Can incentivized peer-to-peer health communication promote preventative health behaviors?
Social networks play a critical role in economic and health behaviors. Goldberg previously tested the impact of peer messaging on tuberculosis (TB) testing rates in India. Individuals were incentivized to share information about getting screened for TB with their peers by receiving a small payment any time their peers was tested. Compared to messaging shared by health officials, peer outreach was more effective in increasing testing rates. Additionally, this strategy was highly cost effective. Goldberg concluded that financial incentives increased the sharing of health information.
As reported in an NBER Working Paper, the team attempted to test this theory in the context of preventing COVID-19 in Zambia. A randomized controlled trial was employed in which participants were grouped into one of four conditions:
- Participants received a message and were asked to forward it to their peers
- Participants received a message and were given financial incentive to forward it to their peers
- Participants and peer participants received a message and were not asked to forward it to anyone
- Participants received a message and were not asked to forward it to anyone (Control group)
Participants were more likely to forward messages when asked to do so. However, individuals who received health messaging from health officials were more likely to seek out COVID-19 testing, and financial incentives did not increase the likelihood of individuals forwarding messages. Additionally, precautionary health behaviors (e.g., masking, hand washing, avoiding gatherings) did not differ between the control group or any other group, nor did peer messaging result in a difference in health behaviors compared to messaging from health officials.
Goldberg posits that these differences between the Indian and Zambian contexts may be explained by the state of mass information at the time of experimentation. COVID-19 messaging via social media and newspapers was ubiquitous, so the messaging disseminated in the study may not have increased knowledge as much as it did for TB prevention in India. Additionally, the Zambian participants only had to forward the message to receive payment, whereas the Indian participants only received payment after their peers had been screened for TB. Thus, the lack of enforceability may have contributed to the lesser effectiveness of the prevention strategy in Zambia.
