Use of Behavioral Economics in Repeat SARS-CoV-2 Antibody Testing in Disadvantaged Communities

Abstract: The rapid spread of the SARS-CoV-2 virus has greatly impacted underserved populations. Thisproject aims to understand social and behavioral determinants of COVID-19 testing andvariations within sub-groups of this population. In partnership with the largest federally qualifiedhealth center in the United States, we will collect survey data and conduct a randomizedexperiment on 2,160 individuals (540 families) to evaluate the effectiveness of risk-basedmessaging 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 ofsocial and behavioral surveys to identify determinants of commitment to testing. They are thenrandomized by strata identified in the survey to receive personalized messaging promotingrepeated testing. Messaging will focus upon either (1a) their household risk or (1b) theirpersonal risk of COVID-19. They are also randomly assigned to either an incentive conditionthat (2a) insures against losing baseline rewards for initial testing, or (2b) that enters them into alottery with a small chance to win $100 if they complete both tests. Both the insurance andlottery conditions carry the same incentive costs. Our previous work in similar populationsdemonstrated that adherence to planned health behaviors is higher with insurance-basedincentives than cash payments of equal value. This experiment compares insurance-basedincentives to lottery incentives that have been shown to be effective in multiple contexts. Finally,we evaluate if social and behavioral determinants of health result in heterogeneous treatmenteffects that can inform customization of incentive offerings in future programs devoted toincreasing uptake of testing or vaccinations among underserved populations.