Nudges to Improve Health Behaviors That Limit COVID-19 Spread

Study Overview
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Brief Summary
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This investigation is a randomized intervention trial that evaluates behavioral nudges (BN) to increase hand washing behavior and subsequently reduce COVID-19 spreading to a targeted high-risk patient population based in Wisconsin.

Official Title
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Using Behavioral Nudges to Improve Preventive Health Behaviors That Limit COVID-19 Spread

Conditions
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Health Behavior, COVID-19

Intervention / Treatment
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* Behavioral: Nudge


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 years or older Provision of signed and dated informed consent form Willingness to comply with all study procedures and lifestyle considerations and availability for the duration of the study Has at least 1 risk factor associated with COVID-19 documented in their electronic medical record Followed by (i.e., actively receiving care) from targeted MCW specialties (Internal Medicine, OBGYN, Surgery) Access to necessary resources for participating in a technology-based activities (i.e., internet access + mobile phone or computer to complete online survey) Maintains a personal address where study materials can be shipped and where participant lives full time Exclusion Criteria: Previous COVID-19 diagnosis or positive COVID-19 test result documented in their electronic medical record Current participation in another treatment or intervention study associated with COVID-19 Previous documented Obsessive-Compulsive Disorder diagnosis in their electronic medical record Non-English speaker Patients hospitalized or incapacitated at onset of potential enrollment No access to electronic platform with internet (e.g., smartphone, tablet, computer)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Inertia<br>Participants simply receive and subsequently have default access (i.e., readily and immediately available) to handwashing (HW) materials. This condition will functionally serve as a control comparison. As the term implies, inertia capitalizes on minimizing effort necessary (e.g., going to the grocery store) to engage in HW behavior in one's personal environment. | Behavioral: Nudge<br>* Application of behavior-change strategies based on principles of behavioral economics, decision-making heuristics, psychological/environmental variables.<br>|
| Experimental: Anchoring<br>Involves once again providing default access to HW materials as above, but adds an explicit written cue to wash hands at a rate of (15) times per day, which is placed directly on the soap dispenser. The stimulus is intended to deliberately prime participant thinking (and subsequent behavior) towards a higher reference point that overshoots a desired target rate of 10+ daily HWs. | Behavioral: Nudge<br>* Application of behavior-change strategies based on principles of behavioral economics, decision-making heuristics, psychological/environmental variables.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hand Washing Behavior | Measured via adapted version of a previously validated questionnaire (Hygiene Inventory - 23), which specifically includes (a) 1 item about approximate hand washing frequency on an average day, with response options of whole numbers from 0-29 and an additional option of 30 or more where higher numbers are generally considered better outcomes, (b) 10 items about hand washing behavior in various contexts, with response options of 1 - Never, 2 - Occasionally, 3 - Usually, and 4 - Always where higher scores are considered better outcomes, and (c) 1 item about general hand hygiene using antibacterial gel or wipes, with response options of 1 - Never, 2 - Occasionally, 3 - Usually, and 4 - Always where higher scores are considered better outcomes. | 8 weeks post-enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical Outcomes - General/Internal Medicine | Patient frequency/rate for the following variables measured via electronic medical record: ED visit (respiratory illness/other) ED visit reason (if non-respiratory) Admission (respiratory Illness) Respiratory Illness secondary to COVID19 ICU admission due to respiratory illness ICU admission due to COVID19 Mechanical Respiratory support Duration of Mechanical support (days) Mortality (respiratory Illness/other) | 12 weeks post-enrollment | 
| Clinical Outcomes - Obstetrics & Gynecology | Patient frequency/rate for the following variables measured via electronic medical record: Respiratory Illness at time of Delivery Pre-delivery COVID19 testing Delivery plan altered due to respiratory illness Miscarriage Preterm labor/birth Preeclampsia Respiratory Illness in newborn Newborn COVID19 testing | 12 weeks post-enrollment | 
| Clinical Outcomes - Surgery | Patient frequency/rate for the following variables measured via electronic medical record: Respiratory Illness at time of surgery Pre-Operative COVID19 testing Surgery delayed due to respiratory illness Surgery delayed due to COVID19 positive Adverse outcome secondary to delay in surgery Post operative intubation >2 days Post operative unplanned reintubation Post operative pneumonia Post operative respiratory illness secondary to COVID19 | 12 weeks post-enrollment |