Research
This page contains select examples of both ongoing and past research. I have divided the selected research into the slightly-overlapping categories of International Development, Economic Evaluation, and Public Health. For a full list of publications, please see my CV.
International Development
Most of my recent research has focused on international development topics. My dissertation is centered on digital innovations for financial inclusion, including the regulation of mobile money and policy decisions of microfinance institutions. During my time with the Evans Policy and Research Group (EPAR), I collaborated with researchers at the American Institutes for Research (AIR) and the Population Council to study the benefits of women’s groups.
“Mobile money interest distributions and savings behavior in Tanzania” [currently under review]
Abstract
In 2014, Tanzania became the first country to implement a policy requiring mobile money providers to distribute interest to mobile money account holders. Supporters of the policy note the potential benefits to users, while banking sector opponents worry that users will forego bank accounts in favor of mobile wallets. This study uses data from Waves 4 and 5 of the Tanzania NPS in a difference-in-differences approach to estimate the impact of an interest policy that rewards mobile savings on savings behavior. I find the treatment effect of the savings incentive policy to be an 11 percentage point increase in the probability that a household will use mobile money to save. Further, there is no indication that users substitute mobile wallets for bank accounts, which should quell concerns of negative outcomes for financial institutions. Mobile interest distribution is a promising yet underexplored mechanism for increasing financial inclusion among the world’s poorest.“Determinants of demand for digital loan repayment among microfinance clients in Uganda” [manuscript in preparation]
Abstract
The rapid spread of mobile money throughout sub-Saharan Africa has paved the way for digital innovations in microfinance. Existing research is largely focused on the implications of digitization for loan repayment rates and operational efficiency, but this paper uniquely centers the overlooked perspectives of microfinance borrowers. I leverage a mixed-methods approach, including a quantitative discrete choice analysis and a qualitative content analysis of stated preferences, to explore the determinants of demand for a digital repayment option among a group of current microfinance clients in Uganda. I find that borrowers’ comfortability with mobile money, education level, and perceptions of the cost and convenience of digital repayment are important determinants of demand. However, qualitative data reveal heterogeneity in borrowers’ understanding of how digital repayment will impact the microfinance group structure and their future access to credit, which has substantial implications for the uptake of digital repayment. These findings can inform the design of digital microfinance innovations and also contribute to the broader literature around technology adoption by highlighting the importance of qualitative data and user-centered research.“Women’s Groups, Covariate Shocks, and Resilience: An Evidence Synthesis of Past Shocks to Inform a Response to COVID-19”, with Schmidt CJ, Kaminsky M, Singh R, Anderson CL, Desai S, & de Hoop T. ECWG working paper , 2021.
Abstract
Women’s groups have the potential to increase the resiliency of members and communities during widespread shocks, such as COVID-19. This evidence synthesis compiles data from past shocks to describe the responses and mitigating effects of women’s groups during shocks. We found that covariate shocks tend to disrupt group activities and resources, but evidence was largely supportive of women’s groups providing resilience to members and communities. We finalize the paper with policy recommendations for women’s groups during COVID-19, including sustainable access to financial resources; equitable distribution of group benefits and burdens; and enhancing community response through meaningful partnerships.
Economic Evaluation
After earning my MPH, I spent four years working as a research associate with the Economic Evaluation Research Group (EERG) at the University of Georgia’s College of Public Health. In my role at EERG, I collaborated on numerous projects at the state, national, and international levels. Most of my work focused on the economic implications of public health initiatives, but I also served as the primary writer of the cost analysis report for OPRE’s national MIHOPE study.
- “There’s no such thing as a free TB diagnosis: Catastrophic TB costs in urban Uganda”, with Ingels JB, Corso PS, Zalwango S, Whalen CC, Sekandi JN. Published in Global Public Health, 2020
Abstract
Identifying and reducing TB-related costs is necessary for achieving the End TB Strategy's goal that no family is burdened with catastrophic costs. This study explores costs during the pre-diagnosis period and assesses the potential for using coping costs as a proxy indicator for catastrophic costs when comprehensive surveys are not feasible. Detailed interviews about TB-related costs and productivity losses were conducted with 196 pulmonary TB patients in Kampala, Uganda. The threshold for catastrophic costs was defined as 20% of household income. Multivariable regression analyses were used to assess the influence of patient characteristics on economic burden, and the positive predictive value (PPV) of coping costs was estimated. Over 40% of patients experienced catastrophic costs, with average (median) pre-diagnosis costs making up 30.6% (14.1%) of household income. Low-income status (AOR = 2.91, 95% CI = 1.29, 6.72), hospitalisation (AOR = 8.66, 95% CI = 2.60; 39.54), and coping costs (AOR = 3.84, 95% CI = 1.81; 8.40) were significantly associated with the experience of catastrophic costs. The PPV of coping costs as an indicator for catastrophic costs was estimated to be 73% (95% CI = 58%, 84%). TB patients endure a substantial economic burden during the pre-diagnosis period, and identifying households that experience coping costs may be a useful proxy measure for identifying catastrophic costs.
“Costs of Evidence-Based Early Childhood Home Visiting: Results from the Mother and Infant Home Visiting Program Evaluation”, with Corso PS, Ingels JB. Published OPRE report, 2022.
In partnership with colleagues at HRSA, OPRE, and MDRC, we conducted this study as part of the nationwide Mother and Infant Home Visiting Program Evaluation (MIHOPE). We surveyed more than 60 local home visiting programs to understand how programs allocate resources, and we developed a unique microcosting methodology to estimate the costs to provide home visiting services to a family for a year. We found that local program costs for serving a family during its first year of home visiting varied considerably, with the cost for the middle half of families ranging between \$1,304 and \$5,788 per year. Average costs did not differ across characteristics of mothers but did vary widely according to the program model being implemented.
