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How can behavior change communication interventions be mobilized to effectively promote adoption of healthy behaviors in urban slums in Kenya during the COVID-19 outbreak?
Initial registration date
June 09, 2020
June 10, 2020 10:42 AM EDT
Other Primary Investigator(s)
Additional Trial Information
To control the spread of coronavirus, the Kenyan Ministry of Health COVID-19 Taskforce has implemented initial prevention and mitigation measures. Of concern are the densely overcrowded, poor urban slums where sanitation and social distancing measures are near impossible. COVID-19 would spread rapidly and be devastating under these conditions. To inform the Taskforce strategy, this study will deploy rapid phone-based surveys on knowledge, attitudes and practices to heads of household sampled from existing randomized evaluation cohorts across five Nairobi urban slums (n~7,500). Iterations of the survey will be conducted every month. Three surveys have been completed to date beginning in March 2020, to better understand awareness of COVID-19 symptoms, perceived risk, awareness of and ability to carry out preventive behaviors, misconceptions, and the social and economic effects of COVID-19 mitigation measures. The Ministry of Health in Kenya has been sending SMS to all Kenyans. A key concern is stigma toward COVID-19 cases or suspected cases, and that household members would not care for asymptomatic COVID-19 infected household members. Before sending messages out on this topic, we will be testing three different versions of the SMS to determine which is the most effective. Participants in our cohort (n=1,910) will be randomly assigned to receive one of three versions of an SMS message meant to reduce stigma. The messages will be simple (control), prosocial or self-benefit motivated. The messages will be sent at two time points 6 days apart and then a survey will be conducted to assess knowledge, attitudes, and behavioral intention. This study aims to measure the effectiveness of these messages in increasing knowledge and reducing stigma, and to determine which motivational approach is more effective. Findings will be shared with the Ministry of Health and used to refine government run SMS campaigns to increase knowledge and adoption of the promoted behaviors.
Abuya, Timothy et al. 2020. "How can behavior change communication interventions be mobilized to effectively promote adoption of healthy behaviors in urban slums in Kenya during the COVID-19 outbreak?." AEA RCT Registry. June 10.
Study participants will be randomly assigned to one of three groups of SMS behavior change messages. The control group will receive a basic SMS message and the two intervention arms will receive a version of the control message that employs one of two motivational approaches. The intervention groups will receive either prosocial or self-benefit motivational messages. We will compare the effects of these messages on knowledge and awareness of the key information promoted in the SMS, improved perceptions toward COVID-19 cases and reduced stigma around COVID-19, as well as self-reported behavioral intention to care for potential asymptomatic COVID-19 infected household members. These changes in knowledge and attitudes will be measured by a mobile-phone based survey.
Intervention Start Date
Intervention End Date
Primary Outcomes (end points)
participants will be randomly assigned to receive one of three different SMS messages around how to care for sick household members that are suspected COVID-19 cases. Through a mobile-phone based survey, we will ascertain knowledge and behavior change based on the type of message received. Questions will include knowledge/awareness of the key SMS message, attitudes around stigma and COVID-19, and intention to care for a sick household member at home.
Primary Outcomes (explanation)
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Three arm randomized trial with participants randomly assigned to receive one of three SMS’s.
Experimental Design Details
we will randomize participants using STATA v15, stratified by informal settlement location (out of five) and gender.
Was the treatment clustered?
Sample size: planned number of clusters
Sample size: planned number of observations
we will collect surveys on each individual included in the stud.
Sample size (or number of clusters) by treatment arms
we will randomize 1,910 individuals to one of the three SMS groups (583 per group).
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
We conducted a power calculation using STATA v15 and estimate that for a 10% minimum detectable effect and specifying alpha=0.0167 to accommodate the 3 group comparison, for a 50% baseline (to be conservative), with 80% power, this yields a sample size of 517 individuals per group, a total of 1,551. The SMS will be sent to 1,910 participants (583 per group) so even with some loss to follow up we should be sufficiently powered to measure an effect.
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Approval Date
IRB Approval Number
Population Council IRB
IRB Approval Date