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

May combine two claims.

Focus group participants found the preconception risk assessment's language understandable and its format well-designed, but they proposed some changes.

“Focus group participants found that the language in the preconception risk assessment was understandable and the format was well-designed but suggested some changes.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants emphasized that the virtual patient advocate should have style and layers and look like a young adult seen on the street, and they suggested adding a stylish haircut, accessories such as jewelry or glasses, and subtle makeup.

“participants also highlighted the importance of the VPA having style and layers, and looking like a young adult they might see walking down the street, and therefore suggested that a stylish haircut, accessories (e.g. jewelry, glasses), and subtle makeup be added to the existing VPA.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants recommended adding an Information button for extra explanation about a question when needed.

“participants recommended adding an “Information” button where they could receive an additional explanation about a question, if needed.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Participants suggested that a uniform or fitted professional shirt, name badge, or stethoscope could symbolize the virtual patient advocate's role as a young female health care professional.

“suggested this could be symbolized by a uniform or fitted professional shirt, name badge, or stethoscope.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The analysis identified 74 content codes from focus group topics and 44 content codes from usability testing.

“A total of 74 content codes were identified from the topics discussed during focus groups, and 44 content codes from usability testing.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants wanted the virtual patient advocate to have a modern name, and the group agreed on the name Gabby.

“Participants also suggested that the VPA have a modern name, and consensus decided the name “Gabby” (Figure 1).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Several participants had trouble with the BMI question that asked for height in inches and suggested separate boxes for feet and inches.

“one question that calculates BMI asks participants to enter their height in inches. Several participants reported difficulty with this calculation and suggested including two separate response boxes for feet and inches.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants proposed letting users complete the questionnaire over multiple sessions and adding a progress bar to show completion progress and improve usability.

“Participants also suggested allowing users to complete the questionnaire in multiple sessions, and adding a progress bar to visually represent their progress in completing the risk assessment to improve usability.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Usability testing participants did not find the story-telling function intuitive, so a simpler interface was made before the pilot began.

“the usability testing participants did not report the story-telling function to be intuitive, so a simpler interface was created prior to the start of the pilot test.”

May combine two claims.

There were a total of 63 sessions, an average of 10.5 sessions per participant.

“for a total of 63 sessions, an average of 10.5 sessions per participant.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There were 550 total individual risks identified.

“There were 550 total individual risks identified”

May combine two claims.

The average session lasted twelve minutes, with a range from two to 32 minutes.

“The average session lasted twelve minutes, with a range from two to 32 minutes.”

May combine two claims.

Combining usability and pilot participants at first use (n=24), most trusted Gabby (17 of 24).

“most participants trusted Gabby (17 of 24)”

May combine two claims.

The average number of risks identified per woman was 23, with a range of 13 to 37.

“the average number of risks identified per woman was 23, with a range of 13 to 37 risks.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Adding functionality focused on stage of change could provide additional benefits.

“Adding stage of change-focused functionality might have added benefits.”

• AssumptionRests on an assumption: The pilot participants' self-reported risk resolution and stage-of-change progression accurately reflect their actual behavior change.

May combine two claims.

Preconception care has been discussed for over 20 years, but implementation in clinical practice has advanced only modestly despite broad interest.

“PCC concepts have been discussed for more than 20 years, but despite broad interest8 there has been only modest progress in implementing these concepts into clinical practice.”

• cites [8] Jack BW Culpepper L Preconception care: risk reduction and health promotion in preparation for pregnancy Journal of the American Medical Association 1990 264 9 1147 1149 2384939 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Gabby's script content was adapted from CDC workgroup material and written at a sixth-grade reading level.

“The Gabby script content is adapted from the information prepared by the CDC workgroup and written at a 6th grade reading level.”

May combine two claims.

The Gabby system's online preconception risk assessment was built from risk assessment tools used in earlier studies and updated according to published CDC clinical work group guidance.

“The Gabby system’s online preconception risk assessment is based on risk assessment tools used in prior studies20 and updated based on the published work of the CDC clinical work group.12”

• cites [20] Jack BW Culpepper L Babcock J Kogan M Wesimiller D Addressing preconception risks at the time of a negative pregnancy test? a randomized trial Journal of Family Practice 1998 47 33 38 9673606Not checked yet

  Not checked in the free run.

