Evidence Lab

The mission of the DGHI Evidence Lab is to conduct objective and high-quality evaluations of global health programs, interventions, and technologies in order to provide evidence of impact. Our goal is that the evidence generated by the DGHI Evidence Lab informs policy, programs and/or funding decisions. To achieve this, the Evidence Lab utilizes rigorous research designs paired with cutting-edge methods to collect and analyze data to understand whether health programs are having their intended effect. Our team blends theory and practice and draws upon the research and policy expertise across Duke University to inform our evaluations and to disseminate new evidence to policymakers, donors and diverse stakeholders in order to inform decision-making. Our team has deep, on-the-ground knowledge and experience with a wide range of global health projects and thus we can offer research and practice-based understandings of regional health challenges. Note that a core principle of the DGHI Evidence Lab is to strengthen the evaluation capacity of our local and project counterparts on collaborative projects.

Leadership


Evaluation of Training on Maternal & Child Morbidity & Mortality, Uganda

LifeNet International (LN) strives to address obstacles to quality health care in sub-Saharan Africa by providing logistics, financing, equipment and training services to existing faith-based health facilities. LN partners with health facilities in under-served areas to oversee quality assurance, provide training for health center staff, and address challenges related to care delivery, management, and supplies. They currently operate in Burundi, Uganda, and the Democratic Republic of Congo. LN has partnered with the Evidence Lab to evaluate the effects of the LN training intervention on improvement in quality of care indicators and maternal and child morbidity and mortality in 10 health facilities in Uganda. The evaluation is a 15-month quasi-experimental longitudinal study that includes direct observations of clinical practices, reviews of medical records, and interviews with providers.


Evaluation of an early-childhood development program for HIV-exposed children, Cameroon

Catholic Relief Services (CRS), motivated to further strengthen the evidence base for their programming, has partnered with the Evidence Lab to evaluate one of their early-childhood development (ECD) programs. While CRS implements ECD programs in many countries, this cluster-randomized trial focuses on HIV-exposed children in Cameroon who receive ECD services within a PEPFAR-funded program implemented by CRS. The study will determine to what extent the CRS program helps children reach age-appropriate developmental milestones. The team will follow 200 mother/baby dyads over a period of 18 months. For more information, visit ClinicalTrials.gov.


Lean Evaluation Methods for Social Enterprises in Health, East Africa and India

“We appreciate that the Evidence Lab team supports us in thinking through our evaluation needs with the USAID SEAD project. The Evidence Lab team clearly has the skills and experience needed to easily pick up opportunities to help us better define how we achieve impact and how we should best measure progress and outcomes related to our interventions/innovations. Such support is hard to come by when you are a growing organization like ours and it helps that we can bounce off ideas and discuss our evaluation needs with you.” Sam Gwer, Executive Director, Afya Research Africa

Visit our toolkit on lean evaluation methods, useful for social enterprises, donors, and partners! The toolkit outlines different ways social enterprises in health can better evaluate their work and communicate their results with tighter timelines and more limited resources.

For social enterprises in health, thoughtful approaches to evaluation are critical for assessing their health and economic impact. The USAID-funded Social Entrepreneur Accelerator at Duke (SEAD) program, and the innovators it supports globally, have benefitted from partnering with the DGHI Evidence Lab to leverage its unique insights and expertise for how to gather and use quality evaluation data from dynamic organizations. Krishna Udayakumar, Duke Faculty, Co-PI of SEAD

Full Spectrum Evaluation

The DGHI Evidence Lab conducts evaluations ranging from formative, pre-intervention research to impact evaluation to policy recommendations and dissemination. We utilize quantitative, qualitative, and mixed-methods approaches. 

Evidence Lab Expertise Includes:

  • Impact evaluation
  • Formative evaluation
  • Process evaluation
  • Implementation science
  • Economic analyses
  • Policy research
  • Research dissemination and utilization

Examples Include:

