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| ID | Type | Description | Link |
|---|---|---|---|
| 3R33AG057395-04S1 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| AltaMed Health Services Corporation | OTHER |
| National Institute on Aging (NIA) | NIH |
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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Personal Risk + Loss Protection | Experimental | Personal Risk + Loss Protection |
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| Personal Risk + Lottery Incentive | Experimental | Personal Risk + Lottery Incentive |
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| Family Risk + Loss Protection | Experimental | Family Risk + Loss Protection |
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| Family Risk + Lottery Incentive | Experimental | Family Risk + Lottery Incentive |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Family Risk Messaging | Behavioral | 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." |
| 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 |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jason Doctor, PhD | University of Southern California | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| AltaMed Health | Los Angeles | California | 90022 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37258079 | Derived | Doctor JN, Berg AH, Knight TK, Kadono M, Stewart E, Sonik R, Hochman M, Sood N. Cross-sectional study examining household factors associated with SARS-CoV-2 seropositivity in low-income children in Los Angeles. BMJ Open. 2023 May 31;13(5):e070291. doi: 10.1136/bmjopen-2022-070291. |
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We drew a simple random sample of patient households without replacement from AltaMed registry. Each household sampled was contacted to identify eligibility and interest. Households met inclusion criteria if at least one member was a patient at AltaMed and the household contained at least one adult and at least one member 5 to 17 years of age.
Between June 2021 and December 2022, potential participants were contacted by phone by a bilingual coordinator and invited to participate in a study about COVID-19.
| ID | Title | Description |
|---|---|---|
| FG000 | Personal Risk + Loss Protection | Personal Risk + Loss Protection Personal Risk Messaging: 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." Loss Protection: 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. |
| FG001 | Personal Risk + Lottery Incentive | Personal Risk + Lottery Incentive Personal Risk Messaging: 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." Lottery Incentive: 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. |
| FG002 | Family Risk + Loss Protection | Family Risk + Loss Protection Family Risk Messaging: 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." Loss Protection: 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. |
| FG003 | Family Risk + Lottery Incentive | Family Risk + Lottery Incentive Family Risk Messaging: 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." Lottery Incentive: 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. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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Households who completed baseline survey and agreed to Time 1 antibody testing.
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| ID | Title | Description |
|---|---|---|
| BG000 | Personal Risk + Loss Protection | Personal Risk + Loss Protection Personal Risk Messaging: 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." Loss Protection: 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. |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | 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 | Participants who attended Time 1 antibody testing. | Posted | Count of Participants | Participants | 6 months |
|
6 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Personal Risk + Loss Protection | Personal Risk + Loss Protection Personal Risk Messaging: 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." Loss Protection: 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. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Jason Doctor | University of Southern California | 213.821.8142 | jdoctor@usc.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 20, 2021 | Jun 3, 2024 | Prot_SAP_000.pdf |
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| Personal Risk Messaging | Behavioral | 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." |
|
| Loss Protection | Behavioral | 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. |
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| Lottery Incentive | Behavioral | 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. |
|
| BG001 | Personal Risk + Lottery Incentive | Personal Risk + Lottery Incentive Personal Risk Messaging: 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." Lottery Incentive: 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. |
| BG002 | Family Risk + Loss Protection | Family Risk + Loss Protection Family Risk Messaging: 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." Loss Protection: 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. |
