Precious Information: Getting Interpretable, Actionable Health Communications Data.

Doing high-quality health communications requires high-quality data, both to describe information environments and diets and as outcomes for program evaluations that seek to change them and the behaviors they foster. When we understand where people gather information, what they learn there, and how it encourages them to act, we can better diagnose where to focus energy and resources-for example, whether to amplify high-quality sources, address low-quality information, or fill information voids with actionable ideas. Too often, however, researchers collect data in ways that conflate the sources of information, the channels through which information is communicated, and the content of that information. This thwarts opportunities to identify specific problems and opportunities. We call for conceptual precision to make good use of respondents' time, to be good stewards of funders' money, and to effectively address the large challenges we face in encouraging protective, pro-social health behaviors.

Does highlighting COVID-19 disparities reduce or increase vaccine intentions? evidence from a survey experiment in a diverse sample in New York State prior to vaccine roll-out.

Racial identity and political partisanship have emerged as two important social correlates of hesitancy towards COVID-19 vaccines in the United States. To examine the relationship of these factors with respondents' intention to vaccinate before the vaccine was available (November/December, 2020), we employed a multi-method approach: a survey experiment that randomized a vaccine-promotion message focused on racial equity in vaccine targeting, stepwise regression to identify predictors of hesitancy, and qualitative analysis of open-ended survey questions that capture how respondents reason about vaccination intentions. Experimental manipulation of a racial equity vaccine promotion message via an online survey experiment had no effect on intention-to-vaccinate in the full sample or in racial, ethnic and partisan subsamples. Descriptively, we find heightened hesitancy among non-Hispanic Black respondents (OR = 1.82, p<0.01), Hispanics (OR = 1.37, p<0.05), Trump voters (OR = 1.74, p<0.01) and non-Voters/vote Other (OR = 1.50, p<0.01) compared with non-Hispanic White respondents and Biden voters. Lower trust in institutions, individualism and alternative media use accounted for heightened hesitancy in Trump voters, but not non-Hispanic Blacks and Hispanics. Older age and female gender identity also persistently predicted lower vaccine intentions. Qualitatively, we find that most hesitant responders wanted to 'wait-and-see,' driven by generalized concerns about the speed of vaccine development, and potential vaccine side-effects, but little mention of conspiracy theories. Identity appears to be an important driver of vaccinate hesitancy that is not fully explained by underlying socioeconomic or attitudinal factors; furthermore, hesitancy was not significantly affected by racial equity messages in this setting.

Cash, COVID-19 and aid cuts: a mixed-method impact evaluation among South Sudanese refugees registered in Kiryandongo settlement, Uganda.

OBJECTIVES: In this paper, we estimate the impact after 4-8 months of a large one-off unconditional cash transfer delivered to refugees during a time of dual shocks: the COVID-19 pandemic and cuts to monthly aid. We focus on four key outcomes: (1) health-seeking behaviour; (2) COVID-19 specific preventive health practices; (3) food security and (4) psychological well-being. METHODS: We use both quantitative and qualitative data to understand the impact of a cash transfer in this context. Quantitatively, we use a baseline survey of 1200 households (Q4 2019) and follow-up with three rounds of phone surveys in Q2 and Q3 2021, capturing at least half the sample in each round. We exploit an experimental variation in the timing of the cash transfer to assess the effect of the cash transfer through ordinary least squares regressions of intention to treat. Controlling for key baseline characteristics, we analyse the effect of the cash transfer on health access, COVID-19 health practices, food security and psychological well-being. Qualitatively, we make use of a longitudinal, small-n sample of refugee respondents, each of whom we interviewed up to 15 times between February and September 2020 to understand change over time and to go deeper into key topics. RESULTS: We do not find a statistically significant effect (6.2%, p=0.188) of receiving the cash transfer on preventative measures against COVID-19. However, households receiving the cash transfer were more food secure, with a 14.4% (p=0.011) improvement on the food security index, have better psychological well-being (24.5%, p=0.003) and are more likely to seek healthcare in the private health facilities (10.4%, p=0.057) as compared with control households. We do not find significant results on the value of food consumption. Overall, we find stronger treatment effects for households that were the first to receive the cash transfers. CONCLUSION: Taken together, we find significant support for the importance of cash transfers to refugee households mitigating against declines in food security and mental well-being in the face of shocks.