  • Joy Noel Baumgartner along with Joe Egger are leading a quasi-experimental longitudinal evaluation of LifeNet International’s training intervention on improvements in quality of care and maternal and child morbidity and mortality in selected LN partner clinics in Uganda.
  • Joe Egger is leading a USAID-funded evaluation of the Social Entrepreneurship Accelerator at Duke (SEAD) initiative, an interdisciplinary program assessing factors that influence how organizations scale innovations in global health in India and East Africa.
  • Lavanya Vasudevan is co-leading an NIH study on mHealth-assisted conditional cash transfers to improve timeliness of childhood vaccinations in Mtwara, Tanzania.
  • Krishna Udayakumar, through Innovations in Healthcare (formerly IPIHD), is developing a database and framework to categorize transformative health innovation globally, facilitating the evaluation of effectiveness and the scalability of global health enterprises.
  • Kathryn Whetten utilized a longitudinal cross-sectional time series design to evaluate orphan services in four geographic areas in Malawi.
  • Randall Kramer is leading an interdisciplinary study of malaria vector control and disease management interventions using a cluster-randomized factorial design in rural settings in Tanzania.
  • Rae Jean Proeschold-Bell evaluated a hepatitis C knowledge and testing campaign for people with HIV infection in North Carolina, USA, using an interrupted time series design.
  • John Bartlett evaluates the outcomes associated with antiretroviral therapy in cohort and randomized controlled studies in resource-limited settings.
  • Melissa Watt is collaborating with IntraHealth on a formative evaluation on the mental health needs of obstetric fistula patients in Mali.
 

 

Our Approach

Innovative Methods

For each evaluation, we consider all research designs and propose the design that offers the optimal degree of causal inference and understanding. We tailor the research design and data collection to each specific project.  Illustrative designs include randomized controlled trials (individual or cluster), interrupted time series analysis, randomized multiple baseline surveys, and quasi-experimental designs. We also often engage in mixed-methods research, utilizing qualitative methods including focus group discussions, in-depth interviews, observations, and daily diaries.

Health Policy Recommendations & Research Utilization

We approach each evaluation with the policy makers in mind, and build in the data collection needed to answer the most pressing policy questions.  We build relationships and take the time to craft useful, data-driven recommendations and disseminate them to a wide range of stakeholders.  Cognizant of the “research to practice” gap, we embrace strategies such as collaborative research, stakeholder engagement, advocacy, and communication that help link evidence to policies, programs and practice.

Building Local Capacity & Attention to Cultural Context

Capacity building activities (e.g. training, building internal assets, collaboration over the full course of project from inception to publication) within our local partnerships is a core principle of the DGHI Evidence Lab.  Local capacity among program and research partners allows communities and countries to utilize improved research methods and/or evidence-based practices after external resources have ended. In addition, together with local collaborators, we reach out to and solicit feedback from community stakeholders and create feedback loops that ensure the project’s research questions and data are accurate and useful.

Our Team

Joy Noel Baumgartner, PhD, Director

Joy Noel Baumgartner leads the Evidence Lab at the Duke Global Health Institute whose mission is to conduct rigorous evaluation research in low- and middle-income countries with local partners to inform evidence-based programs and interventions. She is also an Assistant Research Professor of Global Health at Duke University.  Joy Noel is a public health practitioner and health services researcher with 20 years of experience working in low-resource settings to strengthen the delivery of HIV, reproductive health, MCH, and mental health services.   Her previous projects have included working with Ministries of Health across sub-Saharan Africa to develop and test reproductive health and HIV-related health services interventions with a focus on services integration and meeting the health needs of adolescents.  

Some of Joy Noel’s current research projects include integrating HIV and mental health care in Zambia, developing and testing a model of integrated adolescent healthcare linked to schools in Tanzania, and in East Africa and India, supporting private sector healthcare entrepreneurs to collect stronger M&E data in order to highlight the impact of their innovations.  Joy Noel has a master's degree in Social Work from the University of Wisconsin at Madison and a PhD in Maternal & Child Health from the University of North Carolina at Chapel Hill, and she completed an NIMH postdoctoral fellowship in Psychiatric Epidemiology at Columbia University focused on global mental health.

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Rae Jean Proeschold-Bell, PhD, Advisor, Founding Director

Rae Jean Proeschold-Bell holds a PhD in clinical-community psychology. She has designed and conducted evaluations across a wide-range of interventions, including integrated physical and mental health interventions; sharing of electronic medical records; public health awareness and knowledge campaigns; and weight loss and stress reduction interventions. Rae Jean has employed a variety of research designs, including Randomized Controlled Trials; Interrupted Time Series analysis; and randomized multiple baseline designs. She is skilled in both qualitative and quantitative analysis and has developed and published measures culturally tailored for use with specific populations.

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Jennifer Headley, MSW, Evaluation Research Specialist

Jennifer Headley is an Evaluation Research Specialist with the Duke Global Health Institute Evidence Lab with almost 15 years of experience working in research and capacity building in the field of reproductive health and maternal and child health in low- and middle-income countries. Her current work focuses on helping social entrepreneurs determine how to use evaluation techniques to strengthen their impact statements for their innovations via an Evaluation Toolkit for social enterprises under the USAID-funded project Social Entrepreneurship Accelerator at Duke (SEAD). Previously, Jennifer worked in FHI 360’s Social and Behavioral Health Sciences department for more than 6 years serving as a research analyst and project manager for a wide range of studies, from impact evaluations and randomized controlled trials to formative research and behavioral studies. She has worked with diverse organizations, including universities, global non-profits, consulting firms, government ministries, and entrepreneurs.