| BG003 | Family Risk + Lottery Incentive | Family Risk + Lottery Incentive Family Risk Messaging: 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." Lottery Incentive: 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. |
| BG004 | Total | Total of all reporting groups |
| years |
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| Sex/Gender, Customized | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| OG001 |
| Personal Risk + Lottery Incentive |
Personal Risk + Lottery Incentive Personal Risk Messaging: 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." Lottery Incentive: 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. |
| OG002 | Family Risk + Loss Protection | Family Risk + Loss Protection Family Risk Messaging: 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." Loss Protection: 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. |
| OG003 | Family Risk + Lottery Incentive | Family Risk + Lottery Incentive Family Risk Messaging: 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." Lottery Incentive: 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. |
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| Secondary | Social and Behavioral Determinants of Antibody Testing | Characterize barriers to access, bias, risk attitude and incentive preferences assessed through survey responses | This analysis was conducted on heads of households who completed the baseline survey. | Posted | Count of Participants | Participants | 6 months |
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|
|
|
| 0 |
| 626 |
| 0 |
| 626 |
| 0 |
| 626 |
| EG001 | Personal Risk + Lottery Incentive | Personal Risk + Lottery Incentive Personal Risk Messaging: 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." Lottery Incentive: 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. | 0 | 550 | 0 | 550 | 0 | 550 |
| EG002 | Family Risk + Loss Protection | Family Risk + Loss Protection Family Risk Messaging: 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." Loss Protection: 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. | 0 | 539 | 0 | 539 | 0 | 539 |
| EG003 | Family Risk + Lottery Incentive | Family Risk + Lottery Incentive Family Risk Messaging: 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." Lottery Incentive: 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. | 0 | 449 | 0 | 449 | 0 | 449 |
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| Reported the most trusted source of COVID-19 information is their medical provider |
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| Scored <=5 on risk aversion scale of 0-10, with 0 being more risk averse and 10 more risk prone |
|
Comparison of Time 2 attendance between study arms among respondents who indicated that money was the biggest barrier to getting the vaccine.
| Regression, Logistic |
| 0.098 |
| Slope |
| 0.50 |
| Standard Error of the Mean |
| 0.30 |
| 2-Sided |
| 95 |
| -0.09 |
| 1.10 |
| Superiority |
| Comparison of Time 2 attendance between study arms among respondents who indicated that money was the biggest barrier to getting the vaccine. | Regression, Logistic | 0.982 | Slope | 0.01 | Standard Error of the Mean | 0.37 | 2-Sided | 95 | -0.71 | 0.73 | Superiority |
| Comparison of Time 2 attendance between study arms among respondents who indicated that their medical provider was the most trusted source of COVID-19 information. | Regression, Logistic | 0.177 | Slope | -0.27 | Standard Error of the Mean | 0.20 | 2-Sided | 95 | -0.67 | 0.12 | Superiority |
| Comparison of Time 2 attendance between study arms among respondents who indicated that their medical provider was the most trusted source of COVID-19 information. | Regression, Logistic | 0.117 | Slope | 0.33 | Standard Error of the Mean | 0.21 | 2-Sided | 95 | -0.08 | 0.74 | Superiority |
| Comparison of Time 2 attendance between study arms among respondents who indicated that their medical provider was the most trusted source of COVID-19 information. | Regression, Logistic | 0.809 | Slope | 0.05 | Standard Error of the Mean | 0.23 | 2-Sided | 95 | -0.39 | 0.50 | Superiority |
| Comparison of Time 2 attendance between study arms among respondents who scored below or equal to 5 on the risk aversion scale (scale of 0-10, with 0 being more risk averse and 10 being more risk prone). | Regression, Logistic | 0.847 | Slope | 0.04 | Standard Error of the Mean | 0.19 | 2-Sided | 95 | -0.34 | 0.41 | Superiority |
| Comparison of Time 2 attendance between study arms among respondents who scored below or equal to 5 on the risk aversion scale (scale of 0-10, with 0 being more risk averse and 10 being more risk prone). | Regression, Logistic | 0.993 | Slope | -0.002 | Standard Error of the Mean | 0.20 | 2-Sided | 95 | -0.39 | 0.38 | Superiority |
| Comparison of Time 2 attendance between study arms among respondents who scored below or equal to 5 on the risk aversion scale (scale of 0-10, with 0 being more risk averse and 10 being more risk prone). | Regression, Logistic | 0.671 | Slope | -0.09 | Standard Error of the Mean | 0.22 | 2-Sided | 95 | -0.51 | 0.33 | Superiority |