Adoption and impact of health services through mobile phones? Experimental evidence from Bangladesh

Last registered on January 01, 2024
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Pre-Trial

Trial Information

General Information

Title
Adoption and impact of health services through mobile phones? Experimental evidence from Bangladesh
RCT ID
AEARCTR-0008254
Initial registration date
September 24, 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
September 28, 2021, 4:11 PM EDT

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

Last updated
January 01, 2024, 10:45 PM EST

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

Locations

Country
Bangladesh
Region
South Asia

Primary Investigator

Name
Ferdous Sardar
Affiliation
Bryant University
Contact Primary Investigator

Other Primary Investigator(s)

Additional Trial Information

Status
On going
Start date
2021-07-26
End date
2024-01-10
Keywords
Health
Additional Keywords
mobile health services, telehealth, spillover effect, nudge, technology adoption, health behavior, informal health providers
JEL code(s)
I12, I18, O12, O120
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Both the awareness and the adoption of free public health care services through mobile phones are very low in rural Bangladesh where the need for such services should be higher due to lack of access to qualified health care professionals in those areas. To study how awareness and adoption of these services can be improved and how that would affect health behaviors, I conduct a cluster randomized controlled trial among 4,500 households in 900 neighborhoods (paras) in rural Bangladesh. This RCT has three treatments: (1) the households in the first treatment receive a flyer/leaflet containing information about these services, (2) the households in the second treatment receive the same flyer/leaflet and are encouraged to save these phone numbers in their phone, and (3) the households in the third treatment receive the same flyer/leaflet and are encouraged to save these phone numbers in their phone and to make a call to experience how the service works.
External Link(s)

Registration Citation

Citation
Sardar, Ferdous. 2024. "Adoption and impact of health services through mobile phones? Experimental evidence from Bangladesh." AEA RCT Registry. January 01. https://doi.org/10.1257/rct.8254-3.0
Sponsors & Partners
Experimental Details

Interventions

Intervention(s)
Randomly selected households from randomly selected neighborhoods will receive either of the following three treatments:
(1) information about free public health services through mobile phones and the phone numbers,
(2) the same information as (1) and encouragement by the enumerators to save those phone numbers in their cell phones
(3) the same treatment as (2) and encouragement by the enumerators to make a call at any of those phone numbers
Intervention Start Date
2021-07-26
Intervention End Date
2021-08-10

Primary Outcomes

Primary Outcomes (end points)
Whether they are aware of existence of any public health services through mobile phone
Whether they have received services by calling at any of those phone numbers
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Number of times they received services from substitutes (informal providers like rural doctors, local pharmacist, etc.)
Total health expenditure (and expenditure for medicine purchase)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
This study uses a cluster randomized control trial with the following four arms:
• Control: receive no intervention
• Treatment 1 (T1): receive information about these services and phone numbers
• Treatment 2 (T2): T1 + enumerators encourage the participants to save the phone numbers
• Treatment 3 (T3): T2 + enumerators encourage the participants to make their first call
To maintain SUTVA, the random treatment is assigned at the cluster (para) level. The second level of randomization is done at the household level to measure spillover. In each of the treated paras/clusters, only a subset of the households received treatment, leaving the remaining households as a within-treatment control. Comparing control households in treatment paras to the households in control paras, I will identify within-para spillover effects. The randomization was done in Stata and stratified by administrative unit (upazila).
Being surveyed at the baseline might affect the awareness and behavior of the control group participants and bias the estimates (Zwane et al., 2011). To address this, I survey additional 1500 households from 300 new paras from the 300 villages of the intervention area.
Experimental Design Details
Randomization Method
The randomization was done in Stata and stratified by administrative unit (upazila).
Randomization Unit
Randomization is done at two levels. First, paras were randomly selected for treatment type. Then households from the treated paras were randomly selected for treatment leaving one household from each of the treated paras not to receive any treatment.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
900 paras (neighborhoods).
Sample size: planned number of observations
4500 households.
Sample size (or number of clusters) by treatment arms

Households Paras
Pure control 1500 300
Control 500 120
Treatment 1 600 150
Treatment 2 600 150
Treatment 3 720 180
Within treatment control 480 480
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Estimated experimental-group proportion for a two-sample proportions test Cluster randomized design, Pearson's chi-squared test Study parameters: • Significance= 0.0500 • Power = 0.8000 Primary outcome variable 1: awareness • Control proportion = 0.1000 • MDE: 0.0730 (for treatment 1 and treatment 2) • MDE: 0.0700 (for treatment 3) Primary outcome variable 2: adoption • Control proportion = 0.0500 • MDE: 0.0573 (for treatment 1 and treatment 2) • MDE: 0.0549 (for treatment 3) Assuming intraclass correlation 0.3000 and attrition rate 10%.
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
University of washington
IRB Approval Date
2021-06-24
IRB Approval Number
STUDY00013539
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
August 10, 2021, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
September 10, 2021, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
Though healthcare services via mobile phones is freely available in Bangladesh, very few rural households use it. In this paper, I study whether information and experimentation with the mobile health services (MHS) can improve adoption and how adoption impacts health behaviors. I find that information about the service improves households’ awareness by more than 30 percentage points but does not affect adoption in the following two months. However, encouraging households to make a call and experience how the MHS works increases the adoption of the MHS by 17 percentage points. The adoption of MHS decreases households’ health expenditure, mostly driven by the reduction in medicine consumption. This happens because households that adopt MHS also make fewer visits to informal providers who usually overprescribe medicine.
Citation
Sardar, Ferdous Zaman, Adoption and Impact of Mobile Health Services: Experimental Evidence from Bangladesh. Available at SSRN: https://ssrn.com/abstract=4333117 or http://dx.doi.org/10.2139/ssrn.4333117
URL
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4333117

Reports & Other Materials