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Jack BW, Bickmore T, Yinusa-Nyahkoon L, Reichert M, Julce C, Sidduri N, Martin-Howard J, Zhang Z, Woodhams E, Fernandez J, Loafman M, Cabral HJ. Improving the health of young African American women in the preconception period using health information technology: a randomised controlled trial. Lancet Digit Health 2021; 2:e475-e485. [PMID: 33328115 DOI: 10.1016/s2589-7500(20)30189-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Preconception care focuses on improving women's health before pregnancy as a means to improve their health and future pregnancy outcomes. How to effectively deliver such care is unknown. The aim of this research was to assess the impact of an embodied conversational agent system on preconception risks among African American and Black women. METHODS We did an open-label, randomised controlled trial of women aged 18-34 years, self-identified as African American or Black, or both, and not pregnant, recruited from 35 states in the USA. Sealed allocation envelopes (in permuted blocks of six and eight, prepared using a random number generator) were opened after enrolment. Intervention participants received an online conversational agent called Gabby that assessed 102 preconception risks and delivered 12 months of tailored dialogue using synthesised speech, non-verbal behaviour, visual aids, and health behaviour change techniques such as motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk with a clinician. The primary outcome was the proportion of identified risks at the action or maintenance stage of change at months 6 and 12. The study is registered with ClinicalTrials.gov, NCT01827215. FINDINGS From March 11, 2014, through July 8, 2018, 528 women recruited from 35 states and 242 cities across the USA received the Gabby intervention (n=262) or were assigned to the control group (n=266). Participants identified a mean of 21 preconception risks per woman (SD 9·9). In the intention-to-treat analysis, at 6 months, intervention women reported reaching the action or maintenance stage of change for 50·0% (SD 28·9) of those preconception risks identified compared with 42·7% (28·3) in the control group (incidence rate ratio 1·16, 95% CI 1·07-1·26; p=0·0004). This result persisted at 12 months. INTERPRETATION The Gabby system has the potential to improve women's preconception health. Further research is needed to determine if improving preconception risks impacts outcomes such as preterm delivery. FUNDING National Institute for Minority Health and Health Disparities.
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Affiliation(s)
- Brian W Jack
- Department of Family Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA; Institute for Health Systems Innovation and Policy, Boston University, Boston, MA, USA.
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | - Leanne Yinusa-Nyahkoon
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, USA
| | - Matthew Reichert
- Department of Government, Harvard University, Cambridge, MA, USA
| | - Clevanne Julce
- Department of Family Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Nireesha Sidduri
- Department of Family Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Jessica Martin-Howard
- Department of Family Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA; Institute for Health Systems Innovation and Policy, Boston University, Boston, MA, USA
| | - Zhe Zhang
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | - Elisabeth Woodhams
- Department of Obstetrics and Gynecology, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Juan Fernandez
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | - Mark Loafman
- Department of Family Medicine, Cook County Health System, Chicago, IL, USA
| | - Howard J Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
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Walter AW, Julce C, Sidduri N, Yinusa-Nyahkoon L, Howard J, Reichert M, Bickmore T, Jack BW. Study protocol for the implementation of the Gabby Preconception Care System - an evidence-based, health information technology intervention for Black and African American women. BMC Health Serv Res 2020; 20:889. [PMID: 32958031 PMCID: PMC7504872 DOI: 10.1186/s12913-020-05726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Improving the health of women before pregnancy and throughout a woman's lifespan could mitigate disparities and improve the health and wellbeing of women, infants and children. The preconception period is important for reducing health risks associated with poor maternal, perinatal and neonatal outcomes, and eliminating racial and ethnic disparities in maternal and child health. Low cost health information technology interventions provided in community-based settings have the potential to reach and reduce disparities in health outcomes for socially disadvantaged, underserved and health disparity populations. These interventions are particularly important for Black and African American women who have a disproportionate burden of pregnancy-related complications and infant mortality rates compared to any other racial and ethnic group in the U.S. METHODS This is a hybrid type II implementation-effectiveness cohort study aimed at evaluating appropriateness, acceptability and feasibility implementation outcomes, while also systematically examining the clinical effectiveness of a preconception care (PCC) intervention, the Gabby System, for Black and African American women receiving health services in community-based sites. The intervention will be implemented in six Community Health Centers and six Healthy Start programs across the U.S. Each study site will recruit and enroll 25-50 young Black and African American women who will participate in the intervention for a 6-month period. Appropriateness, acceptability and feasibility of implementing the PCC intervention will be assessed using: 1) Qualitative data derived from individual interviews with Gabby System end-users (clients and patients) and site staff; and, 2) Quantitative data from staff surveys, Gabby System usage and uptake. Aggregate health risk and utilization measures collected directly from the Gabby server will be used to examine the effectiveness of the Gabby System on self-reported behavior change. DISCUSSION This study will examine implementation outcomes and clinical effectiveness of an evidence-based PCC intervention for Black and African American women receiving services in Healthy Start programs and Community Health Centers. Contextual factors that influence uptake and appropriate implementation strategies will be identified to inform future scalability of the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04514224 . Date of registration: August 14, 2020. Retrospectively Registered.
