Comparison of Knowledge and Information-Seeking Behavior After General COVID-19 Public Health Messages and Messages Tailored for Black and Latinx Communities : A Randomized Controlled Trial

Abstract

Background: The paucity of public health messages that directly address communities of color might contribute to racial and ethnic disparities in knowledge and behavior related to coronavirus disease 2019 (COVID-19).

Objective: To determine whether physician-delivered prevention messages affect knowledge and information-seeking behavior of Black and Latinx individuals and whether this differs according to the race/ethnicity of the physician and tailored content.

Design: Randomized controlled trial. (Registration: ClinicalTrials.gov, NCT04371419; American Economic Association RCT Registry, AEARCTR-0005789).

Setting: United States, 13 May 2020 to 26 May 2020.

Participants: 14 267 self-identified Black or Latinx adults recruited via Lucid survey platform.

Intervention: Participants viewed 3 video messages regarding COVID-19 that varied by physician race/ethnicity, acknowledgment of racism/inequality, and community perceptions of mask wearing.

Measurements: Knowledge gaps (number of errors on 7 facts on COVID-19 symptoms and prevention) and information-seeking behavior (number of web links demanded out of 10 proposed).

Results: 7174 Black (61.3%) and 4520 Latinx (38.7%) participants were included in the analysis. The intervention reduced the knowledge gap incidence from 0.085 to 0.065 (incidence rate ratio [IRR], 0.737 [95% CI, 0.600 to 0.874]) but did not significantly change information-seeking incidence. For Black participants, messages from race/ethnicity-concordant physicians increased information-seeking incidence from 0.329 (for discordant physicians) to 0.357 (IRR, 1.085 [CI, 1.026 to 1.145]).

Limitations: Participants' behavior was not directly observed, outcomes were measured immediately postintervention in May 2020, and online recruitment may not be representative.

Conclusion: Physician-delivered messages increased knowledge of COVID-19 symptoms and prevention methods for Black and Latinx respondents. The desire for additional information increased with race-concordant messages for Black but not Latinx respondents. Other tailoring of the content did not make a significant difference.

Primary funding source: National Science Foundation; Massachusetts General Hospital; and National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.

Visual Abstract.. General and Tailored COVID-19 Health Messaging to U.S. Minorities

The paucity of public health messages that directly address communities of color might contribute to racial and ethnic disparities in COVID-19–related knowledge and behavior. This randomized trial examined whether physician-delivered prevention messages affect knowledge and information-seeking behavior of Black and Latinx persons and if this differs according to the race/ethnicity of the physician and the tailored content.

Appendix Figure 1.. Enrollment and randomization of participants.

* Participants who left the survey before the knowledge outcome. † Participants who completed the knowledge questions and were included in the knowledge outcome analysis questions. ‡ Participants left the survey before the links outcome. § Participants completed the survey and were included in all analyses.

Appendix Figure 2.. Study flow diagram: group assigned to a race/ethnicity-concordant physician.

See Appendix Figure 1 for caption.

Appendix Figure 3.. Study flow diagram: group assigned to a race/ethnicity-discordant physician.

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Figure.. Distribution of knowledge gap scores in the control group and among participants who received any intervention.

Bars indicate 95% CIs. A Kolmogorov–Smirnov test of the equality of the distribution resulted in a value of 0.07598 (P < 0.001).