Are Behaviorally Informed Text Messages Effective in Promoting Compliance with COVID-19 Preventive Measures?: Evidence from an RCT in the City of São Paulo

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Finamor Pfeifer, Flora;
Russo, Guilherme A.;
Souza Pacheco, Tainá
Oct 2020
The COVID-19 pandemic has required societal behavioral change in order to slow the spread of the virus. Making people keep proper distance when in public and wear face masks have become a priority for governments around the world. Following previous literature on the effects of behaviorally informed text messages on promoting healthy behavior, São Paulo’s innovation in government lab implemented a text message (SMS)-based intervention informed by behavioral insights aimed at encouraging people to stay at home, wear face masks, and maintain 2 meters distance from others. Specifically, five different SMS frameworks were analyzed – reciprocity towards health workers, social norms, civic duty, risk perception, and self‑efficacy/ collective identity. A field experiment was run in which beliefs about the pandemic, awareness of safe distancing, and social distancing behaviors were measured via a telephone survey. Results indicate that individuals who received text messages became better informed about the correct distance they should keep from others, and more likely to wear a mask. Respondents who received the ‘civic duty’ frame, designed to prime a sense of duty to protect family and friends, were consistently better informed and more likely to always wear a mas than other frames, although this difference is small. Specifically, those who received the ‘civic duty’ message were 12.75% more likely to report the right distance to keep from others and 3% more likely to report always wearing a mask compared to those who did not received a text message. When looking at differences across groups, it was found that men express more risky behavior than women; older individuals go out less and wear a mask more; respondents in richer areas less likely to leave home for work, but more likely to exercise or walk the dog; and, one’s proximity to the disease affects belief and behavior, although differently depending on the relationship’s degree and on the severity of the illness. These results have informed the scale up of this intervention: a second text message intervention of 3 text messages to over 2.7 million citizens, a combined effort between the city Sao Paulo, the Inter-American Development Bank (IDB) and the Partnership for Healthy Cities.