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Affiliation(s)
- Angela Wangari Walter
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, 61 Wilder Street, O'Leary Library, Suite 540-M, Lowell, MA, 01854, USA.
| | - Clevanne Julce
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, 1 BMC Place, Boston, MA, 02118, USA
| | - Nireesha Sidduri
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, 1 BMC Place, Boston, MA, 02118, USA
| | - Leanne Yinusa-Nyahkoon
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, USA
| | - Jessica Howard
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, 1 BMC Place, Boston, MA, 02118, USA
| | - Matthew Reichert
- Department of Government, Harvard University, 86 Brattle Street, Cambridge, MA, 02138, USA
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Brian W Jack
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, 1 BMC Place, Boston, MA, 02118, USA
- Boston University Institute for Health Systems Innovation and Policy, 180 Riverway, Boston, MA, 02215, USA
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Gardiner P, Bickmore T, Yinusa-Nyahkoon L, Reichert M, Julce C, Sidduri N, Martin-Howard J, Woodhams E, Aryan J, Zhang Z, Fernandez J, Loafman M, Srinivasan J, Cabral H, Jack BW. Using Health Information Technology to Engage African American Women on Nutrition and Supplement Use During the Preconception Period. Front Endocrinol (Lausanne) 2020; 11:571705. [PMID: 33584534 PMCID: PMC7874041 DOI: 10.3389/fendo.2020.571705] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE Healthy nutrition and appropriate supplementation during preconception have important implications for the health of the mother and newborn. The best way to deliver preconception care to address health risks related to nutrition is unknown. METHODS We conducted a secondary analysis of data from a randomized controlled trial designed to study the impact of conversational agent technology in 13 domains of preconception care among 528 non-pregnant African American and Black women. This analysis is restricted to those 480 women who reported at least one of the ten risks related to nutrition and dietary supplement use. INTERVENTIONS An online conversational agent, called "Gabby", assesses health risks and delivers 12 months of tailored dialogue for over 100 preconception health risks, including ten nutrition and supplement risks, using behavioral change techniques like shared decision making and motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk to a health care provider. RESULTS After 6 months, women using Gabby (a) reported progressing forward on the stage of change scale for, on average, 52.9% (SD, 35.1%) of nutrition and supplement risks compared to 42.9% (SD, 35.4) in the control group (IRR 1.22, 95% CI 1.03-1.45, P = 0.019); and (b) reported achieving the action and maintenance stage of change for, on average, 52.8% (SD 37.1) of the nutrition and supplement risks compared to 42.8% (SD, 37.9) in the control group (IRR 1.26, 96% CI 1.08-1.48, P = 0.004). For subjects beginning the study at the contemplation stage of change, intervention subjects reported progressing forward on the stage of change scale for 75.0% (SD, 36.3%) of their health risks compared to 52.1% (SD, 47.1%) in the control group (P = 0.006). CONCLUSION The scalability of Gabby has the potential to improve women's nutritional health as an adjunct to clinical care or at the population health level. Further studies are needed to determine if improving nutrition and supplement risks can impact clinical outcomes including optimization of weight. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT01827215.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, United States
- *Correspondence: Paula Gardiner,
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Leanne Yinusa-Nyahkoon
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Matthew Reichert
- Department of Government, Harvard University, Cambridge, MA, United States
| | - Clevanne Julce
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Nireesha Sidduri
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Jessica Martin-Howard
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
- Institute for Health Systems Innovation and Policy, Boston University, Boston, MA, United States
| | - Elisabeth Woodhams
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Jumana Aryan
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Zhe Zhang
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Juan Fernandez
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Mark Loafman
- Department of Family Medicine, Cook County Health System, Chicago, IL, United States
| | - Jayakanth Srinivasan
- Institute for Health Systems Innovation and Policy, Boston University, Boston, MA, United States
- Department of Information Systems, Questrom School of Business, Boston, MA, United States
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Brian W. Jack
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
- Institute for Health Systems Innovation and Policy, Boston University, Boston, MA, United States
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