Mask Up! Testing Strategies to Increase Mask Use in Uganda

Last registered on June 21, 2021

Pre-Trial

Trial Information

General Information

Title
Mask Up! Testing Strategies to Increase Mask Use in Uganda
RCT ID
AEARCTR-0007844
Initial registration date
June 18, 2021

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
June 21, 2021, 11:53 AM EDT

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

Locations

Region

Primary Investigator

Affiliation
University of California, Berkeley

Other Primary Investigator(s)

PI Affiliation
Makerere University
PI Affiliation
Makerere University
PI Affiliation
Makerere University
PI Affiliation
University of California, Berkeley

Additional Trial Information

Status
Completed
Start date
2021-02-04
End date
2021-04-28
Secondary IDs
Abstract
We conducted a mask promotion program to reduce the spread of SARS-Cov-2 in Uganda that was implemented in partnership with the Office of Prime Minister and the Ministry of Health in Uganda. The study involves evaluation of a national program that aimed to provide a free mask to all citizens 6 years or older in Uganda. We combined provision of free masks with educational and behavioral interventions informed by behavioral economics insights. The goal of this pilot program is to understand reasons for low mask adoption, and to help guide policy makers in Uganda and beyond in pursuit of potential scale-ups. This pre-analysis plan outlines the study design and intervention, the main outcomes of interest and the primary methods of analysis for evaluating this program.
External Link(s)

Registration Citation

Citation
Egger, Dennis et al. 2021. "Mask Up! Testing Strategies to Increase Mask Use in Uganda." AEA RCT Registry. June 21. https://doi.org/10.1257/rct.7844-1.0
Sponsors & Partners

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

Request Information
Experimental Details

Interventions

Intervention(s)
Free mask distribution was paired with additional education and behavioral interventions to encourage the recipients to use masks. These treatments explored three different channels through which mask use may have been low up to date in Uganda and similar contexts: lack of access to masks, lack of information about COVID severity or how masks work, inattention or lack of commitment to wear masks. All individuals over the age of 5 in “treat first” villages were offered a free mask by village health teams (VHTs) and received critical information about masks that adhered to the Ministry of Health guidance about masks. Random groups of recipients also received additional messages that reinforced specific information about mask effectiveness, benefits to oneself and the community that test 4 hypotheses of why mask adoption may be low. Interventions are summarized in the table below.
Intervention Start Date
2021-03-13
Intervention End Date
2021-03-16

Primary Outcomes

Primary Outcomes (end points)
Mask ownership, mask use, COVID-19 / mask knowledge, COVID-19 / mask attitudes, COVID-19 / mask behavior, social distancing, physical health, mental health
Primary Outcomes (explanation)
In cases where multiple variables will be used to construct primary outcomes, we will create indexes, where all variables used in the index will be coded in the same direction and weighted by their variance.

Secondary Outcomes

Secondary Outcomes (end points)
Trust in institutions, Living standards and economic activities: Total consumption expenditure in the last 7 days, Food security index, Total household earnings in the last 14 days, Total non-agricultural hours worked (in self-employment & employment) in the last 7 days)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The national mask distribution program focused on delivering a cloth mask to all eligible citizens of Uganda who are 6 years or older. Implementation at the local level was under jurisdiction of the different districts. In most districts, resources were scarce and mask distribution was conducted in a bare-bones fashion (i.e. without additional training, education or messaging) and took multiple weeks to roll out. Our intervention built on this foundation by leveraging the reality that not all districts could receive masks at the same time, and that within a district, the last mile of mask distribution would take some time. We worked with the local officials to randomly select the order in which masks would be delivered to the villages in Mbale district, so that a stepped-wedge design could compare “treat first” to “treat later” villages without delaying mask distribution overall.

Individuals in “treat later” villages would receive masks once mask distribution and education on masks is completed in the “treat first” villages, with an expected lag of approximately 3-4 weeks based on the expected roll-out schedule. Treatments were to be cross-randomized. Given budget constraints, we were able to observe mask behavior and conduct phone surveys only in a subset of randomly selected villages in our treatment area (n=90). The remaining 83 villages would be treated according to the schedule, but no data would be collected.

Masks were delivered to Mbale district in early March 2021 and the district quickly began mobilizing “last mile” distribution to all district villages. Ultimately, the district decided that they would be able to deliver masks to all villages on the same weekend, March 13-14 -- much quicker than anticipated. Given this new reality of mask distribution in Mbale and in order to maintain our study’s goal of not delaying mask delivery for study purposes, we aligned our study plan to accommodate the fact that all villages received masks at the same time. Our study still maintained the randomized selection of which villages received VHT training in addition to basic mask delivery, and the additional education/behavioral interventions.

In other words, in this new setup the “pure control” group of 68 villages received free masks at the same time as all other villages, but the VHTs in these villages were not trained by our study team to deliver education about masks or provide any of the additional treatments. The “pure control” group now reflects the free mask distribution program as it was implemented in remaining parts of the country (i.e. status quo of mask distribution campaign), while the villages where VHTs were trained by our study staff received additional experimental treatments. As the final logistical plans for mask distribution were being worked out, officials in one of the subcounties became uncooperative with our study team, including revealing treatment assignments of all VHTs in the subcounty. Therefore, that subcounty was dropped from the study and no endline data collection occurred there.
Experimental Design Details
Randomization Method
Randomization done in office by a computer.
Randomization Unit
Village
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
173 villages were randomized
Sample size: planned number of observations
We observed mask behavior in 90 villages and 12 markets. We collected phone survey data from 630 individuals (clustered in 90 villages) at baseline and 641 individuals at endline.
Sample size (or number of clusters) by treatment arms
105 villages randomized to get masks first, 68 villages randomized to get masks later.
Cross-randomization of VHTs into treatments:
75 villages get basic education, 15 villages get mask effectiveness education, 15 villages get behavioral nudge, 68 villages get no VHT training (control)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
At alpha 0.05 and power set to 0.80, and an intra-cluster correlation of 0.003 corresponding to the correlation in mask wearing self-reports found in an ongoing study in Kenya, we are powered to detect a difference of 4 percentage points in mask wearing using phone surveys and 1 percentage point using observations in the 90 pilot villages.
IRB

Institutional Review Boards (IRBs)

IRB Name
Higher Degrees, Research and Ethics Committee (HDREC) at Makerere University, School of Public Health
IRB Approval Date
2020-10-11
IRB Approval Number
875
IRB Name
Uganda National Council for Science and Technology (UNCST)
IRB Approval Date
2021-01-20
IRB Approval Number
HS1124ES
IRB Name
The Committee for Protection of Human Subjects (CPHS), University of California, Berkeley
IRB Approval Date
2020-12-22
IRB Approval Number
2020-09-13639
IRB Name
Uganda National Council for Science and Technology (UNCST)
IRB Approval Date
2021-01-20
IRB Approval Number
HS1124ES
IRB Name
The Committee for Protection of Human Subjects (CPHS), University of California, Berkeley
IRB Approval Date
2020-12-22
IRB Approval Number
2020-09-13639
Analysis Plan

Analysis Plan Documents

Mask-Up! Uganda - Pre-Analysis Plan

MD5: 87ee4ef0353bcce8bde6d67842bc3f9d

SHA1: 3f18e5aeab9c93815224a594c7d0bbe0bc8722db

Uploaded At: June 18, 2021

Post-Trial

Post Trial Information

Study Withdrawal

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

Request Information

Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials