利用健康信息技术改善孕前期非裔美国年轻女性的健康：一项随机对照试验。

Improving the health of young African American women in the preconception period using health information technology: a randomised controlled trial.

机构信息

Department of Family Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA; Institute for Health Systems Innovation and Policy, Boston University, Boston, MA, USA.

Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA.

出版信息

Lancet Digit Health. 2020 Sep;2(9):e475-e485. doi: 10.1016/S2589-7500(20)30189-8.

DOI:10.1016/S2589-7500(20)30189-8

PMID:33328115

Abstract

BACKGROUND

Preconception care focuses on improving women's health before pregnancy as a means to improve their health and future pregnancy outcomes. How to effectively deliver such care is unknown. The aim of this research was to assess the impact of an embodied conversational agent system on preconception risks among African American and Black women.

METHODS

We did an open-label, randomised controlled trial of women aged 18-34 years, self-identified as African American or Black, or both, and not pregnant, recruited from 35 states in the USA. Sealed allocation envelopes (in permuted blocks of six and eight, prepared using a random number generator) were opened after enrolment. Intervention participants received an online conversational agent called Gabby that assessed 102 preconception risks and delivered 12 months of tailored dialogue using synthesised speech, non-verbal behaviour, visual aids, and health behaviour change techniques such as motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk with a clinician. The primary outcome was the proportion of identified risks at the action or maintenance stage of change at months 6 and 12. The study is registered with ClinicalTrials.gov, NCT01827215.

FINDINGS

From March 11, 2014, through July 8, 2018, 528 women recruited from 35 states and 242 cities across the USA received the Gabby intervention (n=262) or were assigned to the control group (n=266). Participants identified a mean of 21 preconception risks per woman (SD 9·9). In the intention-to-treat analysis, at 6 months, intervention women reported reaching the action or maintenance stage of change for 50·0% (SD 28·9) of those preconception risks identified compared with 42·7% (28·3) in the control group (incidence rate ratio 1·16, 95% CI 1·07-1·26; p=0·0004). This result persisted at 12 months.

INTERPRETATION

The Gabby system has the potential to improve women's preconception health. Further research is needed to determine if improving preconception risks impacts outcomes such as preterm delivery.

FUNDING

National Institute for Minority Health and Health Disparities.

摘要

背景

孕前保健的重点是改善女性怀孕前的健康状况，以此来提高她们的健康水平和未来妊娠结局。但目前尚不清楚如何有效地提供此类保健。本研究旨在评估一个具身对话代理系统对非裔美国人和黑人女性的孕前风险的影响。

方法

我们对年龄在 18-34 岁之间、自我认同为非裔美国人或黑人、或两者兼有的、未怀孕的女性进行了一项开放标签、随机对照试验，这些女性来自美国 35 个州。在入组后打开密封的分配信封（以六和八的随机块排列，使用随机数生成器制备）。干预组参与者接受了一个名为 Gabby 的在线对话代理的评估，该代理评估了 102 种孕前风险，并使用合成语音、非言语行为、视觉辅助工具以及健康行为改变技术（如动机访谈）提供了 12 个月的个性化对话。对照组收到了一份列出他们孕前风险的信件，并鼓励他们与临床医生交谈。主要结局是在第 6 个月和第 12 个月时处于改变的行动或维持阶段的已识别风险的比例。该研究在 ClinicalTrials.gov 上注册，编号为 NCT01827215。

结果

从 2014 年 3 月 11 日至 2018 年 7 月 8 日，来自美国 35 个州和 242 个城市的 528 名女性参与了这项研究，其中 262 名参与者接受了 Gabby 干预（n=262），266 名参与者被分配到对照组。每位参与者平均识别出 21 种孕前风险（标准差 9.9）。在意向治疗分析中，在 6 个月时，干预组女性报告称，与对照组（42.7%[28.3]）相比，她们在已识别的 50.0%（28.9）的孕前风险中达到了行动或维持阶段（发病率比 1.16，95%置信区间 1.07-1.26；p=0.0004）。这一结果在 12 个月时仍然存在。