How to raise awareness during a pandemic? Evidence from Pakistan

2020-09-23

2020-12-07

Intermediate outcomes:
1. Main (Intermediate) Awareness : Knowledge Symptoms - % of respondents who correctly report the three common symptoms of COVID-19;
1. Main (Intermediate) Awareness : Knowledge Prevention and response strategies - % of respondents who correctly report the three common preventive measures;
1. Main (Intermediate) Perception : Costs of getting infected - Perceived treatment costs (direct costs and forgone income);
1. Main (Intermediate) Perception : Probability of getting infected - % of respondents who have moderate or high concerns of getting infected;
1. Main (Intermediate) Perception : Probability of infecting others - % of respondents who have moderate or high concerns of infecting household members;
1. Main (Intermediate) Perception : Severity - % of respondents who think that COVID-19 sickness can be severe;

Final outcomes:
1. Main (Final) Behavior: Labor supply - % of respondents who have worked outside home in the past 7 days;
1. Main (Final) Behavior: Labor supply - % of respondents reporting that at least one household member worked outside home in the past 7 days;
1. Main (Final) Behavior: Labor supply - # of hours respondent worked per-day outside home;
1. Main (Final) Behavior: Prevention - % of respondents practicing the three common preventive measures;
1. Main (Final) Behavior: Social interactions - % of respondent who received any visits in the past 7 days;
1. Main (Final) Health: COVID-like symptoms - # of household members falling sick with COVID-19 like symptoms in the last 14 days;

Take-up:
1. Main Take up: General Assumptions: Understanding - % of respondents that correctly answered knowledge question about the additional awareness message delivered in the information session;
1. Main Take up: General Assumptions: Understanding - # of correctly answered knowledge questions about the basic awareness message delivered in the information session;
1. Main Take up: Take up: Basic Message - % of respondents reporting that they have received the awareness treatment (basic message);
1. Main Take up: Take up: LHTF - % of respondents reporting that they were exposed to the LHTF intervention [scale];
1. Main Take up: Take up: Specific Message - % of respondents reporting that they have received the awareness treatment (additional message) [scale];

Knowledge about COVID-19, perceptions (likelihood of getting infected, infecting others, severity of sickness and costs), mobility (within and outside village), prevention, social interactions, labor supply outside home and health status, take-up.

Intermediate:
2. Secondary (Intermediate) Awareness : Knowledge Any - % of respondents who have heard of COVID-19;
2. Secondary (Intermediate) Awareness : Knowledge Prevention and response strategies - # of correctly reported emergency measures if suspecting an infection;
2. Secondary (Intermediate) Awareness : Knowledge Transmission Channels - # of correctly answered questions about the transmission of the corona virus [scale];
2. Secondary (Intermediate) Awareness : Knowledge Symptoms - % of respondents indicating that they know the COVID-19 symptoms;
2. Secondary (Intermediate) Awareness : Misconceptions - % of respondents who are aware that spiritual and traditional healers can not treat a COVID-19 infection;
2. Secondary (Intermediate) Awareness : Misconceptions - # of misconceptions related to the COVID-19, correctly identified by respondents [scale];
2. Secondary (Intermediate) Awareness : Misconceptions - % of respondents who are aware that older population is particularly endangered by the COVID-19;
2. Secondary (Intermediate) Perception : Costs of getting infected - Perceived cost for being ill for one week;
2. Secondary (Intermediate) Perception : Costs of getting infected - Perceived number of weeks required until recovery ;
2. Secondary (Intermediate) Perception : Influence on getting infected - % of respondents reporting that their behavior can influence somewhat to a great extent the probablity of infection;


Final outcomes:
2. Secondary (Final) Behavior: Labor supply - # of days respondent worked outside home in the past 7 days;
2. Secondary (Final) Behavior: Labor supply - # of days on average other household members worked outside home in the past 7 days;
2. Secondary (Final) Behavior: Mobility Work - # of days respondent left the village in the past 7 days for work;
2. Secondary (Final) Behavior: Mobility Leisure - % of respondents who have left their village in the past 7 days for leisure ;
2. Secondary (Final) Behavior: Mobility Work- % of respondents who have left their village in the past 7 days for work;
2. Secondary (Final) Behavior: Mobility - # of days respondents stayed at home in the past 7 days without going out at all;
2. Secondary (Final) Behavior: Mobility Work - # of days other household members left the village in the past 7 days for work;
2. Secondary (Final) Behavior: Mobility- % of respondents reporting that other household members have left the village in the past 7 days for work ;
2. Secondary (Final) Behavior: Prevention - % of individuals wearing mask when leaving home in past 7 days;
2. Secondary (Final) Behavior: Prevention - # of occasions respondents wash their hands with soap and water during the day;
2. Secondary (Final) Behavior: Prevention - % of respondents changing religious practices as a prevention measure;
2. Secondary (Final) Behavior: Social interactions - % of respondents who have gone to the mosque or church in the past 7 days;
2. Secondary (Final) Behavior: Social interactions - % of respondents who have attended a social gathering in the past 7 days;
2. Secondary (Final) Behavior: Social interactions - % of respondents reporting that at least one household member has attended a social gathering in the past 7 days;
2. Secondary (Final) Behavior: Social interactions - # of days respondents did not restrict social contact in the past 7 days;
2. Secondary (Final) Health: General health - % of respondents reporting bad current health status;
2. Secondary (Final) Health: General health - % of household members falling sick in last 14 days;
2. Secondary (Final) Health: General health - # of village residents falling seriously ill in the last 14 days ;
2. Secondary (Final) Health: Mortality - # of village residents who have died in the last 14 days;

