Background. The Gabby Preconception Care system is an innovative communication system designed to identify and mitigate health risks for young African American (AA) or Black women before pregnancy, as a means of improving 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 proposed research occurs in Lesotho, a low income country with the second highest HIV and fifth highest tuberculosis prevalence rates worldwide, and a maternal mortality rate (1024/100,000) that is among the highest in Africa. As there are only 6.2 nurses and 0.5 physicians per 10,000 people, both about one-third of the African average, there is an enormous need for mHealth systems to assist the clinical care system. Goals. The goals of this project are to (1) adapt the online Gabby system to a culturally appropriate Gabby Women?s mHealth Program tailored to the medical needs of the country including enhanced HIV/Tb dialogue and interventions, and (2) study the dissemination and implementation of Gabby at all ten government district hospitals in Lesotho. Implementation occurs in partnership with the infrastructure developed by the Lesotho Boston Health Alliance?s physician training program that allows for national dissemination of best practices. Methods. Conduct a type 3 hybrid study design, with a primary focus on implementation and a secondary focus on effectiveness. Approaches include: (1) system adaptation with input from key stakeholders to guide cultural tailoring efforts and script development for use on mobile phones, (2) engaging and assessing site readiness at 10 district hospital in Lesotho, (3) carrying out a 3 month implementation of Gabby among 200 women attending outpatient clinic visits (20 per site), and (4) disseminating results of the implementation. Outcomes. This project will determine the extent to which the mHealth Gabby intervention is successfully disseminated to and implemented at district hospital locations and will measure effectiveness of the system in a low income country setting. Implementation outcome evaluation focuses on four implementation outcomes as defined by Proctor and evaluated using readiness interviews, focus groups, system-generated data, learning communities, and technical assistance logs. Clinical effectiveness is evaluated using stage of change data for individual risks generated by the system at baseline and after 3 months of system use. Results will be disseminated into the clinical, health services research, information technology and policy communities. Significance. The implementation of a user-friendly, culturally competent, evidence-based, scalable mHealth tool to improve the health of young women for whom access to health services is limited is critical to reaching FIC?s research objectives. This project contributes to the evidence base for the use of mHealth to improve clinical and public health outcomes while establishing research capacity and research networks in Lesotho.
The significance of this implementation and clinical effectiveness project is its potential to disseminate a low-cost, user-friendly, evidence-based, scalable mHealth intervention that is culturally adaptive and can be used in all 10 districts in the low-income country of Lesotho by women to improve their health. The Gabby Women?s mHealth Program represents a prototype for the future of mobile health care delivery in that it aligns current technology and augments the care provided by providers, for whom limited time and resources act as restraining factors. This project represents a global dissemination of the Gabby mHealth program?unprecedented in its innovative delivery of preconception care?and will play an important role in efforts to reduce poor birth outcomes for young Basotho women.