Minnesota COVID-19 Testing Project

The goal of this project is to help the state of Minnesota understand why individuals are not getting tested and potentially identify trusted individuals or organizations that could be used in follow-up work to send messages. Investigators focus on the first two issues of unit and item nonresponse, which is not random across the population and thus could lead to nonresponse bias. To do so, investigators are deploying flyers through 10 Twin City area food shelves and potentially through public housing units with information on how to answer an online questionnaire.

Study Overview

• Status: Completed
• Conditions: Covid19; Infectious Disease
• Intervention / Treatment: Behavioral: A $20 Survey Incentive; Behavioral: Emphasis of Government Involvement; Behavioral: Cost-Benefit Frame; Behavioral: Duty Frame; Behavioral: Racial/Ethnic Frame; Behavioral: No Messaging; Behavioral: Emphasis of Academic Researchers Involvement; Behavioral: A $10 Survey Incentive

Detailed Description

In the United States, recent statistics show that African American and Latinx communities bear a disproportionate burden from COVID-19. Reaching vulnerable and underserved populations is therefore crucial to combating the disease. However, most public messaging campaigns are not targeted toward underserved communities and don't address fears of social stigma, mistrust in the healthcare system, or concerns about immigration status.

The goal of this project is to help the state of Minnesota understand why individuals are not getting tested and potentially identify trusted individuals or organizations that could be used in follow-up work to send messages. To do so, investigators are deploying flyers through 10 Twin City area food shelves and potentially through public housing units with information on how to answer an online questionnaire.

This provides us with an opportunity to study who answers surveys and why - and what questions are particularly sensitive. This is of general interest to academicians and policymakers alike.

The quality of household surveys is in decline, for three main reasons. First, households have become increasingly less likely to answer surveys at all (unit nonresponse). Second, those that respond are less likely to answer certain questions (item nonresponse). Third, when households do provide answers, they are less likely to be accurate (measurement error). This is important since household surveys help to estimate the employment rate, healthcare needs and of course the census determines resources/representation.

Investigators focus on the first two issues of unit and item nonresponse, which is not random across the population and thus could lead to nonresponse bias. Census tracts with predominantly Hispanic or Black residents had significantly lower response rates to the American Community Survey as compared to the response rates in predominantly white tracts. Similarly, response rates to the Health Information National Trends Survey (HINTS) were lower in areas with higher levels of Hispanic and minority residents.

Investigators hypothesize that financial incentives may encourage unit response; conversely, a close association with the government may discourage response. To test these hypotheses, investigators plan to cross-randomize the incentive amount offered and the emphasis placed on government involvement in the study on flyers advertising the baseline survey. Individuals will see either a) a 10 dollar incentive, or b) a 20 dollar incentive; and either a) messaging that emphasizes government involvement in the study, or b) messaging that emphasizes the involvement of academic researchers. Flyers will be randomized at the foodshelf-day level.

To test what affects item non-response on potentially sensitive questions, such as questions which ask for health information, investigators hypothesize that ethical framing may encourage individuals to answer questions. This takes two forms --- the deontological (or duty based) frame, and the consequential (or cost-benefit) frame. Moreover, knowing others feel the same way (regarding the obligation or benefits of providing health information) may amplify motivation. Finally, there is the possibility that emphasizing the importance of ethnic and racial disadvantage associated with COVID-19 outcomes may be important for improving item non-response on sensitive questions.

Upon completion of the demographic module of the survey but prior to starting several potentially sensitive survey modules, individuals will see a message that either a) emphasizes the public health benefits of answering the survey questions (cost-benefit frame); b) emphasizes an individual's responsibility to their community (duty frame); c) emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups; or d) provides no messaging. Messaging content will be randomized at the individual level.

• Study Type: Interventional
• Enrollment (Actual): 561
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Minnesota
    • Bloomington, Minnesota, United States, 55420
      • Volunteers Enlisted to Assist People
    • Columbia Heights, Minnesota, United States, 55421
      • Southern Anoka Community Assistance
    • Eden Prairie, Minnesota, United States, 55344
      • People Reaching Out to People Food Shelf
    • Fridley, Minnesota, United States, 55432
      • Fridley Covenant Church
    • Minneapolis, Minnesota, United States, 55407
      • Calvary Lutheran Church Food Shelf
    • Minneapolis, Minnesota, United States, 55411
      • NorthPoint Health and Wellness
    • Minneapolis, Minnesota, United States, 55429
      • Community Emergency Assistance Programs
    • Minnetonka, Minnesota, United States, 55343
      • Intercongregation Communities Association
    • Stillwater, Minnesota, United States, 55082
      • Valley Outreach
    • White Bear Lake, Minnesota, United States, 55110
      • White Bear Area Foodshelf

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:

• All participants who are aged 18 or above and speak English or Spanish

Exclusion Criteria:

• Children, those who do not identify as above or adults who identify as above but do not agree to participate in survey during the consent stage.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

16

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Government/High Incentive/Cost-Benefit Frame; The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).	Behavioral: A $20 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.; Behavioral: Emphasis of Government Involvement; Individuals see a message emphasizing the involvement of the government in the study,; Behavioral: Cost-Benefit Frame; Individuals will see messaging that emphasizes the public health benefits of answering the survey questions in the baseline survey (cost-benefit frame).
Experimental: Government/High Incentive/Duty Frame; The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).	Behavioral: A $20 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.; Behavioral: Emphasis of Government Involvement; Individuals see a message emphasizing the involvement of the government in the study,; Behavioral: Duty Frame; Individuals will see messaging that emphasizes an individual's responsibility to their community in the baseline survey (duty frame),
Experimental: Government/High Incentive/Racial/Ethnic Frame; The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.	Behavioral: A $20 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.; Behavioral: Emphasis of Government Involvement; Individuals see a message emphasizing the involvement of the government in the study,; Behavioral: Racial/Ethnic Frame; Individuals will see messaging that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups in the baseline survey.
Experimental: Government/High Incentive/No Message Frame; The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.	Behavioral: A $20 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.; Behavioral: Emphasis of Government Involvement; Individuals see a message emphasizing the involvement of the government in the study,; Behavioral: No Messaging; Individuals will see no messaging in the baseline survey.
Experimental: Researchers/High Incentive/Cost-Benefit Frame; The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).	Behavioral: A $20 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.; Behavioral: Cost-Benefit Frame; Individuals will see messaging that emphasizes the public health benefits of answering the survey questions in the baseline survey (cost-benefit frame).; Behavioral: Emphasis of Academic Researchers Involvement; Individuals see a message emphasizing the involvement of academic researchers in the study,
Experimental: Researchers/High Incentive/Duty Frame; The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).	Behavioral: A $20 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.; Behavioral: Duty Frame; Individuals will see messaging that emphasizes an individual's responsibility to their community in the baseline survey (duty frame),; Behavioral: Emphasis of Academic Researchers Involvement; Individuals see a message emphasizing the involvement of academic researchers in the study,
Experimental: Researchers/High Incentive/Racial/Ethnic Frame; The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.	Behavioral: A $20 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.; Behavioral: Racial/Ethnic Frame; Individuals will see messaging that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups in the baseline survey.; Behavioral: Emphasis of Academic Researchers Involvement; Individuals see a message emphasizing the involvement of academic researchers in the study,
Experimental: Researchers/High Incentive/No Message Frame; The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.	Behavioral: A $20 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.; Behavioral: No Messaging; Individuals will see no messaging in the baseline survey.; Behavioral: Emphasis of Academic Researchers Involvement; Individuals see a message emphasizing the involvement of academic researchers in the study,
Experimental: Government/Low Incentive/Cost-Benefit Frame; The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).	Behavioral: Emphasis of Government Involvement; Individuals see a message emphasizing the involvement of the government in the study,; Behavioral: Cost-Benefit Frame; Individuals will see messaging that emphasizes the public health benefits of answering the survey questions in the baseline survey (cost-benefit frame).; Behavioral: A $10 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.
Experimental: Government/Low Incentive/Duty Frame; The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).	Behavioral: Emphasis of Government Involvement; Individuals see a message emphasizing the involvement of the government in the study,; Behavioral: Duty Frame; Individuals will see messaging that emphasizes an individual's responsibility to their community in the baseline survey (duty frame),; Behavioral: A $10 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.
Experimental: Government/Low Incentive/Racial/Ethnic Frame; The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.	Behavioral: Emphasis of Government Involvement; Individuals see a message emphasizing the involvement of the government in the study,; Behavioral: Racial/Ethnic Frame; Individuals will see messaging that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups in the baseline survey.; Behavioral: A $10 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.
Experimental: Government/Low Incentive/No Message Frame; The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.	Behavioral: Emphasis of Government Involvement; Individuals see a message emphasizing the involvement of the government in the study,; Behavioral: No Messaging; Individuals will see no messaging in the baseline survey.; Behavioral: A $10 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.
Experimental: Researchers/Low Incentive/Cost-Benefit Frame; The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).	Behavioral: Cost-Benefit Frame; Individuals will see messaging that emphasizes the public health benefits of answering the survey questions in the baseline survey (cost-benefit frame).; Behavioral: Emphasis of Academic Researchers Involvement; Individuals see a message emphasizing the involvement of academic researchers in the study,; Behavioral: A $10 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.
Experimental: Researchers/Low Incentive/Duty Frame; The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).	Behavioral: Duty Frame; Individuals will see messaging that emphasizes an individual's responsibility to their community in the baseline survey (duty frame),; Behavioral: Emphasis of Academic Researchers Involvement; Individuals see a message emphasizing the involvement of academic researchers in the study,; Behavioral: A $10 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.
Experimental: Researchers/Low Incentive/Racial/Ethnic Frame; The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.	Behavioral: Racial/Ethnic Frame; Individuals will see messaging that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups in the baseline survey.; Behavioral: Emphasis of Academic Researchers Involvement; Individuals see a message emphasizing the involvement of academic researchers in the study,; Behavioral: A $10 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.
Experimental: Researchers/Low Incentive/No Message Frame; The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.	Behavioral: No Messaging; Individuals will see no messaging in the baseline survey.; Behavioral: Emphasis of Academic Researchers Involvement; Individuals see a message emphasizing the involvement of academic researchers in the study,; Behavioral: A $10 Survey Incentive; Individuals see a 10 dollar incentive on the flyers advertising the baseline survey.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Effect of monetary incentives in increasing unit response 1	Number of participants who received a flyer that mentions a $20 incentive and completed the survey	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
Effect of monetary incentives in increasing unit response 2	Number of participants who received a flyer that mentions a $10 incentive and completed the survey.	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
Effect of a government frame in reducing unit response 1	Number of participants who received a flyer that mentions a government frame and completed the survey	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
Effect of a government frame in reducing unit response 2	Number of participants who received a flyer that mentions a research frame and completed the survey.	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
Interactions between monetary incentives and a government frame 1	Number of participants who received a flyer that mentions a government frame and $20 incentive and completed the survey	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
Interactions between monetary incentives and a government frame 2	Number of participants who received a flyer that mentions a government frame and $10 incentive and completed the survey	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
Interactions between monetary incentives and a government frame 3	Number of participants who received a flyer that mentions a researcher frame and $20 incentive and completed the survey	This outcome will be assessed during the 20-minute Baseline Survey.
Interactions between monetary incentives and a government frame 4	Number of participants who received a flyer that mentions a researcher frame and $10 incentive and completed the survey	This outcome will be assessed during the 20-minute Baseline Survey.
Demographic characteristics of participants assigned into each treatment arm	Demographic characteristics (e.g. sex, education level, income level, race/ethnicity) of participants who are assigned to each treatment arm and completed the survey.	This outcome will be assessed during the 20-minute Baseline Survey.
Effect of various messaging frames in increasing item non-response	Number of survey participants who are randomly assigned to receive each messaging frame that: a) emphasizes the public health benefits of answering the survey questions (cost-benefit frame); b) emphasizes an individual's responsibility to their community (duty frame); c) emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups; or d) provides no messaging.	This outcome will be assessed during the 20-minute Baseline Survey.

Collaborators and Investigators

• Sponsor: Harvard University
• Collaborators: Abdul Latif Jameel Poverty Action Lab; Government of Minnesota Office of Management and Budget
• Investigators: Principal Investigator: Marcella Alsan, MD, MPH, PhD, Harvard Kennedy School

Publications and helpful links

General Publications

• Griffin, DH. Measuring survey nonresponse by race and ethnicity. In Proceedings of the Annual Meetings of the American Statistical Association. 2002; 11-15.
• Maitland A, Lin A, Cantor D, Jones M, Moser RP, Hesse BW, Davis T, Blake KD. A Nonresponse Bias Analysis of the Health Information National Trends Survey (HINTS). J Health Commun. 2017 Jul;22(7):545-553. doi: 10.1080/10810730.2017.1324539. Epub 2017 May 30.
• Meyer, Bruce D., Wallace KC Mok, and James X. Sullivan. Household surveys in crisis. Journal of Economic Perspectives. 2015; 29(4): 199-226.

Study record dates

Study Major Dates

• Study Start (Actual): September 28, 2020
• Primary Completion (Actual): August 31, 2022
• Study Completion (Actual): August 31, 2022

Study Registration Dates

• First Submitted: September 24, 2020
• First Submitted That Met QC Criteria: September 25, 2020
• First Posted (Actual): September 29, 2020

Study Record Updates

• Last Update Posted (Actual): October 14, 2022
• Last Update Submitted That Met QC Criteria: October 12, 2022
• Last Verified: October 1, 2022

More Information

Terms related to this study

• Keywords: COVID-19; Minnesota; Unit nonresponse; Item nonresponse
• Additional Relevant MeSH Terms: Pathologic Processes; Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; Disease Attributes; COVID-19; Infections; Communicable Diseases
• Other Study ID Numbers: IRB20-1444

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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