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Abstract
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Before
Public health authorities high-income countries encourage excessive testing as a strategy to break the chain of COVID-19 infections and to identify high risk areas. This strategy, is often unfeasible in several developing countries, such as Pakistan. In this study, we design and test the effectiveness of different awareness campaign strategies aiming at encouraging preventive behaviour during a pandemic where ground mobilisation is limited. The awareness campaign is designed and implemented in close cooperation with two implementing partners, Acted Pakistan and the National Rural Support Programme (NRSP). The target population are beneficiaries of the two NGOs across the three provinces of Pakistan, Khyber Pakhtunkhwa, Punjab, and Sindh. As of early September 2020, contacts of NGO beneficiaries and community representatives (incl. community leaders) were collected in 1147 villages. Out of these, 764 villages were randomized to receive the awareness campaign. The remaining 383 villages serve as control group (with no intervention). The awareness campaign is conducted via two modalities: via phone calls (573 villages) or phone calls and remote mobilisation of local task forces (191 villages). Additionally, individuals in the treatment villages were randomized to receive five different awareness messages via phone calls. The survey is conducted remotely, over the phone. Outcomes at baseline were captured for beneficiaries and community representatives (incl. community leaders). We plan to follow the same individuals over 7 bi-monthly short surveys capturing key main outcomes. The endline survey is planned for December 2020. The main aim of the study is to test the effectiveness of the awareness campaign on knowledge, perceptions, behaviour (labour supply and adherence to preventive measures) as well as health status. In addition, we capture information on intervention delivery (implementation and take-up). The awareness campaign is being launched in the last week of September 2020. 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. Thus, once baseline outcomes and characteristics are retrieved, these contacts will also become part of the eligible pool for the research study.
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After
Public health authorities in high-income countries encourage excessive testing as a strategy to break the chain of COVID-19 infections and to identify high risk areas. This strategy is usually unfeasible in many Low and Middle Income Countries (LMICs) countries, such as Pakistan. In this study, we design and test the effectiveness of different awareness campaign strategies aiming at encouraging preventive behavior during a pandemic where ground mobilization is limited. The awareness campaign is designed and implemented in close cooperation with two implementing partners, Acted Pakistan and the National Rural Support Programme (NRSP). The target population are beneficiaries of the two NGOs across the three provinces of Pakistan, Khyber Pakhtunkhwa, Punjab, and Sindh. As of early November 2020, contacts of NGO beneficiaries and community representatives (incl. community leaders) were collected in 1526 (sampled in two waves: 1147+379) villages. Out of these, 1016 (764+252) villages were randomized to receive the awareness campaign. The remaining 510 (383+127) villages serve as control group (with no intervention). The awareness campaign is conducted via two modalities: via phone calls only 762 (573+189) villages or phone calls and remote mobilization of local task forces 254 (191+63) villages. Additionally, individuals in the treatment villages were randomized to receive five different awareness messages via phone calls. The survey is conducted remotely, over the phone. Outcomes at baseline were captured for beneficiaries and community representatives (incl. community leaders). We plan to follow the same individuals over five bi-monthly short surveys capturing key main outcomes. The endline survey is planned for December 2020. The main aim of the study is to test the effectiveness of the awareness campaign on knowledge, perceptions, behavior (labor supply and adherence to preventive measures) as well as health status. In addition, we capture information on intervention delivery (implementation and take-up). The awareness campaign is being launched in the last week of September 2020 and continues until the enplane data collection in December. 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. Thus, once baseline outcomes and characteristics are retrieved, these contacts will also become part of the eligible pool for the research study.
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Last Published
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Before
October 05, 2020 05:18 PM
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After
November 12, 2020 05:18 AM
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Primary Outcomes (End Points)
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Before
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];
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After
For each of our sub-hypotheses, we construct one index consisting of several related outcome variables. These are used as the main outcome variables to test the effects of the awareness campaign. Note that hypotheses 1 and 2 refer to intermediary outcomes, whereas hypotheses 3, 4 and 5 refer to final outcomes.
Awareness: We expect treated individuals to have higher levels of awareness of the ongoing COVID-19 pandemic compared to the control group. Improved awareness is manifested in increased knowledge about the corona virus, the symptoms related to COVID-19, and possible preventive measures. Additionally, we expect that treated individuals are able to better identify misconceptions or false information about the virus as compared to those assigned to the control group.
