Healthcare Providers as Trusted Messengers to Increase Receipt of Tax Credits Among Low-income Families

The purpose of this study is to pilot test the feasibility and preliminary efficacy of healthcare provider referrals to a tax filing app within parent-child health programs to test whether such referrals can increase receipt of tax credits among low-income parents. The study will use a single-group, pre/post test design with a sample of parents who have a child under 6 years of age. Participants will be recruited from parental-child health programs and clinics in Los Angeles and will complete surveys at baseline, immediately after tax filing season, and six months after tax filing season to assess 1) frequency of tax filing after referral (Feasibility), and 2) pre/posttest changes to parent and child health (preliminary efficacy).

Study Overview

• Status: Completed
• Conditions: Depression; Stress; Child Development; Health Care Utilization; Physical Illness
• Intervention / Treatment: Behavioral: Healthcare provider referral to a tax filing app

Detailed Description

Aims: The purpose of this study is to pilot test the feasibility and preliminary efficacy of healthcare provider referrals to a tax filing app within parental-child health programs whether such referrals can increase receipt of tax credits among low-income parents. The study will use a single-group, pre/posttest design. The primary outcome is feasibility, defined as whether or not participants filed taxes after referral. Secondary outcomes are acceptability of the app and preliminary efficacy of the app on improved parent and child health. Specific aims are to:

1. assess frequency of tax filing among parents referred to a tax filing app (Primary outcome/Feasibility)
2. explore pre/posttest changes to parent and child health after referral (Secondary outcome/Preliminary efficacy).

Design: This pilot study will use a single-group, pre/post-test design to assess the feasibility and preliminary efficacy of healthcare provider referrals to a tax filing app.

Intervention: Referrals to a tax filing app

Setting: The setting for this study is maternal/child health programs and clinics in Los Angeles.

Sample: The target population is parents making less than $75,000 per year in income . Parents will be eligible to participate in the study if they are within the income threshold, have one or more children under six years of age, speak English or Spanish, have access to an internet-enabled device (smart phone or tablet), and have a valid tax filing ID (SSN or ITIN). Parents will be ineligible if they have already filed taxes during the study period or are experiencing an acute mental health crisis (e.g., suicidality). We focus on children under six years of age because this is a critical and sensitive developmental window when interventions have potential for outsized impact on child health.

Procedures: Parents will be recruited during program visits/encounters early in tax season in 2023. Those that provide informed consent to participate in the study will complete a baseline survey and receive the assigned intervention (referral to a tax filing app) the same day or within the same week of their program visit. Parents will complete a follow-up survey to assess outcome measures after they receive tax refunds. A second follow-up survey will be sent 3-6 months later (depending on time of filing, and average time of receipt of tax credit this season) to assess medium-term outcomes.

Outcomes. We will assess the following outcomes. The primary study outcome is feasibility; acceptability and preliminary health efficacy are secondary outcomes.

Feasibility: Self-reported tax filing (items developed for this study) Preliminary efficacy: We will assess pre/posttest changes in the following health-related measures as indicators of preliminary efficacy: 1a) parent overall health rating (PROMIS® Scale v1.2 - Global Health [Hays et al., 2009]; Patient Health Questionnaire- 2 [Kroenke et al., 2003); and 1b) child overall health and developing rating (PROMIS® Early Childhood Parent Report Global Health [Forrest et al., 2014]).

Demographic and family health background information (see survey: age, gender, race/ethnicity, income, social determinants of health, health background, other tax filing characteristics) will be collected to identify characteristics of the sample. In future studies, we intend to study in greater depth the physical health outcomes that might be sensitive to this intervention with longer-term follow up.

• Study Type: Interventional
• Enrollment (Actual): 21
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90095
      • UCLA School of Nursing

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 99 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Income <$75,000 per year
• One or more children under 6 years of age
• Has a valid tax filing ID (SSN or ITIN)
• Has access to an internet-enabled device

Exclusion Criteria:

• Experiencing an acute mental health crisis

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention; This arm will receive a healthcare provider referral to a tax filing app	Behavioral: Healthcare provider referral to a tax filing app; Healthcare providers offer a referral to a tax filing app and briefly describe the potential benefits of tax credit receipt

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of Tax Filing at 3 Months: Did You File Taxes This Year? YES/NO	Self-reported tax filing status for the current year	3 months
Rate of Tax Filing at 9 Months: Did You File Taxes This Year? YES/NO	Self-reported tax filing status for the current year	9 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Parents With Positive Depression Score at Baseline	Number of parents with a depression score above the cutoff range (i.e., scores of 3 or greater) on the Patient Health Questionnaire- 2 (score range 0-6, higher scores indicate worse depression symptoms)	Baseline
Number of Parents With Positive Depression Score at 9 Months	Number of parents with a depression score above the cutoff range (i.e., scores of 3 or greater) on the Patient Health Questionnaire- 2 (score range 0-6, higher scores indicate worse depression symptoms)	9 months
Number of Children With Excellent or Very Good Responses Ratings on Child Development at 9 Months	Number of children with ratings of Excellent or Very Good Responses on child development item in the PROMIS Early Childhood Parent Report Global Health 8a ("How well is your child meeting developmental milestones?" Response options of Excellent, Very Good, Good, Fair, or Poor)	9 months

Collaborators and Investigators

• Sponsor: University of California, Los Angeles

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2023
• Primary Completion (Actual): May 31, 2025
• Study Completion (Actual): May 31, 2025

Study Registration Dates

• First Submitted: October 20, 2022
• First Submitted That Met QC Criteria: November 4, 2022
• First Posted (Actual): November 10, 2022

Study Record Updates

• Last Update Posted (Actual): September 22, 2025
• Last Update Submitted That Met QC Criteria: September 17, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Behavior; Treatment Adherence and Compliance; Health Behavior; Depression; Patient Acceptance of Health Care
• Other Study ID Numbers: 22-001575

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