Jennifer works on a variety or DGHI Evidence Lab projects and she particularly enjoys incorporating qualitative techniques and building capacity for research and evaluation. Jennifer has managed studies or led trainings in Guyana, India, Kenya, Kyrgyzstan, Malawi, Peru, South Africa, and Tanzania, and worked in Côte d'Ivoire as a Rural Health Peace Corps Volunteer. She holds a master's degree in Social Work and Social and Economic Development from Washington University in St. Louis.

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Joe Egger, PhD, Technical Expert

Joe Egger

Joe Egger is an epidemiologist who holds the position of Assistant Professor of the Practice of Global Health at the Duke Global Health Institute (DGHI). Dr. Egger is also Associate Director of DGHI’s Research Design & Analysis Core, which provides epidemiological and statistical support to DGHI students, faculty and affiliates. Joe works closely with faculty on a number of experimental and observational studies related to both chronic and infectious diseases. Much of his research has focused on longitudinal data analysis, time series methods, and multi-level modeling of cross-sectional data. Prior to joining Duke in 2013, Joe was the lead epidemiologist for SciMetrika, a public health consulting firm based in Research Triangle Park, NC. Joe has also worked in academic and government settings on a wide array of public health research topics, including influenza, HIV/AIDS, dengue, tobacco, obesity/nutrition, and cancers. He has a master’s degree in medical geography from the University of Washington, and a PhD in infectious disease epidemiology from the London School of Hygiene & Tropical Medicine.

Dr. Egger has been a frequent collaborator with the DGHI Evidence Lab, in particular for our evaluation activities for social enterprises. Dr. Egger is the research lead for a USAID-funded project called the Social Entrepreneurship Accelerator at Duke (SEAD). His SEAD-related work has included investigating factors that affect the scalability of healthcare innovations and evaluating clinical quality improvements among service delivery enterprises. His expertise is frequently utilized for designing impact evaluations for social enterprises in low-resource settings.

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Lavanya Vasudevan, PhD, Technical Expert

Lavanya Vasudevan

Lavanya Vasudevan is a public health researcher with training in epidemiology and biostatistics and an early training background in bench sciences. Dr. Vasudevan holds the title of Research Scholar at the Center for Health Policy and Inequalities Research (CHPIR) in the Duke Global Health Institute. Her research focuses on designing and evaluating novel digital health interventions to support maternal and child health outcomes, primarily with respect to childhood vaccinations and healthcare access among children in adversity in low and middle-income countries. She serves as a technical expert on mHealth to the World Health Organization’s Department for Reproductive Health and Research. She is the co-PI of an NIH R21 grant to examine the effectiveness of an mHealth-assisted conditional cash transfer and reminder system for improving timeliness of childhood vaccinations in Tanzania.

Dr. Vasudevan actively collaborates with the Evidence Lab on the above NIH grant and also supports other public health proposal activities for the Evidence Lab. She received her doctoral degree (Ph.D.) from Cornell University and a Master’s degree in Public Health (MPH) from the Johns Hopkins Bloomberg School of Public Health. She is Certified in Public Health (CPH) by the National Board of Public Health Examiners.

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Kendal Swanson, MA, Economic Consultant

Kendal Swanson joined the Evidence Lab a few months after completing her Masters’ in Economics at Duke in 2015. Using her training in quantitative research methods, statistical analysis, and economic theory, she is working with the team to develop and test an economic analysis toolkit for SEAD innovators. Kendal has hands-on experience working in the field and on qualitative and quantitative studies. She is also at the Sanford School of Public Policy as an associate in research working on impact evaluations of health interventions in India.

 

 

 

 

Evaluation Toolkit for Social Enterprises in Health

As part of the Social Entrepreneurship Accelerator at Duke (SEAD), the Evidence Lab developed a series of tools to help social enterprises in healthcare evaluate their services, products and/or technologies. Most social enterprises work in contexts where they lack the requirements for rigorous, gold-standard evaluations: finances, time to observe changes, and a controlled environment. The toolkit, however, outlines different ways social enterprises in health can better evaluate their work and communicate their results with tighter timelines and more limited resources. Donors and funders may also use the toolkit with their grantees, or to better understand what types of information are reasonable to request from social enterprises in health.

Funded by USAID’s Higher Education Solutions Network (HESN), the tools are publicly available.

