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COVID-19 Health Messaging to Underserved Communities
Last registered on May 14, 2020

Pre-Trial

Trial Information
General Information
Title
COVID-19 Health Messaging to Underserved Communities
RCT ID
AEARCTR-0005789
Initial registration date
May 08, 2020
Last updated
May 14, 2020 10:47 PM EDT
Location(s)
Region
Primary Investigator
Affiliation
MIT
Other Primary Investigator(s)
Additional Trial Information
Status
In development
Start date
2020-04-25
End date
2020-12-31
Secondary IDs
Abstract
In the US, recent statistics show that African American and Latinx communities bear a disproportionate burden from Covid-19. Reaching vulnerable and underserved populations is therefore crucial to combating the disease. However, most public messaging campaigns are not targeted toward underserved communities and don’t address fears of social stigma, mistrust in the healthcare system, or concerns about immigration status.

To tackle these issues, we are conducting a randomized experiment in which a racially- and ethnically-diverse set of doctors from Massachusetts General Hospital will record video messages that we will send to a large sample of diverse individuals across the US. Messages will emphasize health promoting behaviors but some experimental variants will also grapple with the disproportionate burden of Covid-19 among minority populations and the perceived stigma of wearing masks in public. We will test which messengers and which types of messages are most effective at providing information, encouraging health seeking behavior, and inducing health-preserving practices. We plan to disseminate results as soon as possible.
External Link(s)
Registration Citation
Citation
Duflo, Esther . 2020. "COVID-19 Health Messaging to Underserved Communities." AEA RCT Registry. May 14. https://doi.org/10.1257/rct.5789-1.2000000000000002.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
We are conducting a video messaging campaign about Covid19 targeted toward underserved communities (African American and Latinx). Specifically, we have partnered with a diverse set of doctors who are recording different variants of the central video messages to a) inform individuals about the symptoms and spread of Covid19, b) encourage social distancing and hygiene, and c) encourage mask-wearing.

Our intervention varies the racial/ethnic identity of the doctors delivering the messages. Some respondents will see messages delivered by doctors of concordant race or ethnicity, while others will see the same messages delivered by doctors of discordant race or ethnicity (here, white or Asian).

Our intervention also varies several dimensions of the content of the message:
0. All messages include basic information about the symptoms of covid, social distancing, handwashing, disinfecting surfaces, and mask-wearing.
1. "Elephant in the room": Focus groups with doctors suggested that being honest about their patients' concerns might be a successful strategy for reaching underserved populations. We are embracing this suggestion in some messages in a few different ways.
a.) African American - trust in healthcare: The doctor will acknowledge that the medical system has not always earned the trust of the African American community and still remains unequal in how it treats individuals today.
b.) Hispanic - trust in healthcare: The doctor will acknowledge that there’s a lot of fear about immigration status for some members of the Hispanic community, and of what might happen for those people if they get in contact with hospitals or doctors.
c.) Both groups - economics: The doctor will acknowledge that many of the jobs done by minorities are essential and cannot be done remotely. Additionally, when one lives in tight spaces, it is also much more difficult to keep a safe distance.
d.) No "elephant in the room" message
2. CDC vs. Doctor message on social distancing and hygiene: For the message content on social distancing, hygiene, and disinfecting surfaces, we will randomize between one of the partner doctors delivering the message vs. a video of Dr. Birx from the CDC saying the exact same words.
3. Mask De-biasing: Many individuals worry about the stigma from wearing masks. In particular, some might worry that African Americans wearing masks are up to no good. Others might worry that Latinx individuals wearing masks are more likely to be sick. The mask wearers from these communities may think about perceptions when deciding whether to wear a mask or not. We conducted a survey with 2600 individuals from a representative US sample at the end of April. We found beliefs that look quite different from those perceived by African Americans and Hispanics. Specifically we will use this information in some variants of the videos.
a.) No debiasing content.
b.) African-American version: Not very long ago, people might have been afraid if they saw someone, especially a person of color, walking around town with a mask on. They may have thought the person was up to no good. But, in a MIT survey done in mid-April, 8 out of 10 people who saw a photo of an African-American man wearing a mask said they thought they were protecting the community. Still, some people may act uncomfortable around you when you are wearing a mask.
c.) Latinx version: Not very long ago, people might have been afraid if they saw someone walking around town with a mask on was sick or perhaps was up to no good. But, in a MIT survey done in Mid-April, 8 out of 10 people who saw a photo of a person wearing a mask said they thought they were protecting the community. Still, some people may act uncomfortable around you when you are wearing a mask.

