Use of Behavioral Economics in Repeat SARS-CoV-2 Antibody Testing in Disadvantaged Communities

The rapid spread of the SARS-CoV-2 virus has greatly impacted underserved populations. This project aimed to understand social and behavioral determinants of COVID-19 testing and variations within sub-groups of this population. In partnership with the largest federally qualified health center in the United States, a survey was administered and a randomized experiment was conducted on 2,160 individuals (540 families) to evaluate the effectiveness of risk-based messaging and incentives that promote repeated testing for SARS-CoV-2 antibodies. In a 2x2 (Messaging x Incentive) factorial experiment, participants were randomized to receive personalized messaging promoting repeated testing. Messaging focused upon either (1a) household risk or (1b) personal risk of COVID-19. They were also randomly assigned to an incentive condition that (2a) insures against losing baseline rewards for initial testing, or (2b) that enters them into a bonus lottery with a small chance to win $150 if they complete both tests. Both the insurance and lottery conditions carry the same incentive costs. Previous work in similar populations demonstrated that adherence to planned health behaviors is higher with insurance-based incentives than cash payments of equal value. This experiment compared insurance-based incentives to lottery incentives that have been shown to be effective in multiple contexts. Finally, whether social and behavioral determinants of health result in heterogeneous treatment effects that can inform customization of incentive offerings in future programs devoted to increasing uptake of testing or vaccinations among underserved populations was evaluated.