This study applies an iterative user-centred design approach involving frontline birth attendants to create a mobile application ("HBB Prompt") to improve skills retention after initial newborn stabilization training through the Helping Babies Breathe (HBB) program. HBB Prompt will then be piloted at one site after HBB training and skills retention will be compared with a control site without HBB Prompt after HBB training.
Helping Babies Breathe (HBB) is a newborn stabilization course that has been shown to reduce neonatal mortality by up to 47%. Such mortality impact is however not sustained due to rapid skills deterioration. The investigators propose to improve sustainability of HBB's impact by increasing skills retention with an innovative mobile application called HBB Prompt. HBB Prompt will be an interactive tool that guides frontline providers through the steps needed to save newborn babies at birth. HBB Prompt will facilitate individual and group training in health facilities using the Low Dose High Frequency model (LDHF) for resuscitation skills retention. The investigators will robustly develop HBB Prompt by integrating human factors and user-centered design approaches. The investigators will engage end-users and HBB Master Trainers to iteratively collect feedback to develop HBB Prompt for both individual and small group resuscitation practice. The iterative approach will mitigate the common scenario of mobile health (mHealth) solutions unable to achieve sustained success at scale due to lack of comprehensive input from frontline users. The investigators will pilot the app at a single centre and compare it to a control site for HBB skills retention at different time points after initial HBB training.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
20
Mobile app developed through user-centred design in phase 1 of this study
Participants will be encouraged to practice their HBB skills daily
Mbarara University of Science and Technology
Mbarara, Uganda
RECRUITINGHelping Babies Breathe Objective Structured Clinical Exam (OSCE) B score
standardized comprehensive evaluation of HBB skills, 17 out of 23 constitutes a pass score with 23 being the highest score. The OSCE B is a standard Helping Babies Breathe assessment tool that comprises the steps required in successfully assisting a neonate in its transition after birth
Time frame: 12 months from initial HBB training
OSCE B score
standardized comprehensive evaluation of HBB skills, 17 out of 23 constitutes a pass score
Time frame: immediately before initial HBB training
OSCE B score
standardized comprehensive evaluation of HBB skills, 17 out of 23 constitutes a pass score
Time frame: immediately after initial HBB training
OSCE B score
standardized comprehensive evaluation of HBB skills, 17 out of 23 constitutes a pass score
Time frame: 3 months from initial HBB training
OSCE B score
standardized comprehensive evaluation of HBB skills, 17 out of 23 constitutes a pass score
Time frame: 6 months from initial HBB training
HBB 2.0 Knowledge Check
18 questions pertaining to newborn resuscitation
Time frame: at unannounced visits within 12 months of training
Bag and mask ventilation skills check
evaluation of bagging skills to assist breathing - score out of 14
Time frame: at unannounced visits within 12 months of training
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Bag and mask ventilation quality measures with AIR Device
Augmented Infant Resuscitator (AIR) to objectively measure quality of newborn resuscitation during every ventilation epoch. AIR records time stamped data on ventilation quality, such as presence of air leak or obstruction and ventilation rate (www.air-device.com)
Time frame: at unannounced visits within 12 months of training
OSCE A
standardized evaluation of resuscitation skills (slightly different scenario than for OSCE B), 9 out of 12 constitutes a pass score
Time frame: at unannounced visits within 12 months of training
App analytics - pattern of usage
automated reports from the app regarding usage of different components of the app
Time frame: during 12 months after initial training in intervention arm only
App analytics - frequency of usage
frequency of access to different parts of the app, duration of app usage
Time frame: during 12 months after initial training in intervention arm only
App analytics - trends of performance
time trends of knowledge checks and simulation evaluations as noted in the app
Time frame: during 12 months after initial training in intervention arm only
Frequency of practice
for both intervention and control arms, log-books will be reviewed for frequency of practice and in the intervention arm, this will be compared to what is reported through the app
Time frame: during 12 months after initial training
Exit focus group feedback on barriers and facilitators to HBB training and skills maintenance
both intervention and control group participants will be interviewed to provide feedback on facilitators and barriers to HBB skills maintenance, and in the intervention arm, whether HBB Prompt helped or hindered their skills maintenance
Time frame: at end of study (12 months from the start)