Implementation and Dissemination of 'Gabby,' a Health Information Technology System for Young Women, into Community-Based Clinical Sites

Women’s health prior to pregnancy is of critical importance, as healthy women are more likely to have healthy babies. Many women enter pregnancy at risk for poor outcomes because of preexisting medical conditions, exposures to teratogenic factors, or not following preventive actions such as taking folic acid. In efforts to improve maternal health, there has been a focus on preconception care, or engaging young women before they become pregnant. Despite over 30 years of research on maternal and child health outcomes, African American women are still twice as likely as white women to deliver a low birth-weight baby, a racial disparity that calls for specific intervention. Additionally, despite the broad interest in preconception care in recent years, there has been little progress in implementing these strategies into clinical practice. Health information technology (IT) introduces a promising mechanism for evidence-based innovations into the clinical context of health promotion and delivery.

This project will disseminate a low-cost, user-friendly, evidence-based intervention to community-based health providers, study the implementation process, and prepare a toolkit that can be used to facilitate broader dissemination. Researchers have developed the Gabby health IT system, an online conversational agent that screens for over 100 general and reproductive health risks and provides educational behavioral change designed to mitigate the health risks for young African American women. Gabby, the animated computer character, simulates face-to-face conversation that users can access on a web-based platform.

The specific aims of the project are as follows:

• Recruit six Healthy Start sites and six Community Health Centers with Federally Qualified Health Center designation as implementation sites. 
• Conduct site-level needs and resource assessments to guide implementation efforts. 
• Perform training at each site around implementation of the Gabby system into the clinical workflow of the 12 sites. 
• Assemble a preliminary, revised, and final Gabby Implementation toolkit. 
• Analyze each step of the implementation process and broadly disseminate the results of this work to the information technology, clinical, and health services research communities. 

Researchers will introduce Gabby into Healthy Start and Community Health Center sites serving low-income and minority women. They will assess the workflow and readiness of clinic sites and use surveys, key informant interviews, system-generated data, and implementation logs to evaluate the intervention and develop and disseminate an implementation toolkit. Results will demonstrate the ability of new technologies to augment health services already offered by community-based health providers, for whom limited time and resources act as restraining factors. They will also provide evidence about how to disseminate a new platform for addressing health disparities for young African American women.