How does identity shape our health?

Understanding Preconception Health Disparities Amongst African American Women

In the United States, severe health disparities exist on the basis of race. These disparities are especially sharp in preconception health: Black and African American women are twice as likely as white women to have children born with health issues, and four times as likely to die during childbirth. The Covid-19 pandemic has highlighted and magnified these disparities.

This randomized control trial tests whether we can improve preconception health in Black and African American women using education focused on a set of behaviors and conditions that put them at risk for adverse birth outcomes. The study tests the effects of Gabby - a Virtual Patient Advocate designed to supplement in-person care from a physician - on how women respond to 102 preconception health risks across 13 domains like access to healthcare, emotional and mental health, and social determinants of preconception health like racially based discrimination. You can read more about the Gabby project and preconception care amongst Black and African American women here.

The primary results from this work were published in The Lancet Digital Health. Subsequent published studies explored more deeply the effects of our health education intervention for nutrition-related health risks that are especially salient for Black and African Women, as well as the differential effects of Gabby amounts adolescent and young adult women. Current work unpacks data collected in the course of this project to determine whether our intervention was more likely to change health conditions that have been most affected by implicit racial bias from providers. Our subsequent studies test whether our findings can be replicated amongst women serving in the U.S. military, amongst low-income and uninsured women at “healthy start” clinics, and amongst women in Lesotho.

Publications based on this study:

"Improving the health of young African American women in the preconception period using health information technology: a randomised controlled trial." The Lancet Digital Health 2.9 (2020): e475-e485. (with Brian W. Jack, et al.)

"Using Health Information Technology to Engage African American Women on Nutrition and Supplement Use During the Preconception Period." Frontiers in Endocrinology 11 (2021): 1045. (with Paula Gardiner, et al.)

"Promotion of preconception care among adolescents and young adults by conversational agent." Journal of Adolescent Health 67.2 (2020): S45-S51. (with Timothy Bickmore, et al.)

"Study protocol for the implementation of the Gabby Preconception Care System-an evidence-based, health information technology intervention for Black and African American women." BMC health services research 20.1 (2020): 1-14. (with Angela Walter, et al.)

Improving Healthcare Experiences for Patients with Depressive Symptoms

[under review]

Patient rehospitalization is often used as a metric of healthcare system performance - rehospitalization proxies for the underlying health of patients, and is expensive in and of itself. Previous research found that streamlining and improving hospital discharge procedures can substantially reduce rehospitalization rates, but not in patients with mental health conditions like depression.

This randomized control trial tests whether providing more tailored information, along with therapy, can keep patients with depression out of the hospital following discharge. The study intervention provides, telephonically, patients with assistance navigating the healthcare system, tools for patient self-management, and cognitive behavioral therapy over the course of four months, and test the effects of these interventions on subsequent rehospitalization rates. You can read more about project re-engineered discharge (RED), on which this study is based, here and here.