Improving participation in door-to-door vector control campaigns using behavioral economics

Last registered on October 19, 2015


Trial Information

General Information

Improving participation in door-to-door vector control campaigns using behavioral economics
Initial registration date
February 06, 2015

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
February 06, 2015, 1:35 PM EST

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

Last updated
October 19, 2015, 2:52 PM EDT

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



Primary Investigator

University of Pennsylvania

Other Primary Investigator(s)

PI Affiliation
Tulane University
PI Affiliation
University of Pennsylvania

Additional Trial Information

In development
Start date
End date
Secondary IDs
Door-to-door health campaigns are a critical component of many health promotion, disease prevention, and surveillance efforts in a variety of contexts. Unfortunately, participation in these campaigns is often low, undermining the effectiveness of proven interventions. The dangers of low participation are particularly acute when threshold levels of coverage are needed to prevent disease, as a in vaccination or vector control campaigns. New approaches are needed to understand and influence household decisions to participate in door-to-door public health interventions. In this study, we apply novel basic science discoveries from behavioral economics to increase participation in an ongoing Chagas disease vector control campaign in Arequipa, Peru, where we have collaborated with the Ministry of Health for a decade. Low participation currently threatens the success of the campaign; the greatest barriers to participation reported by household include lost work hours, concerns about insecticide, and allergies. The overarching hypothesis of our study is that low rates of participation in door-to-door vector control campaigns can be significantly improved through interventions that incorporate the realities of human decision-making and behavior change. Recent insights from the field of behavioral economics suggest that common cognitive biases and mental shortcuts- such as present bias and following social norms- contribute to low participation in vector control campaigns, as they do in other domains. Through new formative work, we identified three interventions with high potential to overcome these biases and thereby increase participation: responsive scheduling with advance commitment, neighbor recruitment, and contingent group lotteries. The core of our proposed study is a cluster-randomized field trial to evaluate the impact of these three interventions. We first determine the rate of participation under each intervention, and then measure the programmatic and participant costs associated with each, to assess comparative cost-effectiveness. In addition, to address concerns about whether behavioral economic interventions lead to motivation crowd out- when extrinsic motivation for healthy behaviors reduces intrinsic motivation- we assess whether exposure to these interventions is correlated with decreased household participation in three subsequent health campaigns. The development, refinement, and scale-up of our interventions will yield evidence-based practices that can increase the impact of health promotion and disease prevention efforts in the United States and globally.
External Link(s)

Registration Citation

Buttenheim, Alison, Michael Z. Levy and Valerie Paz-Soldan. 2015. "Improving participation in door-to-door vector control campaigns using behavioral economics." AEA RCT Registry. October 19.
Former Citation
Buttenheim, Alison, Michael Z. Levy and Valerie Paz-Soldan. 2015. "Improving participation in door-to-door vector control campaigns using behavioral economics." AEA RCT Registry. October 19.
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Experimental Details


A. Current practice (control). The control arm will consist of the current Ministry of Health campaign. Printed campaign materials are distributed to households. Health promoters request permission to spray and schedule insecticide spray for the next day. Promoters can answer any questions or concerns.

B. Advance commitment responsive scheduling. Households are approached 2-4 weeks prior to the spray date and asked to commit, in advance, to participate. Households that agree to participate are offered convenient 2-hour appointment windows on a future spray date. Planning prompts, which encourage households to make a specific plan to prepare the home for spraying, are also offered. Households can request a paper or text message reminder prior to their scheduled appointment, and will be able to reschedule their appointment if necessary. Households are then also visited before the previously scheduled appointment by the health promoter to confirm the appointment.

C. Neighbor recruitment. One month prior to targeted spray dates, study staff approach formal community leaders (Ministry of Health-trained health promoters, block captains, and elected community officials) and informal neighborhood opinion leaders (corner store owners, day care coordinators), explain the campaign in depth, and ask leaders to serve as neighbor recruiters. Each recruiter is given promotional t-shirts, a clipboard, and the same educational materials used by campaign staff. Recruiters are asked to promote the campaign to a pre-specified list of 10-12 nearby households, wear the campaign t-shirts regularly, and distribute additional Ministry of Health materials.

D. Contingent group sweepstakes. Contiguous households are assigned to sweepstakes groups of 5-7 households. Sweepstakes groups are randomly assigned a lottery number. Households whose lottery group is selected and who participated in spraying will win a hardware store voucher of 50 nuevo soles. If 100% of households in the selected group participated in the spraying, each participating household wins a 100 nuevo soles hardware store voucher. Study staff will inform households about their lottery group, lottery number, and their lottery drawing date (using the Peru national Tinka Megabol). Winners will be notified and vouchers distributed to their homes within 1-2 weeks of the drawing.
Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
Household participation in the vector control campaign.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Cluster-randomized community field trial.

Experimental Design Details
Randomized field trial: This is a cluster-randomized field trial of three novel interventions and the current campaign as the control. Geographically contiguous clusters of approximately 100 households will be identified using mapping data, balanced based on the proportion of households that participated in the previous vector control campaign and the estimated prevalence of vector infestation and then randomly assigned to one of the four arms of the trial. All households in sampled sectors will be included in the trial. Non-participation in the preliminary survey does not preclude inclusion in the sampling frame.
Randomization Method
We will calculate the Mahalanobis distance among clusters based on infestation and participation in the previous spraying campaign (6 months before). We will use datasets from previous spraying campaigns in the city of Arequipa to build a logistic regression model and estimate the impact of infestation in the previous campaign and participation on the previous campaign on participation on a subsequent campaign. We will use the exponentiated coefficients from this model to give different weights to the variables for the estimation of the distances between observations. To balance these two confounding variables (infestation and previous participation), we will divide the geographical clusters in 4 blocks based on the estimated Mahalanobis distance between observations. Finally, we will randomly assign clusters from each block to one of the four intervention arms.
Randomization Unit
Clusters of approximately 100 households
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
56 clusters of 100 households/cluster
Sample size: planned number of observations
5,600 households
Sample size (or number of clusters) by treatment arms
1,400 households control, 1,400 households contingent group lottery, 1,400 responsive scheduling with advanced commitment, and 1,400 neighbor recruitment.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
We use the method of Blitstein et al. to calculate power and sample size for the cluster randomized trial. Our cluster-randomized trial is powered for a head-to-head comparison of the four arms of the trial. All calculations use the Bonferonni correction to account for the six possible comparisons between all pairs of arms; we derived the expected intracluster correlation coefficient parameter (0.02) from our existing data from the most recent campaign in Mariano Melgar district. We selected our sample size based on the lower bound of participation. The power of our trial depends on the participation achieved under the alternative arms. We are powered at 88.5% to detect an increase of 11% over the level of participation achieved in a previously treated district (66%); anything less would not justify the effort and costs of the interventions.

Institutional Review Boards (IRBs)

IRB Name
Tulane University Human Research Protection Program
IRB Approval Date
IRB Approval Number
IRB Name
University of Pennsylvania Office of Regulatory Affairs
IRB Approval Date
IRB Approval Number
45 CFR 46.101
IRB Name
Universidad Peruana Cayetano Heredia Comit√© Institucional de √Čtica
IRB Approval Date
IRB Approval Number
Analysis Plan

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Post Trial Information

Study Withdrawal

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Is the intervention completed?
Data Collection Complete
Data Publication

Data Publication

Is public data available?

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials