Health IT improves engagement in preconception health to reduce racial disparities

August 25, 2020

New research from Boston Medical Center highlights the benefits of using health technology to engage African American and Black women earlier in preconception care in an effort to close the gap on racial disparities in birth outcomes and maternal mortality. Published in The Lancet Digital Health, findings showed that using Gabby, an online health technology system that delivers simulated care, increased the rate of maintaining and acting on identified preconception care risks by 16 percent after six months, compared to patients receiving a letter listing risks and suggesting a follow-up with a clinician. The results were maintained after 12 months.

In the United States, Black women have more than two times the increased risk of delivering a low birth weight infant, and four times the risk of maternal mortality as compared to white women. To address these racial disparities, researchers used the health information technology, Gabby, to help communicate key health messages to overcome barriers to providing health education and counseling. Gabby, an embodied conversational agent with computer-generated characters, simulates face-to-face conversation, allowing women to select the risks they want to discuss, learn about the importance of preconception health and listen to advice on how to take action.

"There is an overarching need to test new interventions in this high-risk population of women," said Brian Jack, MD, a family medicine physician at Boston Medical Center and director of the Boston University Center for Health System Design & Implementation. "It is now well established that mitigating a wide array of health risks at the time of conception can have profound and enduring effects not only on the health of the woman and her newborn, but also on the long-term health of children into adulthood. It is an important finding that a health information technology system can help to reduce these risks during the preconception period."

Prenatal care comes too late to impact the most critical time of embryonic development, especially for women who enter pregnancy with pre-existing conditions that could impact the health of both mother and baby. These conditions include physical and behavioral health conditions, exposure to risky medications or environmental conditions, genetic disorders, substance use disorder, unhealthy diet or weight, domestic abuse, or other concerns. By interacting with women to identify progress, give feedback and assess readiness, Gabby creates a customizable list of identified preconception care risks to assist in tracking progress.

The randomized trial included 528 women aged 18-34 who self-identified as African-American and/or Black and not pregnant, from 35 states around the United States. The women who received the intervention were provided with access to Gabby, that assessed 102 preconception risks and delivered 12 months of tailored dialogue using synthesized speech, nonverbal behavior, visual aids, and health behavior change techniques. The women who were a part of the control group received a letter listing their preconception risks and encouraged them to talk with a clinician.

"We wanted to create a way for patients to take control of their health outside of the doctor's office," said Jack, also a professor of family medicine at Boston University School of Medicine. "A digital conversation agent like Gabby allows for 24/7 access to accurate health information delivered through interactive dialogue based on best clinical practices."

Scalable health information technology like Gabby could be used as a population health tool to assist health systems to deliver preconception care to eligible women. It could also be used to assist clinicians by collecting data ahead of visits, informing patients of risks, improving patient-centered discussions, and directly addressing clinician time restraints.
Funding for this study was supported by the National Institute for Minority Health and Health Disparities of the National Institutes of Health (R01MD006213). The content does not necessarily represent the official views of the National Institutes of Health.

About Boston Medical Center

Boston Medical Center is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $97 million in sponsored research funding in fiscal year 2018. It is the 15th largest funding recipient in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit

Boston Medical Center

Related Health Articles from Brightsurf:

The mental health impact of pandemics for front line health care staff
New research shows the impact that pandemics have on the mental health of front-line health care staff.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

New measure of social determinants of health may improve cardiovascular health assessment
The authors of this study developed a single risk score derived from multiple social determinants of health that predicts county-level cardiovascular disease mortality.

BU study: High deductible health plans are widening racial health gaps
The growing Black Lives Matter movement has brought more attention to the myriad structures that reinforce racial inequities, in everything from policing to hiring to maternal mortality.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

E-health resource improves men's health behaviours with or without fitness facilities
Men who regularly used a free web resource made significantly more health changes than men who did not, finds a new study from the University of British Columbia and Intensions Consulting.

Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.

Mental health of health care workers in china in hospitals with patients with COVID-19
This survey study of almost 1,300 health care workers in China at 34 hospitals equipped with fever clinics or wards for patients with COVID-19 reports on their mental health outcomes, including symptoms of depression, anxiety, insomnia and distress.

Health records pin broad set of health risks on genetic premutation
Researchers from the University of Wisconsin-Madison and Marshfield Clinic have found that there may be a much broader health risk to carriers of the FMR1 premutation, with potentially dozens of clinical conditions that can be ascribed directly to carrying it.

Attitudes about health affect how older adults engage with negative health news
To get older adults to pay attention to important health information, preface it with the good news about their health.

Read More: Health News and Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to