Hypothesis 1 The treatment increases respondents’ awareness of the COVID-19 virus. H 1.1 The treatment increases knowledge about the COVID-19 virus.
H 1.2 The treatment reduces misconceptions about the COVID-19 virus.
H 1.3 The treatment reduces stigma about the COVID-19 virus.
Perceptions: We expect the treatment to alter perceptions about: (1) the severity of the disease, (2) the likelihood of contracting COVID-19, (3) the likelihood of infecting other family members, (4) the expected cost of getting infected, and (5) the influence of individual behavior on the likelihood of contracting the virus.
Hypothesis 2 The treatment changes respondents’ perceptions about COVID-19.
H 2.1 The treatment changes perceptions about the severity of the COVID-19 virus [d].
H 2.2 The treatment changes perceptions about the likelihood of getting infected with the COVID-19 virus [p(l + s; h; V)].
H 2.3 The treatment changes perceptions about the likelihood of infecting others with the COVID-19 virus [pi(.)].
H 2.4 The treatment changes perceptions about the costs of getting infected with the COVID- 19 virus [C].
H 2.5 The treatment changes perceptions about own behavior and the probability of getting infected with the COVID-19 virus.
Here, we do not make claims about the direction of changes. For instance, a positive adjustment indicates that the individual will report at endline a higher likelihood of contracting the virus and/ or infecting others, relative to the baseline and to peers in the control group. Additionally, selected beneficiaries may report perceiving the virus to be more severe and/ or perceiving treatment costs to be higher. The direction of change is governed by a number of factors that will be examined further in Section 3.3 on the heterogeneity of effects.
Behavior The treatment is expected to improve adherence to preventive measures. The preventive measures under scrutiny include: Hand hygiene practices, wearing of a mask, reduced labor supply and reduced social interactions. Following the theoretical framework presented in Section 2.2, reduced labor supply and social interactions are more costly for individuals given their direct impact on the household’s utility.
Hypothesis 3 The treatment increases respondents’ adherence to preventive measures. H 3.1 The treatment increases the number of reported prevention measures.
H 3.2 The treatment reduces mobility.
H 3.3 The treatment reduces social interactions.
H 3.4 The treatment reduces labor supply.
Health: We further test the hypothesis that the treatment has an effect on the health status of recipients. We capture (only) self-reported health status.
Hypothesis 4 The treatment improves respondents’ general health status.
The awareness treatment is administered to only one of the household members. However, in addition to the anticipated direct impact of the awareness treatment on the respondent’s behavior and health status, we expect an indirect impact of the treatment on other household members through a spillover of information. We expect this indirect effect to be larger if the respondent is the household head and hence the main decision maker. In the case of the LHTF treatment, which is administered at the village level, all individuals in treatment villages can directly benefit from information provided by the program. Effects on household members other than the main respondent can thus be understood as indirect effects only, or a combination of indirect and direct effects, depending on whether a household member was reached by the LHTF.
Hypothesis 5 The treatment impacts the prevention behavior and health status of other house- hold members and village residents.
H 5.1 The treatment reduces mobility of other household members.
H 5.2 The treatment reduces social interaction of other household members.
H 5.3 The treatment reduces the labor supply of other household members.
H 5.4 The treatment improves the general health status of other household members and village residents.
Finally, we expect that the higher the intensity of the intervention, the higher the impact on the outcome variables. Intensity is defined in terms of exposure to more than one treatment at the same time, with a maximum of three possible treatments, Tba, Tad, and LHTF, at the same time.
Hypothesis 6 The higher the intensity of treatment, the higher the impact on key outcome variables.
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Primary Outcomes (Explanation)
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Before
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.
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After
see above
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Planned Number of Clusters
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Before
1147 villages. A further sample of villages will be added and randomized into the study.
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After
1526 (sampled in two waves: 1147+379) villages
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Planned Number of Observations
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Before
12883 individuals. More individuals will be added and randomized into the study following two upcoming data collection waves.
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After
18,789 individuals (12,883 in sample 1 and 5,906 in sample 2). More individuals will be added and randomized into the study following two upcoming data collection waves.
