Use of Behavioral Economics in Repeat SARS-CoV-2 (COVID-19) Antibody Testing in Disadvantaged Communities

Background: The purpose of this study was to examine the social and behavioral determinants of COVID-19 testing and to identify subgroup variations among underserved populations disproportionately affected by the pandemic. The study sought to understand how targeted messaging and incentive-based interventions could increase participation in repeated SARS-CoV-2 antibody testing. By exploring how individuals in underserved communities respond to risk framing and motivational structures, the study aimed to inform future strategies to improve equitable testing and vaccination uptake.

Materials/Methods: A survey and a randomized factorial experiment were administered to participants to evaluate the impact of messaging and incentives on repeated antibody testing for SARS-CoV-2. The 2x2 (Messaging x Incentive) design randomly assigned participants to one of four conditions. Messaging was either household-focused, emphasizing family-level COVID-19 risk, or individual-focused, emphasizing personal risk. Incentives were either insurance-based, where participants were guaranteed baseline rewards for completing initial testing, or lottery-based, offering entry into a drawing for a $150 bonus if both tests were completed. Both incentive types carried equivalent financial value. The intervention design was informed by behavioral economics research suggesting that insurance-style incentives may be more effective than direct cash payments in encouraging adherence to health behaviors. Data from surveys were used to assess social and behavioral determinants of health and to examine how these characteristics influenced responses to the different intervention types.

Outcome/Impact: The study provided critical insight into how messaging and incentive framing affect health behaviors within underserved populations. By comparing the effectiveness of household versus individual risk communication and insurance-based versus lottery incentives, the study identified which approaches most effectively promoted repeated testing adherence. Results helped clarify how social and behavioral determinants shape heterogeneous treatment effects, enabling future public health programs to tailor incentive and communication strategies for improved testing and vaccination uptake among vulnerable groups. The findings also contributed to the broader evidence base on behavioral interventions in health equity and pandemic response.