COVID-19 Health Messaging to Underserved Communities

Recent data have shown that covid19 is disproportionately infecting and killing African Americans and Latinx people in the United States. The aim of the study is to determine which messages are most effective at increasing knowledge and changing behaviors that can protect individuals and their communities from the virus. To accomplish this aim, we plan to recruit approximately 20,000 Hispanic and African-American individuals and randomly assign them to videos that vary either the sender or the framing of the message, while providing the relevant public health information.

Study Overview

• Status: Completed
• Conditions: Coronavirus
• Intervention / Treatment: Behavioral: Messaging

Detailed Description

The following procedures will be followed. The research subjects will participate online.

1. Doctors from MGH who express interest in participating will record messages according to our scripts (US Doctors Script African American, US Doctors Script Latinx). They will be instructed to film several different versions each.
2. We will recruit a sample of Latinx and African American study participants from across the country through Lucid, an online survey firm that has access to a large subject pool.
3. Participants will first read a consent script and give us their informed consent (US Doctors Messaging Consent)

4. Participants will then navigate through the following steps

   1. Brief demographics survey questions (US Doctors Messaging Survey)
   2. Videos 1 and 2: Introduction, Acknowledgement, Social Distancing (US Doctors Script African American, US Doctors Script Latinx). Individuals in the control group will not see videos.
   3. Beliefs survey questions (US Doctors Messaging Survey)
   4. Video 3: Masks (US Doctors Script African American, US Doctors Script Latinx). Again, individuals in the control group will not see a video here.
   5. Main outcomes survey (US Doctors Messaging Survey)
   6. Control group is shown a version of all 3 videos at end (US Doctors Script African American, US Doctors Script Latinx).

5. The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.

   1. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.
   2. Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.
   3. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.
   4. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.
   5. Some individuals in a control group will only see messages after all surveying has been completed.

• Study Type: Interventional
• Enrollment (Actual): 14267
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Cambridge, Massachusetts, United States, 02138
      • JPAL North America

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria: Hispanic and African-American adult individuals, men and women - oversample of those with less completed education Exclusion Criteria: children, those who do not identify as above

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

17

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Control - CDC - Mask (Control) - Concordant; Control Intro, CDC Social Distancing, Mask Control version delivered by minority doctor of same background as the recipient - other definitions are similar	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Control - CDC - Mask (Control) - Discordant; Control Intro, CDC Social Distancing, Mask Control version delivered by majority doctor of different background as the recipient - other definitions are similar	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Control - MGH - Mask (Control) - Concordant; Control Intro, MGH Social Distancing, Mask Control version delivered by concordant doctor	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Control - MGH - Mask (Control) - Discordant; Control Intro, MGH Social Distancing, Mask Control version delivered by discordant doctor	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Ack. Discrimination- MGH - Mask (Control) - Concordant; Introduction Acknowledges past discrimination, MGH doctor talks about Social Distancing, Mask Control all by concordant MD	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Ack. Discrimination- MGH - Mask (Control) - Discordant; Introduction Acknowledges past discrimination, MGH doctor talks about Social Distancing, Mask Control all by discordant MD	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Ack. econ. circumstance- MGH - Mask (Control ) Concordant; Intro econ. circumstance -MGH - Mask (Control ) Concordant	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Ack. econ. circumstance - MGH - Mask (Control ) Discordant	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Control Intro - CDC - Mask (antiStigma) Concordant; Control Intro - CDC - Mask (antiStigma) Concordant messenger	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Control Intro - CDC - Mask (antiStigma) Discordant; Control Intro - CDC - Mask (antiStigma) discordant messenger	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Control - MGH - MaskS (antiStigma) Concordant messenger; Control - MGH - MaskS (antiStigma) Concordant sender	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Control- MGH-MaskS (antiStigma) Discordant messenger; Control - MGH - MaskS (antiStigma) Discordant sender	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Ack. Discrimination - MGH - MaskS (antiStigma) Concordant; Acknowledge Discrimination - MGH - MaskS (antiStigma) Concordant sender	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Ack. Discrimination - MGH - MaskS (antiStigma) Discordant; Acknowledge Discrimination - MGH - MaskS (antiStigma) Discordant sender	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Ack. Econ Hardship- MGH - Mask (antiStigma) Concordant; Acknowledge Econ Hardship- MGH - Mask (antiStigma) Concordant sender	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Experimental: Ack. Econ Hardship- MGH - Mask (antiStigma) Discordant; Acknowledge Econ Hardship- MGH - Mask (antiStigma) discordant sender	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.
Placebo Comparator: Info later - Pure Control; This group will not receive the videos but will receive information later.	Behavioral: Messaging; o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document.; Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject.; Whether the message includes an acknowledgment of "elephant in the room" issues for each target group: trust in the medical system or fear of deportation.; Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians.; Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey.; Some individuals in a control group will see messages later.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence Rate for Knowledge Gaps: Control vs. Any Intervention	Incidence rate for knowledge gaps is the count of knowledge gaps divided by the maximum possible count: 7	The outcome was measured immediately following the intervention in the 15-minute baseline survey.
Incidence Rate for Information-seeking Behavior: Control vs. Any Intervention	Incidence rate for Information-seeking behavior is the count of links demanded divided by the maximum possible count: 10	The outcome was measured immediately following the intervention in the 15-minute baseline survey.
Incidence Rate for Knowledge Gaps by Intervention	Incidence rate for knowledge gaps is the count of knowledge gaps divided by the maximum possible count: 7	The outcome was measured immediately following the intervention in the 15-minute baseline survey.
Incidence Rate for Information-seeking Behavior by Intervention	Incidence rate for Information-seeking behavior is the count of links demanded divided by the maximum possible count: 10	The outcome was measured immediately following the intervention in the 15-minute baseline survey.

Collaborators and Investigators

• Sponsor: National Bureau of Economic Research, Inc.
• Collaborators: Massachusetts General Hospital; Yale University; Massachusetts Institute of Technology; Stanford University; Harvard University

Publications and helpful links

General Publications

• Alsan M, Stanford FC, Banerjee A, Breza E, Chandrasekhar AG, Eichmeyer S, Goldsmith-Pinkham P, Ogbu-Nwobodo L, Olken BA, Torres C, Sankar A, Vautrey PL, Duflo E. Comparison of Knowledge and Information-Seeking Behavior After General COVID-19 Public Health Messages and Messages Tailored for Black and Latinx Communities : A Randomized Controlled Trial. Ann Intern Med. 2021 Apr;174(4):484-492. doi: 10.7326/M20-6141. Epub 2020 Dec 21.

Study record dates

Study Major Dates

• Study Start (Actual): May 13, 2020
• Primary Completion (Actual): May 24, 2020
• Study Completion (Actual): May 26, 2020

Study Registration Dates

• First Submitted: April 28, 2020
• First Submitted That Met QC Criteria: April 28, 2020
• First Posted (Actual): May 1, 2020

Study Record Updates

• Last Update Posted (Actual): July 27, 2021
• Last Update Submitted That Met QC Criteria: July 24, 2021
• Last Verified: July 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Coronavirus Infections
• Other Study ID Numbers: 2003000118

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Generally, economists will post code and de-identified data when the findings are published
• IPD Sharing Time Frame: Generally, social scientists post code and de-identified data when the findings are published
• IPD Sharing Access Criteria: To be determined, if published alongside the paper data and code may be gated.
• IPD Sharing Supporting Information Type: SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No