.

Experimental Design

Experimental Design
Randomized control trial at the individual level
Experimental Design Details
We will use the administrative records of the public health clinics in Armenia. Health clinic administrative records in Armenia are complete and of high quality. Armenia has a nationwide e-health system that is updated following the patients’ visits. Because the health sector is dominated by public health facilities, we are very likely to have information on most of the diabetes and hypertension screening tests conducted.
We will first randomly select public health facilities in urban and rural areas that will be sufficient to reach our desired sample size of 2000 individuals (see power calculations below). From the patient records at these public health facilities, we will then randomly draw our experimental sample, proportionally to the size of the catchment population of the health facilities, from the list of individuals 35-68 who have not been screened in the last 12 months. This sample extracted from the Armenia e-health administrative system will also include our baseline values.
Randomization Method
randomization done in office by a computer
Randomization Unit
Individual
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
No clusters as treatment is randomized at the individual level
Sample size: planned number of observations
2000 individuals
Sample size (or number of clusters) by treatment arms
Proposed sample size
Treatment 1: 400
Treatment 2: 400
Treatment 3: 400
Treatment 4: 400
Comparison: 400
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
OUTCOME 1: Screening rates for diabetes mellitus among individuals 35-68 Unit: percentage Assumed baseline mean of variable: 0.395 Assumed standard deviation of variable: 0.030 Minimum detectable effect (power 0.80): 20% increase, from 0.395 to 0.474 Minimum detectable effect (power 0.90): 30% increase, from 0.395 to 0.5135 OUTCOME 2: Screening rates for hypertension among individuals 35-68 Unit: percentage Assumed baseline mean of variable: 0.6185 Assumed standard deviation of variable: 0.021 Minimum detectable effect (power 0.80): 15% increase, from 0.6185 to 0.7113 Minimum detectable effect (power 0.90): 20% increase, from 0.6185 to 0.7422
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
IRB Approval Date
IRB Approval Number
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
February 20, 2020, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
February 20, 2020, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
6934 patients
Was attrition correlated with treatment status?
Yes
Final Sample Size: Total Number of Observations
2000 patients
Final Sample Size (or Number of Clusters) by Treatment Arms
400 patients in each of the 4 intervention group + 400 patients in the control group
Data Publication

Data Publication

Is public data available?
No

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Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
This randomized controlled trial investigates the impact of four demand-side interventions on health screening for diabetes and hypertension among Armenian adults. The interventions are 1) personalized invitations from a physician, 2) personalized invitations with information about peer screening behavior, 3) personalized invitations with a labeled but unconditional financial incentive, and 4) personal invitations with a conditional financial incentive. Compared with the control group, interventions 1 to 3 led to a significant increase in the screening rate of about 15 percentage points for diabetes and hypertension. The highest impact was measured for intervention 4 leading to a 31.2 percentage point increase in both screenings.
Citation
Damien de Walque, Adanna Chukwuma, Nono Ayivi-Guedehoussou, Marianna Koshkakaryan, Invitations, incentives, and conditions: A randomized evaluation of demand-side interventions for health screenings, Social Science & Medicine, Volume 296, 2022, 114763, ISSN 0277-9536,
URL
https://doi.org/10.1016/j.socscimed.2022.114763

Reports & Other Materials