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Sample size (or number of clusters) by treatment arms
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Before
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
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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
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After
Number of clusters (villages) by treatment arms
No awareness: 510 villages
Awareness via phone only: 762 villages
Awareness via phone + loudspeakers: 254 villages
Cross-randomized messages via phone:
Basic awareness phone calls in 204 villages
Basic awareness phone calls + info on severity of coronavirus 193 villages
Basic awareness phone calls + info on individual's prob of getting infected 203 villages
Basic awareness phone calls + info on HHm's prob of getting infected 222 villages
Basic awareness phone calls + info on cost of health treatment 194 villages
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Intervention (Hidden)
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Before
Two types of awareness campaign strategies are implemented: 1) direct awareness campaigns for NGO beneficiaries (treatment arm 1) and 2) awareness campaign via the remote mobilization of local task forces on the ground (treatment arm 2). Both interventions are implemented via the phone. Out of 1147 villages, 764 were randomized to receive the awareness campaign. The remaining 383 villages serve as control group.
Treatment arm 1: In 764 villages NGO beneficiaries are contacted by NGO representatives over the phone and receive a 15-minute awareness raising session on general topics relating to COVID-19, specifically: i) an introduction to what COVID-19 virus is and how it is transmitted; ii) a description of the main risk groups and symptoms of the COVID-19 virus, iii) information on recommended preventive behavior, and iv) recommendations on how to react in case the respondent suspects that he/she or a household member is infected by the virus. In addition to delivering the above awareness message (referred to as “basic awareness message”), a subset of individuals was further randomized to receive one of four types of additional (5-min) messages. Each of these “additional messages” highlights a different aspect related to the COVID-19 virus: i) the (potential) severity of sickness, ii) the (potential) likelihood of contracting COVID-19, iii) the (potential) likelihood of infecting other family members, and iv) the (potential) cost of contracting the COVID-19 virus.
Treatment arm 2: In 191 villages, in addition to the above, 2) a local health task force (LHTF) composed of social workers or other NGO collaborators are remotely trained to implement simple awareness activities such as distributing posters, spreading awareness messages via loudspeakers (e.g. about hygiene rules and social distancing recommendations).
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After
Two types of awareness campaign strategies are implemented: 1) direct awareness campaigns for NGO beneficiaries (treatment arm 1) and 2) awareness campaign via the remote mobilization of local task forces on the ground (treatment arm 2). Both interventions are implemented via the phone. In sample 1, out of 1147 villages, 764 were randomized to receive the awareness campaign. The remaining 383 villages serve as control group. The final sample consists of 1526 (sampled in two waves: 1147+379) villages. Out of these, 1016 (764+252) villages were randomized to receive the awareness campaign. The remaining 510 (383+127) villages serve as control group (with no intervention). The awareness campaign is conducted via two modalities: via phone calls only 762 (573+189) villages or phone calls and remote mobilization of local task forces 254 (191+63) villages. In more detail:
Treatment arm 1: In 1016 villages NGO beneficiaries are contacted by NGO representatives over the phone and receive a 15-minute awareness raising session on general topics relating to COVID-19, specifically: i) an introduction to what COVID-19 virus is and how it is transmitted; ii) a description of the main risk groups and symptoms of the COVID-19 virus, iii) information on recommended preventive behavior, and iv) recommendations on how to react in case the respondent suspects that he/she or a household member is infected by the virus. In addition to delivering the above awareness message (referred to as “basic awareness message”), a subset of individuals was further randomized to receive one of four types of additional (5-min) messages. Each of these “additional messages” highlights a different aspect related to the COVID-19 virus: i) the (potential) severity of sickness, ii) the (potential) likelihood of contracting COVID-19, iii) the (potential) likelihood of infecting other family members, and iv) the (potential) cost of contracting the COVID-19 virus.
Treatment arm 2: In 254 villages, in addition to the above, 2) a local health task force (LHTF) composed of social workers or other NGO collaborators are remotely trained to implement simple awareness activities such as distributing posters, spreading awareness messages via loudspeakers (e.g. about hygiene rules and social distancing recommendations).
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Secondary Outcomes (End Points)
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Before
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;
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After
see above
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Secondary Outcomes (Explanation)
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Before
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
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After
see above
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