Summary

In 2018, in response to the digital gender divide, the government of Chhattisgarh (a state in central India), launched the ambitious SKY program, providing free smartphones to two million women in rural areas across the state who live in locations with more than 1,000 residents. With this new internet access, women may have better access to information—including health information—that may be accurate or inaccurate. With the arrival of the pandemic, India has been a major source and consumer of Covid-19 and other inaccurate health-related information. While we all have a sense that inaccurate health information is harmful and can impede protective health behaviors, it has been difficult to know if this is true or to get a fix on how harmful it is. To address this gap in our understanding, the research team will compare villages included in the SKY initiative and those not included, allowing them to assess the causal effect of internet access on information-seeking and health-protective behaviors. Researchers will identify who is more susceptible to inaccurate health information (across gender, education, and age distribution), indicating how resources from the global community could be mobilized to target vulnerable communities.

Summary

Hesitancy to take safe vaccines is a long-standing problem that predates Covid-19 and the outbreaks of measles surging in recent years. Some of the most effective interventions for vaccine hesitancy involve counseling sessions with trusted physicians who can address individual concerns. Unfortunately, such approaches are time consuming, costly, and depend on citizens having ready access to trusted primary care physicians. To overcome these barriers, this research team will iteratively develop and test an online, individually-tailored, and interactive video-based decision aid, designed to help people make decisions about vaccines by helping them become informed by a better understanding of their risks and benefits, how vaccines work, and how vaccines are developed.  Using a data efficient, incremental approach to randomized trials, the team will follow-up with participants to test whether engaging with these decision aids increases their uptake of both Covid-19 and influenza vaccines. If impactful, the team will make the final interactive decision aid freely available in both English and Spanish.

Summary

In Tanzania, local radio stations—including station managers, journalists, and DJs—act as trusted messengers and influencers. Early in the Covid-19 pandemic, media restrictions limited the ability of radio to respond to Covid-19. Now, with restrictions loosened, local radio stations generally want to serve their communities with accurate and relevant public health information, but often lack the capacity to do so effectively. An interdisciplinary team will partner with local radio stations to assess a four-month nationwide radio campaign that combines common drama content and radio-specific content relating to a variety of health issues about which inaccurate and misleading information is prevalent. Researchers will randomly assign 25 local radio stations (a mix of for-profit, community, and donor-driven radio) to air this campaign, with another 25 stations acting as a control group. A subset of villages covered by treated radio stations and served by particular health facilities will also receive an in-person mobilization campaign to stimulate audience interest, while a separate study will assess the impact of incentivized exposure to the campaign. Over two years, researchers and radio stations will assess the impact of the program on Covid-19 vaccination knowledge, attitudes, and uptake, as well as trust in and use of essential health services more broadly. Beyond the campaign’s immediate impact, researchers hope that the project will equip interested parties at local radio stations with the knowledge and skills to recognize and dispel inaccurate and misleading information as it emerges.

Summary

Adolescence is a time when youth start engaging more with their own health—and seeking information about their bodies and health choices online. While this is true of adolescents the world over, it can present an extra challenge in contexts of low literacy and limited internet experience. Partnering with JEEViKA (Bihar Rural Livelihoods Promotion Society) and DataLEADS, researchers will evaluate if inoculating against inaccurate health information through a grassroots training program will be effective in addressing the beliefs and behaviors that stem from inaccurate health information among secondary school students in India. In randomly selected schools, students will participate in four two-hour sessions over a period of three months, in which they will learn about the problem of inaccurate health information in India and its consequences, how and why inaccurate and misleading information spreads, and strategies to inoculate against it. The effectiveness of these sessions will be measured by comparing between students in schools with and without these sessions (who will instead receive lessons in conversational English), including students’ self-reported attitudes and identification of inaccurate health information, as well as behavioral outcomes such as whether they flag dubious content online, comply with public health measures, and the quality of their news diet.

Summary

We conducted a “megastudy” with 3.5 million pharmacy patients in November 2022 simultaneously testing eight behaviorally-informed interventions aimed at encouraging Covid-19 booster vaccinations in the United States. Many eligible Americans have not yet received a booster, suggesting a need for new ways of effectively encouraging vaccination to counter inaccurate health information, low motivation, and logistical barriers. Our megastudy testing new means of encouraging booster vaccination was designed by an interdisciplinary team of scientists. We found that sending two sets of vaccination reminders seven days apart resulted in a 20% relative increase in 30-day Covid-19 booster vaccinations and generated a positive spillover effect, increasing 30-day flu vaccinations by 7%. Offering patients free round-trip Lyft rides to pharmacies had no benefit over and above sending simple reminders. Both experts and laypeople incorrectly predicted that offering free rides would outperform sending reminders. In Fall 2023, we are conducting a follow-up, large scale RCT with over 1 million pharmacy patients to further investigate our megastudy’s top-performing intervention.

