Can a social media campaign increase the use of long-acting reversible contraception? Evidence from a cluster randomized control trial using Facebook

Abstract

ObjectiveTo test whether an informational campaign carried out on social media increased use of long-acting reversible contraception (LARC). Study designWe implemented a stratified cluster randomized control trial to identify the effect of an informational campaign carried out using Facebook advertisements designed to increase knowledge of the efficacy, ease of use and safety of LARC. We randomized all zip codes in a three-state study area to either a control group or a treatment group. Female Facebook users age 18–34 living in treated clusters received advertisements developed by the researchers in partnership with Planned Parenthood of Northern New England (PPNNE), which sponsored the campaign. We assessed changes in the number and rate of LARC insertions at PPNNE health centers by patients' treatment status. ResultsFacebook showed 1.8 million advertisements to women residing in 536 randomly assigned treatment clusters. Women living in 545 control clusters did not receive advertisements. We observed 152,743 patient visits across PPNNE's 21 health centers over a 26-month period spanning the advertisement campaign. After treatment, the number of LARC insertions increased by 5.7% (95% CI 0.4%–11.3%, p=.04) among patients living in treated relative to control clusters. This result, however, is driven by patients at a single large health center that was experiencing an increase in patient volume prior to the intervention. If we drop this clinic from the sample, we find no evidence that the campaign had an effect on LARC insertions (0.8% reduction, 95% CI −7.6 to 6.5, p=.83). Moreover, if we control for patient volume, we also find no evidence that the campaign increased insertions per patient (0.5% relative increase in insertions, 95% CI −4.9% to 5.2%, p=.87). ConclusionWe conclude that the intervention did not have a detectable impact on LARC insertions in the 4 months after the ad campaign. ImplicationsThis project demonstrates the importance of evaluating the impact of resources invested on advertising with the goal of promoting public health.