Health Insurance Loss during COVID-19 May Increase Support for Universal Health Coverage.

CONTEXT: The United States is the only high-income country that relies on employer-sponsored health coverage to insure a majority of its population. Millions of Americans lost employer-sponsored health insurance during the COVID-19-induced economic downturn. We examine public opinion toward universal health coverage policies in this context. METHODS: Through a survey of 1,211 Americans in June 2020, we examine the influence of health insurance loss on support for Medicare for All (M4A) and the Affordable Care Act (ACA) in two ways. First, we examine associations between pandemic-related health insurance loss and M4A support. Second, we experimentally prime some respondents with a vignette of a sympathetic person who lost employer-sponsored coverage during COVID-19. FINDINGS: We find that directly experiencing recent health insurance loss is strongly associated (10 pp, p < 0.01) with greater M4A support and with more favorable views of extending the ACA (19.3 pp, p < 0.01). Experimental exposure to the vignette increases M4A support by 6 pp (p = 0.05). CONCLUSIONS: In the context of the COVID-19 pandemic, situational framings can induce modest change in support for M4A. However, real-world health insurance losses are associated with larger differences in support for M4A and with greater support for existing safety net policies such as the ACA.

Influence of Organizational Structure and Administrative Processes on the Performance of State-Level Malaria Programs in Nigeria.

Abstract-Studies have found links between organizational structure and performance of public organizations. Considering the wide variation in uptake of malaria interventions and outcomes across Nigeria, this exploratory study examined how differences in administrative location (a dimension of organizational structure), the effectiveness of administrative processes (earmarking and financial control, and communication), leadership (use of data in decision making, state ownership, political will, and resourcefulness), and external influences (donor influence) might explain variations in performance of state malaria programs in Nigeria. We hypothesized that states with malaria program administrative structures closer to state governors will have greater access to resources, greater political support, and greater administrative flexibility and will therefore perform better. To assess these relationships, we conducted semistructured interviews across three states with different program administrative locations: Akwa-Ibom, Cross River, and Niger. Sixty-five participants were identified through a snowballing approach. Data were analyzed using a thematic framework. State program performance was assessed across three malaria service delivery domains (prevention, diagnosis, and treatment) using indicators from Nigeria Demographic and Health Surveys conducted in 2008 and 2013. Cross River State was best performing based on 2013 prevention data (usage of insecticide-treated bednets), and Niger State ranked highest in diagnosis and treatment and showed the greatest improvement between 2008 and 2013. We found that organizational structure (administrative location) did not appear to be determinative of performance but rather that the effectiveness of administrative processes (earmarking and financial control), strong leadership (assertion of state ownership and resourcefulness of leaders in overcoming bottlenecks), and donor influences differed across the three assessed states and may explain the observed varying outcomes.

The impact of text message reminders on adherence to antimalarial treatment in northern Ghana: a randomized trial.

BACKGROUND: Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens. METHODS: Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression. RESULTS: 1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252). CONCLUSION: The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency. TRIAL REGISTRATION: ClinicalTrials.gov NCT01722734.

Methodological considerations for studying diabetes: understandings and actions in Chennai, India.

As per the World Health Organization's global noncommunicable disease (NCD) strategy, data on health perceptions and behaviours are critical to designing and tailoring interventions to slow rising NCD prevalence and the toll on public health and economic well-being. Intervention planning, implementation, monitoring, and evaluation require understanding the relevant public's sense of personal risk, prevention awareness, and willingness to undertake preventative measures, as well as structural barriers impeding engagement in healthy behaviours, seeking treatment, and managing illness. This article details the design features and challenges of a study focused on the aforementioned features in Chennai, India. These features and challenges have relevance across Asia. As such, communication and collaboration between Asian researchers and program planners can enrich results for all involved. Establishing such a forum should be high on Asia's global health agenda.