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.
Developing a digital marketplace for family planning: Pilot randomized encouragement trial (2018) with Arun Augustine, Violet Naanyu, Anna-Karin Hess, and Lulla Kiwinda, Journal of Medical Internet Research (surveys, data, and full replication materials)
“What is the best method of family planning for me?”: a text mining analysis of messages between users and agents of a digital health service in Kenya (2019) with Alex Whitcomb, Cynthia Kahumbura, Joseph Rosen, Sidd Goyal, Daphine Achieng, and Ben Bellows, Gates Open Research (data, and full replication materials)
A traumatic brain injury (TBI) prognostic model to support in-hospital triage in a low income country: a machine learning based approach (in press) with Thiago Augusto Hernandes Rocha, Cyrus Elahi, Núbia Cristina da Silva, Francis Sakita, Anthony Fuller, Michael M. Haglund, Blandina T. Mmbaga, Catherine A. Staton, and Joao Ricardo Nickenig Vissoci, forthcoming in the Journal of Neurosurgery.
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.
Developing and validating a perinatal depression screening tool in Kenya blending Western criteria with local idioms: A mixed methods study (2018) with Hawa Tuli, Edith Kwobah, Diana Menya, Irene Chesire, and Christina Schmidt, Journal of Affective Disorders (surveys, data, and full replication materials)
We’re exploring how artificial intelligence can be used to expand access to treatment for perinatal depression. Our team of researchers at Duke University, service providers at Jacaranda Health in Kenya, and AI experts at X2AI are adapting an evidence-based treatment called Thinking Healthy for automated delivery via SMS in Kenya. Read more about our work at healthymoms.app.
Expanding access to depression treatment in Kenya through automated psychological support: Protocol for a single-case experimental design pilot study (2019) with Nicholas Pearson, Sathyanath Rajasekharan, Michiel Rauws, Angela Joerin, Edith Kwobah, Christine Musyimi, Chaya Bhat, Rachel Jones, and Yihuan Lai, JMIR Res Protoc.
Expanding access to depression treatment in Kenya through automated psychological support: Development and usability study (2020) with Yihuan Lai, Nicholas Pearson, Sathyanath Rajasekharan, Michiel Rauws, Angela Joerin, Edith Kwobah, Christine Musyimi, Chaya Bhat, Rachel Jones, and Eve Puffer, JMIR Formative Research.
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.
The returns to microenterprise support among the ultra-poor: A field experiment in post-war Uganda (2016) with Christopher Blattman, Julian Jamison, and Jeannie Annan, American Economic Journal: Applied Economics (surveys, data, and full replication materials)
Does poverty alleviation decrease depression symptoms in post-conflict settings? A cluster-randomized trial of microenterprise assistance in northern Uganda (2016) with Christopher Blattman, Julian Jamison, and Jeannie Annan, Global Mental Health (surveys, data, and full replication materials)
Women’s entrepreneurship and intimate partner violence: A cluster randomized trial of microenterprise assistance and partner participation in post-conflict Uganda (2015) with Christopher Blattman, Julian Jamison, and Jeannie Annan, Social Science & Medicine (surveys, data, and full replication materials)
Promoting recovery after war in northern Uganda: Reducing daily stressors by alleviating poverty (2013) with Jeannie Annan and Moriah Brier, Journal of Child & Adolescent Trauma
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.
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.
Impact of the 2014 Ebola virus disease outbreak in Liberia on parent preferences for harsh discipline practices: A quasi-experimental, pre-post design (2018) with Rhea Chase, John Zayzay, Amy Finnegan, and Eve Puffer, Global Mental Health
A qualitative study of mechanisms underlying effects of a parenting intervention in rural Liberia (2017) with Ali Giusto, Elsa Friis, Amanda Sim, Rhea Chase, John Zayzay, and Eve Puffer, European Journal of Development Research
Parents Make the Difference: A randomized-controlled trial of a parenting intervention in Liberia (2015) with Eve Puffer, Rhea Chase, Amanda Sim, John Zayzay, Eduardo Garcia-Rolland, and Laura Boone, Global Mental Health (surveys, data, and full replication materials)
Associations between fathers’ and sons’ sexual risk in rural Kenya: The potential for intergenerational transmission (2017) with Ali Giusto and Eve Puffer, Journal of Adolescent Health
A church-based intervention for families to promote mental health and prevent HIV among adolescents in rural Kenya: Results of a randomized pilot trial (2016) with Eve Puffer, Kathleen Sikkema, Rose Ogwang-Odhiambo, and Sherryl Broverman, Journal of Consulting and Clinical Psychology
Family functioning and mental health changes following a family therapy intervention in Kenya: a pilot trial (2020) with Eve Puffer, Elsa Healy, Ali Giusto, Bonnie Kaiser, Puja Patel, and David Ayuku, Journal of Child and Family Studies
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).
The prevalence and process of pediatric HIV disclosure: A population-based prospective cohort study in Zimbabwe (2019) with Amy Finnegan, Lisa Langhaug, Katie Schenk, Eve Puffer, Simbarashe Rusakaniko, Yujung Choi, and Simbarashe Mahaso, PLoS One. (surveys, data, and full replication materials)
Caregiver self-efficacy to talk about sex predicts conversations about HIV transmission risk with perinatally infected young people in Zimbabwe (in press) with Langhaug, L., Finnegan, A., Schenk, K., Puffer, E.S., and Rusakaniko, S., AIDS Care.
Participatory mapping in low-resource settings: Three novel methods used to engage Kenyan youth in community-based HIV prevention research (2016) with Eve Puffer, Virginia Warren, and Sherryl Broverman, Global Public Health
A clinical decision support system for integrating tuberculosis and HIV care in Kenya: A human-centered design approach (2014) with Caricia Catalani, Keny Aggrey, Philip Owiti, Lameck Diero, Ada Yueng, Dennis Israelski, and Paul Biondich, PLoS One
Do clinical decision-support reminders for medical providers improve isoniazid preventative therapy prescription rates among HIV-positive adults?: study protocol for a randomized controlled trial (2015) with Caricia Catalani, Lameck Diero, Jane Carter, Adrian Gardner, Charity Ndwiga, Keny Aggrey, Philip Owiti, Dennis Israelski, and Paul Biondich
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.
Reconcilable differences? Human diversity, cultural relativity, and sense of community (2011) with Greg Townley, Bret Kloos, and Margarita Franco, American Journal of Community Psychology
Facilitating youth participation in a context of forced migration: A photovoice project in northern Uganda (2009) with Bret Kloos, Journal of Refugee Studies