Summary

Practitioners are currently searching for ways to help people distinguish between true and false information and to reduce the spread of false information in online spaces. Meanwhile, scientists have recently identified and tested a number of interventions aimed to do just that. However, these interventions have each been tested in different conditions with different types of users. Thus, practitioners are left unsure about which interventions will work best for their particular situation. In other words, we have a bunch of problems and a bunch of new tools, but it’s not yet clear which tool is most useful for each problem. A multidisciplinary, multinational team of 80 information experts will work to identify the eight most promising interventions and test their effectiveness with approximately 30,000 participants. The researcher team will then test the most effective interventions on English-speaking YouTube. This process will allow the researchers to create a handbook for practitioners, detailing the relative strengths and weaknesses of each intervention and guiding their choices. There will never be one winning intervention that works for all users and all situations, but the project will help practitioners build a toolkit of useful interventions for inaccurate health information and understand which interventions will be most effective for their particular problem.

Summary

Because misconceptions about Covid-19 and vaccination vary considerably between nations and different demographic groups within them, public health messages are more persuasive when they are tailored and delivered by members of one’s group, including members in online communities. Partnering with grassroots organizations in Brazil, Mexico, and the US, this study will evaluate the effectiveness of health-information messaging generated from members of a given community. Researchers will recruit organizations with online presence in each nation, and ask them to revise currently used Covid-19 messages in order to better appeal to their peers. Using traditional online surveys and randomized evaluations on Facebook and YouTube, researchers will assess how well these community-generated messages fare in improving vaccine attitudes and intentions, relative to the messages currently in use, which have been created by technical experts who represent government and public health organizations. A follow-up study will test how well community generated messaging combats inaccurate health information. Finally, project findings will result in vital insights to the development and validation of a messaging pipeline infrastructure that, once in place, holds great potential to optimize targeted messaging for a variety of public health attitudes/behaviors and subcommunity groups across the world.

Summary

In Haiti, Malawi, and Rwanda, community health workers (CHWs) working with Partners in Health have expressed stress and concern that they do not have all the information and skills they need to encourage vaccination—including for Covid-19—as they work in difficult circumstances and changing information environments. CHWs are the frontline of health information and care, as well as the primary entry point into the larger health system. Researchers working in and with Partners in Health and its local affiliates—Abwenzi Pa Za Umoyo (Malawi), Zanmi Lasante (Haiti), and Inshuti Mu Buzima (Rwanda)—will test a new system to support these trusted health messengers as they in turn support their communities. This SMS- and phone-based system will allow CHWs to identify and report inaccurate health information and raise questions, then receive tailored scripts and guidance to use in their communities. Researchers will randomly select areas around 44 community health clinics to better understand what the CHWs there know and how they are communicating about both Covid-19 and mental health. Partners in Health will then provide 12 months of information messaging to CHWs on one of those topics (also randomly selected). The research teams will periodically measure attitudes and intentions about Covid-19 and about mental health in those communities and track if use of services such as Covid-19 vaccinations changes after CHWs have more accurate, tailored information to share.

Summary

Despite being the first country to receive Covid-19 vaccines through the COVAX Vaccines Global Access facility, the proportion of Ghanaians fully vaccinated remains low. Several studies point to the role of misleading health information and inaccurate beliefs to explain low demand, despite regular outreach activities. Meanwhile, in Ghana, as in similar settings, health workers are trusted by the population for the advice and treatment they provide. In a cluster-randomized controlled trial undertaken in collaboration with the Ghana Health Service, we will compare health facilities maintaining routine operations to others randomized to two low-cost strategies inciting health workers to engage patients and carers during routine consultations and encourage them to get vaccinated against Covid-19. In a light-touch intervention, health workers will receive basic instructions and a monitoring sheet to track discussions with patients. In the other arm, they will be trained in effective communication skills to overcome patients’ vaccine hesitancy. While asking health workers to encourage patients to get vaccinated could successfully leverage their trust capital, there are concerns about health workers’ willingness to add to their existing workload on the one hand, and negative spillovers of having such conversations on the other hand. Through high-frequency data collection over two months, we will carefully monitor the extent to which health workers try to persuade patients, and whether these talks alter patients’ knowledge and beliefs, as well as vaccination uptake. We will also use natural variation in political support to analyze whether political polarization affects these outcomes.

