In October, Dr. Folasade May, an internist and public health researcher at the University of California at Los Angeles, introduced a new routine in the workplace. Once a week, she took the three-minute walk from her office to a coronavirus testing site on campus. After checking her temperature and scanning a barcode on her phone, she gently wiped the inside of her nose. An email with their results would arrive within a day or two.
Week after week her results were negative. She continued to participate in the testing program after vaccination and continued to test negative. And then, two weeks ago, an email landed in her inbox that amazed her: her sample was positive for the coronavirus.
The result – which turned out to be false positives – briefly threw her life into chaos.
“Our whole family was turned upside down for an afternoon trying to figure out how to split up in our little house, find out who’s going to look after the kids and who else we’re going to expose,” said Dr. May.
It’s a situation other families may soon find themselves in as mass coronavirus screening programs kick off in schools and in the workplace. Some of these programs make testing compulsory, but many others will rely on voluntary participation – or people who do regular tests themselves in their own home.
The more people participate, the more effectively these programs can slow down the spread of the virus and keep track of things. But there are also clear barriers to participation, ranging from inconvenience to concern about the consequences of a positive outcome. This could mean missing a child, keeping a child away from school, or days of quarantine.
“There are tremendous effects of a positive Covid test that many people are very wary of, especially when they are feeling good,” said Dr. May, who examines the health disparities and barriers to access to health care. “I don’t know people are going to come out in droves to do it.”
Although coronavirus screening is new, researchers in various fields – including behavioral economics, implementation science, and health psychology – have spent years studying how people can be encouraged to engage in other types of health-related behaviors, including cancer screening, HIV testing, and vaccination. Some of these strategies could help health officials develop coronavirus screening programs or even vaccination programs with better participation rates.
“The reality is that people have to wake up and decide whether to do this on a specific day or week,” said Harsha Thirumurthy, associate director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania. “And we know – from many examples of people choosing to test for other health conditions, or even people choosing to engage in other health-related behaviors – that people are constantly weighing the costs and benefits of these services.”
Here are five ways health officials can say to put the calculus off.
Just do it
People tend towards the status quo, the tendency to leave things as they are rather than shake them up. Many studies have shown that people are more likely to be involved in a variety of behaviors, from organ donation to inclusion on a 401 (k) plan, when these behaviors are listed as the default choices.
In a randomized clinical trial of nearly 5,000 emergency patients, researchers found that the proportion of patients willing to take a rapid HIV test increased from 38 percent to 66 percent when the test was presented as a medical service they purposely provided had to refuse. rather than one they had to proactively ask for.
Similarly, if they are not enabled, but disabled, the likelihood of wider coronavirus screening program involvement is higher. “The more you ask people to put their own cognitive and behavioral efforts into this cause, the less likely they are to do so,” said Derek Reed, who heads the Laboratory of Applied Behavioral Economics at the University of Kansas.
And of course, the actual testing process should be quick and convenient, experts say, with strategically placed test locations and streamlined procedures that allow people to easily incorporate testing into their routines.
Ask people to plan
Experts also suggested asking people to think about the logistics of when and how to get tested. Studies show that people who clearly formulate a plan for how they want to achieve something – whether it’s a vote on an upcoming election or if they get a flu vaccine – are more likely to get their way.
April 5, 2021, 4:37 p.m. ET
One way, said Dr. Reed, would be to text people reminders of their test appointments and ask them to reply with a 1 if they want to go to the appointment, a 2 if they want to drive, or a 3 if you plan on going to the appointment Take bus. “And then, depending on the answer, just automatically ping back Google map directions or a link to maps or timetables on the campus or community bus system,” he said.
These type of nudges are likely most effective for people who are already motivated to get tested but may have trouble getting through. “Often times, you have to nudge them a little, just removing friction, to get rid of those small costs,” said Sebastian Linnemayr, behavioral economist at RAND Corporation, a think tank in California.
Provide (the right) incentives
Health officials could also reward people who participate in testing programs. “There must likely be some incentive at the patient level,” said Dr. May. “We saw the same thing with cancer screening. We have seen health insurers incentivize patients to participate in healthy lifestyles and to participate in screening programs. “
But the specific incentives are important, and some studies suggest they do People are more motivated by the opportunity to win a large reward than they are guaranteed to receive a smaller payout.
In a November survey of 200 University of Kansas students, Dr. Reed and colleagues found that 70 percent of them would be willing to get tested if the university gave them a $ 5 gift card. But if the university instead entered a lottery where they had a 5 percent chance of winning $ 100, 88 percent said they would attend, said Dr. Reed, who shared his findings with the university.
These type of lotteries can be effective because people tend to overestimate their chances of winning. “The other part of it is that the lottery introduces an element of fun or engagement into this idea that you are part of something that other people participate in,” said Dr. Thirumurthy.
Make use of social ties
Peer pressure can be a powerful public health tool. For example, research has shown that college women are more likely to receive the human papillomavirus vaccine if they believe their peers will too.
Government, school and workplace leaders can help make coronavirus testing a social norm by making it public how many others are participating. “Then send that information over and over again:” Don’t miss out, 85 percent have already been tested and make the school a better place, “said Dr. Linnemayr. He added,” It’s really important that you signal: ‘This is an activity that we value and reward as a community.’ “
Health officials might also consider making more explicit use of social networks. In a randomized study conducted in Kenya, Dr. Thirumurthy notes that providing two HIV self-test kits to women and encouraging them to give one to their male partners significantly increased the percentage of men tested for HIV
He is now working with colleagues to evaluate a similar program for the coronavirus and is asking people to distribute self-test kits to others in their social circles.
“Who has the strongest ability to convince you to test?” Said Dr. Thirumurthy. “Will it be your employer or someone in the community? Or will it be someone who is a close friend or family member? “
Support people who test positive
However, even the smartest nudges won’t be enough to convince people to get tested if they believe that a positive result will have a devastating effect on their lives. A major barrier to HIV testing has been the fear of potential recipients that positive tests would cost them their friends, jobs, homes, or health insurance.
A positive coronavirus test doesn’t necessarily carry the same stigma, but it can have a serious impact on people’s lives. “If it keeps you from work and you can’t make an income to support your family, that isn’t a beginner for a lot of people,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University.
Governments, employers and community organizations should therefore do everything possible to reduce the costs associated with positive tests, say health experts. This could mean giving paid vacation or allowing employees to work remotely if they need to be quarantined. Offering hotel vouchers so that people have a safe place to isolate; or offer financial and food aid. Such services can “mitigate” the blow of positive testing, said Dr. Thirumurthy: “There has to be some kind of safety net.”