Comparison of Virtual Training to In-Person Training of Helping Babies Breathe in Ethiopia

Helping Babies Breathe (HBB) is a program that teaches providers in low- and middle-income countries about neonatal resuscitation. Historically, HBB training was delivered in person. During the COVID-19 pandemic, many subject matter experts were unable to travel to conduct HBB courses. Innovative methods for teaching HBB are needed to promote the acquisition and retention of resuscitation skills and knowledge.

Study Overview

• Status: Active, not recruiting
• Conditions: Neonatal Death; Birth Asphyxia
• Intervention / Treatment: Behavioral: HBB Virtual Training; Behavioral: HBB In-person Training

Detailed Description

In this non-inferiority randomized controlled trial, medical students, nursing students, and midwifery students will be randomized to receive either standard in-person HBB training (control) or virtual telesimulation training (intervention). The hypothesis is that virtual delivery is as effective as in-person training of HBB content when teaching neonatal resuscitation skills and knowledge to medical, nursing, and midwifery students.

• Study Type: Interventional
• Enrollment (Actual): 262
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Rishi Mediratta; Phone Number: (650) 497-8000; Email: rishimd@stanford.edu
• Study Contact Backup: Name: Melkamu Berhane; Email: melkamuarefayine@gmail.com

Study Locations

• Ethiopia
  • Jimma, Ethiopia
    • Jimma University
    • Contact: Melkamu Berhane; Email: melkamuarefayine@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Adults
• Year IV through year VI medical students; year II through year IV nursing students; year II through year III midwifery students at Jimma University in Jimma, Ethiopia.

Exclusion Criteria:

