A JAMA Network Open study today describes successful deployment of a video tool to improve COVID-19 knowledge, beliefs, and risk-reduction behaviors of Black and White adults.
In the randomized clinical trial, a team led by Harvard Medical School researchers randomly assigned a video message about COVID-19 to 18,233 Black and White adults with less than a college education recruited from Aug 7 to Sep 6, 2020. The goal was to assess whether the messages would increase coronavirus knowledge, information seeking, and protective behaviors if they were tailored to Black adults.
The control group viewed three videos on fitness guidelines, recommended sugar consumption, and the importance of sleep and then completed an outcome survey, while the intervention group saw three videos on COVID-19 delivered by physicians of different ages, sexes, and races.
Video 1 of the intervention group discussed asymptomatic coronavirus spread and common symptoms, and video 2 talked about case numbers and virus circulation in the United States, with one version addressing how Black adults were three times more likely than White adults to test positive for COVID-19 and four times more likely to die from it. Video 3 detailed Centers for Disease Control and Prevention recommendations for physical distancing amid the pandemic.
The researchers also randomly assigned participants in both groups to view videos of an actor reading one of two American Medical Association (AMA) statements, one of them on the detrimental effects of structural racism on health equity and the other on drug price transparency.
Smaller knowledge gaps, more info-seeking
In total, 6,303 Black participants and 7,842 White participants were assigned to the intervention group, while 1,576 Black and 1,968 White participants were assigned to the control group. Median participant age was 40.2 years, 55.9% were women, and 23.8% reported an annual household income of more than $60,000.
At baseline, 68.4% of all participants said they always wore a face mask indoors when away from home, and 31.2% reported always wearing one outdoors. Relative to White participants, Black participants were twice as likely to report always wearing a mask outdoors and were also more likely to say they practiced hand hygiene and physical distancing.
Relative to the control group, the intervention group had smaller gaps in COVID-19 knowledge (incidence rate ratio [IRR], 0.89), more demand for information on the virus (IRR, 1.05), and more willingness to pay for a face covering ($14.07 vs $14.58).
The intervention had more of an effect on White than Black participants in terms of COVID-19 knowledge (IRR, 0.80 vs 0.94), and tailoring the messages to Black adults didn't change differential knowledge or individual behaviors.
The only significant difference was the desire to donate to a Black-directed charity. The combination of the AMA anti-racism statement, a Black physician, and a video talking about racial disparities significantly increased the direction of donations to a Black charity by both Black and White participants (ordinary least squares coefficient, $30.60).
In both groups, self-reported protective behaviors improved, although not to a statistically significant degree (IRR, 0.96). And the effects of the messages did not differ by race in an F test (F=0.0112) or among different intervention groups (F=0.324). No significant differences occurred by sex or political affiliation around the demand for COVID-19 information or willingness to pay for a face mask, although the effect of the intervention on knowledge gaps was larger among participants with at least a high school education.
Disproportionate COVID burden in Black adults
A follow-up survey a few days later among 6,217 people showed that 20.1% of the intervention group and 18.0% of the control group reported taking all four precautions against COVID-19, while 21.6% and 17.4%, respectively, said they took no precautions.
"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," the authors wrote, noting that trust in Black and White physicians appeared equal. "Highlighting health conditions that disproportionately affect the Black community is one step toward increasing public consciousness of structural racism."
The researchers added that the video intervention was inexpensive. "However, future studies implemented at a large scale are needed to confirm whether these kinds of interventions can change behavior in a way that will affect clinical outcomes," they wrote. "In ongoing work, we will study scale up messaging by doctors using social media."
Plain language, improved health literacy
In a commentary in the same journal, Aisha Langford, PhD, MPH, of NYU Langone Health, said that the COVID-19 pandemic highlighted the importance of effective communication in achieving good health outcomes. "Health professionals were tasked with managing fear and uncertainty against the backdrop of what has been called an infodemic (ie, too much information), which included COVID-19 misinformation," she wrote.
Trusted messengers such as physicians can use plain language to combat misinformation, and efforts to increase health literacy can help adults adopt healthy behaviors, seek accurate information, and make informed decisions, Langford added. "In the days ahead, health professionals will need to build vaccine confidence, clearly communicate updates to the COVID-19 science, and support new social norms."
She called for future research into whether the type of physician messenger (eg, primary care, specialist) affects intervention effectiveness and whether other trusted messengers (eg, community health workers, nurses, pharmacists) can achieve comparable results.
"Research is also needed to determine when general and/or mass messages (ie, 1 message for everyone), group-targeted messages (eg, for parents of children aged 12-15 years), and individually tailored messages based on personal characteristics are best used to enhance health knowledge and risk reduction behaviors for COVID-19 and other health conditions," Langford concluded.
