Effect of Physician-Delivered COVID-19 Public Health Messages and Messages Acknowledging Racial Inequity on Black and White Adults' Knowledge, Beliefs, and Practices Related to COVID-19: A Randomized Clinical Trial
Carlos Torres, Lucy Ogbu-Nwobodo, Marcella Alsan, Fatima Cody Stanford, Abhijit Banerjee, Emily Breza, Arun G Chandrasekhar, Sarah Eichmeyer, Mohit Karnani, Tristan Loisel, Paul Goldsmith-Pinkham, Benjamin A Olken, Pierre-Luc Vautrey, Erica Warner, Esther Duflo, COVID-19 Working Group, Ingabire Grace Balinda, Richard Bido-Medina, Allison Brandt, Kemar Brown, Sherri-Ann Burnett-Bowie, Lindsay Pindyck Carter, Jonathan Chou, Adriana Cohen-Hauseman, Kristen Cotter, Carine Davila, Paola Daza, Ariel Frey-Vogel, Linda Galligani, Wanda Gonzalez, Marita Gove, Daniel Hall, Kayla Theresa Hartjes, Jonathan Hauseman, Linda Herrera Santos, Kelly John Holland, Katie Hsih, Aisha James, Hannah Janoowalla, Gracia Kwete, Desta Lissanu, Merranda Logan, Lizbeeth Lopez, Wanda Lopez-Rodriguez, Njambi Mathenge, Juan Matute, George Molina, Leah Morelli, Maeve O'Neill, Tawakalitu Oseni, Asishana Osho, Vashti Otuya, Numa Perez, Meryl Perlman, Rozanne Puleo, Daniela Romero Crousillat, Ana Maria Rosales, Shiva Saboori, Gloria Salazar, Shannon Scott-Vernaglia, Ashley Yih Shaw, Sahael Stapleton, Clark Van Den Berghe, Christopher Velez, Carlos Torres, Lucy Ogbu-Nwobodo, Marcella Alsan, Fatima Cody Stanford, Abhijit Banerjee, Emily Breza, Arun G Chandrasekhar, Sarah Eichmeyer, Mohit Karnani, Tristan Loisel, Paul Goldsmith-Pinkham, Benjamin A Olken, Pierre-Luc Vautrey, Erica Warner, Esther Duflo, COVID-19 Working Group, Ingabire Grace Balinda, Richard Bido-Medina, Allison Brandt, Kemar Brown, Sherri-Ann Burnett-Bowie, Lindsay Pindyck Carter, Jonathan Chou, Adriana Cohen-Hauseman, Kristen Cotter, Carine Davila, Paola Daza, Ariel Frey-Vogel, Linda Galligani, Wanda Gonzalez, Marita Gove, Daniel Hall, Kayla Theresa Hartjes, Jonathan Hauseman, Linda Herrera Santos, Kelly John Holland, Katie Hsih, Aisha James, Hannah Janoowalla, Gracia Kwete, Desta Lissanu, Merranda Logan, Lizbeeth Lopez, Wanda Lopez-Rodriguez, Njambi Mathenge, Juan Matute, George Molina, Leah Morelli, Maeve O'Neill, Tawakalitu Oseni, Asishana Osho, Vashti Otuya, Numa Perez, Meryl Perlman, Rozanne Puleo, Daniela Romero Crousillat, Ana Maria Rosales, Shiva Saboori, Gloria Salazar, Shannon Scott-Vernaglia, Ashley Yih Shaw, Sahael Stapleton, Clark Van Den Berghe, Christopher Velez
Abstract
Importance: Social distancing is critical to the control of COVID-19, which has disproportionately affected the Black community. Physician-delivered messages may increase adherence to these behaviors.
Objectives: To determine whether messages delivered by physicians improve COVID-19 knowledge and preventive behaviors and to assess the differential effectiveness of messages tailored to the Black community.
Design, setting, and participants: This randomized clinical trial of self-identified White and Black adults with less than a college education was conducted from August 7 to September 6, 2020. Of 44 743 volunteers screened, 30 174 were eligible, 5534 did not consent or failed attention checks, and 4163 left the survey before randomization. The final sample had 20 460 individuals (participation rate, 68%). Participants were randomly assigned to receive video messages on COVID-19 or other health topics.
Interventions: Participants saw video messages delivered either by a Black or a White study physician. In the control groups, participants saw 3 placebo videos with generic health topics. In the treatment group, they saw 3 videos on COVID-19, recorded by several physicians of varied age, gender, and race. Video 1 discussed common symptoms. Video 2 highlighted case numbers; in one group, the unequal burden of the disease by race was discussed. Video 3 described US Centers for Disease Control and Prevention social distancing guidelines. Participants in both the control and intervention groups were also randomly assigned to see 1 of 2 American Medical Association statements, one on structural racism and the other on drug price transparency.
Main outcomes and measures: Knowledge, beliefs, and practices related to COVID-19, demand for information, willingness to pay for masks, and self-reported behavior.
Results: Overall, 18 223 participants (9168 Black; 9055 White) completed the survey (9980 [55.9%] women, mean [SD] age, 40.2 [17.8] years). Overall, 6303 Black participants (34.6%) and 7842 White participants (43.0%) were assigned to the intervention group, and 1576 Black participants (8.6%) and 1968 White participants (10.8%) were assigned to the control group. Compared with the control group, the intervention group had smaller gaps in COVID-19 knowledge (incidence rate ratio [IRR], 0.89 [95% CI, 0.87-0.91]) and greater demand for COVID-19 information (IRR, 1.05 [95% CI, 1.01-1.11]), willingness to pay for a mask (difference, $0.50 [95% CI, $0.15-$0.85]). Self-reported safety behavior improved, although the difference was not statistically significant (IRR, 0.96 [95% CI, 0.92-1.01]; P = .08). Effects did not differ by race (F = 0.0112; P > .99) or in different intervention groups (F = 0.324; P > .99).
Conclusions and relevance: In this study, a physician messaging campaign was effective in increasing COVID-19 knowledge, information-seeking, and self-reported protective behaviors among diverse groups. Studies implemented at scale are needed to confirm clinical importance.
Trial registration: ClinicalTrials.gov Identifier: NCT04502056.
Conflict of interest statement
Conflict of Interest Disclosures: Dr Olken reported receiving ad credits from Facebook outside the submitted work. No other disclosures were reported.
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Source: PubMed