Funding Year: 2016

Brian Jack, MD: Implementation of a Health Information Technology System for Young African American Women into A Community-Based Clinical Site

Background: Black and African American (AA) women are more than two times as likely to deliver low-birth weight infants as white women. An embodied conversational agent, “Gabby”, was designed to deliver web-based preconception care to Black and AA women, by assessing health risks and delivering culturally tailored interventions to minimize these risks and disparities in birth outcomes. Gabby is now being disseminated beyond the research environment into the community for women receiving services from the San Antonio Healthy Start (SAHS) program.

Methods: We assessed site readiness for dissemination and implementation activities in SAHS, the pilot site for our larger study involving 12 sites. Using the Consolidated Framework for Implementation Research (CFIR), we explored five domains (Intervention, Inner-setting, Outer-setting, Individuals Involved, and Process) and surveyed Healthy Start leaders, clinicians, and administrative staff about constructs within each domain.

Results: Attributes of the Intervention Characteristics domain were favorable at SAHS as stakeholders perceived Gabby to have a strong evidence base, aligned closely with the Healthy Start preconception care assessments, and believed Gabby was low in complexity and costs. Outer setting – We faced several unanticipated challenges, one of which was establishing a Memorandum of Understanding with SAHS. This process involved legal counsel from each organization which delayed implementation activities for almost a year. Inner setting characteristics included a strong learning climate and organizational culture, established goals and feedback loops among staff. Coordination and effective communication among various tiers of stakeholders will be improved upon for future sites to streamline implementation processes. Process – An engaged and activated site champion was critical in getting support from additional site staff. Our collaborative relationship with the SAHS site champion resulted in more effective and sustained planning and execution of pre-implementation tasks. Site training of the Gabby system augmented prior knowledge about Gabby system components, enhanced motivation of the Individuals Involved in the implementation, and increased self-efficacy about introducing Gabby to clients.

Conclusion: Lessons learned and the general principles of the CFIR implementation and evaluation processes investigated at San Antonio Healthy Start will assist our implementation at additional sites and will facilitate the creation of a Gabby Implementation Manual.