COVID-19 Health Messaging to Underserved Communities

Study Overview
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Brief Summary
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Recent data have shown that covid19 is disproportionately infecting and killing African Americans and Latinx people in the United States. The aim of the study is to determine which messages are most effective at increasing knowledge and changing behaviors that can protect individuals and their communities from the virus. To accomplish this aim, we plan to recruit approximately 20,000 Hispanic and African-American individuals and randomly assign them to videos that vary either the sender or the framing of the message, while providing the relevant public health information.

Detailed Description
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The following procedures will be followed. The research subjects will participate online. Doctors from MGH who express interest in participating will record messages according to our scripts (US Doctors Script African American, US Doctors Script Latinx). They will be instructed to film several different versions each. We will recruit a sample of Latinx and African American study participants from across the country through Lucid, an online survey firm that has access to a large subject pool. Participants will first read a consent script and give us their informed consent (US Doctors Messaging Consent) Participants will then navigate through the following steps Brief demographics survey questions (US Doctors Messaging Survey) Videos 1 and 2: Introduction, Acknowledgement, Social Distancing (US Doctors Script African American, US Doctors Script Latinx). Individuals in the control group will not see videos. Beliefs survey questions (US Doctors Messaging Survey) Video 3: Masks (US Doctors Script African American, US Doctors Script Latinx). Again, individuals in the control group will not see a video here. Main outcomes survey (US Doctors Messaging Survey) Control group is shown a version of all 3 videos at end (US Doctors Script African American, US Doctors Script Latinx). The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will only see messages after all surveying has been completed.

Official Title
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COVID-19 Health Messaging to Underserved Communities

Conditions
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Coronavirus

Intervention / Treatment
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* Behavioral: Messaging


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Hispanic and African-American adult individuals, men and women - oversample of those with less completed education Exclusion Criteria: children, those who do not identify as above

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: Control - CDC - Mask (Control) - Concordant<br>Control Intro, CDC Social Distancing, Mask Control version delivered by minority doctor of same background as the recipient - other definitions are similar | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Control - CDC - Mask (Control) - Discordant<br>Control Intro, CDC Social Distancing, Mask Control version delivered by majority doctor of different background as the recipient - other definitions are similar | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Control - MGH - Mask (Control) - Concordant<br>Control Intro, MGH Social Distancing, Mask Control version delivered by concordant doctor | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Control - MGH - Mask (Control) - Discordant<br>Control Intro, MGH Social Distancing, Mask Control version delivered by discordant doctor | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Ack. Discrimination- MGH - Mask (Control) - Concordant<br>Introduction Acknowledges past discrimination, MGH doctor talks about Social Distancing, Mask Control all by concordant MD | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Ack. Discrimination- MGH - Mask (Control) - Discordant<br>Introduction Acknowledges past discrimination, MGH doctor talks about Social Distancing, Mask Control all by discordant MD | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Ack. econ. circumstance- MGH - Mask (Control ) Concordant<br>Intro econ. circumstance -MGH - Mask (Control ) Concordant | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Ack. econ. circumstance - MGH - Mask (Control ) Discordant<br> | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Control Intro - CDC - Mask (antiStigma) Concordant<br>Control Intro - CDC - Mask (antiStigma) Concordant messenger | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Control Intro - CDC - Mask (antiStigma) Discordant<br>Control Intro - CDC - Mask (antiStigma) discordant messenger | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Control - MGH - MaskS (antiStigma) Concordant messenger<br>Control - MGH - MaskS (antiStigma) Concordant sender | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Control- MGH-MaskS (antiStigma) Discordant messenger<br>Control - MGH - MaskS (antiStigma) Discordant sender | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Ack. Discrimination - MGH - MaskS (antiStigma) Concordant<br>Acknowledge Discrimination - MGH - MaskS (antiStigma) Concordant sender | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Ack. Discrimination - MGH - MaskS (antiStigma) Discordant<br>Acknowledge Discrimination - MGH - MaskS (antiStigma) Discordant sender | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Ack. Econ Hardship- MGH - Mask (antiStigma) Concordant<br>Acknowledge Econ Hardship- MGH - Mask (antiStigma) Concordant sender | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Experimental: Ack. Econ Hardship- MGH - Mask (antiStigma) Discordant<br>Acknowledge Econ Hardship- MGH - Mask (antiStigma) discordant sender | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<br>|
| Placebo Comparator: Info later - Pure Control<br>This group will not receive the videos but will receive information later. | Behavioral: Messaging<br>* o The video messages each participant in one of the treatment groups sees will be randomized on the following dimensions. The different versions are clearly demarcated in the US Doctors Scripts document. Racial or ethnic identity of the doctor delivering the messages: concordant vs. discordant identity to the subject. Whether the message includes an acknowledgment of elephant in the room issues for each target group: trust in the medical system or fear of deportation. Whether the social distancing component of the message is delivered by Dr. Birx of the CDC or recorded by the MGH physicians. Whether individuals are given information about how representative individuals perceive mask wearers of color. This information comes from results of our nationally representative pilot survey. Some individuals in a control group will see messages later.<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 | Incidence rate for knowledge gaps is the count of knowledge gaps divided by the maximum possible count: 7 | The outcome was measured immediately following the intervention in the 15-minute baseline survey. | 
| Incidence Rate for Information-seeking Behavior: Control vs. Any Intervention | Incidence rate for Information-seeking behavior is the count of links demanded divided by the maximum possible count: 10 | The outcome was measured immediately following the intervention in the 15-minute baseline survey. | 
| Incidence Rate for Knowledge Gaps by Intervention | Incidence rate for knowledge gaps is the count of knowledge gaps divided by the maximum possible count: 7 | The outcome was measured immediately following the intervention in the 15-minute baseline survey. | 
| Incidence Rate for Information-seeking Behavior by Intervention | Incidence rate for Information-seeking behavior is the count of links demanded divided by the maximum possible count: 10 | The outcome was measured immediately following the intervention in the 15-minute baseline survey. |