Monday, April 27, 2020

Who trusts the healthcare system in Georgia?

[Note: This article was co-published with OC Media. It was written by Rati Shubladze, a policy analyst at CRRC Georgia. The views presented in this article do not represent the views of CRRC Georgia or any related entity.]

Trust in healthcare institutions is important, especially during a pandemic like the current COVID-19 outbreak. In the name of public health, numerous individual freedoms and economic activities are restricted.

Without trust in the messages of public health officials, measures aimed at preventing the spread of the virus are less likely to be complied with, exacerbating the spread of the virus.

The recent events surrounding attendance at religious ceremonies and healthcare highlights the importance of trust in health institutions. The tensions between the church and healthcare professionals, including a public verbal clash between a high ranking church official and the National Center for Disease Control and Public Health, show this.

Indeed, despite recommendations from healthcare specialists to stay home, the Orthodox Church in Georgia still held Easter liturgy with parishioners in attendance.

This situation leads to the questions: who is more or less likely to trust healthcare officials in Georgia and does this trust interact with religious belief?

The 2019 Caucasus Barometer Survey provides some answers to these questions. The data was collected in mid-autumn 2019, before the current crisis. This has both advantages and disadvantages.

On the one hand, attitudes could not have been influenced by the current crisis. Therefore, the responses allow an understanding of who would be more or less predisposed to trusting healthcare institutions before the crisis and therefore who would be more or less likely to comply with healthcare institution mandates.

On the other hand, the data do not enable an understanding of how trust has changed in response to the current crisis.

At the time of the 2019 Caucasus Barometer survey, the plurality (43%) of Georgians trusted the country’s healthcare system. This is a relatively high level of trust compared to other institutions.

Out of 15 social and political institutions, the healthcare system was the fourth most trusted institution.

Further analysis using demographic variables, including settlement type, age, gender, employment, internet usage, minority status, and education suggests that males, those living in rural areas, ethnic minorities, and those that do not use the internet have higher chances of trusting the healthcare system, controlling for other factors. Other demographic factors do not show statistically significant differences.

Note: The original healthcare trust questions was asked using a 5-point scale. For the purpose of analysis, the options ‘fully trust’ and ‘rather trust’ were coded as ‘trust’ and options ‘fully distrust’ and ‘rather distrust’ were coded as ‘distrust’. The variables about ethnicity and Internet usage were also recoded. The minority status variable codes the following ethnicities as non-Georgian: Armenian, Azerbaijani, Russian, Kurd or Yezidi, other Caucasian, and other ethnicities. In the internet usage variable, options ‘at least once a week’, ‘at least once a month’, and ‘less often’ were coded as ‘less often’; ‘never’ and ‘do not know what the internet is’ were coded as ‘never’. 

Importantly, three of the above characteristics are interconnected, as minorities mostly dwell in rural areas of Georgia, and internet usage is least common in rural areas and among ethnic minorities.

Indeed, the higher levels of trust among these groups could be because minorities and rural people are more likely to trust public institutions generally.

Given the situation surrounding public health officials and the church, it is important to understand whether there are interactions between trust in religious institutions and healthcare officials.

Indeed, the Caucasus Barometer data suggest trust toward religious institutions is associated with trust in the healthcare system. However, the observed relation tells us more about the phenomenon of general institutional trust. The results are similar when the relation between trust in the healthcare system and trust toward other institutions, like the army, police, banking system, or media are examined.

A second way of looking at it that does not suffer from trust being correlated with trust is through looking at the association between frequency of attending religious ceremonies and trust in healthcare institutions.

Caucasus Barometer 2019 data suggest no statistically significant association between trust in the healthcare system and how frequently people attend religious ceremonies, controlling for other demographic factors.

Based on this, the church-going population appears to have been no more or less likely to trust healthcare officials before the COVID-19 crisis.

Prior to the COVID-19 crisis, trust toward the healthcare system was associated with where people live, ethnicity, sex, and internet usage. Religiosity did not appear to be related to trust in the healthcare system before COVID-19. Whether these factors still hold true remains to be seen.

To explore the Caucasus Barometer 2019 survey findings for Georgia, visit CRRC’s Online Data Analysis portal. Replication code for the data analysis is available at CRRC’s GitHub repository here

Tuesday, April 21, 2020

Study suggests large numbers in Georgia to celebrate Easter in church

Note: This article was co-published with OC Media. It was written by Koba Turmanidze, President of CRRC Georgia. The views presented in this article do not necessarily reflect the views of CRRC Georgia or any related entity.

Research by CRRC Georgia suggests that a large number of Georgia’s Orthodox Christians intend to celebrate at Church.

As Easter celebrations approach in Georgia, a study by CRRC Georgia suggests that a large number of Georgia’s Orthodox Christians still intend to celebrate at Church. The survey of Facebook users found that around 40% of people who usually celebrate Easter in Church intended to do so again this year despite the pandemic.

With Easter celebrations approaching, quarantine rules have become even stricter: driving of private cars has been forbidden and movement in and out of the four largest cities of Georgia has been restricted.

While most organisations are closed or are working digitally, the Georgian Orthodox Church has continued traditional services. Moreover, the church has refused to call on believers to celebrate Easter at home, and the government seems unwilling to enforce emergency rules on the Church.

Instead, the Prime Minister has hinted that it is the responsibility of citizens to stay home, while the churches should remain open. ‘I’m sure that wise citizens will guess that they should not place responsibility on the church and should not want to hear the call from the church – don’t come to the church’, he stated.     

This is not the first time government officials have used subtle suggestions, or nudges, with the goal of altering people’s church-going habits.

Earlier this month, Paata Imnadze, the highly regarded deputy head of the National Centre for Disease Control and Public Health also voiced a similar view.

‘I would like to address Christian believers. Let’s protect our mother-Church, and our priests, by praying at home and not going to church.’

While such nudges often succeed in changing people’s attitudes and even behaviours, CRRC Georgia’s research shows that in the current situation, this approach may not be working.

To test the impact of Imnadze’s ‘nudge’ on people’s intentions to go to church for Easter celebrations, CRRC Georgia conducted an experiment using Facebook’s A/B test tool.

The tool disseminates two or more announcements which will randomly show up in Facebook users’ news feeds. In this case, Facebook users were randomly shown advertisements to fill out one of the two versions of a questionnaire: one included Imnadze’s statement as an introduction to the survey, while the other did not. The two surveys were identical in every other respect. 

The randomised test was active for 72 hours from 11–14 April and reached 240,000 users, accumulated 22,100 clicks, and resulted in 7,560 completed questionnaires.

Of the 7,560 adults, 42% read or saw Imnadze’s statement before filling out the questionnaire. Analysis of the results did not show any impact from the nudge.

In the two groups, 16% reported that they would celebrate Easter in the church. As expected, far more respondents reported celebrating Easter in the church in the past (38%), suggesting that people have adapted their plans to the emergency situation.

Yet the nudge played no role: regardless of being in the treatment or control group, about 60% of respondents who usually would celebrate Easter in Church reported they would stay home this year, while about 40% still planned to go to church.

Importantly, there was no effect of the nudge across different demographic groups (e.g. men and women, older and younger people).

Further analysis looked at different factors that correlate with whether people changed their choice to celebrate Easter at the Church.

Respondents’ religiosity shows an unsurprising pattern. Frequent churchgoers and respondents who consider religion important in their lives were more likely to stay loyal to their past practise of celebrating Easter in the church than less religious respondents (i.e. those who go to church less frequently and consider religion less important).

Perhaps unsurprisingly, concern about the spread of COVID-19 makes respondents more cautious, and hence, more likely to change Easter celebration practice from church to home.

Women, people with tertiary education, and older respondents are also more likely to move Easter celebrations from church to home, whereas employed respondents are less likely to change their past practice of celebrating in the church.

While the survey gathered a large number of responses, the results should be read with caution.
The survey is clearly not representative of the population of Georgia, which is reflected in a different demographic profile of the Facebook respondents.

Unlike nationally representative surveys, the Facebook sample overrepresented women (82%), the employed (61%), the university-educated (65%), and younger people (the average age was 37). Moreover, it is hard to say whether the survey represents Facebook users in Georgia, since respondents self-selected into the survey.

Nevertheless, the group that saw and did not see Imnadze’s message on the survey were very similar, with identical demographic profiles. Hence, if the treatment and control groups answered the Easter celebration question differently, this could be attributed to the reminder of Imnadze’s nudge.

While it is not possible to exclude the possibility that the tested and similar nudges already impacted the respondents before they completed the Facebook survey, the findings still suggest that subtle suggestions are not sufficient to change people’s Easter holiday plans.

While a significant share of respondents changed their usual ways of celebration, a reminder of Imnadze’s suggestion did not change this.

Religiosity seems to be an obstacle towards adaptation to the current situation: while many believers and frequent churchgoers reported they would celebrate from home, many are still unconvinced and will likely help spread the virus this Sunday unless emergency rules are enforced on the Church as elsewhere in the country.

Monday, April 13, 2020

As COVID-19 sends political campaigning to Facebook, will polarisation increase?

[Note: This article was co-published with OC Media, here. The article was written by Dustin Gilbreath, Deputy Research Director at CRRC Georgia. The views presented in the article do not necessarily reflect the views of CRRC-Georgia or any related entity.]

With Georgia in an election year and traditional face-to-face campaigning out of the question given the COVID-19 outbreak, the importance of Facebook in Georgian politics is only likely to grow.

Facebook is an important part of Georgian politics. Political campaigns are fought, and public opinion thought to often be formed on the platform.

The Government of Georgia and the ruling Georgian Dream party found it so important that they even set up numerous fake accounts posing as news sources, some of which Facebook later took down.

The perceived importance of Facebook is likely well-deserved. Among the 70% of Georgians that use the internet at least sometimes, it is by far most people’s most frequent activity; 72% of the public reports that one of their main three online activities is using Facebook, according to the NDI and CRRC November and December 2019 survey.

Given this, the question emerges, do Facebook users in Georgia have different political attitudes than non-users?

An analysis of the November and December 2019 NDI survey suggests that they have relatively similar attitudes to other internet users with one key exception — Facebook users have stronger opinions on political issues.

This suggests that if political campaigning moves further onto Facebook, people’s views could become more entrenched leading to more political polarisation.

On the November/December NDI and CRRC survey, respondents who reported using the internet were asked how often they encounter political news on Facebook. Among the response options was, ‘I do not use Facebook’, which 8% of internet users reported.

Based on this figure and a question on internet usage, a third (31%) of the public report not using the internet, 64% report using the internet and Facebook, and 6% use the internet, but not Facebook.

To understand who was more or less likely to be part of these different segments of society, a statistical model controlling for age, settlement type, household wealth, education level, and sex was run.  The data suggest that Facebook users and internet users who do not use Facebook are more demographically similar to each other than those that do not use the internet.

The results suggest that people who use the internet but not Facebook are less likely to live in urban areas outside Tbilisi, are older (average age of 47 versus 39), and more likely to be male.

Those who use the internet but do not use Facebook compared to people who do not use the internet live in wealthier households, are more likely to have a higher education, are younger (average age of 47 versus 60), and are more likely to live in urban areas outside the capital and rural areas than in Tbilisi.

When comparing those who use Facebook to those who do not use the internet, the pattern is similar.

Given the large role that Facebook plays in politics in Georgia, it would be reasonable to assume that people who use Facebook and people who do not but are still online might have different political views.

To explore this issue, a matching analysis was used to identify individuals that are similar along demographic lines, except for the fact that they either use Facebook or they use the internet, but not Facebook.

The results show few differences. The two groups do not have significantly different preferences for political parties. They both also tend to assess government performance similarly. They are equally likely to report that they are going to vote in the next parliamentary elections. They are also no more or less certain in who they are going to vote for.

There is one important difference, however — people who use Facebook are more likely to express their opinions. People who use the internet but not Facebook reported they don’t know and refused to answer questions significantly more often than people who use Facebook in this survey.

This finding has a number of potential interpretations. It may suggest that Facebook is informing people about politics in the country, and therefore, they can respond to the survey questions, which focus on politics, more easily.

It could also suggest that Facebook is polarising in Georgia. People that use the platform are significantly less likely to report uncertainty on the wide variety of issues asked about on the survey, hinting at stronger opinions.

Aside from these potential explanations, caution is warranted in interpreting Facebook as causing these patterns. Another potential interpretation is that people who do not use Facebook but are online are more cautious in sharing their opinions in public.

This would explain why they refused to answer more often and are not engaged in a platform that thrives on people sharing news about themselves and their views on politics. However, working against this view is the fact that both groups reported equal comfort in expressing their opinion in a quasi-public forum.

Taken together, the data suggests that there are relatively few differences between people who are on Facebook and not on Facebook but still using the internet, with one key distinction. People using Facebook are more likely to express their opinions.

This may point to Facebook either serving as a tool to inform the public or as a source of division. Alternatively, Facebook may draw the already more opinionated and informed. Potentially, it is both.

In either case, if politics is increasingly concentrated on Facebook in light of the COVID-19 outbreak, Georgian voters may become more informed and opinionated about politics. With stronger opinions, polarisation too may become stronger in Georgia.

Note: The data used in the above is available here. Replication code for the analysis is available here. In some cases in the above, figures may not sum to 100%. This is generally due to rounding error.

Monday, April 06, 2020

Appointment of Supreme Court Justices: What people in Georgia know and think about the process

In the beginning of September 2019, the High Council of Justice provided a list of 20 Supreme Court Justice candidates to the Parliament of Georgia for approval. In September-November 2019 parliament conducted the hearing process for candidates, and on December 12th 2020 14 candidates were appointed to Supreme Court. The Georgian media covered the process extensively.

But, what does the public in Georgia know about the process of appointment of the Supreme Court Justices, and what is their attitude towards the newly appointed justices and judicial institutions? A phone survey conducted on January 30 - February 10, 2020 suggests that people in Georgia are divided between trusting and distrusting judicial institutions. While more than half of the public have heard about the Supreme Court appointment process, they have little trust in it, and largely have not heard of the new justices.

The majority of the Georgian speaking population (63%) reports that they have heard about the hearings in parliament for Supreme Court candidates, and more than half of the population (54%) says that they are aware of the outcomes of the hearings.  More than half (55%) of those who have heard about the appointments report that they do not trust the process. Similarly, more than half (53%) of the people who had heard of the process think that parliament carried out the appointment process unfairly.

The survey asked respondents whether justice will improve, stay the same or get worse if the candidates were appointed as Supreme Court Justices. About one fourth of the adult Georgian speaking population (26%) reported that the appointment of the 14 candidates will improve justice in the country, the same share (26%) think that the state of justice will stay the same. About a fifth of the population (20%) believe it will get worse. The remainder either did not know or refused to answer the question.  A similar question was asked on a September 2019 survey: “If these 20 candidates are appointed to the Supreme Court, do you think justice in Georgia will improve, stay the same or get worse?” The results have not changed substantively between waves of the survey, with a slight decline in the share responding don’t know and slight increase in the share responding it would have a positive impact.

The survey asked the respondents who were aware of the appointment process to share their first association about it. Almost one third (32%) did not provided any association, responding don’t know. The top five associations included “Unfairness” (14%), “Distrust” (14%), “Biased” (5%), “Fight” (5%), and “Open process” (4%). Overall, 11% reported a positive association, while 53% reported a negative one. One percent of responses were neutral. Two percent of population refused to answer the question.

The survey asked about whether each candidate should or should not be appointed to the Supreme Court. Most people had not heard about the candidates.  Approximately one tenth of the population approved of the appointments of Nino Kadagidze (11%), Giorgi Mikautadze, (11%), and Shalva Tadumadze (10%). All other candidates had lower levels of approval.

Respondents were asked to name the most important events of the Autumn/Winter, 2019-2020, but were allowed to name up to 3 events. Only 3% of Georgian-speaking adult population named the appointment process of Supreme Court justices. The most commonly named events were the protests in response to the failure to pass a proportional electoral system (13%), Dr. Vaja Gaprindashvili’s abduction (10%), and the mass arrests of the aforementioned rally participants (10%). Half of respondents (49%) could not identify a most important event during the period. 

The public is divided in whether they trust the High Council of Justice, Supreme Court, and the court system in general. The chart below shows that about half of the public trusts and distrusts each of these institutions. This result has not changed since September, when the same questions were asked on another survey.

The public is divided in their trust towards judicial institutions, such as the High Council of Justice, Supreme Court, and the court system in general.  More than half of the population has heard of the Supreme Court justice appointment process, however most of them do not trust the process and believe that the Parliament of Georgia did not lead the appointment process fairly. Despite this, few people found the Supreme Court appointment process to be among the most important events of the Autumn/Winter of 2019-2020. The majority of people in Georgia say that they have never heard about the candidates.  Among those who are aware of the appointment process, attitudes are more negative than positive.