For African American and Latinx respondents, we will randomize whether the doctor's ethnic/racial identity is discordant vs. concordant (2 arms x 2 types of communities)

For each community, we will randomize among 9 versions of the message. We are not cross-randomizing all components, but rather are using the following combinations:
1. Pure control: Individual only sees a brief introductory video before answering the survey questions. These respondents will see a full set of messages only after answering all of our questions.
2. No elephant, doctor SD message, no mask de-biasing
3. Elephant-trust, doctor SD message, no mask de-biasing
4. No elephant, CDC SD message, no mask de-biasing
5. Elephant-trust, CDC SD message, no mask de-biasing
6. No elephant, doctor SD message, mask de-biasing
7. Elephant-trust, doctor SD message, mask de-biasing
8. No elephant, CDC SD message, mask de-biasing
9. Elephant-trust, CDC SD message, mask de-biasing
Intervention Start Date
2020-05-13
Intervention End Date
2020-06-05
Primary Outcomes
Primary Outcomes (end points)
Our key outcomes fall into the following categories:
1) Response to the video messages (interest, trust, intent to follow video's recommendations)
2) Knowledge about covid19 (symptoms, prevention, social distancing)
3) Trust in doctors
4) Beliefs (first and second order) about mask-wearers
5) Interest in learning more about how to effectively practice social distancing and hygiene (links about disinfecting one's home, how to work out in small spaces).
6) Interest in learning how to make a mask at home (whether they want to and do watch a short instructional video.)
7) Health seeking behavior
8) Incentivized and unincentivized questions about allocating resources toward different organizations or priorities relating to health and covid19.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
1. We will recruit individuals through an online survey firm who identify as African American or Hispanic. We are targeting 95% who have high school education or less and the remaining 5% with college or more. We will obtain informed consent. Participation in the study involves watching our videos and completing a survey questionnaire online.
2. Respondents will answer a pre-treatment questionnaire. Individuals who identify at Hispanic will be able to respond to all questions in Spanish and to watch videos either recorded in Spanish or subtitled or dubbed.
3. Respondents (in all treatment groups) will watch different variants of the informational videos. Before watching the mask video, respondents will be asked first and second order beliefs about a photo of a mask wearer from their community.
4. Respondents answer the post-treatment questionnaire
5. Members of the control group are shown one complete set of videos.
6. Respondents are debriefed.
Experimental Design Details
Randomization Method
Randomization will be done on a computer. Individuals will be randomized to treatment after they fill out the pre-treatment questionnaire.
Randomization Unit
The unit of randomization is the individual.
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
We plan to reach 10,000 subjects who identify as African American and 5,000 subjects who identify as Hispanic.
Sample size: planned number of observations
We plan to have 15,000 total respondents.
Sample size (or number of clusters) by treatment arms
In total, we have 9 different script variants. The doctors recording the messages will either be of concordant or discordant race/ethnicity to the subject (2 variants). This yields a total of 18 sub-cells for each racial/ethnic group. This gives more than 550 observations per cell for the African American respondents and 275 observations per cell for the Hispanic respondents.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Massachusetts Institute of Technology
IRB Approval Date
2020-05-05
IRB Approval Number
2003000118
Analysis Plan
Analysis Plan Documents
Analysis Plan - Alsan et al

MD5: b8506f8b346808c66ed9941ac1971b15

SHA1: abce0d3596003e3cfec9533c87f4c4b628eefd16

Uploaded At: May 14, 2020

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, Papers & Other Materials
Relevant Paper(s)
REPORTS & OTHER MATERIALS