Improving the health of young African American women in the preconception period using health information technology: a randomised controlled trial

Brian W Jack; Timothy Bickmore; Leanne Yinusa-Nyahkoon; Matthew Reichert; Clevanne Julce; Nireesha Sidduri; Jessica Martin-Howard; Zhe Zhang; Elisabeth Woodhams; Juan Fernandez; Mark Loafman; Howard J Cabral

doi:10.1016/S2589-7500(20)30189-8

Improving the health of young African American women in the preconception period using health information technology: a randomised controlled trial

Lancet Digit Health. 2020 Sep;2(9):e475-e485. doi: 10.1016/S2589-7500(20)30189-8.

Authors

Affiliations

¹ 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. Electronic address: bjack@bu.edu.
² Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA.
³ College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA, USA.
⁴ Department of Government, Harvard University, Cambridge, MA, USA.
⁵ Department of Family Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA.
⁶ 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.
⁷ Department of Obstetrics and Gynecology, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA.
⁸ Department of Family Medicine, Cook County Health System, Chicago, IL, USA.
⁹ Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA.

PMID: 33328115
DOI: 10.1016/S2589-7500(20)30189-8

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.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Behavior Therapy / methods*
Black or African American*
Communication*
Female
Health Behavior*
Health Promotion / methods*
Humans
Internet*
Motivational Interviewing
Preconception Care / methods*
Pregnancy
Pregnancy Outcome / ethnology
Risk Assessment
Technology
United States
Young Adult

Associated data

ClinicalTrials.gov/NCT01827215