Recent Publications by Evidence Lab Team Members and Collaborators

Evaluation Research

Evaluating the effects of organizational and educational interventions on adherence to clinical practice guidelines in a low-resource primary-care setting in Kenya.
Authors: Egger JR, Stankevitz K, Korom R, Angwenyi P, Sullivan B, Wang J, Hatfield S, Smith E, Popli K, Gross J.
Citation: Health Policy & Planning 2017 Mar 15.

Integrating family planning services into HIV care and treatment clinics in Tanzania: evaluation of a facilitated referral model.
Authors: Baumgartner JN, Green M, Weaver MA, Mpangile G, Kohi TW, Mujaya SN, Lasway C.
Citation: Health Policy & Planning 2014 Aug;29(5):570-9.

An interrupted time series evaluation of a hepatitis C intervention for persons with HIV.
Authors: Proeschold-Bell RJ, Hoeppner B, Taylor B, Cohen S, Blouin R, Stringfield B, Muir AJ.
Citation: AIDS & Behavior 2011 Nov;15(8):1721-31.

Observational Research

Correlates of postpartum common mental disorders: results from a population-based study in Amhara region, Ethiopia.
Authors: Baumgartner JN, Parcesepe A, Mekuria YG, Abitew DB, Gebeyehu W, Okello F, Shattuck D.
Citation: Archives in Women’s Mental Health. 2016 Oct;19(5):937-42.

Comparing patterns of sexual risk among adolescent and young women in a mixed-method study in Tanzania: implications for adolescent participation in HIV prevention trials.
Authors: Tolley EE, Kaaya S, Kaale A, Minja A, Bangapi D, Kalungura H, Headley JBaumgartner JN.
Citation: J Int AIDS Soc. 2014 Sep 8;17(3 Suppl 2):19149.

The sexual risk context among the FEM-PrEP study population in Bondo, Kenya and Pretoria, South Africa.
Authors: Headley J, Lemons A, Corneli A, Agot K, Ahmed K, Wang M, Odhiambo J, Skhosana J, Tharaldson J, Van Damme L, MacQueen K; FEM-PrEP Study Group.
Citation: PLoS One. 2014 Sep 17;9(9):e106410.

Maternal determinants of timely vaccination coverage among infants in rural Bangladesh.
Authors: Vasudevan L, Labrique AB, Mehra S, Wu L, Levine O, Feikin D, Klemm R, Christian P, West KP Jr.
Citation: Vaccine. 2014 Sep 22;32(42):5514-9.

Lopinavir/ritonavir monotherapy after virologic failure of first-line antiretroviral therapy in resource-limited settings.
Authors: Bartlett JA, Ribaudo HJ, Wallis CL, Aga E, Katzenstein DA, et al.
Citation: AIDS. 2012 Jul 17;26(11):1345-54.

Theoretical, Methodological, & Technical Articles

Domestic violence among adolescents in HIV prevention research in Tanzania: participant experiences and measurement issues.
Authors: Baumgartner JN, Kaaya S, Karungula H, Kaale A, Headley J, Tolley E.
Citation: Maternal & Child Health Journal 2015 Jan;19(1):33-9.

A randomized longitudinal factorial design to assess malaria vector control and disease management interventions in rural Tanzania.
Authors: Kramer RA, Mboera LE, Senkoro K, Lesser A, Shayo EH, Paul CJ, Miranda ML.
Citation: Int J Environ Res Public Health. 2014 May 16;11(5):5317-32.

Measuring social inclusion--a key outcome in global mental health.
Authors: Baumgartner JN, Burns JK.
Citation: International Journal of Epidemiology 2014 Apr;43(2):354-64.

mHealth innovations as health system strengthening tools: 12 common applications and a visual framework.
Authors: Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G.
Citation: Global Health Science & Practice 2013 Aug 6;1(2):160-71.

Use of a randomized multiple baseline design: rationale and design of the spirited life holistichealth intervention study.
Authors: Proeschold-Bell RJ, Swift R, Moore HE, Bennett G, Li XF, Blouin R, Williams VP, Williams RB Jr, Toole D.
Citation: Contemp Clin Trials. 2013 Jul;35(2):138-52. Epub 2013 May 16. Erratum in: Contemp Clin Trials. 2014 Jan;37(1):165.

Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.
Authors: Thoumi A, Udayakumar K, Drobnick E, Taylor A, McClellan M.
Citation: Health Affairs (Millwood). 2015 Sep;34(9):1489-97.

Reducing the global burden of Preterm Birth through knowledge transfer and exchange: a research agenda for engaging effectively with policymakers.
Authors: Yamey G, Horváth H, Schmidt L, Myers J, Brindis CD.
Citation: Reproductive Health. 2016 Mar 18;13:26.