• Minors
• Individuals who are not medical, nursing, or midwifery students at Jimma University.
• Individuals who attended a neonatal resuscitation training course in the preceding year.
• Individuals who would be unavailable or unwilling to participate in follow-up study activities throughout the 2-month post-initial training period.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Virtual HBB Teaching; HBB Virtual Training (Intervention): Participants will receive a blend of virtual training and telesimulation delivered by pediatricians from Ethiopia. The intervention consists of one day of virtual lectures and didactics from the HBB curriculum and skill assessments using neonatal mannequins.	Behavioral: HBB Virtual Training; HBB Virtual Training (Intervention): The 2nd edition HBB training course focuses on preparation for birth, routine care for all babies, the Golden Minute, and continued ventilation with normal or slow heart rate. The one-day virtual training will be delivered remotely to participants via Zoom. Facilitators and training materials will be the same in both the control and intervention arms.
Active Comparator: In-person HBB Teaching; Participants will receive in-person HBB instruction by pediatricians from Ethiopia. The control consists of one day of HBB lectures and didactics and skill assessments using neonatal mannequins.	Behavioral: HBB In-person Training; HBB In-Person Training (Control): The 2nd edition HBB training course focuses on preparation for birth, routine care for all babies, the Golden Minute, and continued ventilation with normal or slow heart rate. The one-day in-person training will be delivered in person. Facilitators and training materials will be the same in both the control and intervention arms.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Helping Babies Breathe Objective Structured Clinical Exam (OSCE) B	Compare skill retention between the virtual delivery of Helping Babies Breathe (HBB) with the in-person delivery of HBB. This is a standardized evaluation of HBB skills, a score of 17 out of 23 is required to pass. Score range: 0 to 23, higher scores indicate better HBB skills, and a score of 17 or higher is required to pass.	Two months after HBB training (approximately 15 minutes to assess)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Helping Babies Breathe Objective Structured Clinical Exam (OSCE) B	Compare skill acquisition between the virtual delivery of Helping Babies Breathe (HBB) with the in-person delivery of HBB. This is a standardized evaluation of HBB skills, a score of 17 out of 23 is required to pass. Score range: 0 to 23, higher scores indicate better HBB skills, and a score of 17 or higher is required to pass.	Immediately after HBB training (approximately 15 minutes to assess)
Helping Babies Breathe Objective Structured Clinical Exam (OSCE) A	Compare skill retention between the virtual delivery of Helping Babies Breathe (HBB) with the in-person delivery of HBB. This is a standardized evaluation of HBB skills, a score of 9 out of 12 is required to pass. Score range: 0 to 12, higher scores indicate better HBB skills, and a score of 9 or higher is required to pass.	Two months after HBB training (approximately 10 minutes to assess)
Helping Babies Breathe Objective Structured Clinical Exam (OSCE) A	Compare skill acquisition between the virtual delivery of Helping Babies Breathe (HBB) with the in-person delivery of HBB. This is a standardized evaluation of HBB skills, a score of 9 out of 12 is required to pass. Score range: 0 to 12, higher scores indicate better HBB skills, and a score of 9 or higher is required to pass.	Immediately after HBB training (approximately 10 minutes to assess)
Helping Babies Breathe Bag and Mask Ventilation score	Compare skill acquisition between virtual delivery of Helping Babies Breathe (HBB) with the in-person delivery of HBB. This is a standardized evaluation of bag and mask ventilation, a score out of 14. Score range: 0 to 14, higher scores indicate better HBB skills, and a score of 14 is required to pass.	Immediately after HBB training (approximately 10 minutes to assess)
Helping Babies Breathe Bag and Mask Ventilation score	Compare skill retention between virtual delivery of Helping Babies Breathe (HBB) with the in-person delivery of HBB. This is a standardized evaluation of bag and mask ventilation, a score out of 14. Score range: 0 to 14, higher scores indicate better HBB skills, and a score of 14 is required to pass.	Two months after HBB training (approximately 10 minutes to assess)
Helping Babies Breathe Multiple Choice Questionnaire score	Determine baseline understanding of HBB material for each participant. This exam contains 18 questions pertaining to HBB curriculum. Score range: 0 to 18, higher scores indicate better HBB knowledge, and a score of 15 or higher is required to pass.	Immediately before HBB training (approximately 20 minutes to assess)
Helping Babies Breathe Multiple Choice Questionnaire score	Determine knowledge acquisition of HBB material for each participant. This exam contains 18 questions pertaining to HBB curriculum. Score range: 0 to 18, higher scores indicate better HBB knowledge, and a score of 15 or higher is required to pass.	Immediately after HBB training (approximately 20 minutes to assess)
Helping Babies Breathe Multiple Choice Questionnaire score	Determine knowledge retention of HBB material for each participant. This exam contains 18 questions pertaining to HBB curriculum. Score range: 0 to 18, higher scores indicate better HBB knowledge, and a score of 15 or higher is required to pass.	Two months after HBB training (approximately 20 minutes to assess)
NeoNatalie Live Data: Heart rate	NeoNatalie Live is a mannequin that will provide data on bag-mask ventilation proficiency. During each simulation, the heart rate of the mannequin will be collected per participant.	Immediately after HBB training (approximately 10 minutes to assess)
NeoNatalie Live Data: Ventilation pressure	NeoNatalie Live is a mannequin that will provide data on bag-mask ventilation proficiency. During each simulation, the ventilation pressure of the mannequin will be collected per participant.	Immediately after HBB training (approximately 10 minutes to assess)
NeoNatalie Live Data: Time to spontaneous breathing	NeoNatalie Live is a mannequin that will provide data on bag-mask ventilation proficiency. Data about the amount of time it takes to reach a ventilation rate of 40-60 breaths per minute will be collected per participant.	Immediately after HBB training (approximately 10 minutes to assess)
NeoNatalie Live Data: Ventilation attempts	NeoNatalie Live is a mannequin that will provide data on bag-mask ventilation proficiency. Data about the number of ventilation attempts will be collected per participant.	Immediately after HBB training (approximately 10 minutes to assess)
NeoNatalie Live Data: Heart rate	NeoNatalie Live is a mannequin that will provide data on bag-mask ventilation proficiency. During each simulation, the heart rate of the mannequin will be collected per participant.	Two months after HBB training (approximately 10 minutes to assess)
NeoNatalie Live Data: Ventilation pressure	NeoNatalie Live is a mannequin that will provide data on bag-mask ventilation proficiency. During each simulation, the ventilation pressure of the mannequin will be collected per participant.	Two months after HBB training (approximately 10 minutes to assess)
NeoNatalie Live Data: Time to spontaneous breathing	NeoNatalie Live is a mannequin that will provide data on bag-mask ventilation proficiency. Data about the amount of time it takes to reach a ventilation rate of 40-60 breaths per minute will be collected per participant.	Two months after HBB training (approximately 10 minutes to assess)
NeoNatalie Live Data: Ventilation attempts	NeoNatalie Live is a mannequin that will provide data on bag-mask ventilation proficiency. Data about the number of ventilation attempts will be collected per participant.	Two months after HBB training (approximately 10 minutes to assess)
Attitude Questionnaire	5-point Likert scale designed to assess perceived confidence in performing HBB skills.	Immediately before HBB training (approximately 5 minutes to assess)
Attitude Questionnaire	5-point Likert scale designed to assess perceived confidence in performing HBB skills as well as evaluation satisfaction with the course and its instructors.	Immediately after HBB training (approximately 5 minutes to assess)
Attitude Questionnaire	5-point Likert scale designed to assess sustained perceived confidence in performing HBB skills as well as evaluation satisfaction with the course and its instructors.	Two months after HBB training (approximately 5 minutes to assess)
Profile of perceived barriers and facilitators	Focus group discussions will be intended to understand differences in perceived barriers/facilitators of training. This will explore confidence in performing HBB techniques and attitudes toward virtual and in-person delivery of content. The objective of the focus groups will be to identify key themes around participants' perspectives of the HBB training to provide context around the outcomes listed above.	Two months after HBB training (approximately 60 minutes to assess)

Collaborators and Investigators

• Sponsor: Stanford University
• Collaborators: Jimma University; Laerdal Foundation
• Investigators: Study Chair: Rishi Mediratta, Stanford University

Publications and helpful links

General Publications

• Sobelman C, Richard K, McQuilkin P, Fahey N. Adapting Helping Babies Breathe into a Virtual Curriculum: Methods, Results, and Lessons Learned. Glob Pediatr Health. 2021 May 31;8:2333794X211019698. doi: 10.1177/2333794X211019698. eCollection 2021.
• Jones-Bamman C, Niermeyer S, McConnell K, Thomas JF, Olson C. Teaching Helping Babies Breathe via Telehealth: A New Application in Rural Guatemala. Biomed Hub. 2019 Sep 24;4(3):1-6. doi: 10.1159/000502934. eCollection 2019 Sep-Dec.

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2023
• Primary Completion (Actual): August 19, 2023
• Study Completion (Estimated): January 1, 2024

Study Registration Dates

• First Submitted: April 27, 2023
• First Submitted That Met QC Criteria: May 8, 2023
• First Posted (Actual): May 11, 2023

Study Record Updates

• Last Update Posted (Estimated): November 9, 2023
• Last Update Submitted That Met QC Criteria: November 8, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: Helping Babies Breathe (HBB) training
• Additional Relevant MeSH Terms: Pathologic Processes; Wounds and Injuries; Infant, Newborn, Diseases; Pregnancy Complications; Death; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Asphyxia; Asphyxia Neonatorum; Perinatal Death
• Other Study ID Numbers: 62973

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No