Covid-19 Messaging to Underserved Communities - 2nd Experiment

Study Overview
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Brief Summary
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The aim of the study is to build off results from our first experiment (NCT04371419) , and test whether messages that acknowledge racial injustice on behalf of institutions affect the retention of knowledge and movement of beliefs and behavior with respect to Covid-19. The investigators will also test the effect of concordance of providers and whether highlighting the unequal burden of the disease has additional effects on knowledge, beliefs and behavior regarding covid-19. The sample will include African American and white adult Americans and oversample those with less than a college degree.

Detailed Description
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Recent data have shown that covid19 is disproportionately infecting and killing African Americans and Latinx people in the United States. Moreover, since our last experiment, the killing of George Floyd by Minnesota police has raised awareness of structural racism in the United States. The aim of the study is to build off results from our first experiment (NCT04371419) , and test whether messages that acknowledge racial injustice on behalf of institutions affect the retention of knowledge and movement of beliefs and behavior with respect to Covid-19. The investigators will also test the effect of concordance of providers and whether highlighting the unequal burden of the disease has additional effects on knowledge, beliefs and behavior regarding covid-19.The sample will include African American and white adult Americans and oversample those with less than a college degree.

Official Title
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Covid-19 Messaging to Underserved Communities - 2nd Experiment

Conditions
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Covid19

Intervention / Treatment
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* Behavioral: Acknowledgement Racial Injustice AMA
* Behavioral: African American Sender Acknowledgement
* Behavioral: African American Sender in Informational Videos.
* Behavioral: Racial Inequality Highlighted
* Behavioral: AMA Acknowledgement Drug Pricing
* Behavioral: White Sender in Acknowledgement
* Behavioral: White Sender in Informational Videos
* Behavioral: No Racial Inequality Highlighting
* Behavioral: Placebo videos


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adults who self-identify as African American or white. an oversample of individuals with less than a college education Exclusion Criteria:

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 |
| --- | --- |
| Experimental: AMA RI - B- B - R<br>Respondents will be randomized to an AMA statement acknowledging racial injustice read by an African American individual. The messenger / doctor in the follow-up AMA videos will also be African American - the message on Covid-19 will include information on the disproportionate impact on communities of color. | Behavioral: Acknowledgement Racial Injustice AMA<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants will receive a AMA statement on racial injustice.<br>Behavioral: African American Sender Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a African American sender in acknowledgment of AMA<br>Behavioral: African American Sender in Informational Videos.<br>* Investigators will vary the sender of the informational covid-19 videos. In this arm, participants receive a African American sender in informational videos.<br>Behavioral: Racial Inequality Highlighted<br>* Investigators will include information on race-specific covid-19 cases and deaths in one variation in the messaging. In this arm, participants receive disproportionate race-specific Covid-19 facts<br>|
| Experimental: AMA RI - B - B - N<br>Respondents will be randomized to an AMA statement acknowledging racial injustice read by an African American individual. The messenger / doctor in the follow-up AMA videos will also be African American - the message on Covid-19 will not include information on the disproportionate impact on communities of color. | Behavioral: Acknowledgement Racial Injustice AMA<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants will receive a AMA statement on racial injustice.<br>Behavioral: African American Sender Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a African American sender in acknowledgment of AMA<br>Behavioral: African American Sender in Informational Videos.<br>* Investigators will vary the sender of the informational covid-19 videos. In this arm, participants receive a African American sender in informational videos.<br>Behavioral: No Racial Inequality Highlighting<br>* In this arm, the disproportionate burden of Covid-19 on communities of color will not be highlighted<br>|
| Experimental: AMA RI - W - W - R<br>Respondents will be randomized to an AMA statement acknowledging racial injustice read by a white individual. The messenger / doctor in the follow-up AMA videos will be white - the message on Covid-19 will include information on the disproportionate impact on communities of color. | Behavioral: Acknowledgement Racial Injustice AMA<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants will receive a AMA statement on racial injustice.<br>Behavioral: Racial Inequality Highlighted<br>* Investigators will include information on race-specific covid-19 cases and deaths in one variation in the messaging. In this arm, participants receive disproportionate race-specific Covid-19 facts<br>Behavioral: White Sender in Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm, participants receive a white sender in the acknowledgement<br>Behavioral: White Sender in Informational Videos<br>* Investigators will vary the messenger of the informational covid-19 videos. In this arm, participants receive white sender in the informational video<br>|
| Experimental: AMA RI - W - W - N<br>Respondents will be randomized to an AMA statement acknowledging racial injustice read by a white individual. The messenger / doctor in the follow-up AMA videos will be white - the message on Covid-19 will not include information on the disproportionate impact on communities of color. | Behavioral: Acknowledgement Racial Injustice AMA<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants will receive a AMA statement on racial injustice.<br>Behavioral: White Sender in Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm, participants receive a white sender in the acknowledgement<br>Behavioral: White Sender in Informational Videos<br>* Investigators will vary the messenger of the informational covid-19 videos. In this arm, participants receive white sender in the informational video<br>Behavioral: No Racial Inequality Highlighting<br>* In this arm, the disproportionate burden of Covid-19 on communities of color will not be highlighted<br>|
| Experimental: AMA DP - B- B - R<br>Respondents will be randomized to an AMA statement acknowledging drug pricing read by an African American individual. The messenger / doctor in the follow-up AMA videos will also be African American - the message on Covid-19 will include information on the disproportionate impact on communities of color . | Behavioral: African American Sender Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a African American sender in acknowledgment of AMA<br>Behavioral: African American Sender in Informational Videos.<br>* Investigators will vary the sender of the informational covid-19 videos. In this arm, participants receive a African American sender in informational videos.<br>Behavioral: Racial Inequality Highlighted<br>* Investigators will include information on race-specific covid-19 cases and deaths in one variation in the messaging. In this arm, participants receive disproportionate race-specific Covid-19 facts<br>Behavioral: AMA Acknowledgement Drug Pricing<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants receive AMA information on drug pricing<br>|
| Experimental: AMA DP - B- B - N<br>Respondents will be randomized to an AMA statement acknowledging drug pricing read by an African American individual. The messenger / doctor in the follow-up AMA videos will also be African American - the message on Covid-19 will not include information on the disproportionate impact on communities of color. | Behavioral: African American Sender Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a African American sender in acknowledgment of AMA<br>Behavioral: African American Sender in Informational Videos.<br>* Investigators will vary the sender of the informational covid-19 videos. In this arm, participants receive a African American sender in informational videos.<br>Behavioral: AMA Acknowledgement Drug Pricing<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants receive AMA information on drug pricing<br>Behavioral: No Racial Inequality Highlighting<br>* In this arm, the disproportionate burden of Covid-19 on communities of color will not be highlighted<br>|
