Using Health Information Technology to Engage African American Women on Nutrition and Supplement Use During the Preconception Period

Abstract

ImportanceHealthy nutrition and appropriate supplementation during preconception have important implications for the health of the mother and newborn. The best way to deliver preconception care to address health risks related to nutrition is unknown.MethodsWe conducted a secondary analysis of data from a randomized controlled trial designed to study the impact of conversational agent technology in 13 domains of preconception care among 528 non-pregnant African American and Black women. This analysis is restricted to those 480 women who reported at least one of the ten risks related to nutrition and dietary supplement use.InterventionsAn online conversational agent, called “Gabby”, assesses health risks and delivers 12 months of tailored dialogue for over 100 preconception health risks, including ten nutrition and supplement risks, using behavioral change techniques like shared decision making and motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk to a health care provider.ResultsAfter 6 months, women using Gabby (a) reported progressing forward on the stage of change scale for, on average, 52.9% (SD, 35.1%) of nutrition and supplement risks compared to 42.9% (SD, 35.4) in the control group (IRR 1.22, 95% CI 1.03–1.45, P = 0.019); and (b) reported achieving the action and maintenance stage of change for, on average, 52.8% (SD 37.1) of the nutrition and supplement risks compared to 42.8% (SD, 37.9) in the control group (IRR 1.26, 96% CI 1.08–1.48, P = 0.004). For subjects beginning the study at the contemplation stage of change, intervention subjects reported progressing forward on the stage of change scale for 75.0% (SD, 36.3%) of their health risks compared to 52.1% (SD, 47.1%) in the control group (P = 0.006).ConclusionThe scalability of Gabby has the potential to improve women’s nutritional health as an adjunct to clinical care or at the population health level. Further studies are needed to determine if improving nutrition and supplement risks can impact clinical outcomes including optimization of weight.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT01827215.

Reproductive Life Planning in Adolescents

“…A novel digital online conversational agent "Gabby" 30,31 undertakes RLP by starting with a preconception health risk assessment that includes current pregnancy plans. From the risk assessment, Gabby creates a personalized, individual 25,26 the online MyPath reproductive goals assessment 32 was designed to be used prior to primary care visits.…”

“…The online conversational agent "Gabby" was tested in African American women aged 15 to 22 years and was found to be acceptable in this population group. 30 "Gabby" was also further tested in women in Australia. While the study recruited women aged 18 years or older, one of the key findings was that this tool could be targeted to those at school because of ease of access and use of information technology.…”

Effectiveness of a digital dietary intervention program targeting young adults before parenthood: protocol for the PREPARED randomised controlled trial

“… 7 8 Research in low-income and middle-income countries settings has evaluated the effects of providing dietary supplements. 9 Some studies are also in the planning, among them The Healthy Life Trajectories Initiative, the HELTI-project, which is a consortium of four studies evaluating whether an integrated intervention starting preconceptionally will reduce non-communicable disease (NCD) risk in participants’ future children. 9 10 HELTI primarily recruits women (one study partner also recruits partners), and women who are planning to have children.…”

“… 9 Some studies are also in the planning, among them The Healthy Life Trajectories Initiative, the HELTI-project, which is a consortium of four studies evaluating whether an integrated intervention starting preconceptionally will reduce non-communicable disease (NCD) risk in participants’ future children. 9 10 HELTI primarily recruits women (one study partner also recruits partners), and women who are planning to have children. In our study, we recruit men and women individually, regardless of partnership and plans for children.…”

“…Existing studies typically relate to improving diet in couples with compromised fertility or target women who are actively planning pregnancy 7 8. Research in low-income and middle-income countries settings has evaluated the effects of providing dietary supplements 9. Some studies are also in the planning, among them The Healthy Life Trajectories Initiative, the HELTI-project, which is a consortium of four studies evaluating whether an integrated intervention starting preconceptionally will reduce non-communicable disease (NCD) risk in participants’ future children 9 10.…”