Note: This blog post has been produced with the assistance of the European Union. Its contents are the sole responsibility of CRRC-Georgia, EMC, and IDFI and do not necessarily reflect the views of the European Union.

On January 30- February 10, 2020, within the EU-funded project “Facilitating Implementation of Reforms in the Judiciary (FAIR)”, CRRC-Georgia conducted a phone survey to understand people’s knowledge of and attitudes towards the Supreme Court  appointment process. The survey resulted in 766 completed interviews, and is representative of the adult Georgian-speaking population of the country. The theoretical margin of error of the survey is 3.5% for estimates near 50%, 3.1% for estimates near 75% and 25%, and 2.1% for estimates near 10% and 90%.

Wednesday, April 01, 2020

How think tanks can support the COVID-19 response through survey data

[Note: This article was originally published at On Think Tanks. It was written by CRRC Georgia's deputy research director, Dustin Gilbreath. The views expressed in this article do not necessarily reflect the views of CRRC Georgia or any related entity.]

COVID-19 is likely to be the largest challenge the world has faced since the Second World War. In the last two weeks, unemployment claims in the US have exceeded the highest number recorded during the great recession. And the virus is expanding at an exponential rate. While some governments have responded in a generally effective manner (for example Georgia), many have been laggards in their response.

Just as think tanks played a critical role in the aftermath of the Second World War, they too can play a role in supporting governments through and after the present crisis. Providing accurate, timely, and actionable quantitative research is one such way that think tanks could provide immediate support to response efforts. While John Hopkins University is mapping COVID-19 data to enable an understanding of the virus’s spread, there is a clear need for data on a wide array of other issues.

Here I run through some of the main challenges and areas in which governments will need data to inform their response, and share a research proposal concept note, in the hope that it will support other think tanks to develop their own proposals and work towards better-informed solutions faster.

Social measures to contain the virus

At present, the main challenge facing the world is containing the virus. While this is a medical phenomenon, it is also clearly a social one. Indeed, social distancing and self-isolation are the key strategies being promoted at the moment. For these to be effective, however, compliance is critical. Public opinion polls have the potential to not only estimate levels of awareness of important practices, but also which groups are more or less likely to comply with them. With this public opinion data, government efforts can be more targeted at encouraging social distancing and isolation among different groups.

Economic consequences
The economic downturn is the second major issue the world faces. With all but essential businesses shutting down in many countries, and lower consumer demand across a wide range of sectors even if businesses remain open, the world is clearly headed for recession. But how many people have lost jobs? And in which sectors? Which regions have been hardest hit? Again, public opinion polls can provide estimates for all of these.

Governments traditionally rely on large samples of face to face interviews for economic statistics. This means that economic data is unlikely to be forthcoming in the near future. In its place, telephone surveys have the potential to provide a reasonably accurate understanding of how many people are out of work or facing issues around food security, among other economic issues.

Cross-cutting issues
Aside from containing the virus and the economic collapse directly, polling has the potential to address a wide range of cross-cutting issues, from gender divisions in care work to Russian propaganda.

For example, around the world, women do a disproportionate amount of unpaid care work. With children home from school, the increased levels of care work may mean that the crisis impacts women more than men along some domains. Surveys can measure these and help inform policy efforts to alleviate these impacts.

Disinformation or propaganda is another key issue with important implications during the crisis. To take an example from Georgia, Russia has long spread propaganda in the country about the Lugar Lab, suggesting that it is a biological weapon development centre. The Lab has played a critical role in Georgia’s response to the virus. Opinion polls can enable an immediate understanding of how propaganda is spreading and inform messaging efforts against Russian propaganda.

An example survey research data concept note
Clearly, surveys have the potential to inform a wide array of policies. Indeed, in places like the UK, the Government has already commissioned them to inform response efforts. However, developing countries are less likely to be able to afford or have experience in polling in response measures. Given this, donors need to step up now more than ever to enable a strong response.

In support of helping think tanks do just this, here is CRRC-Georgia’s concept note for survey data collection to inform the COVID-19 response in Georgia. Although, at the time of writing, we have not received funding (if you want to fund something like this, do get in touch), we felt that this proposal might help other organisations to rapidly create their own proposals, in turn cutting down the time between proposals and funding being delivered to enable effective response. Response time aside, we hope sharing the proposal will encourage potential collaboration and learning from each other (we’d be happy to hear others thoughts on this).