I study how to bring health services closer to the people who need them. My work spans the continuum from formative studies that use design thinking approaches to create new services, to large scale randomized controlled trials to estimate the impact of interventions.


Digital Health and Data Science

I co-founded a digital health company called Nivi and serve as an advisor. Launched in 2016, Nivi’s core product is the first digital contraceptive screening and referral service in East Africa. Anyone with a basic mobile phone can complete a free screening, receive personalized recommendations for contraceptive methods, referrals to nearby healthcare providers, and provide feedback on their experience with providers and methods. Nivi is unique in its ability to use data on women’s contraceptive preferences and behavior to bring efficiency and transparency to family planning markets, help women to make informed choices, and give healthcare providers, governments, and industry new insights and tools for advancing public health and engaging consumers on a more personal level. Nivi is easy to use, private, and free.

Perinatal Depression

Depression is a leading cause of disability worldwide, and women suffering from perinatal depression are a particularly underserved population. Depression during pregnancy and in the postpartum period is associated with a number poor outcomes for women and their children, including increased maternal morbidity and mortality, poor infant health, and poor early childhood outcomes. While effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated. We are trying to change that by creating better screening tools and developing entirely new treatment delivery channels that have the potential for a step change in expanding access to care.

Poverty and Mental Health

What is the relationship between poverty and mental illness? Do interventions intended to alleviate poverty have indirect effects on mental health? I began studying these questions in 2009 with Chris Blattman, Jeannie Annan, and Julian Jamison. We partnered with AVSI, an Italian development agency with deep roots in Uganda, to conduct a 3-year cluster randomized trial of skills training and cash transfer program called WINGS.

More recently, I teamed up with Hyunsan Cho, Eve Puffer, and John Gallis to conduct a secondary analysis of the impact of a school support intervention on mental health. From 2011 to 2014, Hyunsan and colleagues conducted a cluster randomized trial of a school support intervention for orphans in Kenya. We found that the intervention prevented depression severity scores from increasing over time among adolescents recruited from intervention schools. There was no evidence of treatment heterogeneity by gender or baseline depression status. The intervention effect on depression was partially mediated by higher levels of continuous school enrollment among the intervention group, but this mediated effect was small. We concluded that school support for orphans may help to buffer against the onset or worsening of depression symptoms over time, promoting resilience among an important at-risk population.

Family-Based Interventions

Most kids grow up in family systems, so promoting child development, health, and well-being means engaging families in prevention and treatment. Family-based work presents some interesting methodological and implementation challenges, however. How do you measure constructs like family functioning and child maltreatment? What is the best way to rigorously evaluate complex interventions? I’ve had the opportunity to explore these issues in Kenya and Liberia through a collaboration with Eve Puffer. She heads a research team that develops and tests family-based interventions. Some of her work is done in partnership with the International Rescue Committee.

Parents Make the Difference

READY

HIV

I’ve worked on a number of studies that touch on issues related to HIV prevention and treatment. Most recently, I led a team in Zimbabwe developing a measure of caregiver readiness to disclose a child’s HIV status to the child (NICHD 5R21HD076695-03).

Forced Migration

As a doctoral student just starting out in global mental health, I spent the better part of 2007 living in northern Uganda and learning about community rebuilding after decades of protracted conflict.