The effect of an mLearning application on nurses’ and midwives’ knowledge and skills for the management of postpartum hemorrhage and neonatal resuscitation: pre–post intervention study

Abstract

Background Globally, mobile learning (mLearning) tools have attracted considerable attention as a means of continuous training for healthcare workers. Rwanda like other low-resource settings with scarce in-service training opportunities requires innovative approaches that adapt technology to context to improve healthcare workers’ knowledge and skills. One such innovation is the safe delivery application (SDA), a smartphone mLearning application for Basic Emergency Obstetric and Neonatal Care (BEmONC) content. This study assessed the effect of the SDA intervention on nurses’ and midwives’ knowledge and skills for the management of postpartum hemorrhage (PPH) and neonatal resuscitation (NR). Methods The study used a pre–post test design to compare knowledge and skills of nurses and midwives in the management of PPH and NR at two measurement points: immediately prior to SDA intervention and after 6 months of SDA intervention. The intervention took place in two district hospitals in Rwanda and included 54 participants. A paired-sample t-test was used to measure the pre–post intervention, mean knowledge and skills scores differences. Confidence intervals (CIs) and effect size were calculated. A t-test and a one-way Anova were used to test for potential confounders. Results The analysis included 54 participants. Knowledge scores and skills scores on PPH management and NR increased significantly from baseline to endline measurements. The mean difference for PPH knowledge is 17.1 out of 100; 95% CI 14.69 to 19.49 and 2.6% for PPH skills; 95% CI 1.01 to 4.25. The mean difference for NR knowledge is 19.1 out of 100; 95% CI 16.31 to 21.76 and 5.5% for NR skills; 95% CI 3.66 to 7.41. Increases were unaffected by participants’ attendance to in-service training 6 months prior and during SDA intervention and previous smartphone use. However, pre- and post-intervention skills scores were significantly different by years of experience in obstetric care. Conclusion The SDA intervention improved the knowledge and skills of nurses and midwives on the management of PPH and NR as long as 6 months after SDA introduction. The results are highly relevant in low-income countries like Rwanda, where quality of delivery care is challenged by a lack of in-service continuous training for healthcare providers.

Context specific realities and experiences of nurses and midwives in basic emergency obstetric and newborn care services in two district hospitals in Rwanda: a qualitative study

“…This was a reflection about the baseline survey findings on the knowledge and skills in the management of PPH and NR, and on a 6 months’ record review of the BEmONC outcomes - Apgar score and PPH progressions. The survey results indicated that the average knowledge score was 47.2% and the average skills score was 59.9% among 33 midwives and 21 nurses interviewed for the survey [ 25 ]. The record review findings revealed an unstable newborn outcome (Apgar score < 7) following 10 min NR recorded in 62% ( n = 78) newborn cases and an unstable maternal outcome (persistent bleeding ≥500mls) following PPH management recorded in 19% ( n = 13) maternal cases.…”

“…The aim of this aspect of the study was to explore the participating nurses and midwives’ experiences and perceptions of obstetric care with a special focus on PPH management and NR. The objective of this aspect of the study was two-fold; one part was to elucidate from the participants’ explanations of the research findings [ 25 ] from the quantitative part of the research. The second part was to explore context specific factors that influence their work as obstetric care givers in their respective hospitals.…”

Context Specific Realities and Experiences of Nurses and Midwives in Basic Emergency Obstetric and Newborn Care Services in Two District Hospitals in Rwanda

“…This was a re ection about the baseline survey ndings on the knowledge and skills in the management of PPH and NR, and on a six months' record review of the BEmONC outcomes -Apgar score and PPH progressions. The survey results indicated that the average knowledge score was 47.2% and the average skills score was 59.9% among 54 nurses and midwives interviewed for the survey [23]. Nurses and midwives admitted to being surprised by the survey and record review results.…”

“…This was a re ection about the baseline survey ndings on the knowledge and skills in the management of PPH and NR, and on a six months' record review of the BEmONC outcomes -Apgar score and PPH progressions. The survey results indicated that the average knowledge score was 47.2% and the average skills score was 59.9% among 54 nurses and midwives interviewed for the survey [23]. The record review ndings revealed an unstable newborn outcome (Apgar score < 7) following 10 minutes NR recorded in 62% (n = 78) newborn cases and an unstable maternal outcome (persistent bleeding ≥ 500mls) following PPH management recorded in 19% (n = 13) maternal cases.…”

“…The aim of this aspect of the study was to explore the participants' experiences and perceptions of obstetric care with a special focus on PPH management and NR. The objective of this aspect of the study was two-fold; one part was to elucidate from the participants' explanations of the research ndings [23] from the quantitative part of the research. The second part was to explore context speci c factors that in uence their work as obstetric care givers in their respective hospitals.…”