| Experimental: AMA DP - W- W - R<br>Respondents will be randomized to an AMA statement acknowledging drug pricing read by a white individual. The messenger / doctor in the follow-up AMA videos will be white - the message on Covid-19 will include information on the disproportionate impact on communities of color. | Behavioral: Racial Inequality Highlighted<br>* Investigators will include information on race-specific covid-19 cases and deaths in one variation in the messaging. In this arm, participants receive disproportionate race-specific Covid-19 facts<br>Behavioral: AMA Acknowledgement Drug Pricing<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants receive AMA information on drug pricing<br>Behavioral: White Sender in Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm, participants receive a white sender in the acknowledgement<br>Behavioral: White Sender in Informational Videos<br>* Investigators will vary the messenger of the informational covid-19 videos. In this arm, participants receive white sender in the informational video<br>|
| Experimental: AMA DP - W- W - N<br>Respondents will be randomized to an AMA statement acknowledging drug pricing read by a white individual. The messenger / doctor in the follow-up AMA videos will be white - the message on Covid-19 will not include information on the disproportionate impact on communities of color. | Behavioral: AMA Acknowledgement Drug Pricing<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants receive AMA information on drug pricing<br>Behavioral: White Sender in Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm, participants receive a white sender in the acknowledgement<br>Behavioral: White Sender in Informational Videos<br>* Investigators will vary the messenger of the informational covid-19 videos. In this arm, participants receive white sender in the informational video<br>Behavioral: No Racial Inequality Highlighting<br>* In this arm, the disproportionate burden of Covid-19 on communities of color will not be highlighted<br>|
| Placebo Comparator: Control: AMA RI - B - B<br>Respondents will be randomized to an AMA statement acknowledging racial injustice read by an African American individual. The messenger / doctor in the follow-up AMA videos will also be African American - No message on Covid-19 will be shown. Acknowledgement Racial Injustice AMA: Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants will receive a AMA statement on racial injustice. African American Sender Acknowledgement: Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a African American sender in acknowledgment of AMA | Behavioral: Acknowledgement Racial Injustice AMA<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants will receive a AMA statement on racial injustice.<br>Behavioral: African American Sender Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a African American sender in acknowledgment of AMA<br>Behavioral: African American Sender in Informational Videos.<br>* Investigators will vary the sender of the informational covid-19 videos. In this arm, participants receive a African American sender in informational videos.<br>Behavioral: Placebo videos<br>* Videos not related to covid-19 will be shown<br>|
| Placebo Comparator: Control: AMA RI - W - W<br>Respondents will be randomized to an AMA statement acknowledging racial injustice read by a white individual. The messenger / doctor in the follow-up AMA videos will also be white - No message on Covid-19 will be shown. Acknowledgement Racial Injustice AMA: Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants will receive a AMA statement on racial injustice. White Sender Acknowledgement: Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a white sender in acknowledgment of AMA | Behavioral: Acknowledgement Racial Injustice AMA<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants will receive a AMA statement on racial injustice.<br>Behavioral: White Sender in Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm, participants receive a white sender in the acknowledgement<br>Behavioral: White Sender in Informational Videos<br>* Investigators will vary the messenger of the informational covid-19 videos. In this arm, participants receive white sender in the informational video<br>Behavioral: Placebo videos<br>* Videos not related to covid-19 will be shown<br>|
| Placebo Comparator: Control: AMA DP - B - B<br>Respondents will be randomized to an AMA statement acknowledging drug pricing read by an African American individual. The messenger / doctor in the follow-up AMA videos will also be African American - No message on Covid-19 will be shown. African American Sender Acknowledgement: Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a African American sender in acknowledgment of AMA AMA Acknowledgement Drug Pricing: Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants receive AMA information on drug pricing | Behavioral: African American Sender Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a African American sender in acknowledgment of AMA<br>Behavioral: African American Sender in Informational Videos.<br>* Investigators will vary the sender of the informational covid-19 videos. In this arm, participants receive a African American sender in informational videos.<br>Behavioral: AMA Acknowledgement Drug Pricing<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants receive AMA information on drug pricing<br>Behavioral: Placebo videos<br>* Videos not related to covid-19 will be shown<br>|
| Placebo Comparator: Control: AMA DP - W - W<br>Respondents will be randomized to an AMA statement acknowledging drug pricing read by a white individual. The messenger / doctor in the follow-up AMA videos will also be white - No message on Covid-19 will be shown. White Sender Acknowledgement: Investigators will also vary the messenger of the acknowledgement sender. In this arm participants receive a white sender in acknowledgment of AMA AMA Acknowledgement Drug Pricing: Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants receive AMA information on drug pricing | Behavioral: AMA Acknowledgement Drug Pricing<br>* Investigators will examine whether acknowledgements of racial inequality are helpful towards improving knowledge retention and behaviors associated with the intervention among participants. In this arm, participants receive AMA information on drug pricing<br>Behavioral: White Sender in Acknowledgement<br>* Investigators will also vary the messenger of the acknowledgement sender. In this arm, participants receive a white sender in the acknowledgement<br>Behavioral: White Sender in Informational Videos<br>* Investigators will vary the messenger of the informational covid-19 videos. In this arm, participants receive white sender in the informational video<br>Behavioral: Placebo videos<br>* Videos not related to covid-19 will be shown<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence Rate for Knowledge Gaps: Control vs. Any Intervention | Participants were asked to identify ways to prevent COVID-19 spread and identify four common symptoms. The incidence rate for knowledge gaps is the count of knowledge gaps divided by the maximum possible count: 10. | The outcome was measured immediately following the intervention in the baseline survey. | 