Summary

While fact-checks and digital literacy training can effectively counter inaccurate health information, fact-checks have usually very low reach, and getting social media users to consume such training is challenging. Partnering with fact-checkers AfricaCheck (in Kenya, Nigeria, and South Africa) and ChequeaBolivia, this research team will conduct two studies to test approaches to counter inaccurate health information and change users’ engagement with reliable information. In the first study, in Kenya, South Africa, and Bolivia, the team will recruit 600 positive social media influencers—high-profile journalists and social activists with large followings—interested in countering inaccurate health information among their followers, and provide a randomly selected half of those influencers with digital-literacy—training resources and fact-checks, along with modest financial compensation. They will track followers’ daily online posting and sharing behavior over six months. In the second study, researchers will first test whether providing the fact-checkers in Bolivia, Kenya, Nigeria, and South Africa with data on viral posts by serial spreaders of inaccurate health information improves the quality of their fact-checking. The researchers will choose a random half of spreaders who consistently spread inaccurate health information and share such information with the fact-checkers over a six-month period, and see whether it increases the likelihood that the fact-checkers verify those posts. In Bolivia, the researchers will additionally study the effect of the fact-checker directly reaching out to spreaders of inaccurate health information and their followers to debunk the inaccurate health information they have shared or have been subjected to and provide digital literacy training materials. They will assess whether such reaching out improves the quality of followers’ posting and sharing behavior over six months.

Summary

The Health Ambassadors trial tests a strategy of mobilizing “voices for science” to initiate conversations with those who are hesitant about vaccination. The goal of these encounters is to overcome such hesitancy and promote trust in scientific health information. The broader goal of the intervention strategy is to define an approach that goes beyond unilateral messaging to improve public responses to health emergencies. While Covid-19 motivated the study, the trial will promote adherence to a variety of public health recommendations, including vaccination against diseases other than Covid-19 (e.g., cholera, typhoid, HPV, and Hepatitis B).

Each country team will recruit “health ambassadors” with relevant expertise to be deployed to initiate conversations with the vaccine hesitant, with a focus on urban areas with high population density. In Malawi and Zimbabwe, the ambassadors will be recruited from among the community nurses and health workers currently engaged in the public health system. In Côte d’Ivoire and Senegal, ambassadors will be recruited among graduates from biomedical sciences.  The ambassadors will be trained on a protocol based on the AIMS (Announce, Inquire, Mirror, Secure) methodology. The study will help health authorities to define a scalable strategy for increasing the speed of public uptake of urgent health measures.

Summary

Addressing critical public health challenges, including infectious disease outbreaks and chronic conditions, is essential for societal well-being. Yet, the uptake of vital healthcare resources like vaccines and screenings often falls short. Developing evidence-based interventions to promote positive health behaviors is imperative. To guide effective public health efforts, it is crucial to understand why behavioral interventions succeed in some contexts but not in others, and to examine when deploying a given intervention will be most successful in the field. Our interdisciplinary project combines insights from psychology and behavioral economics, to understand when and among whom behavioral interventions can effectively change individuals’ health behaviors in natural settings as well as how to optimally combine different types of interventions. Leveraging large-scale randomized controlled trials (RCTs), lab experiments, archival data, and machine learning, we will examine a wide range of consequential health behaviors (Covid-19 and flu vaccinations, cancer screening uptake, chronic condition management). The resulting knowledge will help develop nuanced theories of health decision making and advance the scientific frontier of building demand for vaccines and preventive screenings while also helping explain why promising scientific findings fail to replicate in certain settings. Ultimately, this research has the potential to enhance the impact and reach of public health initiatives by offering actionable insights for customizing interventions to specific sub-populations and temporal contexts.

Summary

A major challenge, particularly in low-income countries, is how to increase vaccine uptake in a cost-effective way, especially in difficult-to-reach rural areas. Our previous work in Sierra Leone found that bringing mobile Covid-19 vaccination teams to remote villages quickly increased vaccination rates several fold. Because transportation is the largest cost, this project will test if cost-effectiveness can be improved by bundling more vaccines in the same mobile vaccine teams. Working with the Expanded Programme on Immunization at the Sierra Leone Ministry of Health and Sanitation and their technical partner Concern Worldwide, we are testing if bringing Covid, HPV for 10- to 12-year-old girls, and routine childhood vaccinations to villages together can be effective and cost-effective, with potential for scaling. We are also testing if endorsements from high-level authorities to disseminate accurate vaccine information increases vaccine uptake in the villages.

