The Gabby System assesses preconception health-related risk factors of young black and African American women and helps them minimize these health topics through education and using behavior change techniques.
Learning Objectives:
Know and explain the different components of the Gabby System.
Understand the various behavioral techniques that the Gabby System uses to promote health behavior change.
How it Works
The enrollment process involves the clients and site champion or staff members responsible for enrolling clients. The steps in the enrollment process include:
Introduce the client to the Gabby System using informational paper handouts and the electronic materials as needed.
Ask the client if they are willing to use the Gabby System.
After the client agrees to participate, enroll the client (refer to Module 3 for instructions on enrollment). Enrollment usually takes 10-15 minutes to complete. Enrollment involves creating a username and password and can be done face to face or via phone.
The client logs into the Gabby System using the username and password they created during enrollment.
Gabby introduces herself. Clients are asked to read and then accept the terms and conditions of the Gabby System before moving forward.
Clients complete a health survey all in one sitting. The survey could take between 20-30 minutes depending on the client’s knowledge of their medical history. The survey can be completed at home, so staff members do not need to be present while clients complete the health survey.
Health Survey
The health survey must be completed in one sitting! Clients can not save their answers and then return to complete the survey at another time.
The health survey includes over 100 health topics in 13 domains. The domains include:
Healthcare and Programs
Inter-partner Violence (IPV) Relationships
Sexual and Reproductive Health
Health Conditions and Medicines
Genetic Health History
Emotional and Mental Health
Everyday Discrimination
Immunizations and Vaccines
Infectious Diseases
Substance Use
Nutrition and Exercise
Environmental Issues
Reproductive Life Plan
Clients’ responses to health survey questions will flag certain health topics that are then listed on the“My Health To-Do List”.
My Health To-Do List
The My Health To-Do List acts as the home screen where women are able to view the health topics that they flagged during the health survey. After clicking on a topic, women are able to learn about each topic in detail by engaging in a conversation with Gabby.
(Click to enlarge)
The “My Health To-Do List” is divided into two parts:
“Living Well” – educates women about ways to change their health behaviors over time.
“Staying Well”– educates women on immediate action items and mostly involve going to the doctor. An example of a Staying Well topic is getting an annual flu vaccine.
Clients can select each of the health topics listed and learn more about it from the Gabby System. Once clients have gone through a health topic with the Gabby System, a check mark will appear next to that topic.
On the right-hand column, there are four tabs:
“All Health Topics” allows clients to explore all the health topics included in the Gabby System, and not just the ones flagged by responses to the health survey.
“Gabby’s Blog”offers personal stories and recommendations about preconception care. This link directs clients to the Boston University Medical Campus Family Medicine Site, and blog topics include stress, nutrition, and self-care tips.
“Health Apps & Websites”provides a list of health websites and mobile applications about family planning, general health, nutrition, and physical activity.
“Words to Know’provides a list of the words and phrases that appear in the Gabby System and their definitions.
On the My Health To-Do List, clients can customize settings such as changing the background color, inserting an inspirational quote, and setting a health or personal goal for themselves. Clients also have the option to print their My Health To-Do List and email it to themselves or a health provider. There is also an option to watch a tutorial about how to use the Gabby System.
Stages of Behavior Change
The end goal of the Gabby System is to improve the preconception health of young black and African American women by increasing their healthy behaviors and decreasing unhealthy behaviors. Behavior change takes time, and the Gabby System is to move clients through the stages of health behavior change:
Precontemplation: Individuals do not believe their behavior is problematic and therefore do not intend to take immediate or future action to change this behavior
Contemplation:Individuals recognize their unhealthy behavior and plan to address it within the next 6 months
Preparation:Individuals take small steps toward health behavior change.
Action: Individuals actively change their health behavior
Maintenance: Individuals have engaged in the new health behavior for 6 months or more
Relapse: Individuals return to their unhealthy behavior
(Click to enlarge). Source: https://www.verywellmind.com/the-stages-of-change-2794868. Accessed February 6, 2020
Behavior Change Techniques
The Gabby System asks a variety of questions to determine which stage of change clients are in. The role of the Gabby System is to move clients from pre-contemplation and contemplation to action and maintenance.
The Gabby System uses several techniques to drive behavior change in clients:
Problem Solving:With the help of the Gabby System, clients are able to find solutions to common barriers that prevent them from engaging in healthy behaviors.
Goal Setting:The Gabby System allows clients to set long-term goals. Goal setting helps move clients towards action and maintenance.
Homework: Through short homework assignments, the Gabby System allows clients to stay engaged and focused on achieving their health goals.
For example, if a user smokes and is interested in quitting, a homework assignment might be to inquire about nicotine replacement therapies at their local pharmacy.
As another example,if a user reports frequent alcohol consumption,a homework assignment may be to track the number of alcoholic beverages consumed each day for the next two weeks.
Sequential Instructions:The Gabby System provides specific steps and action items to help clients move from the planning phase to the action phase.
To learn more about the scientific evidence that informed the development of the Gabby System, read our previous publications.
The graphic below describes the flow of the Gabby System and how it guides clients from pre-contemplation to contemplation and then action.
(Click to enlarge)
Key Takeaways:
The health survey can only be taken once and must be completed in one sitting. A client is able to independently complete the survey at home, and on average, the survey takes between 20-30 minutes to complete.
Responses from the health survey are populated into the client’s tailored “My Health To-Do List” which is a list of action items to access health dialogue that can also be emailed or printed.
Clients can explore all health topics available in the Gabby System, and are not limited to the topics flagged when completing the health survey.
The Gabby System uses several behavioral techniques, including motivational interviewing and shared decision making, to facilitate health behavior change in clients.
