Publications

Refugees in protracted displacement are often limited in their opportunities for income-generating activities and investments, making them dependent on aid for meeting basic needs. In the context of stretched humanitarian aid budgets, it is a necessary policy question to determine ways to increase refugees’ self-reliance. In this study, we combine a randomized controlled trial with extensive longitudinal qualitative data to explore the multidimensional impacts of a large, one-time, unconditional transfer of 1,000 USD to households of predominantly South Sudanese refugees living in protracted displacement in Uganda. Estimated after 19 months, we find that the transfer significantly increased households’ consumption, asset values, business ownership, business revenue, psychological well-being, and self-reliance. We find positive but insignificant effects on food security, migration, employment, or female empowerment. Overall, a large one-time cash transfer given in the context of shocks has multidimensional improvements in refugees’ lives, providing meaningful movement towards self-reliance.

Dignity is frequently held up as an important value by those delivering and receiving global development aid. In this paper, we develop a conceptual framework of dignity – the dignity chain–across the global development sector. We operationalize this framework through three pillars, which we label as representation, agency, and equality. We then assess empirically components related to development programs’ funding, design, and outcomes through three pilot experiments:

First, we examine how US citizens value respectful development in their intended charitable giving. We find that potential, individual donors in our sample are not willing to compensate charities for costly efforts to affirm dignity. Second, we examine how US-based non-profit professionals perceive respectful development in their work. We find development professionals state willingness to take pay cuts or serve fewer recipients if that means enhanced dignity efforts of their organizations. Third, we examine what difference small acts of respect for dignity in the research process make to low-income study participants in Kenya.

We find that low-effort actions of the kind that development professionals anticipate their organizations would support do not improve aid recipients’ altruistic behavior, self-efficacy, or well-being. Through these three small-scale survey experiments, we document a high stated commitment to the idea of dignity and uncover questions for further research about how to feasibility and effectively respect dignity across the dignity chain.

Racial identity and political partisanship have emerged as two important social correlates of hesitancy towards COVID-19 vaccines in the United States. To examine the relationship of these factors with respondents’ intention to vaccinate before the vaccine was available (November/December, 2020), we employed a multi-method approach: a survey experiment that randomized a vaccine-promotion message focused on racial equity in vaccine targeting, stepwise regression to identify predictors of hesitancy, and qualitative analysis of open-ended survey questions that capture how respondents reason about vaccination intentions. Experimental manipulation of a racial equity vaccine promotion message via an online survey experiment had no effect on intention-to-vaccinate in the full sample or in racial, ethnic and partisan subsamples. Descriptively, we find heightened hesitancy among non-Hispanic Black respondents (OR = 1.82, p<0.01), Hispanics (OR = 1.37, p<0.05), Trump voters (OR = 1.74, p<0.01) and non-Voters/vote Other (OR = 1.50, p<0.01) compared with non-Hispanic White respondents and Biden voters.

Lower trust in institutions, individualism and alternative media use accounted for heightened hesitancy in Trump voters, but not non-Hispanic Blacks and Hispanics. Older age and female gender identity also persistently predicted lower vaccine intentions. Qualitatively, we find that most hesitant responders wanted to ‘wait-and-see,’ driven by generalized concerns about the speed of vaccine development, and potential vaccine side-effects, but little mention of conspiracy theories. Identity appears to be an important driver of vaccinate hesitancy that is not fully explained by underlying socioeconomic or attitudinal factors; furthermore, hesitancy was not significantly affected by racial equity messages in this setting.

The United States is the only high-income country that relies on employer-sponsored health coverage to insure a majority of its population. Millions of Americans lost employer-sponsored health insurance during the COVID-19-induced economic downturn. We examine public opinion toward universal health coverage policies in this context.

Through a survey of 1,211 Americans in June 2020, we examine the influence of health insurance loss on support for Medicare for All (M4A) and the Affordable Care Act (ACA) in two ways. First, we examine associations between pandemic-related health insurance loss and M4A support. Second, we experimentally prime some respondents with a vignette of a sympathetic person who lost employer-sponsored coverage during COVID-19.

We find that directly experiencing recent health insurance loss is strongly associated (10 pp, p < 0.01) with greater M4A support and with more favorable views of extending the ACA (19.3 pp, p < 0.01). Experimental exposure to the vignette increases M4A support by 6 pp (p = 0.05).

In the context of the COVID-19 pandemic, situational framings can induce modest change in support for M4A. However, real-world health insurance losses are associated with larger differences in support for M4A and with greater support for existing safety net policies such as the ACA.

Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens.

Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression.

1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252).

The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment. Further research is needed to develop the most effective text message content and frequency.