Using Innovative Communication Technology to Improve the Health of Young African American Women

The United States has one of the highest infant mortality rates among industrialized nations, which is disproportionately high for black women. Despite focusing on improving access to prenatal care, the rate has not declined. It may be that by the time a woman is pregnant it is too late to change the risks that lead to infant mortality. As such, focus is turning to pre-conception care to identify and address risk factors for adverse pregnancy outcomes prior to pregnancy.

This project modified an existing virtual patient advocate (VPA), a clinical patient education system, to become a preconception health education tool directed towards young African-American women. Modifications were based on prior focus group and key informant interviews, as well as evidence based content. These modifications included the development of a personalized and comprehensive online risk assessment tool of preconception risks; scripts with culturally appropriate health promotion and behavior change messages; and a library of stories to pre-populate the system.

The main objectives of the project were to:

• Design a new VPA for a Web-based behavior change and patient activation system that is informed by qualitative research with the target audience.
• Develop VPA dialogue for 15- to 21-year-old African-American women. Develop a social networking interface that allows users to recommend other people who could benefit from the intervention, and perform a proof-of-concept test of this new system to improve the health of African-American women.
• Analyze the impact of the newly designed system.
• Disseminate this new technology to at least two other academic medical centers.

A new VPA character called Gabby was created specifically to address preconception care. Gabby is an African-American female because focus groups had confirmed that users have a preference for receiving health information from a VPA of their same race and gender. The system was tested by 15 individuals who used the VPN in the lab; Gabby was further modified based on their experiences. A pilot project was completed with nine testers using the system for 2 months. Interviews were conducted after testing and at the end of the pilot.

During the pilot, six of the nine testers used the system at least once. The six testers identified 128 risks that they "discussed" with Gabby, with participants choosing to add 43 items to a "My Health To-Do List." At the time of followup, the testers reported having resolved or taken action on 83 percent of the items on their lists. Interviews revealed that while participants could be hesitant to initiate sensitive conversations with their providers, they were comfortable with and receptive to the VPA, since it was considered anonymous. The project indicates that the use of an online tailored health risk assessment and education system is a viable way to deliver preconception health information to this population.