The hero of preconception care
Health care might have found its Wonder Woman. She can identify health risks in young African-American women and help them successfully resolve those risks. She is engaging, empathetic, culturally competent, and extremely knowledgeable in preconception care. And soon, her advice will be available at any time to participants in a new study at Boston Medical Center meant to overcome factors that are detrimental to black women's health, like limited physician time and resources.
She can also be everywhere at once because Gabby, a significant healthcare disruptor, is not a real, physical person. The Gabby Preconception Care system, her formal name, is an embodied, online animated character, delivered via computer or tablet screen. She is programmed and designed to screen young black and African-American women for more than 100 general and reproductive health risks and to help them resolve those risks for before pregnancy.
"Gabby is part of a new effort to focus on engaging young women before they become pregnant - a concept called preconception care," said Brian Jack, MD, chief of family medicine at Boston Medical Center. "Essentially, healthy women are more likely to have healthy babies."
Despite decades of research, health disparities in birth outcomes persist for black and African-American women, who are more than two times as likely to deliver a low-birth weight infant as white women. Intervention studies in prenatal care have not been shown to lessen persistent disparities in birth outcomes, and it may be too little, too late in attempts to resolve concerning health disparities. In addition, there has been only modest progress in implementing what is known about preconception care into clinical practice, and little research has been done to translate preconception care knowledge into health delivery systems.
Jack's team has spent the last six years developing, refining, and studying Gabby to fill that delivery gap in preconception care. She represents a prototype for the future of health care delivery by aligning with current technology and supplementing the care provided by community-based health providers.
Gabby faces her next test in real-world clinical settings at six Healthy Start and six Community Health Center sites. The new study, which is supported by a $1.58 million grant from the Agency for Healthcare Research and Quality (AHRQ), will recruit 60 black or African-American women to interact with Gabby over six to nine months - at times decided by users.
Gabby has been successful in her mission to reduce pregnancy health risks before. In a randomized control trial, Gabby identified and successfully resolved health risks by more than 25 percent compared to a control group. Almost two-thirds of participants in the trial reported they used information from Gabby to improve their health, and another 22 percent planned to do so in the future.
"Gabby's ability to deliver content in a simple, conversational style is the closest person to person communication a device can provide. Her nonverbal conversational behaviors also enhance recall of critical information, as education is the key to the Gabby System and mitigating health risks," said Jack, who is also a professor and chair of the department of family medicine at Boston University School of Medicine.
The content of the Gabby system is tailored to women's desired outcome and is based on the Centers for Disease Control and Prevention "Content of Preconception Care." For example, Gabby can tell the difference between women who are interested in pregnancy prevention versus women who want to become pregnant. Gabby delivers specific health behavior change dialogue using techniques like motivational interviewing and shared decision making.
Subjects in the study will be able to create a "My Health to-Do List" during and after their interactions with Gabby, which they can share with their medical providers. Post study, Jack plans to release an implementation toolkit to facilitate broader dissemination of Gabby.
"The Gabby System is designed to extend the patient-provider conversation beyond the office," Jack said. "Gabby won't replace the interaction between patients and providers, but instead serves as a catalyst for discussions between them. She's another resource that can be offered by providers to ultimately facilitate the invaluable, and often time-consuming work clinicians intend to accomplish with their patients, but do not always manage to do so."