• cites [12] Jack BW Atrash H Coonrod DV Moos M-K O’Donnell JK Johnson K The clinical content of preconception care: an overview and preparation of this supplement Am J Obstet Gynecol 2008 199 Suppl S266 279 19081421 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Virtual patient advocates are well suited to deliver preconception care because they can reach many patients, reduce clinician time demands, control costs, and achieve high acceptability through culturally appropriate and low-health-literacy-appropriate content.

“VPAs are ideal for delivering PCC because they can potentially reach a large number of patients, alleviate clinician time restraints, and control costs while simultaneously having high patient acceptability through culturally appropriate content17 and information appropriate to those with low health literacy.18, 19”

• cites [17] King A Bickmore T Campero M Pruitt L Yin L Employing ’Virtual Advisors’ in Preventive Care for Underserved Communities: Results from the COMPASS Study Journal of Health Communication (to appear) PMC7187757 23941610 sourceNot checked yet

  Not checked in the free run.

• cites [18] Bickmore T Pfeifer L Jack B Taking the time to care: empowering low health literacy hospital patients with virtual nurse agents Computers in Medicine 2009 sourceNot checked yet

  Not checked in the free run.

• cites [19] Bickmore TW Pfeifer LM Byron D Usability of conversational agents by patients with inadequate health literacy: evidence from two clinical trials J Health Commun 2010 15 Suppl 2 197 210 20845204 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Even though early prenatal care became more accessible over the past 20 years, outcomes did not improve.

“Despite increased access to early prenatal care over the course of the past 20 years, outcomes have not improved.5,6”

• cites [5] Klerman LV Ramey SL Goldenberg RL Marbury S Hou J Cliver SP A randomized trial of augmented prenatal care for multiple-risk, medicaid-eligible African American women Am J Public Health 2001 91 1 105 111 11189800 PMC1446489 sourceNot checked yet

  Not checked in the free run.

• cites [6] Stevens-Simon C Orleans M Low-birthweight prevention programs: the enigma of failure Birth 1999 26 3 184 191 10655819 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Members of the CDC Select Panel on Preconception Care clinical committee reviewed and edited the Gabby risk assessment within their clinical expertise.

“In addition, the Gabby risk assessment was reviewed and edited by members of the clinical committee of the CDC Select Panel on Preconception Care in the areas of their clinical expertise.”

May combine two claims.

The virtual patient advocate mimics an empathic clinician's face-to-face conversation, including gaze, posture, and hand gestures, to deliver tailored patient education, check comprehension, and track progress.

“The VPA emulates the face-to-face conversational behavior of an empathic clinician, including nonverbal communicative behavior such as gaze, posture, and hand gestures to deliver patient education messages tailored to individual needs, assess patient comprehension, and record progress.14, 15, 16”

• cites [14] Bickmore T Gruber A Picard R Establishing the computer-patient working alliance in automated health behavior change interventions Patient Education and Counseling 2005 59 21 30 16198215 sourceNot checked yet

  Not checked in the free run.

• cites [15] Bickmore T Giorgino T Health dialog systems for patients and consumers Journal of Biomedical Informatics 2006 39 556 571 16464643 sourceNot checked yet

  Not checked in the free run.

• cites [16] Bickmore T Pfeifer L Relational agents for antipsychotic medication adherence Proceedings of the CHI’08 Workshop on Technology in Mental Health 4 6 2008 Florence, ItalyNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Focus group transcript analysis started after the first group so early findings could shape initial programming, which later focus group participants then reviewed and gave feedback on.

“Analysis of focus group transcripts began after the first focus group so that early findings could inform initial programming, which participants in later focus groups reviewed and provided feedback on.”

May combine two claims.

Evidence indicates that health information technology improves healthcare access by streamlining services, reducing geographic barriers, and tailoring education and promotion to patients' health literacy, values, and cultural and linguistic preferences.

“Emerging evidence suggests that HIT increases access to healthcare by streamlining clinical services, reducing barriers such as remote geographic location, and tailoring patient education and health promotion messages to fit patients’ health literacy levels, personal values, and cultural and linguistic preferences.13”

• cites [13] Bickmore T Pfiefer L Yin L The role of gesture in document explanation by embodied conversation agents International Journal of Semantic Computing 2008 2 1 47 70Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Before participants heard about a risk, their stage of change for that risk was assessed using the Transtheoretical Model.

“Prior to hearing information about a risk, the participant’s stage of change from the Transtheoretical Model23 for that risk was assessed.”

• cites [23] National Cancer Institute Theory at a glance: a guide for health promotion practice 2 US Department Health and Human Services 2005Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The CDC's Select Panel on Preconception Care published a guiding vision for preconception health and healthcare in 2006.