Summary

Healthcare decisions, including decisions to vaccinate, are an amalgamation of complex cultural, social, and psychological interactions, including perceptions of risk, trust in healthcare, locally relevant norms of behavior, and social learning. Understanding both the proximate as well as ultimate-level drivers of vaccine decision-making is crucial to alleviating the burden of disease, and increasing vaccine uptake. In contrast with the large existing body of work on healthcare decision-making from industrialized countries, our study will take place in a set of rural, underserved communities in northwest Namibia, in a region undergoing rapid market integration. This will allow us to determine how shifts in cultural norms, perceptions of disease, and interactions with national healthcare systems affect the ways people learn about disease and their likelihood of using preventative care measures like vaccines. This region is well-suited for this project because the population consists of multiple ethnic groups with variable levels of market integration, different experiences with colonial powers and systemic discrimination, and varying experience with the healthcare system, all of which we predict will influence future healthcare decisions. Specifically, in collaboration with the University of Namibia, we will examine how local models of illness shape vaccination practice, how individual-level factors—including medical mistrust—shape perceptions and use of the healthcare system, how sociodemographic factors shape vaccine beliefs, and how social learning influences individual vaccination decisions.

Summary

Addressing the spread of inaccurate information online requires learning how social media architectures affect informed decision-making. In search of such an intervention, this team of researchers will conduct one of the most systematic tests to date of the effects of altering information environments by substantially decreasing exposure to untrustworthy sources. Importantly, their intervention will create sustained changes to information exposure over time by encouraging users to mute untrustworthy accounts and measure the effects of this intervention on real-world behavior. In this way, they will assess the extent to which respondents can be nudged to alter the set of accounts to which they are exposed and thus the information they consume and engage with online. Through this study, the team will help popularize a design approach that combines a paired individual-level survey and social media data, providing a new framework for conducting and evaluating online behavioral interventions. Use of this design will provide a building block for future research on the effects of online information exposure on offline behavior. Finally, using the results of this study, researchers will be able to provide important guidance to platforms, policymakers, and researchers about how to most effectively counter inaccurate information about Covid-19 and other topics.

Summary

In Sierra Leone, Covid-19 vaccine demand lags supply. To increase demand for Covid-19 and other vaccines, this research team is partnering with Sierra Leone’s Ministry of Health and Sanitation (MoSH) and Development Media International (DMI) to investigate two complementary approaches to encourage vaccination. Researchers will experimentally evaluate the relative efficacy of trainings on vaccine literacy and detection of inaccurate health information against a control condition among unvaccinated social media users in Freetown. Study outcomes include vaccination uptake, inaccurate health information discernment, demand for formal health information, and vaccine knowledge. Additionally, online (WhatsApp) and offline (in-person) social network information will also be elicited to assess how the interventions impact information-sharing within networks.

Summary

Meta, Twitter, YouTube, and other social media websites have struggled to make effective governance decisions on behalf of billions of users every day, and inaccurate health information continues to run rampant. At an individual level, many users of these systems find themselves trapped in inaccurate health information bubbles, sometimes built inadvertently via the networks they have created. In an attempt to address these challenges, this team of researchers will design, build, and evaluate network-transforming interventions: software-assisted systems to alter underlying networks that spread inaccurate health information online. In this context, a health information monitor Twitter account will continuously track emerging inaccurate health information on English-speaking Twitter and deliver counter-messaging to the recipients of that inaccurate information—with the aim of motivating users to unfollow the source. The research team will introduce a roadmap for information interventions that can operate outside of corporations and governments, fill the gaps left by the constraints of industry and regulation, and promote safe and trustworthy online experiences. 

Summary

Rates of Covid-19 vaccination are low and declining in Senegal, with fewer than 16% of the eligible population currently fully vaccinated. Meanwhile, novel malaria vaccines are scheduled to be released for use in children under the age of five this year. While vaccine hesitancy has contributed to low uptake of the Covid-19 vaccination, it is unclear the extent to which this can be attributed to the low perceived value/convenience of accessing the vaccine as opposed to more explicit refusal of available doses. This study aims to harness the acceptability and high uptake of routine childhood vaccinations administered through Senegal’s Expanded Programme on Immunization to test the impact of offering Covid-19 vaccination/boosters to mothers during regular well-child visits, randomizing messages designed to counter vaccine hesitancy, and bundling with offers of childhood vaccines. Through a cluster randomized control trial with health posts across regions of Senegal, along with formative focus group interviews and discussions with mothers and stakeholders in the Ministry of Health, we aim to develop sustainable and affordable evidence-based interventions that may scale up to the national level and improve our knowledge of the acceptability of Covid-19 and childhood vaccines in Senegal.