The Benefits of Knowledge: Mortality Risks, Mental Health and Life-Cycle Behaviors
Last registered on November 07, 2019


Trial Information
General Information
The Benefits of Knowledge: Mortality Risks, Mental Health and Life-Cycle Behaviors
Initial registration date
October 31, 2019
Last updated
November 07, 2019 8:15 AM EST

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Primary Investigator
University of Pennsylvania
Other Primary Investigator(s)
PI Affiliation
University of Pennsylvania
PI Affiliation
University of Pennsylvania
PI Affiliation
University of Technology Sydney
Additional Trial Information
On going
Start date
End date
Secondary IDs
Recent improvements in adult life expectancies in high HIV-prevalence sub-Saharan African (SSA) low-income countries (LICs) have reversed previous adverse trends in adult survival during the 1990s and early 2000s when the HIV/AIDS epidemic considerably reduced life expectancies. Despite these improvements, there is widespread evidence that many individuals have distorted survival and disease perceptions (SDPs) and are overly pessimistic about their own survival and disease environment. For example, rural Malawians underestimate their chances to survive five years by 33–45%, which is consistent with considerable overestimation of local HIV prevalence and morbidity. These distorted SDPs are likely to affect mental health and influence a wide range of behaviors, including sexual behaviors, labor supply, human capital investments, and preparations for old-age. Despite the recent strong evidence about the benefits of more accurate SDPs, however, there are no population-based randomized controlled trials (RCTs) that have directly evaluated this hypothesis. The RCT proposed as part of this R21 project, which builds on separately-funded collection for mature adults in Malawi, is designed to (i) explore possibilities to improve the accuracy of SDPs by providing information about current health and mortality risks through a health-information intervention, and (ii) test whether more accurate SDPs improve mental health, life-course decision-making and a broad range of social/economic outcomes among mature adults (= individuals aged 45+). If our hypotheses are supported, this research will provide strong support for cost-effective health-information programs that are highly pertinent in SSA LICs, where mortality levels and disease conditions/treatments have changed rapidly in recent years, and more generally, among older individuals who are likely to underestimate their longevity given recent progress in reductions of old-age mortality. The Specific Aims of this project include: (1) Conduct exploratory research in 2016 on how to effectively convey evidence-based information about recent mortality levels and trends to mature adults to increase the accuracy of survival and disease perceptions (SDPs) in Malawi, and subsequent to the already-funded 2016 data collection for mature adults, conduct a health-information intervention that randomizes 50\% of the study population (700+ individuals in 65+ villages) in a treatment group that will receive detailed information about recent mortality and health trends. (2) Collect new data in 2017 on (a) SDPs (including subjective expectations about survival, health, local HIV prevalence), (b) health (including mental health and cognitive function), (c) health behaviors and expenditures, (d) life-cycle behaviors and preparations for old age. (3) Using existing data, already-funded data collection and new data collection funded through this project on SDPs, health and life-cycle behaviors for the period 2006–18, (a) evaluate the causal impacts of health information on (i) SDPs, (ii) mental health and health behaviors, and (iii) labor supply, savings, intergenerational transfers and other life-cycle behaviors, (b) investigate the pathways through which SDPs affect these behaviors and outcomes.
Registration Citation
Ciancio, Alberto et al. 2019. "The Benefits of Knowledge: Mortality Risks, Mental Health and Life-Cycle Behaviors." AEA RCT Registry. November 07.
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Experimental Details
The "Benefits-of-Knowledge" (BenKnow) health-information intervention focused on about 1,500 mature adults (individuals aged 45 years or older) in rural Malawi and who previously participated in the Malawi Longitudinal Study of Families and Health (MLSFH). 50% of the study population were randomized in a treatment group that receive a BenKnow health-information intervention that provided detailed information about recent mortality and health trends, as well as individual-specific life-table-based information about probabilities of surviving and dying.
Intervention Start Date
Intervention End Date
Primary Outcomes
Primary Outcomes (end points)
- survival and disease perceptions (SDPs), including subjective likelihood of dying within 1, 5 and 10 years

- health-related behaviors, including sexual risk-taking, smoking, alcohol consumption, health-care utilization,

- physical and mental health

- life-cycle behaviors such as savings, work efforts, investments in children
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
- social, economic and demographic characteristics of respondents and their households
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The study population for this project was selected from the Malawi Longitudinal Study of Families and Health (MLSFH), and the study was conducted in three regions of rural Malawi: Rumphi (North), Mchinji (Center), and Balaka (South). The study population included about 1,500 mature adults (individuals aged 45+) who had previously participated in the MLSFH. The study included the collection of social science data, mental health (including depression) scales, cognitive function scales. The study also includes the measurement of weight, height, grip strength and blood pressure. Migrants will be traced using a migration follow-up. The study also included a benefits-of-knowledge (BenKnow) health-information intervention that provides information to individuals about the local survival and disease context (survival probabilities, along with relevant background information).

In the treatment villages (50% of villages, about 750 individuals) the health-information intervention provided to respondents detailed information about recent mortality trends. This health-information intervention was implemented in 2017 subsequent to the 2017 MLSFH survey. Specifically, the BenKnow health-information intervention started by reminding the respondent about the 5-year and 10-year own mortality expectations that s/he had reported in the 2017 Main Survey, followed by introductory questions about whether respondent were aware of recent changes in mortality levels. The core of the BenKnow health-information intervention then consisted of the following two components:

1. Narratives about changing mortality provided by video clips: Respondents were initially shown 3 video clips with the duration of about four minutes each. In these short video clips, individuals (trained local actors following a prepared script) explained how they noticed that people nowadays live longer in rural Malawi. The first video depicts a carpenter in his workshop, the second a female tailor in her shop sitting at a sewing machine and the third an old man sitting in front of his house. The videos emphasize overall that people live longer due to better access to food, health care, and availability of ART.

2. Life-table survival probabilities conveyed via visual aids: Subsequent to the videos, respondents were shown a health-information sheet with visual information on 5-year and 10-year life-table survival probabilities for individuals of the same gender and within the same 5yr age group, with different figures conveying how many persons, out of 10 alive at the time of the intervention, could be expected to be alive five or ten years in the future.

The information provided to participants during the BenKnow health-information intervention did not involve any deception or systematic misinformation; all information provided as part of the intervention was based on the best available estimates of the local survival and disease context.
Experimental Design Details
Not available
Randomization Method
village-level randomization of study participants into treatment or control group, with randomization implemented in STATA using random number generators.
Randomization Unit
Village (specifically, within each study region, villages were paired by size starting from the two biggest villages, followed by the two second biggest, etc. Then we randomly assigned treatment status to one village in each pair. The procedure guaranteed a similar sample size in the treatment group (N=779) and control group (N=774))
Was the treatment clustered?
Experiment Characteristics
Sample size: planned number of clusters
about 120 villages (58 villages in treatment group)
Sample size: planned number of observations
Sample size (or number of clusters) by treatment arms
N=779 (individuals) in treatment group, and N=774 (individuals) in control group
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB Name
University of Malawi College of Medicine Research and Ethics Committee (COMREC)
IRB Approval Date
IRB Approval Number
IRB Name
University of Pennsylvania
IRB Approval Date
IRB Approval Number
Analysis Plan

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