Take-up
2. Secondary Take up: General Assumptions: Access to utilities - % of respondents reporting that they have access to masks;

Knowledge about COVID-19 virus, misconceptions, perceptions (cost of getting infected, own behavior influence), prevention, mobility, social interactions, labour supply, health, take-up.
2. Secondary Take up: General Assumptions: Access to utilities - % of respondents reporting that they have access to masks

We conduct an RCT with ten treatment arms (excluding the control group). The RCT is designed to evaluate two different strategies of conducting remote awareness campaigns for NGO beneficiaries. The first one consists in an awareness campaign over the phone and the second one is awareness campaign over the phone accompanied by awareness via a local health task force (LHTF) team mobilized over the phone but conducting awareness activities on the ground(e.g. awareness via posters, loudspeakers). We followed a two-stage randomization process.
First, we stratify the prioritized universe of revenue villages by the implementing partner. In each stratum, 33% of revenue villages were assigned to control, and 67% to treatment. Among the treated villages, 75% were assigned to receive awareness campaign over the phone, while 25% were assigned to receive the awareness campaign over the phone and – in addition – via the LHTF.
Secondly, treated individuals were randomized to receive five different awareness treatments about COVID-19 over the phone: basic awareness(t0); basic awareness + additional message on the potential severity of sickness (t1); basic awareness + additional message on the potential likelihood of contracting COVID-19 (t2); basic awareness + additional message on the potential likelihood of infecting others (t3); basic awareness + additional message on the potential cost of contracting COVID-19 (t4).
While the baseline data for randomization is fixed, we do collect additional refresher contacts in the same villages and also plan to collect a new sample of additional villages to which the study will be extended.
The same experimental design will be applied.

We conduct an RCT with ten treatment arms (excluding the control group). The RCT is designed to evaluate two different strategies of conducting remote awareness campaigns for NGO beneficiaries. The first one consists in an awareness campaign over the phone and the second one is awareness campaign over the phone accompanied by awareness via a local health task force (LHTF) team mobilized over the phone but conducting awareness activities on the ground(e.g. awareness via posters, loudspeakers). We followed a two-stage randomization process.
First, we stratify the prioritized universe of revenue villages by the implementing partner. In each stratum, 33% of revenue villages were assigned to control, and 67% to treatment. Among the treated villages, 75% were assigned to receive awareness campaign over the phone, while 25% were assigned to receive the awareness campaign over the phone and – in addition – via the LHTF.
Secondly, treated individuals were randomized to receive five different awareness treatments about COVID-19 over the phone: basic awareness(t0); basic awareness + additional message on the potential severity of sickness (t1); basic awareness + additional message on the potential likelihood of contracting COVID-19 (t2); basic awareness + additional message on the potential likelihood of infecting others (t3); basic awareness + additional message on the potential cost of contracting COVID-19 (t4).
While the baseline data for randomization is fixed, we do collect additional refresher contacts in the same villages and also plan to collect a new sample of additional villages to which the study will be extended.
The same experimental design will be applied.

We apply the procedure outlined above for randomization. In each stage, we apply a re-randomization procedure incorporating multivariate balance checks.


In order to allow us to test the null hypothesis that the treatment effect is zero (or any other value) and to calculate confidence intervals we will apply randomization inference.
To reduce the number of tests in our analysis, we pool primary outcomes that are similar in the sense that they are expected to be proxies of the same underlying behavior and test the same hypotheses or sub-hypotheses. Details on this and other strategies to adjust for multiple hypothesis testing are presented in the PAP.

Randomization at revenue village (RVs) and individual level.

Yes

1147 villages. A further sample of villages will be added and randomized into the study.

