Information Constraints and Preventive Behavior amongst COVID-19 Risk Groups in Khyber Pakhtunkhwa, Pakistan

Last registered on February 09, 2022

Pre-Trial

Trial Information

General Information

Title
Information Constraints and Preventive Behavior amongst COVID-19 Risk Groups in Khyber Pakhtunkhwa, Pakistan
RCT ID
AEARCTR-0006307
Initial registration date
August 18, 2020

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
August 18, 2020, 10:59 AM EDT

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

Last updated
February 09, 2022, 10:44 AM EST

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

Locations

Primary Investigator

Affiliation
Leibniz University of Hannover

Other Primary Investigator(s)

PI Affiliation
Friedrich–Alexander University Erlangen–Nürnberg
PI Affiliation
Georg-August-Universität Göttingen
PI Affiliation
Georg-August-Universität Göttingen
PI Affiliation
Khyber Medical University
PI Affiliation
The University of Edinburgh

Additional Trial Information

Status
Completed
Start date
2020-08-20
End date
2020-11-30
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
As the COVID-19 pandemic progresses, strict lockdown measures are eased and individual preventive behavior might decrease. At the same time, neither effective treatment nor vaccination are available, so that it remains crucial to shield in particular the population groups that are at higher risk to experience a complicated disease course from an infection. Such individual preventive behavior is particularly relevant in resource-constrained settings, where access to adequate healthcare services is limited, such as in our study location in Pakistan. To motivate the adoption of such measures, the government of Pakistan has issued detailed recommendations for preventive actions for its population and spread this message through various channels. Data from our telephone survey with low-income households shows though that gaps in knowledge and practice prevail. We are therefore evaluating whether a more targeted and personalized information campaign of the local public health service (Social Health Protection Initiative) can contribute to narrowing this gap, especially for the at-risk population.
The expected outcome of this trial is twofold: first, we test whether the SMS-based information campaign can increase the knowledge and adoption of recommended actions in both the general and the at-risk population. Beyond the effectiveness in both groups, we test whether light personalization based on the risk group increases this effect. Secondly, through the combination of the interview and health insurance enrollment as well as claims data, we plan to demonstrate the scale-up potential of such an intervention. This will on the one hand shed light on a low-cost complement in the control of a pandemic and showcase the possibility to use administrative data to effectively target the most vulnerable when resources are limited.
External Link(s)

Registration Citation

Citation
Rogge, Lisa et al. 2022. "Information Constraints and Preventive Behavior amongst COVID-19 Risk Groups in Khyber Pakhtunkhwa, Pakistan." AEA RCT Registry. February 09. https://doi.org/10.1257/rct.6307
Experimental Details

Interventions

Intervention(s)
The intervention consists of six text messages informing the recipients of the risk groups for a complicated COVID-19 disease course as well as preventive measures against a COVID-19 infection.
Intervention Start Date
2020-08-20
Intervention End Date
2020-09-20

Primary Outcomes

Primary Outcomes (end points)
Uptake of preventive practices
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Knowledge of risk groups, knowledge of preventive practices
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Study participants are sampled from the list of 1.5 million households in the Pakistani province Khyber Pakhtunkhwa who are enrolled in the free public health insurance. A randomly selected subset was already part of our telephone survey on attitudes, practice and knowledge regarding COVID-19 between April and July 2020, so that we know that around 70% of households have at least one member who is at increased risk for a complicated COVID-19 infection based on age and preconditions. This subset forms the basis of the intervention sample: Within the risk group, 2/3 are allocated to the treatment group, of which half receives the same generic messages as the non-risk group and for the other half the information on the risk groups is personalized to the condition(s) that apply to their household. Similarly, two thirds of the non-risk group receive the intervention, while the remainign third serves as the control group and receives no messages. To reach the desired sample size, an additional sample is drawn from the household list, of which two thirds are randomly allocated to the treatment and one third to the control group. Outcomes will be measured one week after completion of the intervention through a telephone survey and over the course of 2 months through calls to a telemedicine helpline.
Experimental Design Details
Randomization Method
Randomization done in office by a computer
Randomization Unit
Household
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
NA
Sample size: planned number of observations
Intervention sample: 21500; Interview target: 2500
Sample size (or number of clusters) by treatment arms
Interviewed sample: 418 personalized messages, 418 generic messages and 418 control in risk group; 343 generic messages, 172 control in non-risk group
Additional sample (exact distribution across risk groups and personalization will only be known after the post-intervention interviews): 13,333 treatment; 6,667 control
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Ethics committee of the University of Göttingen
IRB Approval Date
2020-08-03
IRB Approval Number
N/A
IRB Name
Research Ethics Committee, Khyber Medical University
IRB Approval Date
2020-06-29
IRB Approval Number
Dir/KMU-EB/IT/000784
Analysis Plan

There are documents in this trial unavailable to the public. Use the button below to request access to this information.

Request Information

Post-Trial

Post Trial Information

Study Withdrawal

There are documents in this trial unavailable to the public. Use the button below to request access to this information.

Request Information

Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

There are documents in this trial unavailable to the public. Use the button below to request access to this information.

Request Information

Program Files

Program Files
Yes
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
Preventing infections is crucial for population groups that are at higher risk to experience a
complicated disease course and have limited access to healthcare. Our research with low-
income households from Pakistan first documents gaps in knowledge and individual preventive
practices in the context of the COVID-19 pandemic, despite pervasive public information
campaigns. Second, using a randomized experiment, we evaluate whether a more targeted
and personalized SMS information campaign exploiting administrative health records could
contribute to narrowing this gap. We find that the intervention helped the at-risk population to
adhere to higher levels of handwashing in the time between the first and second wave of
infections, and all message recipients were more than twice as likely to use tele-medical
services compared to the control group.
Citation
Rogge, Lisa; Khan, Sheraz Ahmad; Khan, Zohaib; Noon, Muhammad Jawad; Landmann, Andreas; Vollmer, Sebastian; 2021, "The Effect of Personalized Health Information on Preventive Behavior amongst COVID-19 Risk Groups: a Randomized Experiment in Pakistan", Courant Research Centre Discussion Papers No. 289

Reports & Other Materials