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Background Improving the health of women before pregnancy and throughout a woman’s lifespan could mitigate disparities and improve the health and wellbeing of women, infants and children. The preconception period is important for reducing health risks associated with poor maternal, perinatal and neonatal outcomes, and eliminating racial and ethnic disparities in maternal and child health. Low cost health information technology interventions provided in community-based settings have the potential to reach and reduce disparities in health outcomes for socially disadvantaged, underserved and health disparity populations. These interventions are particularly important for Black and African American women who have a disproportionate burden of pregnancy-related complications and infant mortality rates compared to any other racial and ethnic group in the U.S. Methods This is a hybrid type II implementation-effectiveness cohort study aimed at evaluating appropriateness, acceptability and feasibility implementation outcomes, while also systematically examining the clinical effectiveness of a preconception care (PCC) intervention, the Gabby System, for Black and African American women receiving health services in community-based sites. The intervention will be implemented in six Community Health Centers and six Healthy Start programs across the U.S. Each study site will recruit and enroll 25–50 young Black and African American women who will participate in the intervention for a 6-month period. Appropriateness, acceptability and feasibility of implementing the PCC intervention will be assessed using: 1) Qualitative data derived from individual interviews with Gabby System end-users (clients and patients) and site staff; and, 2) Quantitative data from staff surveys, Gabby System usage and uptake. Aggregate health risk and utilization measures collected directly from the Gabby server will be used to examine the effectiveness of the Gabby System on self-reported behavior change. Discussion This study will examine implementation outcomes and clinical effectiveness of an evidence-based PCC intervention for Black and African American women receiving services in Healthy Start programs and Community Health Centers. Contextual factors that influence uptake and appropriate implementation strategies will be identified to inform future scalability of the intervention. Trial registration ClinicalTrials.gov NCT04514224 . Date of registration: August 14, 2020. Retrospectively Registered.

African-American children demonstrate poorer asthma outcomes than children of any other racial group, and poor asthma management has been identified as a contributing factor. Researchers suggest cultural beliefs about health and illness may influence families' approach to asthma management, and encourage health care providers to examine these beliefs during the clinical encounter. Beliefs, however, do not directly translate into asthma management behaviors. From an ecocultural perspective, asthma management is a compromise between what is desirable according to cultural beliefs and practical within a family's ecological context. Ecological barriers, or social and environmental constraints, to asthma management have been identified, yet little is known about the factors underlying these barriers or how African-American parents navigate these barriers to manage their children's asthma. Furthermore, it remains unclear what African-American parents believe health care providers can do to support parents as they manage asthma within their ecological context. According to family-centered care, parents are experts of their families and asthma management experiences. Therefore, through semi-structured interviews this dissertation examines the perspective of 19 African-American parents of children with asthma living in the inner-city. Data analysis identifies four adaptive routines parents use to manage asthma within their ecological context: (1) give young children with asthma responsibility for medication use, (2) monitor the availability of the school nurse, (3) manage air quality, and (4) frequently clean the home, as well as three roles parents believe health care providers have in supporting asthma management: (1) prescribing environmental control resources, (2) assisting parents in accessing resources for daily family life, and (3) providing ongoing education for parents and school personnel. Findings indicate that parents desire health care providers who understand their ecological context. Examining family routines is presented as a practical approach that health care providers can use to understand the daily and socio-historical context of African-Americans living in the inner city. Collaboration among families, health care providers, policy makers, researchers, and public health advocates to minimize the existing childhood asthma disparity, and improve the health of African-American children with asthma is indicated.

[...] simply understanding a family's explanatory model of asthma does not directly translate into predicting the family's asthma management behaviors. [...] it is important to understand explanatory models in context.