12883 individuals. More individuals will be added and randomized into the study following two upcoming data collection waves.

Number of clusters (villages) by treatment arms




treatm_0_IE1 No awareness

Control villages: 383 villages




treatm_1_IE1 Basic awareness

Awareness villages: 110 73.83%
Awareness + LHTF villages: 39 26.17%

Total villages: 149 100%



treatm_2_IE1 + severity of coronavirus

Awareness villages: 110 78.01%
Awareness + LHTF villages: 31 21.99%

Total villages: 141




treatm_3_IE1 + individual's prob of getting infected

Awareness villages: 110 72.37%
Awareness + LHTF villages: 42 27.63%

Total villages: 152




treatm_4_IE1 + HHm's prob of getting infected

Awareness villages: 127 76.97%
Awareness + LHTF villages: 38 23.03%

Total villages: 165




treatm_5_IE1 + cost of health treatment
Awareness villages: 116 73.89%
Awareness + LHTF villages: 41 26.11%

Total villages: 157
.




Sample size by treatment arm


treatm_0_IE1 No awareness

Control individuals: 4161


treatm_1_IE1 Basic awareness

Awareness individuals: 1,265 72.53 %
Awareness + LHTF individuals: 479 27.46%

Total individuals: 1,744


treatm_2_IE1 + severity of coronavirus

Awareness individuals: 1,265 72.53 %
Awareness + LHTF individuals: 479 27.46%

Total individuals: 1,744



treatm_3_IE1 + individual's prob of getting infected

Awareness individuals: 1,265 72.53 %
Awareness + LHTF individuals: 480 27.52%

Total individuals: 1,745



treatm_4_IE1 + HHm's prob of getting infected

Awareness individuals: 1,265 72.53 %
Awareness + LHTF individuals: 479 27.46%

Total individuals: 1,744



treatm_5_IE1 + cost of health treatment

Awareness villages: 1,266 72.55%
Awareness + LHTF villages: 479 27.45%

Total individuals: 1,745

To calculate the base (or pre-treatment) level of all main outcome variables, we used baseline data from the subsample (sample 1) of observations already available at the time of registration. This data was collected from beginning of August until the 3rd week of September and includes 12,883 individual observations. We look at MDEs for three different evaluations: i) any awareness treatment vs. the control group; ii) any awareness treatment + local health task force (LHTF) vs. awareness treatment only; and iii) any awareness treatment + an additional awareness message vs. awareness treatment only. Whereas i) and ii) are implemented at village level, iii) is randomized at individual level. We estimate minimum detectable differences (MDEs) given alpha=0.5 and power=0.8 and consider a conservative scenario in terms of attrition. For treatments which are implemented on village level, we estimate to be left with 6 observations per village at the end of the trial. This equals 37.5% of the observations we are aiming for and thus an attrition rate of 62.5%. For treatments implemented at individual level, we use an attrition rate of 60%. The following MDEs account for the inclusion of control variables. Given the above assumptions, we can detect a relative change from a baseline level of 13.3 percent to an expected level of 15.9-16.6 percent (impact of 19.5-25.8%) for knowledge of the main COVID-19 symptoms, depending on the level of comparison; a relative change from a baseline level of 29.0 percent to an expected level of 32.4-33.5 percent (impact of 11.7-15.4%) for knowledge of the main preventive measures; a relative change from a baseline level of 37.3 percent to an expected level of 41.4-42.7 percent (impact of 10.9-14.5%) for being highly or moderately concerned about getting infected; a relative change from a baseline level of 47.8 percent to an expected level of 52.1-53.5 percent (impact of 9.0-11.8%) for being highly or moderately concerned about infecting others; a change from a baseline level of 12,636.03 Pakistani Rupees (PKR) to an expected level of 15,349,07-16,224.40 PKR (impact of 21.5-28.4%) for the perceived average cost of getting infected; a relative change from a baseline level of 32.4 percent to an expected level of 27.9-29.1 percent (impact of -10.2-14.0%) for having had visits in the previous 7 days; a relative change from a baseline level of 39.4 percent to an expected level of 34.7-35.9 percent (impact of -9.0-11.9%) for having worked outside home in the previous 7 days; a change from a baseline level of 2.62 hours to an expected level of 2.23-2.33 (impact of -11.0-14.9%) for hours worked per day in the previous 7 days; a relative change from a baseline level of 23.3 percent to an expected level of 26.4-27.4 percent (impact of 13.1-17.6%) for practicing all 3 main preventive measures; and a change from a baseline level of 0.1 to an expected level of 0.061-0.078 (impact of -23.2-40.7%) for the amount of people within a household with common corona virus symptoms.