Background. The Gabby Preconception Care system is an innovative communication system designed to identify and mitigate or resolve health risks for young Black and African American (AA) women before pregnancy, as a means of reducing racial health disparities in birth outcomes. ?Gabby? is an online animated character that simulates face-to-face conversation and engages women in an empathic dialogue to educate them about their health risks. The system was shown to significantly reduce participants? risks in a randomized control trial. Goal. The project?s goal is to disseminate the Gabby Health Information Technology system in the real-world setting of 12 community-based health providers, study the implementation process, and prepare an implementation toolkit to facilitate broader dissemination. Significance. This work will introduce Gabby into Healthy Start and Community Health Center (CHC) sites serving low-income, minority women, a group AHRQ has identified as a high priority population. The dissemination of a low-cost, user-friendly, culturally competent, evidence- based, scalable intervention to improve the health of young AA women is critical to reaching a number of Healthy People 2020 objectives including: 1) Maternal, Infant, and Child Health: reducing the number of infant deaths (MICH-1.3) and preterm live births (MICH-9.1); and 2) Reproductive and Sexual Health service delivery to females aged 15-44 years (FP-7.1). Methods. Our implementation approach includes: 1) Engaging 6 Healthy Start sites and 6 CHCs; 2) assessing the workflow and readiness of clinical sites; 3) implementing Gabby at clinical sites; 4) assembling a preliminary, revised, and final implementation toolkit; and 5) broadly disseminating the toolkit and results of the implementation. Input from an Advisory Board and a modified Delphi panel will guide implementation efforts and toolkit development. Data sources include qualitative and quantitative methods, such as surveys/ assessments, key informant interviews, system-generated data, learning communities, and implementation logs. Evaluation will focus on site recruitment, training, and engagement; client engagement; clinical risk reduction; toolkit, technical assistance, and support resources; and dissemination efforts. Outcomes. This project will determine the extent to which Gabby is successfully disseminated to and implemented at community-based clinical sites. A comprehensive toolkit will be created for use in future dissemination of the evidence-based Gabby system, which is unprecedented in its innovative delivery of health promotion and risk reduction messaging?a promising approach for the reduction of health disparities for Black and AA women.
The significance of this implementation project is its potential to disseminate a low-cost, user- friendly, evidence-based, scalable intervention that is culturally adaptive and can be used across a range of health care and community settings to improve the health of young Black and African American women. The Gabby Health Information Technology system represents a prototype for the future of health care delivery in that it aligns the current technology and augments the care provided by community-based health providers, for whom limited time and resources act as restraining factors. This project represents the first step in the nationwide dissemination of the Gabby system?unprecedented in its innovative delivery of preconception care?and will play an integral role in efforts to reduce health disparities in birth outcomes for Black and African American women.