Can Improved Public Health Messaging Address COVID-19 Disparities?
By Amy Finkelstein, PhD
March 19, 2021
Amy Finkelstein is the John and Jennie S. MacDonald Professor of Economics at the Massachusetts Institute of Technology, the director and a research associate of the Health Program at the National Bureau of Economic Research, and co-scientific director of J-PAL North America. Her areas of specialization are public finance and health economics.
It’s been well documented that communities of color — especially Black, Latinx, and Native American communities — have been hit disproportionately hard by COVID-19. They’ve experienced higher infection and mortality rates than their white counterparts, while also being underrepresented in early vaccine distribution.
These disparities stem from a complex web of factors, including unequal access to health care, gaps in educational attainment, and occupational differences. Knowledge gaps around COVID-19 symptoms and transmission may also play a role, perhaps reflecting the paucity of public health messages directly addressing communities of color and their specific concerns.
Motivated by the role that lack of information may play in contributing to disparities, researchers Esther Duflo, Marcella Alsan and Fatima Cody Stanford, along with a team of other physicians and economists, conducted a randomized controlled trial last May to evaluate the effectiveness of physician-delivered video messages in increasing COVID-19 related knowledge and health information-seeking behavior.
Approximately 15,000 self-identified Black and Latinx individuals were recruited via an online survey platform to participate in the study. One in nine participants were randomly assigned to a control group, while the rest were assigned to the intervention group.
In the intervention group, participants were shown three videos which covered: (1) major COVID symptoms and preventive practices, (2) social distancing advice and (3) mask-wearing information. Some participants were randomly selected to view videos that included (1) acknowledgment of the difficulties faced by communities of color in accessing health services and/or (2) information about perceptions of mask-wearing in the community. In addition, for each set of videos, the researchers randomly varied whether the physician in the video was white or matched the participant’s race or ethnicity.
The researchers measured how many COVID-19 knowledge questions the participants answered correctly and how many informational web links they clicked on after watching the videos (the control group answered the same questions and were offered the same web links before watching the videos).
The results showed that, relative to the control group, watching any combination of the three video messages reduced COVID-19 knowledge gaps but had no significant impact on health information-seeking behavior. The magnitudes of these effects were similar for both Black and Latinx individuals. The researchers found that viewing videos delivered by race/ethnic-concordant physicians did not affect COVID-19 knowledge retention for either Black or Latinx respondents. However, it did increase health information-seeking behavior for Black individuals.
While this study did have limitations (researchers couldn’t assess whether participants’ actual behavior changed or if their knowledge increases were sustained), these findings underscore the importance of public health messaging for increasing COVID-19 knowledge among Black and Latinx communities, especially as we strive to get as many people as possible vaccinated. Recent polling data has shown that vaccine acceptance has risen among many Black and Latinx adults who wanted more information before getting the vaccine — the so-called “wait and see” group — and continued targeted education from race-concordant physicians could accelerate this uptake increase.
With the government set to invest $1.5 billion in a vaccine confidence PR campaign in the coming weeks and months — and other groups like white men and Republicans still reluctant to get vaccinated in large numbers — making sure we provide the right information to the right groups from the right messengers will be critical.
Disclaimer: Amy Finkelstein is married to Ben Olken, one of the co-investigators of this study.