Cardiovascular Diseases Clinical Trial
Official title:
The Nueva Ecija Cardiovascular Risk Experiment: An Evaluation of the Impact of Risk Information and Screening on Primary Prevention of Cardiovascular Disease
This study seeks to assess how beliefs about health risks, specifically the risk of cardiovascular disease (CVD), affect health lifestyles and the demand for preventive care in a low-income setting. It also aims to establish the effectiveness of the Package of Essential Noncommunicable Disease Interventions in the Philippines (PhilPEN) in delivering primary prevention of CVD. To meet these objectives, the study is designed as a randomized parallel experiment with two separate, non-overlapping treatment groups and one control group. The experiment will be implemented in Nueva Ecija province, Philippines.
This study seeks to assess how beliefs about health risks, specifically the risk of
cardiovascular disease (CVD), affect health lifestyles and the demand for preventive care in
a low-income setting. It also aims to establish the effectiveness of the Package of Essential
Noncommunicable Disease Interventions in the Philippines (PhilPEN) in delivering primary
prevention of CVD.To realize the first objective, the investigators will measure the accuracy
of beliefs about exposure to CVD risk and, subsequently, randomly provide information on
personal CVD risk based on measured risk factors. This will allow assessment of the extent to
which biased beliefs constrain demand for primary prevention and sustain unhealthy
lifestyles. In addition, the investigators will test whether beliefs about susceptibility to
CVD are responsive to the receipt of information on personal risk, and whether health
behaviors and the demand for CVD screening and medication are affected by any revision of
beliefs.
To meet the second objective the investigators will randomly encourage uptake of the PhilPEN
program's risk screening by offering entry to a money prize lottery conditional on attending
a health clinic where the program operates. The induced random variation in clinic attendance
will be used to estimate the program's impact on exposure to risk factors, medication of
hypertension, the predicted risk of CVD and awareness of this risk.
Meeting both objectives will allow the investigators to distinguish between scenarios. One is
that PhilPEN is effective in preventing CVD of patients who access the program but its impact
on population health is muted because poor information on susceptibility to CVD reduces the
demand for primary prevention. Another is that even if improved information is effective in
raising this demand, this will have little impact on population health through PhilPEN
because of deficiencies in the operation of the program in health facilities.
Within the Nueva Ecija province, the investigators will randomly sample barangays (N=304),
subsequently households (n=5019) and, finally, one person aged 40-70 within each household.
At the barangay level, the investigators will randomly allocate to a treatment group
receiving the lottery incentive to attend a health clinic (n=2261), another treatment group
receiving information on personal CVD risk (n=497) and a control group (n=2261). A baseline
survey (January-April 2018) will record data on initial health, health behavior, health
knowledge, risk perceptions, risk attitudes, time preferences, health care utilization and
expenditure and socioeconomic characteristics, and deliver the treatments. A follow-up survey
9-12 months later will record outcomes.
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