Reaching Women through Health Information Technology: The Gabby Preconception Care System

Abstract

Purpose The CDC has endorsed the concept of preconception care (PCC). New tools must be developed to promote PCC. Design Development and testing of a health information technology system to provide PCC. Setting An urban safety net hospital and an urban university. Subjects Community recruitment of 31 women in focus groups and 15 women participating in observed usability testing; 9 students recruited from the Office of Minority Health Preconception Peer Educators program participated in pilot testing for 2 months. Intervention Online interactive animated character (“Gabby”) designed to identify and modify preconception risks. Measures Qualitative transcripts, preconception risk assessment, server data for system usage, self-administered satisfaction surveys and follow-up phone calls. Analysis Descriptive statistics of subjects’ demographics, satisfaction, PCC risks and system usage. Transcripts coded using NVIVO. Results Subjects (n=24) reported an average of 23 preconception risks; in the pilot, 83% of risks added to the “My Health To-Do List” were addressed by the subject. 73% of risks identified as Contemplative progressed to Action or Maintenance. Differences were noted in effectiveness of the system based on initial stage of change for each risk. Conclusion Results suggest that the PCC system could be effective in influencing positive behavior change. Adding stage of change-focused functionality might have added benefits. This system has great potential to assist in the delivery of preconception care.

Rationale and design of the Atrial Fibrillation health Literacy Information Technology Trial: (AF-LITT)

“…The ECA has been used in multiple contexts for health intervention to foster a therapeutic alliance and assist self-care in individuals with chronic medical conditions, particularly those with inadequate health literacy. [12][13][14][15] This pilot RCT will implement a novel ECA designed to improve HRQoL and anticoagulation adherence in individuals with AF.…”

Determining Pre-Conception Risk Profiles Using a National Online Self-Reported Risk Assessment: A Cross-Sectional Study

“…Although several initiatives have been developed, only a few instruments are described and published in the scientific literature. Gardiner et al [28] published results on the early testing of an animated character, designed to simulate the face-to-face conversational behaviour of an empathic clinician. This Gabby system is one of few published examples of such an e-tool approach for personalized pre-conception care.…”

Supporting longitudinal change in many health behaviors

“…Based on our review of the literature, experience with a prior multiple behavior change system [3], and our PCC pilot work [8], we identified a number of challenges in designing a system to support multiple, longitudinal, behavior change. These challenges, and our approaches to address them, include the following.…”

“…The initial PCC system was developed using input from eight focus groups (31 women total) and usability testing with 15 women, and evaluated in a two-month pilot study with 9 additional women [8]. Satisfaction was rated highly by all participants, and participants in Transtheoretical Model [14] ("Stages of Change") • Posits that people go through a well-defined series of stages in changing behavior.…”

“…In our pilot work, we have discovered that the average woman in our target demographic has 23 (range 13-37) preconception risks that need to be addressed [8]. Thus, preconception care represents an application domain in which many health behaviors need to be changed, with the set of behaviors potentially different for each user, and many of which require longitudinal support.…”