Minnesota COVID-19 Testing Project

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.