Abstract

Ensuring people know and follow health recommendations is essential to stopping the spread of COVID-19. In Zambia, researchers are measuring the impact of a peer information sharing strategy on people’s learning and adherence to COVID-19 health protocols. This study is part of a three-country research program aiming to find evidence on the most effective strategies to communicate health measures.

Policy Issue

As of late January 2021, COVID-19 has infected over 100 million people worldwide and killed over 2.1 million.¹ Human behavior is a critical factor in determining the severity of epidemics, since individuals and societies can either fuel or slow the spread of contagious diseases.² To decrease the rates of infection, people must change their behaviors in accordance with health recommendations. This requires that they learn, trust, and apply various health measures. People may trust information shared with them by their peers more than they would trust information shared by third parties, such as companies or government agencies. How can health officials and policymakers communicate information in such a way that people effectively adjust their behavior?

In the United States, Ghana, and Zambia, researchers are conducting three randomized evaluations to test different information campaign strategies to promote adherence to preventative health guidelines. Because researchers are conducting these evaluations in high- and low-income countries, the studies will analyze how individuals’ knowledge and decision-making shape different public health patterns and will provide evidence applicable across a range of contexts.

Context of the Evaluation

In Zambia, over 42,000 cases of COVID-19 and nearly 600 deaths have been reported as of late January 2021.^[3 COVID-19 is a contagious respiratory disease whose severity varies among individuals: some people do not have symptoms but can transmit the virus, while others have serious medical complications that can lead to death. Despite the discovery of new COVID-19 vaccines, they are not widely available in many countries, including in Zambia. Therefore, the best way to prevent the disease is to wear a mask, wash hands frequently, and keep distance from others.⁴ Governments have adopted different strategies to promote these measures among the population, but there is limited evidence on which strategies are the most effective at increasing adherence to COVID-19 guidelines.

Details of the Intervention

In Zambia, researchers are measuring the impact of a peer information sharing strategy on people’s learning and adherence to COVID-19 health protocols. All of the 20,000 study participants will receive text messages with information on COVID-19 safety. The messages, formulated in conjunction with Zambia’s Ministry of Health, provide key facts about the ways COVID-19 can spread and concrete steps to reduce transmission. In particular, the messages encourage destigmatization of COVID-19 and promote three main behaviors: wearing masks in public, washing hands, and avoiding blaming others. The text messages also will ask recipients to share the contact information for five friends.

Then, researchers will randomly assign the 20,000 text message recipients to one of the four groups:

• Group 1: Participants are asked to forward the COVID-19 informational messages to five friends without receiving a financial incentive.
• Group 2: Participants are asked to forward the COVID-19 informational messages to five friends, and in exchange they are offered a financial inventive of an amount equivalent to the daily median wage.
• Group 3: The research team, under the auspices of a local health authority, forwards the COVID-19 informational messages to the participant’s five friends.
• Comparison group: Participants receive no further intervention

All participants will receive minor compensation (US$1) for their participation, and users in Groups 1 and 2 will also receive compensation for the cost of sending the text messages to friends. This compensation is different from the financial incentive for Group 2. The research team will survey the original 20,000 participants and their contacts to see which information sharing strategy is most successful to promote social distancing, handwashing, and mask-wearing.

Results and Policy Lessons

Project ongoing; results forthcoming.

Sources

¹ Johns Hopkins University (JHU) “COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE)”.