Development of a novel mobile application, HBB Prompt, with human factors and user-centred design for Helping Babies Breathe skills retention in Uganda

Abstract

Background Helping Babies Breathe (HBB) is a life-saving program that has helped reduce neonatal morbidity and mortality, but knowledge and skills retention after training remains a significant challenge for sustainability of impact. User-centred design (UCD) can be used to develop solutions to target knowledge and skills maintenance. Methods We applied a process of UCD beginning with understanding the facilitators of, and barriers to, learning and retaining HBB knowledge and skills. HBB Master Trainers and frontline HBB providers participated in a series of focus group discussions (FGDs) to uncover the processes of skills acquisition and maintenance to develop a mobile application called “HBB Prompt”. Themes derived from each FGD were identified and implications for development of the HBB Prompt app were explored, including feasibility of incorporating strategies into the format of an app. Data analysis took place after each iteration in Phase 1 to incorporate feedback and improve subsequent versions of HBB Prompt. Results Six HBB trainers and seven frontline HBB providers participated in a series of FGDs in Phase 1 of this study. Common themes included lack of motivation to practise, improving confidence in ventilation skills, ability to achieve the Golden Minute, fear of forgetting knowledge or skills, importance of feedback, and peer-to-peer learning. Themes identified that were not feasible to address pertained to health system challenges. Feedback about HBB Prompt was generally positive. Based on initial and iterative feedback, HBB Prompt was created with four primary functions: Training Mode, Simulation Mode, Quizzes, and Dashboard/Scoreboard. Conclusions Developing HBB Prompt with UCD to help improve knowledge and skills retention was feasible and revealed key concepts, including drivers for successes and challenges faced for learning and maintaining HBB skills. HBB Prompt will be piloted in Phase 2 of this study, where knowledge and skills retention after HBB training will be compared between an intervention group with HBB Prompt and a control group without the app. Trial registration Clinicaltrials.gov (NCT03577054). Retrospectively registered July 5, 2018, https://clinicaltrials.gov/ct2/show/study/NCT03577054.

Use of digital technologies for staff education and training programmes on newborn resuscitation and complication management: a scoping review

“…The most common methods were eLearning platforms (n=10) 22 33 35–38 40 41 109 and mobile applications (n=9). Mobile applications included the Safe Delivery App (SDA), 51 53–57 Helping Babies Breathe Prompt 58 and the Life-Saving Instruction for Emergencies applications. 59 60 Blended use of digital technology was more common in high-income countries (HICs) (n=34), as was use of high-fidelity mannequins for simulation-based neonatal resuscitation training (n=27).…”

Utilization of a novel mobile application, “HBB Prompt”, to reduce Helping Babies Breathe skills decay

“…Therefore, ongoing efforts to improve sustainability of training need to focus on how to maintain resuscitation skills. Although Phase 1 [ 32 ] of this study attempted to address the issue of sustainability by focusing on UCD of HBB Prompt to suit end-user needs for acquisition and maintenance of skills of knowledge, the low frequency of usage of the app appeared to be mostly influenced by daily realities and limitations due to structural factors and daily workflow. While some of these issues were raised during the design phase, they were deemed out of scope of the development of HBB Prompt.…”

“…The study (Clinicaltrials.gov: NCT03577054) consisted of two phases. Phase 1 was the development phase where HBB Prompt was created via an iterative approach utilizing UCD and focus group discussions (FGD) [ 32 ]. Phase 2 is the assessment phase where we collected data at the two hospitals—one that was exposed to the app, and the other that was not.…”

“…Within Simulation mode, rater mode shows users an HBB checklist that can be used to provide feedback serving as a peer-to-peer learning tool. Further details can be found in our publication outlining the details of HBB Prompt [ 32 ].…”

“…It is within this context that a novel mobile application, HBB Prompt, was created in 2019 [ 31 ]. This mobile application was created using user-centered design (UCD) [ 32 ] and has four parts, including: Training mode, to demonstrate with videos the steps of the HBB algorithm; Simulation mode, to facilitate individual and peer-to-peer practice of resuscitation scenarios; Quizzes/Knowledge check, to refresh knowledge about HBB; and a Scoreboard/Dashboard that summarises user performance and app usage, to increase user motivation and accountability for maintaining skills.…”