Clinical trial NCT04568889: Minnesota COVID-19 Testing Project
Official title: Minnesota COVID-19 Testing Project
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Covid19
Infectious Disease
Keywords: COVID-19
Minnesota
Unit nonresponse
Item nonresponse
Lead sponsor: Harvard University
Sponsor class: OTHER
Collaborators: name: Abdul Latif Jameel Poverty Action Lab
name: Government of Minnesota Office of Management and Budget
First posted: 2020-09-29
Enrollment: 561
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The goal of this project is to help the state of Minnesota understand why individuals are not getting tested and potentially identify trusted individuals or organizations that could be used in follow-up work to send messages. Investigators focus on the first two issues of unit and item nonresponse, which is not random across the population and thus could lead to nonresponse bias. To do so, investigators are deploying flyers through 10 Twin City area food shelves and potentially through public housing units with information on how to answer an online questionnaire.

Detailed description: In the United States, recent statistics show that African American and Latinx communities bear a disproportionate burden from COVID-19. Reaching vulnerable and underserved populations is therefore crucial to combating the disease. However, most public messaging campaigns are not targeted toward underserved communities and don't address fears of social stigma, mistrust in the healthcare system, or concerns about immigration status.

The goal of this project is to help the state of Minnesota understand why individuals are not getting tested and potentially identify trusted individuals or organizations that could be used in follow-up work to send messages. To do so, investigators are deploying flyers through 10 Twin City area food shelves and potentially through public housing units with information on how to answer an online questionnaire.

This provides us with an opportunity to study who answers surveys and why - and what questions are particularly sensitive. This is of general interest to academicians and policymakers alike.

The quality of household surveys is in decline, for three main reasons. First, households have become increasingly less likely to answer surveys at all (unit nonresponse). Second, those that respond are less likely to answer certain questions (item nonresponse). Third, when households do provide answers, they are less likely to be accurate (measurement error). This is important since household surveys help to estimate the employment rate, healthcare needs and of course the census determines resources/representation.

Investigators focus on the first two issues of unit and item nonresponse, which is not random across the population and thus could lead to nonresponse bias. Census tracts with predominantly Hispanic or Black residents had significantly lower response rates to the American Community Survey as compared to the response rates in predominantly white tracts. Similarly, response rates to the Health Information National Trends Survey (HINTS) were lower in areas with higher levels of Hispanic and minority residents.

Investigators hypothesize that financial incentives may encourage unit response; conversely, a close association with the government may discourage response. To test these hypotheses, investigators plan to cross-randomize the incentive amount offered and the emphasis placed on government involvement in the study on flyers advertising the baseline survey. Individuals will see either a) a 10 dollar incentive, or b) a 20 dollar incentive; and either a) messaging that emphasizes government involvement in the study, or b) messaging that emphasizes the involvement of academic researchers. Flyers will be randomized at the foodshelf-day level.

To test what affects item non-response on potentially sensitive questions, such as questions which ask for health information, investigators hypothesize that ethical framing may encourage individuals to answer questions. This takes two forms --- the deontological (or duty based) frame, and the consequential (or cost-benefit) frame. Moreover, knowing others feel the same way (regarding the obligation or benefits of providing health information) may amplify motivation. Finally, there is the possibility that emphasizing the importance of ethnic and racial disadvantage associated with COVID-19 outcomes may be important for improving item non-response on sensitive questions.

Upon completion of the demographic module of the survey but prior to starting several potentially sensitive survey modules, individuals will see a message that either a) emphasizes the public health benefits of answering the survey questions (cost-benefit frame); b) emphasizes an individual's responsibility to their community (duty frame); c) emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups; or d) provides no messaging. Messaging content will be randomized at the individual level.

Eligibility criteria: Inclusion Criteria:

* All participants who are aged 18 or above and speak English or Spanish

Exclusion Criteria:

* Children, those who do not identify as above or adults who identify as above but do not agree to participate in survey during the consent stage.

Primary outcomes:
measure: Effect of monetary incentives in increasing unit response 1
timeFrame: This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
measure: Effect of monetary incentives in increasing unit response 2
timeFrame: This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
measure: Effect of a government frame in reducing unit response 1
timeFrame: This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
measure: Effect of a government frame in reducing unit response 2
timeFrame: This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
measure: Interactions between monetary incentives and a government frame 1
timeFrame: This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
measure: Interactions between monetary incentives and a government frame 2
timeFrame: This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.
measure: Interactions between monetary incentives and a government frame 3
timeFrame: This outcome will be assessed during the 20-minute Baseline Survey.
measure: Interactions between monetary incentives and a government frame 4
timeFrame: This outcome will be assessed during the 20-minute Baseline Survey.
measure: Demographic characteristics of participants assigned into each treatment arm
timeFrame: This outcome will be assessed during the 20-minute Baseline Survey.
measure: Effect of various messaging frames in increasing item non-response
timeFrame: This outcome will be assessed during the 20-minute Baseline Survey.
Secondary outcomes:
Other outcomes:
Locations:
city: Bloomington
country: United States
facility: Volunteers Enlisted to Assist People
state: Minnesota
city: Columbia Heights
country: United States
facility: Southern Anoka Community Assistance
state: Minnesota
city: Eden Prairie
country: United States
facility: People Reaching Out to People Food Shelf
state: Minnesota
city: Fridley
country: United States
facility: Fridley Covenant Church
state: Minnesota
city: Minneapolis
country: United States
facility: Calvary Lutheran Church Food Shelf
state: Minnesota
city: Minneapolis
country: United States
facility: NorthPoint Health and Wellness
state: Minnesota
city: Minneapolis
country: United States
facility: Community Emergency Assistance Programs
state: Minnesota
city: Minnetonka
country: United States
facility: Intercongregation Communities Association
state: Minnesota
city: Stillwater
country: United States
facility: Valley Outreach
state: Minnesota
city: White Bear Lake
country: United States
facility: White Bear Area Foodshelf
state: Minnesota
Study officials:
affiliation: Harvard Kennedy School
name: Marcella Alsan, MD, MPH, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Griffin, DH. Measuring survey nonresponse by race and ethnicity. In Proceedings of the Annual Meetings of the American Statistical Association. 2002; 11-15.
citation: Maitland A, Lin A, Cantor D, Jones M, Moser RP, Hesse BW, Davis T, Blake KD. A Nonresponse Bias Analysis of the Health Information National Trends Survey (HINTS). J Health Commun. 2017 Jul;22(7):545-553. doi: 10.1080/10810730.2017.1324539. Epub 2017 May 30.
citation: Meyer, Bruce D., Wallace KC Mok, and James X. Sullivan. Household surveys in crisis. Journal of Economic Perspectives. 2015; 29(4): 199-226.