In a working paper series of the US-based National Bureau of Economic Research, a cluster randomised trial in Bangladesh conducted across 600 villages on community mask-wearing behaviour has shown that a combination of interventions of free mask distribution, communicating the importance of wearing a mask, periodic reminders and monitoring and role-modelling by public officials and community leaders, can improve compliance.
Conducted over 10 weeks and covering 341,830 adults, the study found mask-wearing increased by 29 percentage points, leading to an estimated 50,947 additional adults wearing masks in intervention villages, assuming three members per household. There were 64,937 households in the intervention group and 64,183 households in the control group.
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The study conducted by researchers from across the globe, including from Yale School of Management, Stanford University, and Innovations for Poverty Action, moved with two key primary objective — to assess which of multiple interventions would increase proper wearing of masks, and whether mask promotion unintentionally creates moral hazards and decreases social distancing.
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A series of strategies were deployed to promote mask usage, including free household distribution, distribution and promotion at markets and mosques, mask advocacy by Imams during Friday prayers, etc. Pilot projects in two districts found that “free mask distribution alone is not sufficient to increase mask-wearing, but adding periodic monitoring in public places to remind people to wear the distributed masks had large effects on behavior”.
The larger randomised cluster trial established that “combining mask distribution, role-modeling and active mask promotion — rather than mask distribution and role-modeling alone – seems critical to achieving the full effect”.
Several elements saw no additional effect on mask wearing. These included the interventions of text reminders, public signage commitments, monetary or non-monetary incentives, or police accompanying the mask promoters.
The finding about police’s presence being ineffectual and instead seeing better outcomes by periodic reminders from community-level leaders suggests “the operative mechanism is not any threat of formal legal sanctions, but shame and people’s aversion to a light informal social sanction”.
The researchers note the findings “should be interpreted with caution, as these behavioral responses may be context-dependent”. Yet they also note: “The intervention package that proves effective in our trial would be feasible to implement in a similar fashion throughout South Asia and in other world regions.”
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