| Incidence Rate for Knowledge Gaps: Control vs. Any Intervention - Follow up | Participants were asked to identify ways to prevent COVID-19 spread and identify four common symptoms. Incidence rate for knowledge gaps is the count of knowledge gaps divided by the maximum possible count: 10. | The outcome was measured at a follow-up within 2 weeks following the intervention | 
| Incidence Rate for Information-seeking Behavior: Control vs. Any Intervention | Participants were offered the option of requesting additional information on COVID-19 related resources by clicking on up to five links that included more content. We measured information seeking behavior as the number of links for which participants expressed interest, a count variable between 0 (lowest information seeking behavior) and 5 (greatest information seeking behavior). Incidence rate for interest in links is the count of links demanded divided by the maximum possible count: 5. | The outcome was measured immediately following the intervention in the baseline survey. | 
| Incidence Rate - Safety Gap Score: Control vs. Any Intervention | Participants were asked about how often they engaged in four behaviors of interest: if they wore a mask indoors/outdoors; if they washed their hands; if they followed social distancing guidelines. The safety gap index takes values of 0 (if a participant reported that they always practiced the four behaviors of interest) up to 4 (none). Incidence rate for safety gaps is the count of safety gaps divided by the maximum possible count: 4. | The outcome was measured at a follow-up within 2 weeks following the intervention. | 
| Willingness to Pay (WTP) for Masks: Control vs. Any Intervention | WTP: the participants will be asked to choose between two masks vs an unrestricted gift card. They will be asked what amount of gift card would make them just as happy to receive two mask versus the gift card. | The outcome was measured immediately following the intervention in the baseline survey. | 
| Incidence Rate Ratio (IRR) - Knowledge Gap | Participants were asked to identify ways to prevent COVID-19 spread and identify four common symptoms. The incidence rate for knowledge gaps is the count of knowledge gaps divided by the maximum possible count: 10. The incidence rate ratio compares the incidence rate of participants in Arm A vs. Arm B within the intervention group (i.e. those who received covid-19-related videos), within in the control group (i.e. those who saw placebo videos), or across the intervention and control group. Arms A and B are described in each Arm/Group Title. The overall number of participants analyzed is all equal across 6 arms/groups because the outcome measure data presented below came from a single negative binomial regression. | The outcome was measured immediately following the intervention in the baseline survey. | 
| Incidence Rate Ratio (IRR) - Knowledge Gap - Follow up | Participants were asked to identify ways to prevent COVID-19 spread and identify four common symptoms. The incidence rate for knowledge gaps is the count of knowledge gaps divided by the maximum possible count: 10. The incidence rate ratio compares the incidence rate of participants in Arm A vs. Arm B within the intervention group (i.e. those who received covid-19-related videos), within in the control group (i.e. those who saw placebo videos), or across the intervention and control group. Arms A and B are described in each Arm/Group Title. The overall number of participants analyzed is all equal across 6 arms/groups because the outcome measure data presented below came from a single negative binomial regression. | The outcome was measured at a follow-up within 2 weeks following the intervention | 
| Incidence Rate Ratio (IRR) - Information-seeking Behavior | Participants were offered the option of requesting additional information on COVID-19 related resources by clicking on up to 5 links that included more content. We measured information seeking behavior as the number of links for which participants expressed interest, a count variable between 0 (lowest information seeking behavior) and 5 (greatest information seeking behavior). Incidence rate for interest in links is the count of links demanded divided by the maximum possible count: 5. The incidence rate ratio compares the incidence rate of participants in Arm A vs. Arm B within the intervention group (i.e. those who received covid-19-related videos), within in the control group (i.e. those who saw placebo videos), or across the intervention and control group. Arms A and B are described in each Arm/Group Title. The overall number of participants analyzed is all equal across 6 arms/groups because the outcome measure data presented below came from a single negative binomial regression. | The outcome was measured immediately following the intervention in the baseline survey. | 
| Incidence Rate Ratio (IRR) - Safety Gap Score | Participants were asked about how often they engaged in four behaviors of interest: if they wore a mask indoors/outdoors; if they washed their hands; if they followed social distancing guidelines. The safety gap index takes values of 0 (if a participant reported that they always practiced the four behaviors of interest) up to 4 (none). Incidence rate for safety gaps is the count of safety gaps divided by the maximum possible count: 4. The incidence rate ratio compares the incidence rate of participants in Arm A vs. Arm B within the intervention group (i.e. those who received covid-19-related videos), within in the control group (i.e. those who saw placebo videos), or across the intervention and control group. Arms A and B are described in each Arm/Group Title. The overall number of participants analyzed is all equal across 6 arms/groups because the outcome measure data presented below came from a single negative binomial regression. | The outcome was measured at a follow-up within 2 weeks following the intervention. | 
| OLS Regression Coefficients - Willingness to Pay (WTP) for Masks | WTP: the participants will be asked to choose between two masks vs an unrestricted gift card. They will be asked what amount of gift card would make them just as happy to receive two mask versus the gift card. The regression coefficients compares the incidence rate of participants in Arm A vs. Arm B within the intervention group (i.e. those who received covid-19-related videos), within in the control group (i.e. those who saw placebo videos), or across the intervention and control group. Arms A and B are described in each Arm/Group Title. The overall number of participants analyzed is all equal across 6 arms/groups because the outcome measure data presented below came from a single ordinary least squares (OLS) regression for WTP masks). | The outcome was measured immediately following the intervention in the baseline survey. |