Gabby Implementation: Parent Protocol
Condition: Preconception Care
Study type: Observational

Summary: 
      The Gabby Preconception Care program 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. The
      system uses embodied conversational agent technology the investigators call "Gabby," who
      empathically interacts with users to assess health risks and delivers interventions to
      resolve or mitigate these risks. This research team has been working on the "Gabby"
      Preconception Care program, which features Virtual Patient Advocate (VPA) technology, for
      over seven years and the system is now ready for dissemination beyond the research
      environment and into the clinical and community context. The purpose of this project is to
      examine the implementation and dissemination process of the evidence-based Gabby Program.

      Caseworkers at Healthy Start (HS) Programs and healthcare providers at Community Health
      Centers (CHC's) do not have time to assess for the over 100 preconception health risks that
      can impact birth outcomes; our system can assist by streamlining that assessment to create a
      personalized list of risks.Gabby will be introduced/released to sites as part of their
      standard of care where patients and clients can then share their list with healthcare
      providers and case workers/managers to make their in-person interactions much more effective.
      Studies by the research team have shown that Gabby reduces health risks by 25 percent among
      young Black and AA women. The investigators will evaluate the success of the implementation
      process through both quantitative and qualitative measures including key informant telephone
      interviews and guidance from a Gabby Toolkit Advisory Board in order to prepare an
      implementation toolkit that can be used to facilitate broader dissemination. The Gabby
      program will not be evaluated as a research intervention, as this has been done previously,
      instead, how well the Gabby program worked within each site will be assessed.
    

Detailed description: 
      The investigators' implementation approach includes: 1) engaging 6 Healthy Starts and 4 CHCs
      and assessing the workflow and readiness of these clinical sites; 2) implementing the Gabby
      program for a period of 3-6 months at each of these clinical sites; 3) assembling a
      preliminary, revised, and final implementation toolkit; and 4) broadly disseminating the
      toolkit and results of the implementation. Input from a Gabby Toolkit Advisory Board will
      guide implementation efforts and toolkit development to be used for wider dissemination into
      other clinical based sites.

      Data sources will 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.
    

Intervention name(s): Gabby implementation; Evaluate the Gabby implementation
Intervention type(s): Other; Other
Intervention description(s): Iimplement an evidence-based preconception care intervention, Gabby, into community-based health settings; Assess implementation outcomes using the Proctor Implementation Outcomes Framework
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study population will consist of staff members at participating sites and clients who
        use the Gabby system. The staff will be from the 6 selected Healthy Start sites and the 6
        selected Community Health Centers who volunteer to participate by responding to a survey,
        being interviewed, or participating in a focus group about implementation of the Gabby
        program. The clients will be adult eligible women who receive services from one of the
        participating sites who meet the eligibility criteria.
      
Keywords: Healthy Start program; Community Health Centers; Implementation Science Research; Uptake; Organizational Readiness; Health Information Technology; Embodied Conversational Agent; Preconception Health; Black and African American women