Minnesota COVID-19 Testing Project

Not Applicable

Completed

• Conditions: Covid19; Infectious Disease
• Interventions: Behavioral: A $20 Survey Incentive; Behavioral: A $10 Survey Incentive; Behavioral: Emphasis of Government Involvement; Behavioral: Emphasis of Academic Researchers Involvement; Behavioral: Cost-Benefit Frame; Behavioral: Duty Frame; Behavioral: Racial/Ethnic Frame; Behavioral: No Messaging

• Registration Number: NCT04568889
• Lead Sponsor: Harvard University

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.

Study Timeline

• Study First Submitted: 2020-09-24
• Study First Submitted QC: 2020-09-25
• Study Start: 2020-09-28
• Study First Posted: 2020-09-29
• Primary Completion: 2022-08-31
• Study Completion: 2022-08-31
• Status Verified: 2022-10
• Last Update Submitted: 2022-10-12
• Last Update Posted: 2022-10-14

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 561

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.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Researchers/High Incentive/Cost-Benefit Frame	Cost-Benefit Frame	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Government/High Incentive/Cost-Benefit Frame	Cost-Benefit Frame	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Government/High Incentive/Racial/Ethnic Frame	Emphasis of Government Involvement	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Government/High Incentive/Cost-Benefit Frame	A $20 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Government/High Incentive/Duty Frame	Emphasis of Government Involvement	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Government/High Incentive/Duty Frame	Duty Frame	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Government/High Incentive/Racial/Ethnic Frame	Racial/Ethnic Frame	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Government/High Incentive/No Message Frame	No Messaging	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.
Government/High Incentive/Cost-Benefit Frame	Emphasis of Government Involvement	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Government/High Incentive/Racial/Ethnic Frame	A $20 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Government/High Incentive/No Message Frame	Emphasis of Government Involvement	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.
Government/High Incentive/Duty Frame	A $20 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Government/High Incentive/No Message Frame	A $20 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.
Researchers/High Incentive/Cost-Benefit Frame	A $20 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Researchers/High Incentive/Cost-Benefit Frame	Emphasis of Academic Researchers Involvement	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Researchers/High Incentive/Duty Frame	A $20 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Researchers/High Incentive/Duty Frame	Emphasis of Academic Researchers Involvement	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Researchers/High Incentive/Racial/Ethnic Frame	Racial/Ethnic Frame	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Researchers/High Incentive/Duty Frame	Duty Frame	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Researchers/High Incentive/Racial/Ethnic Frame	A $20 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Researchers/High Incentive/Racial/Ethnic Frame	Emphasis of Academic Researchers Involvement	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Researchers/High Incentive/No Message Frame	A $20 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.
Researchers/High Incentive/No Message Frame	Emphasis of Academic Researchers Involvement	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.
Researchers/Low Incentive/Racial/Ethnic Frame	Racial/Ethnic Frame	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Researchers/Low Incentive/Duty Frame	Duty Frame	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Researchers/High Incentive/No Message Frame	No Messaging	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.
Government/Low Incentive/Duty Frame	A $10 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Government/Low Incentive/No Message Frame	A $10 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.
Researchers/Low Incentive/Cost-Benefit Frame	A $10 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Researchers/Low Incentive/Racial/Ethnic Frame	A $10 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Researchers/Low Incentive/Racial/Ethnic Frame	Emphasis of Academic Researchers Involvement	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Government/Low Incentive/Cost-Benefit Frame	A $10 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Researchers/Low Incentive/Duty Frame	Emphasis of Academic Researchers Involvement	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Government/Low Incentive/Cost-Benefit Frame	Emphasis of Government Involvement	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Government/Low Incentive/Cost-Benefit Frame	Cost-Benefit Frame	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Government/Low Incentive/Racial/Ethnic Frame	A $10 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Government/Low Incentive/No Message Frame	No Messaging	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.
Researchers/Low Incentive/Cost-Benefit Frame	Cost-Benefit Frame	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Researchers/Low Incentive/No Message Frame	Emphasis of Academic Researchers Involvement	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.
Researchers/Low Incentive/No Message Frame	No Messaging	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.
Government/Low Incentive/Duty Frame	Emphasis of Government Involvement	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Government/Low Incentive/Duty Frame	Duty Frame	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Government/Low Incentive/Racial/Ethnic Frame	Emphasis of Government Involvement	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Government/Low Incentive/Racial/Ethnic Frame	Racial/Ethnic Frame	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.
Government/Low Incentive/No Message Frame	Emphasis of Government Involvement	The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.
Researchers/Low Incentive/Cost-Benefit Frame	Emphasis of Academic Researchers Involvement	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).
Researchers/Low Incentive/Duty Frame	A $10 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).
Researchers/Low Incentive/No Message Frame	A $10 Survey Incentive	The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.

Primary Outcome Measures

Name	Time	Method
Effect of monetary incentives in increasing unit response 1	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.	Number of participants who received a flyer that mentions a $20 incentive and completed the survey
Effect of a government frame in reducing unit response 2	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.	Number of participants who received a flyer that mentions a research frame and completed the survey.
Interactions between monetary incentives and a government frame 1	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.	Number of participants who received a flyer that mentions a government frame and $20 incentive and completed the survey
Effect of monetary incentives in increasing unit response 2	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.	Number of participants who received a flyer that mentions a $10 incentive and completed the survey.
Interactions between monetary incentives and a government frame 3	This outcome will be assessed during the 20-minute Baseline Survey.	Number of participants who received a flyer that mentions a researcher frame and $20 incentive and completed the survey
Effect of a government frame in reducing unit response 1	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.	Number of participants who received a flyer that mentions a government frame and completed the survey
Demographic characteristics of participants assigned into each treatment arm	This outcome will be assessed during the 20-minute Baseline Survey.	Demographic characteristics (e.g. sex, education level, income level, race/ethnicity) of participants who are assigned to each treatment arm and completed the survey.
Effect of various messaging frames in increasing item non-response	This outcome will be assessed during the 20-minute Baseline Survey.	Number of survey participants who are randomly assigned to receive each messaging frame that: 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.
Interactions between monetary incentives and a government frame 2	This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.	Number of participants who received a flyer that mentions a government frame and $10 incentive and completed the survey
Interactions between monetary incentives and a government frame 4	This outcome will be assessed during the 20-minute Baseline Survey.	Number of participants who received a flyer that mentions a researcher frame and $10 incentive and completed the survey

Trial Locations

Locations (10)

Volunteers Enlisted to Assist People; 🇺🇸 Bloomington, Minnesota, United States

Southern Anoka Community Assistance; 🇺🇸 Columbia Heights, Minnesota, United States

People Reaching Out to People Food Shelf; 🇺🇸 Eden Prairie, Minnesota, United States

Fridley Covenant Church; 🇺🇸 Fridley, Minnesota, United States

Calvary Lutheran Church Food Shelf; 🇺🇸 Minneapolis, Minnesota, United States

NorthPoint Health and Wellness; 🇺🇸 Minneapolis, Minnesota, United States

Community Emergency Assistance Programs; 🇺🇸 Minneapolis, Minnesota, United States

Intercongregation Communities Association; 🇺🇸 Minnetonka, Minnesota, United States

Valley Outreach; 🇺🇸 Stillwater, Minnesota, United States

White Bear Area Foodshelf; 🇺🇸 White Bear Lake, Minnesota, United States