Evaluating the Impact of Risk Information and Screening on Cardiovascular Disease Prevention in the Philippines

Description:  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 Non-communicable 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 behaviours 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, and 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 will record data on initial health, health behavior, health knowledge, risk perceptions, risk attitudes, time preferences, health care utilisation and expenditure and socioeconomic characteristics, and deliver the treatments. A follow-up survey 9-12 months later will record outcomes.

Involved Researchers & Departments:

  • Prof. Dr. Owen O’Donnell & Jenny Kudymowa - Department of Applied Economics, ESE
  • Prof. Dr. Joseph Capuno & Prof. Dr. Aleli Kraft - University of the Philippines Diliman

Contact Info: Prof. Dr. Owen O’Donnell (odonnell@ese.eur.nl)

Countries Involved: The Philippines

Funding: Swiss Agency for Development and Cooperation (SDC) and the Swiss National Science Foundation Programme for Research on Global Issues for Development (r4d) (Grant: 400640_160374: Inclusive social protection for chronic health problems)