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Increasing participation in a vector control campaign: a cluster randomised controlled evaluation of behavioural economic interventions in Peru
  1. Alison M Buttenheim1,
  2. Valerie A Paz-Soldán2,
  3. Ricardo Castillo-Neyra3,
  4. Amparo M Toledo Vizcarra4,
  5. Katty Borrini-Mayori4,
  6. Molly McGuire2,
  7. Claudia Arevalo-Nieto4,
  8. Kevin G Volpp5,
  9. Dylan S Small6,
  10. Jere R Behrman7,
  11. Cesar Naquira-Verlarde8,
  12. Michael Z Levy3
  1. 1 Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2 Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
  3. 3 Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  4. 4 Zoonotic Disease Research Lab, OneHealth Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Peru
  5. 5 Medical Ethics and Health Policy, School of Medicine, University of Pennsylvania Perelman, Philadelphia, Pennsylvania, USA
  6. 6 Department of Statistics, University of Pennsylvania Wharton School, Philadelphia, Pennsylvania, USA
  7. 7 Department of Economics School of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  8. 8 Universidad Peruana Cayetano Heredia, Arequipa, Peru
  1. Correspondence to Dr Alison M Buttenheim; abutt{at}


Objective To assess the efficacy of strategies informed by behavioural economics for increasing participation in a vector control campaign, compared with current practice.

Design Pragmatic cluster randomised controlled trial.

Setting Arequipa, Peru.

Participants 4922 households.

Interventions Households were randomised to one of four arms: advanced planning, leader recruitment, contingent group lotteries, or control.

Main outcome measures Participation (allowing the house to be sprayed with insecticide) during the vector control campaign.

Results In intent-to-treat analyses, none of the interventions increased participation compared with control (advanced planning adjusted OR (aOR) 1.07 (95% CI 0.87 to 1.32); leader recruitment aOR 0.95 (95% CI 0.78 to 1.15); group lotteries aOR 1.12 (95% CI 0.89 to 1.39)). The interventions did not improve the efficiency of the campaign (additional minutes needed to spray house from generalised estimating equation regressions: advanced planning 1.08 (95% CI −1.02 to 3.17); leader recruitment 3.91 (95% CI 1.85 to 5.97); group lotteries 3.51 (95% CI 1.38 to 5.64)) nor did it increase the odds that houses would be sprayed in an earlier versus a later stage of the campaign cycle (advanced planning aOR 0.94 (95% CI 0.76 to 1.25); leader recruitment aOR 0.68 (95% CI 0.55 to 0.83); group lotteries aOR 1.19 (95% CI 0.96 to 1.47)). A post hoc analysis suggested that advanced planning increased odds of participation compared with control among households who had declined to participate previously (aOR 2.50 (95% CI 1.41 to 4.43)).

Conclusions Achieving high levels of household participation is crucial for many disease prevention efforts. Our trial was not successful in improving participation compared with the existing campaign. The trial highlights persistent challenges to field experiments as well as lessons about the intervention design process, particularly understanding barriers to participation through a behavioural lens.

Trial registration number American Economic Association AEARCTR-0000620.

  • change disease
  • cluster randomised trial
  • public health
  • control strategies

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  • Handling editor Seye Abimbola

  • Contributors AMB, MZL, VAPS, RCN, KGV, JRB, CNV and MZL contributed to conceptualising and designing the trial. All authors contributed to intervention design and trial implementation. AMB, VAPS, TCN, AMTV, KBM, MM, CA-N, and MZL contributed significantly to data acquisition. AMB, RCN, CAN, DSS and MZL conducted data cleaning and analysis. All authors provided comments towards drafts of the article and approved this version for submission.

  • Funding This study was funded by a grant from Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD075869). Support for formative and pilot work was provided by grants from the University of Pennsylvania’s University Research Foundation and Global Engagement Fund.

  • Disclaimer Funders of this study had no role in study design, data collection, data analysis, writing of the report or decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from the Institutional Review Boards of the Universidad Peruana Cayetano Heredia, the University of Pennsylvania and Tulane University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The full data set and statistical code are available from the corresponding author.