Minnesota COVID-19 Testing Project

The goal of this project is to help the state of Minnesota understand why individuals are not getting tested and potentially identify trusted individuals or organizations that could be used in follow-up work to send messages. Investigators focus on the first two issues of unit and item nonresponse, which is not random across the population and thus could lead to nonresponse bias. To do so, investigators are deploying flyers through 10 Twin City area food shelves and potentially through public housing units with information on how to answer an online questionnaire.

In the United States, recent statistics show that African American and Latinx communities bear a disproportionate burden from COVID-19. Reaching vulnerable and underserved populations is therefore crucial to combating the disease. However, most public messaging campaigns are not targeted toward underserved communities and don't address fears of social stigma, mistrust in the healthcare system, or concerns about immigration status. The goal of this project is to help the state of Minnesota understand why individuals are not getting tested and potentially identify trusted individuals or organizations that could be used in follow-up work to send messages. To do so, investigators are deploying flyers through 10 Twin City area food shelves and potentially through public housing units with information on how to answer an online questionnaire. This provides us with an opportunity to study who answers surveys and why - and what questions are particularly sensitive. This is of general interest to academicians and policymakers alike. The quality of household surveys is in decline, for three main reasons. First, households have become increasingly less likely to answer surveys at all (unit nonresponse). Second, those that respond are less likely to answer certain questions (item nonresponse). Third, when households do provide answers, they are less likely to be accurate (measurement error). This is important since household surveys help to estimate the employment rate, healthcare needs and of course the census determines resources/representation. Investigators focus on the first two issues of unit and item nonresponse, which is not random across the population and thus could lead to nonresponse bias. Census tracts with predominantly Hispanic or Black residents had significantly lower response rates to the American Community Survey as compared to the response rates in predominantly white tracts. Similarly, response rates to the Health Information National Trends Survey (HINTS) were lower in areas with higher levels of Hispanic and minority residents. Investigators hypothesize that financial incentives may encourage unit response; conversely, a close association with the government may discourage response. To test these hypotheses, investigators plan to cross-randomize the incentive amount offered and the emphasis placed on government involvement in the study on flyers advertising the baseline survey. Individuals will see either a) a 10 dollar incentive, or b) a 20 dollar incentive; and either a) messaging that emphasizes government involvement in the study, or b) messaging that emphasizes the involvement of academic researchers. Flyers will be randomized at the foodshelf-day level. To test what affects item non-response on potentially sensitive questions, such as questions which ask for health information, investigators hypothesize that ethical framing may encourage individuals to answer questions. This takes two forms --- the deontological (or duty based) frame, and the consequential (or cost-benefit) frame. Moreover, knowing others feel the same way (regarding the obligation or benefits of providing health information) may amplify motivation. Finally, there is the possibility that emphasizing the importance of ethnic and racial disadvantage associated with COVID-19 outcomes may be important for improving item non-response on sensitive questions. Upon completion of the demographic module of the survey but prior to starting several potentially sensitive survey modules, individuals will see a message that either a) emphasizes the public health benefits of answering the survey questions (cost-benefit frame); b) emphasizes an individual's responsibility to their community (duty frame); c) emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups; or d) provides no messaging. Messaging content will be randomized at the individual level.

The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).

The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).

The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.

The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.

The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).

The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).

The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.

The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $20 incentive. Then the participant is assigned to the arm that provides no messaging.

The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).

The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).

The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.

The participant is assigned to receive a flyer that includes a message emphasizing government involvement and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.

The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the public health benefits of answering the survey questions (i.e. cost-benefit frame).

The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes an individual's responsibility to their community (i.e. duty frame).

The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to be a message that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups.

The participant is assigned to receive a flyer that includes a message emphasizing the involvement of academic researchers and a $10 incentive. Then the participant is assigned to the arm that provides no messaging.

Individuals will see messaging that emphasizes the public health benefits of answering the survey questions in the baseline survey (cost-benefit frame).

Individuals will see messaging that emphasizes an individual's responsibility to their community in the baseline survey (duty frame),

Individuals will see messaging that emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups in the baseline survey.

This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.

This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.

Number of participants who received a flyer that mentions a government frame and completed the survey

This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.

This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.

Number of participants who received a flyer that mentions a government frame and $20 incentive and completed the survey

This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.

Number of participants who received a flyer that mentions a government frame and $10 incentive and completed the survey

This outcome will be assessed when the individual agrees to participate in the Baseline survey, which takes approximately 20 minutes.

Number of participants who received a flyer that mentions a researcher frame and $20 incentive and completed the survey

Number of participants who received a flyer that mentions a researcher frame and $10 incentive and completed the survey

Demographic characteristics (e.g. sex, education level, income level, race/ethnicity) of participants who are assigned to each treatment arm and completed the survey.

Number of survey participants who are randomly assigned to receive each messaging frame that: a) emphasizes the public health benefits of answering the survey questions (cost-benefit frame); b) emphasizes an individual's responsibility to their community (duty frame); c) emphasizes the disproportionate impact of COVID-19 on certain ethnic and racial groups; or d) provides no messaging.

Inclusion Criteria: All participants who are aged 18 or above and speak English or Spanish Exclusion Criteria: Children, those who do not identify as above or adults who identify as above but do not agree to participate in survey during the consent stage.

Griffin, DH. Measuring survey nonresponse by race and ethnicity. In Proceedings of the Annual Meetings of the American Statistical Association. 2002; 11-15.

Maitland A, Lin A, Cantor D, Jones M, Moser RP, Hesse BW, Davis T, Blake KD. A Nonresponse Bias Analysis of the Health Information National Trends Survey (HINTS). J Health Commun. 2017 Jul;22(7):545-553. doi: 10.1080/10810730.2017.1324539. Epub 2017 May 30.

Meyer, Bruce D., Wallace KC Mok, and James X. Sullivan. Household surveys in crisis. Journal of Economic Perspectives. 2015; 29(4): 199-226.