Use of Behavioral Economics in Repeat SARS-CoV-2 (COVID-19) Antibody Testing in Disadvantaged Communities

Study Overview
=================
Brief Summary
-----------------
Repeat testing for SARS-CoV-2 antibodies in disadvantaged communities will help identify active and recovered infections over time, and as more is understood about antibody protection, it may help identify persons who have immunity. Many questions about social barriers and behavioral facilitators remain unanswered. This project aims to evaluate the effectiveness of risk-based messaging and incentives that promote repeated testing for SARS-CoV-2 antibodies, as well as to understand social and behavioral determinants of COVID-19 testing and variations within sub-groups of this population.

Detailed Description
-----------------
The rapid spread of the SARS-CoV-2 virus has greatly impacted underserved populations. This project aims to understand social and behavioral determinants of COVID-19 testing and variations within sub-groups of this population. In partnership with the largest federally qualified health center in the United States, investigators will collect survey data and conduct a randomized experiment on 2,160 individuals (540 families) to evaluate the effectiveness of risk-based messaging and incentives that promote repeated testing for SARS-CoV-2 antibodies. In a 2 x 2 (Messaging x Incentive) factorial experiment, participants complete a comprehensive set of social and behavioral surveys to identify determinants of commitment to testing. Participants are then randomized to receive customized messaging promoting repeated testing. Messaging will focus upon either (1a) household risk or (1b) personal risk of COVID-19. Participants are also randomly assigned to an incentive condition that either (2a) insures against losing baseline rewards for initial testing, or (2b) entry into a lottery with a small chance to win $150 if both tests are completed. Both the loss protection and lottery conditions carry the same incentive costs. Previous work in similar populations demonstrates that adherence to planned health behaviors is higher with insurance-based incentives than cash payments of equal value. This experiment compares insurance-based incentives to lottery incentives that have been shown to be effective in multiple contexts. Finally, the investigators evaluate if social and behavioral determinants of health result in heterogeneous treatment effects that can inform customization of incentive offerings in future programs devoted to increasing uptake of testing or vaccinations among underserved populations.

Official Title
-----------------
Use of Behavioral Economics in Repeat SARS-CoV-2 (COVID-19) Antibody Testing in Disadvantaged Communities

Conditions
-----------------
SARS-CoV-2

Intervention / Treatment
-----------------
* Behavioral: Family Risk Messaging
* Behavioral: Personal Risk Messaging
* Behavioral: Loss Protection
* Behavioral: Lottery Incentive


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Adults and children 5 years of age and older Exclusion Criteria: Children under 5 years of age

Ages Eligible for Study
-----------------
Minimum Age: 5 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Personal Risk + Loss Protection<br>Personal Risk + Loss Protection | Behavioral: Personal Risk Messaging<br>* Personal risk framing may engender concern for oneself. Households randomized to personal risk messaging will receive the following message: Antibody testing will help you understand your risk of getting COVID-19.<br>Behavioral: Loss Protection<br>* Household members are offered a baseline incentive with a 90% (9 in 10) chance of $60 and receive insurance on winning the baseline incentive for repeat antibody testing.<br>|
| Experimental: Personal Risk + Lottery Incentive<br>Personal Risk + Lottery Incentive | Behavioral: Personal Risk Messaging<br>* Personal risk framing may engender concern for oneself. Households randomized to personal risk messaging will receive the following message: Antibody testing will help you understand your risk of getting COVID-19.<br>Behavioral: Lottery Incentive<br>* Household members are offered a baseline incentive with a 90% (9 in 10) chance of $60 and receive a bonus lottery incentive with a 4 small (1 in 25) chance of winning $150 for repeat antibody testing.<br>|
| Experimental: Family Risk + Loss Protection<br>Family Risk + Loss Protection | Behavioral: Family Risk Messaging<br>* Family risk framing may engender concern for loved ones. It may also make it easier to mentally simulate family burdens with COVID-19 such as knowing how several people in the family becoming sick could adversely affect the lives of everyone in the family. Households randomized to family risk messaging will receive the following message: Antibody testing will help you understand your family's risk of getting COVID-19.<br>Behavioral: Loss Protection<br>* Household members are offered a baseline incentive with a 90% (9 in 10) chance of $60 and receive insurance on winning the baseline incentive for repeat antibody testing.<br>|
| Experimental: Family Risk + Lottery Incentive<br>Family Risk + Lottery Incentive | Behavioral: Family Risk Messaging<br>* Family risk framing may engender concern for loved ones. It may also make it easier to mentally simulate family burdens with COVID-19 such as knowing how several people in the family becoming sick could adversely affect the lives of everyone in the family. Households randomized to family risk messaging will receive the following message: Antibody testing will help you understand your family's risk of getting COVID-19.<br>Behavioral: Lottery Incentive<br>* Household members are offered a baseline incentive with a 90% (9 in 10) chance of $60 and receive a bonus lottery incentive with a 4 small (1 in 25) chance of winning $150 for repeat antibody testing.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Attendance rate at Time 2 SARS-CoV-2 antibody test | Effectiveness of risk-based messaging and incentives to encourage attendance at Time 2 testing for SARS-CoV-2 antibodies | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Social and behavioral determinants of antibody testing | Characterize barriers to access, bias, risk attitude and incentive preferences assessed through survey responses | 6 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
antibodies