Does bundling reminders with messages debunking misconceptions improve the demand for preventive health services? A randomized controlled trial among adults with hypertension in Punjab, India

Regular follow-up visits are a crucial component of prevention and care for several important non-communicable diseases (NCDs). Yet evidence across low- and middle-income countries (LMICs) reveals low demand for preventive healthcare visits. While reminders are commonly used to improve follow-up visit attendance, we hypothesized that low demand could also be driven by misconceptions about the need for preventive care. We thus conducted a randomized evaluation of an enhanced reminder intervention that combined a traditional reminder with debunking information aimed at correcting misconceptions around preventive healthcare. We focused specifically on correcting misconceptions about and improving follow-up visit attendance for hypertension among a sample of 463 individuals with uncontrolled blood pressure recruited from two public hospitals in Punjab, India. Our enhanced reminder was highly effective and improved follow-up visit attendance by 12.1 percentage points. Importantly, we found widespread misconceptions about when hypertension care and treatment are needed among participants at baseline. However, our enhanced reminder did not significantly correct these misconceptions, suggesting that the reminder's effect was primarily mediated through its effect on salience rather than belief correction. While our reminder improved preventive care seeking, the results reveal the challenge of changing deeply rooted misconceptions and suggest that there is still significant scope for further improving demand by combining reminders with more effective belief correction strategies.