A physician-based messaging campaign led to increased Covid-19 knowledge, information-seeking, and self-reported protective behaviors across a cohort of both Black and White patients, despite being tailored to the Black community, researchers found.
While physical distancing and mask wearing remain effective in reducing the spread of Covid-19, fatigue over maintaining pandemic measures and politicization of these measures have caused waning uptake of necessary preventive strategies—a shift that is particularly dangerous to Black residents in the U.S., who have been disproportionately affected by the Covid-19 pandemic due to the cumulative impact of systemic racism and health care inequities.
Carlos Torres, MD, of Harvard Medical School in Boston, and colleagues in the Covid-19 Working Group, conducted an analysis to determine whether Covid-19 messaging delivered by physicians increased disease knowledge and improved preventive behavior among White and Black patients and “to assess whether various ways of increasing the relevance of messages to the Black community (i.e., physician race, AMA acknowledgments of racial injustices, or information about the disproportionate burden of Covid-19 on the Black community) affects their impact on both White and Black participants.”
Their findings were published in JAMA Network Open.
The study authors found that “[e]xposure to public health video messages about Covid-19 recorded by a diverse set of physicians decreased knowledge gaps on Covid-19 symptoms, preventive behaviors, and transmission among Black and White participants with modest incomes, relative to a control condition that saw placebo videos. The effect on knowledge was substantial and clear.” Importantly, the effects did not differ by race.
They noted that these results mirror findings from a previous study by the Covid-19 Working Group from May 2020 and extends them to White patients. However, they also observed something new with this analysis: “a modest but statistically significant increase in the demand for more information, the willingness to pay for high quality masks, and self-reported behavior at follow-up.”
Torres and colleagues concluded that physician messaging campaigns may be an effective, inexpensive tool for increasing Covid-19 education in both Black and White patients; however, they added that future trials conducted at a larger scale will be necessary to confirm “whether these kinds of interventions can change behavior in a way that will affect clinical outcomes.”
Study participants were recruited online from Aug. 7 through Sept. 6, 2020, via the survey company Lucid, which recruits survey participants by advertising surveys to third-party suppliers; participants age 18 years or older who self-identified as White or Black and did not have a college degree were eligible for inclusion.
After answering a series of demographic questions, participants were shown three videos and then answered outcome survey questions. In the control group, patients saw three “placebo” videos with generic health recommendations for fitness, sugar intake, and quality sleep. Meanwhile, the intervention group watched three videos on Covid-19, “recorded by several physicians of varied age, gender, and race.” Both groups were shown video messages from either a Black or a White physician.
Each of the three Covid-19 videos discussed a different topic:
- “Video 1 defined Covid-19 and discussed common symptoms associated with Covid-19 as well as asymptomatic transmission.
- “Video 2 reminded the viewer that Covid-19 was actively circulating in the United States.
- “Video 3 described the Centers for Disease Control and Prevention social distancing guidelines.”
The study authors also cross-randomized variants of video 2 in the intervention group—Variant 1 emphasized the number of new Covid cases in the week of July 6, 2020; Variant 2 added that Black individuals were three times as likely to become infected as White individuals and four times as likely to die from Covid-19 infection. Also, at the beginning of the study, all participants were shown a video of an actor reading a public statement from the AMA.
“The AMA antiracism statement, issued on June 7, 2020, ’recognizes that racism in its systemic, structural, institutional, and interpersonal forms is an urgent threat to public health, the advancement of health equity, and a barrier to excellence in the delivery of medical care,’” the study authors explained. “The AMA placebo intervention was an AMA statement on drug pricing.”
The study’s main outcomes were knowledge, beliefs, and practices related to Covid-19, demand for information on the virus, willingness to pay for masks, and self-reported preventive behavior.
A total of 18,223 participants (9,168 Black; 9,055 White 9,980 [55.9%] women, mean [SD] age, 40.2 [17.8] years) completed the survey; of these, 6,303 Black participants (34.6%) and 7,842 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]),” Torres and colleagues reported. “Self-reported safety behavior improved, although the difference was not statistically significant (IRR, 0.96 [95% CI, 0.92-1.01]; P=0.08). Effects did not differ by race (F=0.0112; P>0.99) or in different intervention groups (F=0.324; P>0.99).”
The study authors noted that, despite the heightened awareness of racial justice issues during the period of this study and polarization in the political discourse of the time, the effects “are remarkably similar across racial and political lines,” suggesting that physicians “still have the ability to inform and persuade members of society from a broad range of backgrounds.”
Moreover, tailoring the intervention’s messaging to Black participants did not impact behavior, the AMA statement on antiracism did not influence participants’ attentiveness to the message, and, notably, “the intervention made both Black and White participants more willing to focus resources both toward Covid-19 in general and toward the Black community in particular.”
Study limitations included that it was conducted online, limiting participation to those with internet access and possibly limiting generalizability; participants’ preventive health behaviors were not directly observed, as outcomes were self-reported; outcomes might be subject to social desirability bias; and the final clinical significance of these findings is uncertain, as effects on all outcomes were quantitatively small.
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Exposure to public health video messages about Covid-19 recorded by a diverse set of physicians and tailored to the Black community decreased knowledge gaps on Covid-19 symptoms, preventive behaviors, and transmission among both Black and White participants.
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Physician messaging campaigns may be an effective, inexpensive tool for increasing Covid-19 education in both Black and White patients.
John McKenna, Associate Editor, BreakingMED™
Coauthor Olken reported receiving ad credits from Facebook outside the submitted work.
Cat ID: 190
Topic ID: 79,190,730,933,190,926,192,927,151,928,925,934
