Birth Asphyxia, Neonatal Death
Conditions
Keywords
Helping Babies Breathe, newborn resuscitation, skills retention, mobile health, user-centred design
Brief summary
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.
Detailed description
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.
Interventions
BEHAVIORALHBB Prompt
Mobile app developed through user-centred design in phase 1 of this study
BEHAVIORALLow-Dose High Frequency training
Participants will be encouraged to practice their HBB skills daily
Sponsors
The Hospital for Sick Children
Mbarara University of Science and Technology
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcomes assessor at analysis stage will be masked to allocation of participants
Intervention model description
Parallel Assignment
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Frontline birth attendants involved in the delivery or care of babies in the maternity ward, theater or pediatric wards with a possibility of involvement in newborn resuscitation.
Exclusion criteria
* Health workers providing care in other wards other than maternity and pediatrics.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Helping Babies Breathe Objective Structured Clinical Exam (OSCE) B score | 12 months from initial HBB training | 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 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Bag and mask ventilation skills check | at unannounced visits within 12 months of training | evaluation of bagging skills to assist breathing - score out of 14 |
| App analytics - pattern of usage | during 12 months after initial training in intervention arm only | automated reports from the app regarding usage of different components of the app |
| App analytics - frequency of usage | during 12 months after initial training in intervention arm only | frequency of access to different parts of the app, duration of app usage |
| App analytics - trends of performance | during 12 months after initial training in intervention arm only | time trends of knowledge checks and simulation evaluations as noted in the app |
| Frequency of practice | during 12 months after initial training | 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 |
| Exit focus group feedback on barriers and facilitators to HBB training and skills maintenance | at end of study (12 months from the start) | 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 |
| OSCE B score | immediately before initial HBB training | standardized comprehensive evaluation of HBB skills, 17 out of 23 constitutes a pass score |
| HBB 2.0 Knowledge Check | at unannounced visits within 12 months of training | 18 questions pertaining to newborn resuscitation |
| Bag and mask ventilation quality measures with AIR Device | at unannounced visits within 12 months of training | 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) |
| OSCE A | at unannounced visits within 12 months of training | standardized evaluation of resuscitation skills (slightly different scenario than for OSCE B), 9 out of 12 constitutes a pass score |
Other
| Measure | Time frame | Description |
|---|---|---|
| Fresh stillbirths | during 12 month study period | number of fresh stillbirths will be recorded from the birth register of each site |
| In hospital neonatal mortality | during 12 month study period | number of neonatal deaths prior to discharge will be recorded from the birth register of each site |
| Infants requiring bagging | during 12 month study period | number of babies requiring bagging will be recorded from the birth register of each site |
| Delivery Volume | during 12 month study period | number of births will be recorded from the birth register of each site |
Countries
Uganda
Contacts
Primary ContactFrancis Bajunirwe, PhD
Outcome results
None listed