“In 2006, the Select Panel on Preconception Care, formed by the Centers for Disease Control (CDC), published the guiding vision for preconception health and healthcare.11”

• cites [11] Centers for Disease Control and Prevention (CDC) Recommendations for improving preconception health and health care—United States: a report of the CC/ATSDR preconception care workgroup and the select panel on preconception care Morbidity and Mortality Weekly Reports 2006 55 RR-6 1 23 16617292Not checked yet

  Not checked in the free run.

May combine two claims.

The risk assessment covers 12 preconception care domains and more than 100 individual risk factors drawn from the AJOG preconception health supplement.

“The risk assessment instrument records information in 12 domains of preconception care and includes over 100 individual risk factors, derived from the risks selected for the American Journal of Obstetric and Gynecology (AJOG) supplement for Preconception Health and Health Care.21”

• cites [21] Jack B Atrash H Preconception health and health care: the clinical content of preconception care AJOG 12 2008 199 6 Supplement BNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Most women recognize the value of optimizing health before pregnancy and most doctors consider preconception care important, yet few obstetrician-gynecologists or family physicians deliver comprehensive preconception care.

“Although most women understand the importance of optimizing their health before pregnancy and most physicians think PCC is important, few obstetricians/gynecologists or family physicians provide comprehensive PCC to their patients.9, 10”

• cites [9] Henderson JT Weisman CS Grason H Are two doctors better than one? women’s physician use and appropriate care Women’s Health Issues 2002 12 138 149 12015186 sourceNot checked yet

  Not checked in the free run.

• cites [10] Williams J Abelman S Fassett E Health care provider knowledge and practices regarding folic acid: United States, 2002-2003 [electronic version] Maternal and Child Health Journal 2006 10 suppl S67 S72 16721664 PMC1592153 sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two research team members coded each transcript, and disagreements were resolved using evidence from the transcripts.

“Two research team members coded each transcript, and coding discrepancies were reconciled using supportive evidence from transcripts.”

May combine two claims.

Preliminary data on the Gabby system are very encouraging and show that an automated system may be able to improve the quality, reach, delivery, acceptability, and high cost of preconception care.

“Preliminary data on the Gabby system are very encouraging and show that an automated system may be able to improve the quality, reach, delivery, acceptability, and high cost of preconception care.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The finding that 83 percent of risks were either resolved or the participant had taken action at the two-month follow-up could have been influenced by social desirability bias.

“the finding that 83 percent of risks were either resolved or the participant had taken action at the two-month follow-up could have been influenced by social desirability bias.”

Probably not a substantial claim: may not pass S3 (load-bearing).

African American women might particularly benefit from a HIT system designed for their use.

“It is also possible that African American women might particularly benefit from a HIT system designed for their use.27”

• cites [27] Baylor AL Shen E Huang X Which pedagogical agent do learners choose? the effects of gender and ethnicity E-Learn (World Conference on E-Learning in Corporate, Government, Healthcare, & Higher Education) 2003 Phoenix, ArizonaNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The Gabby system can address problems of fidelity of message, scale, ease of delivery, quality, clinician time restraints, and patient acceptability.

“can address problems of fidelity of message, scale, ease of delivery, quality, clinician time restraints, and patient acceptability.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

It is possible that participants recruited from the PPE population were more interested and informed about health and more motivated to improve their preconception health status.

“It is also possible that participants recruited from the PPE population were more interested and informed about health and more motivated to improve their preconception health status.”

May combine two claims.

Participants felt the system was useful, easy to use, took an appropriate amount of time, trustworthy, and reliable.

“The participants felt that the system was useful, easy to use, took an appropriate amount of time, trustworthy, and reliable.”

Classified as probably not a substantial claim.

Recruitment of subjects was limited to a half-day at a PPE training.

“Recruitment of subjects was limited to a half-day at a PPE training.”

May combine two claims.

The focus groups supported the conclusion that the web-based system is culturally appropriate, familiar, and workable for delivering health risk assessment and interventions.

“Focus group findings confirmed that our web-based system is a culturally relevant, familiar, and viable method for delivering a health risk assessment and interventions”

May combine two claims.

A web-based system is a familiar and viable method for delivering health risk assessment and interventions to young African American women.

“A web-based system is a familiar and viable method for delivering health risk assessment and interventions to young African American women”

• AssumptionRests on an assumption: The focus group participants' internet access is representative of the target population of young African American women.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The Gabby system can be used across a range of health care, educational and community settings.

“Finally, it can be used across a range of health care, educational and community settings.”