Effect of Physician-Delivered Messages on Adults’ COVID-19 Knowledge, Beliefs, and Practices | Health Disparities | JN Learning | AMA Ed Hub [Skip to Content]
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Effect of Physician-Delivered COVID-19 Public Health Messages and Messages Acknowledging Racial Inequity on Black and White Adults’ Knowledge, Beliefs, and Practices Related to COVID-19A Randomized Clinical Trial

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Do messages delivered by physicians increase COVID-19 knowledge and improve preventive behaviors among White and Black individuals?

Findings  In this randomized clinical trial of 18 223 White and Black adults, a message delivered by a physician increased COVID-19 knowledge and shifted information-seeking and self-protective behaviors. Effects did not differ by race, and tailoring messages to specific communities did not exhibit a differential effect on knowledge or individual behavior.

Meaning  These findings suggest that physician messaging campaigns may be effective in persuading members of society from a broad range of backgrounds to seek information and adopt preventive behaviors to combat COVID-19.

Abstract

Importance  Social distancing is critical to the control of COVID-19, which has disproportionately affected the Black community. Physician-delivered messages may increase adherence to these behaviors.

Objectives  To determine whether messages delivered by physicians improve COVID-19 knowledge and preventive behaviors and to assess the differential effectiveness of messages tailored to the Black community.

Design, Setting, and Participants  This randomized clinical trial of self-identified White and Black adults with less than a college education was conducted from August 7 to September 6, 2020. Of 44 743 volunteers screened, 30 174 were eligible, 5534 did not consent or failed attention checks, and 4163 left the survey before randomization. The final sample had 20 460 individuals (participation rate, 68%). Participants were randomly assigned to receive video messages on COVID-19 or other health topics.

Interventions  Participants saw video messages delivered either by a Black or a White study physician. In the control groups, participants saw 3 placebo videos with generic health topics. In the treatment group, they saw 3 videos on COVID-19, recorded by several physicians of varied age, gender, and race. Video 1 discussed common symptoms. Video 2 highlighted case numbers; in one group, the unequal burden of the disease by race was discussed. Video 3 described US Centers for Disease Control and Prevention social distancing guidelines. Participants in both the control and intervention groups were also randomly assigned to see 1 of 2 American Medical Association statements, one on structural racism and the other on drug price transparency.

Main Outcomes and Measures  Knowledge, beliefs, and practices related to COVID-19, demand for information, willingness to pay for masks, and self-reported behavior.

Results  Overall, 18 223 participants (9168 Black; 9055 White) completed the survey (9980 [55.9%] women, mean [SD] age, 40.2 [17.8] years). Overall, 6303 Black participants (34.6%) and 7842 White participants (43.0%) were assigned to the intervention group, and 1576 Black participants (8.6%) and 1968 White participants (10.8%) were assigned to the control group. Compared with the control group, the intervention group had smaller gaps in COVID-19 knowledge (incidence rate ratio [IRR], 0.89 [95% CI, 0.87-0.91]) and greater demand for COVID-19 information (IRR, 1.05 [95% CI, 1.01-1.11]), willingness to pay for a mask (difference, $0.50 [95% CI, $0.15-$0.85]). Self-reported safety behavior improved, although the difference was not statistically significant (IRR, 0.96 [95% CI, 0.92-1.01]; P = .08). Effects did not differ by race (F = 0.0112; P > .99) or in different intervention groups (F = 0.324; P > .99).

Conclusions and Relevance  In this study, a physician messaging campaign was effective in increasing COVID-19 knowledge, information-seeking, and self-reported protective behaviors among diverse groups. Studies implemented at scale are needed to confirm clinical importance.

Trial Registration  ClinicalTrials.gov Identifier: NCT04502056

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: May 9, 2021.

Published: July 14, 2021. doi:10.1001/jamanetworkopen.2021.17115

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Torres C et al. JAMA Network Open.

Corresponding Author: Esther Duflo, PhD, Department of Economics, Massachusetts Institute of Technology, 77 Massachusetts Ave, Building E52-544, Cambridge, MA 02139 (eduflo@mit.edu).

Author Contributions: Dr Duflo had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Torres, Ogbu-Nwobodo, Alsan, Banerjee, Breza, Chandrasekhar, Eichmeyer, Goldsmith-Pinkham, Olken, Vautrey, Duflo.

Acquisition, analysis, or interpretation of data: Ogbu-Nwobodo, Stanford, Banerjee, Breza, Chandrasekhar, Karnani, Loisel, Goldsmith-Pinkham, Olken, Vautrey, Warner, Duflo.

Drafting of the manuscript: Ogbu-Nwobodo, Alsan, Stanford, Chandrasekhar, Loisel, Olken, Vautrey, Warner, Duflo.

Critical revision of the manuscript for important intellectual content: Torres, Ogbu-Nwobodo, Stanford, Banerjee, Breza, Eichmeyer, Karnani, Goldsmith-Pinkham, Olken, Warner.

Statistical analysis: Breza, Chandrasekhar, Karnani, Loisel, Goldsmith-Pinkham, Olken, Vautrey, Duflo.

Obtained funding: Breza, Goldsmith-Pinkham, Duflo.

Administrative, technical, or material support: Torres, Alsan, Stanford, Breza, Karnani, Goldsmith-Pinkham, Warner.

Supervision: Torres, Ogbu-Nwobodo, Breza, Vautrey, Duflo.

Conflict of Interest Disclosures: Dr Olken reported receiving ad credits from Facebook outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by grant 2029880 from the National Science Foundation to Drs Alsan and Duflo, the Physician/Scientist Development Award from the Executive Committee on Research at Massachusetts General Hospital to Dr Stanford, grant P30 DK040561from the National Institutes of Health to Dr Stanford, grant L30 DK118710 from the National Institutes of Health to Dr Stanford, and the Clinician-Teacher Development Award from the Massachusetts General Physicians Organization at Massachusetts General Hospital to Dr Torres.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Members: The members of the COVID-19 Working Group appear in Supplement 3.

Disclaimer: The findings and conclusions expressed are solely those of the authors and do not represent the views of their funders.

Data Sharing Statement: See Supplement 4.

Additional Contributions: We thank the Center for Diversity and Inclusion, especially Sandra Pena Ordonez, BS, and Elena Olson, JD for their assistance in this project. We thank Minjeong Joyce Kim, BS (Stanford University), and Sirena Yu (Massachusetts Institute of Technology), for their research assistance. These individuals were not compensated for their time.

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