“Benefit-cost analysis of undergraduate education programs: An example analysis of the Freshman Research Initiative”, with Corso PS, Rodenbusch SE, Dolan EL. Published in CBE-Life Sciences Education, 2018.
Abstract
Institutions and administrators regularly have to make difficult choices about how best to invest resources to serve students. Yet economic evaluation, or the systematic analysis of the relationship between costs and outcomes of a program or policy, is relatively uncommon in higher education. This type of evaluation can be an important tool for decision makers considering questions of resource allocation. Our purpose with this essay is to describe methods for conducting one type of economic evaluation, a benefit-cost analysis (BCA), using an example of an existing undergraduate education program, the Freshman Research Initiative (FRI) at the University of Texas Austin. Our aim is twofold: to demonstrate how to apply BCA methodologies to evaluate an education program and to conduct an economic evaluation of FRI in particular. We explain the steps of BCA, including assessment of costs and benefits, estimation of the benefit-cost ratio, and analysis of uncertainty. We conclude that the university's investment in FRI generates a positive return for students in the form of increased future earning potential.
Public Health
While at UW, I worked as a research assistant for the COVID-19 State Policy Research Team. We constructed the nation’s most detailed and complete repository of state-level COVID-19 policies, and our primary collaborators at IHME have used the dataset in their development of several high-profile articles, such as
- Global Burden of Disease Long COVID Collaborators [includes Walcott R]. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA, 2022.
During my time with EERG at UGA, I led a number of public health evaluations for local and state partners, as well as several global health initiatives.
- “A statewide hospital-based safe infant sleep initiative: Measurement of parental knowledge and behavior”, with Salm Ward TC, Ingels JB, Llewellyn NA, Miller TJ, Corso PS. Published in the Journal of Community Health, 2018
Abstract
Sleep-related infant deaths are a leading cause of infant mortality in Georgia, and these deaths are largely associated with unsafe sleep practices among caregivers. In early 2016, the Georgia Department of Public Health launched the Georgia Safe to Sleep Hospital Initiative, providing hospitals with safe infant sleep information and educational materials to be distributed to families and newborns. This study examined the knowledge and behaviors of a sample of Georgia parents after the implementation of the Hospital Initiative and identified the family characteristics and intervention components most closely associated with the knowledge and practice of safe infant sleep. The primary caretakers of all infants born in Georgia from August to October 2016 were invited to complete a web-based survey 1 month after hospital discharge. The final sample size included 420 parents of newborns, and the primary outcomes assessed included two measures of knowledge and four measures of infant sleep behaviors regarding infant sleep position and location. Most respondents demonstrated knowledge of the correct recommended sleep position (90%) and location (85%). Logistic regression revealed that receipt of information in the hospital was significantly correlated with safe sleep behaviors, and infant sleep habits tended to influence safe sleep practices. Additionally, Medicaid parents receiving bassinets from the hospital were 74% less likely to bed share (OR 0.26; 95% CI 0.007). Implementation of a statewide hospital initiative was associated with high levels of parental knowledge and behavior and may have been successful in reducing the practice of bed sharing among Medicaid parents.
- “The impact of nursing students on the health-related quality of life and perceived social support of a rural population in Ecuador: Effects of a service-based learning course” with Murcia AM, Berry GM, Juna C, Roldós MI, Corso PS. Published in the International Journal for Equity in Health, 2018.
Abstract
Background: Students seeking degrees in healthcare in Ecuador participate in community improvement projects and provide free health services under the supervision of faculty health professionals. The aim of this study is to determine the impact of a community-based intervention delivered by nursing students on health-related quality of life (HRQoL) and perceived social support of a rural population in Ecuador. Methods: A quasi-experimental non-equivalent control group design study was conducted in two rural communities in Tumbaco, Ecuador. Families from one rural community were invited to participate in the intervention, receiving 8 weekly home visits from nursing students. Families from a neighboring community were similarly recruited as wait-list controls. One member of each family was consented into the study; the final sample included 43 intervention participants and 55 control participants. HRQoL and perceived social support were assessed before and after the intervention in both groups. The SF-12 was used to measure HRQoL, including eight domain scores and two composite scores, and the Interpersonal Support Evaluation List was used as an indicator of perceived social support. Difference-in-differences (DD) analyses were conducted to mitigate the effects of any baseline differences in the non- equivalent control group design. Results: When compared to the control group, the intervention group realized significant improvements in the physical component summary score of the SF-12 (4.20, p < 0.05) and the physical function domain of the SF-12 (4.92, p < 0.05). There were no statistically significant differences for any other components of the SF-12 or in the measure of perceived social support. Conclusions: Nursing students completing their rural service rotation have the potential to improve the health-related quality of life of rural residents in Ecuador. Future research should continue to examine the impact of service-based learning on recipient populations.
- “Emergency department use among uninsured adults before and after enrolling in a free clinic”, with Ingels JB, Corso PS. [working paper]
Abstract
The objective of this study was to examine emergency department (ED) use among a group of uninsured adults before and after gaining access to primary care at a free clinic. We identified a cohort of 185 adult patients and compared rates of ED use by visit severity. The rate of non-emergent ED visits decreased by 39% when comparing the cohort’s ED use before and after clinic enrollment (rate ratio=0.61, p=0.001). There were no significant reductions in emergent ED visits. Gaining access to primary care through a free clinic has the potential to reduce non-emergent ED visits for uninsured adults.