Group incentives and the demand for preventive care

Last registered on October 31, 2019
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Pre-Trial

Trial Information

General Information

Title
Group incentives and the demand for preventive care
RCT ID
AEARCTR-0004690
Initial registration date
September 18, 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
September 19, 2019, 11:58 AM EDT

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

Last updated
October 31, 2019, 12:22 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Country
El Salvador
Region
San Salvador

Primary Investigator

Name
Mylene Lagarde
Affiliation
LSE
Contact Primary Investigator

Other Primary Investigator(s)

PI Name
Carlos Ruimallo-Herl
PI Affiliation
Erasmus School of Economics

Additional Trial Information

Status
In development
Start date
2019-09-30
End date
2020-11-30
Keywords
Health
Additional Keywords
Financial incentives; social pressure; lottery; health behaviour.
JEL code(s)
C93; D91; I12
Secondary IDs
Abstract
Although team incentives are seen as powerful tools to leverage the power of social effects, they have rarely been used to encourage desirable behaviours outside firms. In this study, we investigate whether team incentives are more effective than equivalent individual payments to increase the demand for a preventive visit for cardiovascular diseases (CVDs) in El Salvador. Despite the availability of effective preventive treatments, CVDs are responsible for most deaths and disability worldwide, especially in most Latin American countries where they are a growing epidemic. Yet, in many settings, individuals with a high risk of developing a CVDs remain undiagnosed and those with established CVDs are poorly monitored. In addition to the usual financial and information barriers, behavioural biases may contribute to the low demand for preventive care as CVDs and their risk factors are often asymptomatic. In this study, we seek to increase the demand for preventive CVD check-ups by using financial incentives leveraging the power of social effects in existing networks. In partnership with a micro-finance organisation in San Salvador that offers group loans, we compare team and individual incentives conditional on attending a preventive health check-up, in two alternative designs: a small financial reward and a lottery with a chance to win a large financial prize. We also use detailed information about social networks to study the heterogeneity of effects of alternative schemes.
External Link(s)

Registration Citation

Citation
Lagarde, Mylene and Carlos Ruimallo-Herl. 2019. "Group incentives and the demand for preventive care." AEA RCT Registry. October 31. https://doi.org/10.1257/rct.4690-1.1
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
Across all arms, group members will be given basic information about CVDs and a voucher for a free preventive check-up. The voucher will come with varying benefits depending on the treatment arm to which the group is randomly assigned:
1. Individual incentive, conditional on doing the preventive check-up
2. Group incentive, conditional on all members of a group doing the check-up.
3. Individual lottery incentive - if s/he wins the lottery, an individual only gets the price if s/he has completed the check-up.
4. Group lottery incentive - if they win the lottery, a group only gets the price if all members have completed the check-up.
5. Control. Individuals who do the check-up receive do not receive any additional benefit.
Intervention Start Date
2019-10-01
Intervention End Date
2020-02-28

Primary Outcomes

Primary Outcomes (end points)
Utilization of services (take-up of preventive check-up) ;
Health behaviors (smoking, diet, physical activity, health-care seeking, adherence to treatment);
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
• Perceived risk of CVDs
• Perceived need to change lifestyle and health behaviors (smoking, diet, physical activity);
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Recruitment into the study will take place between October 2019 and January 2020, in the agency of the MFI located in the municipality of Soyapango, a satellite city of the capital San Salvador. All groups including between three to seven members who come to the agency to start a new joint liability microcredit loan, will be eligible to take part in the study. Recruitment of groups into the study will occur on the day their loan is disbursed, when all group members have to be present.

Once they agree to take part, all group members will be interviewed for the baseline survey. At the end of the interview, the group will be randomised to one of the study arms following a randomization sequence generated prior to the start of the fieldwork by the researchers using a web-based randomization tool. We will stratify by group size and group type to ensure a high degree of balance and obtain the desired proportions across treatment groups within each stratum.
The randomized sequences will be concealed from the MFI staff who plan the group appointments so that they cannot manipulate appointments to assign some groups to one treatment or the other. Equally, as groups will be ordered by recruitment date and time, we will easily be able to verify that supervisors follow the allocation sequence.
Experimental Design Details
Randomization Method
Groups will be randomized following a randomization sequence generated prior to the start of the fieldwork by the researchers using a web-based randomization tool (https://www.sealedenvelope.com/simple-randomiser/v1/lists).
Randomization Unit
Clusters: new loan groups of the micro-finance organization will be randomized to one of the five treatment arms.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
400 loan groups
Sample size: planned number of observations
Approximately 2,000 individuals, members of the loan groups.
Sample size (or number of clusters) by treatment arms
80 loan groups (clusters) in each arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
London School of Economics
IRB Approval Date
2019-08-23
IRB Approval Number
000909b
IRB Name
Comite Nacional de Etica de la Investigacion en Salud
IRB Approval Date
2019-05-13
IRB Approval Number
CNEIS/2019/006
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials