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

Natalie Hoi-Man Chan, Hasan S Merali, Niraj Mistry, Ryan Kealey, Douglas M Campbell, Shaun K Morris, Santorino Data, Natalie Hoi-Man Chan, Hasan S Merali, Niraj Mistry, Ryan Kealey, Douglas M Campbell, Shaun K Morris, Santorino Data

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://ichgcp.net/clinical-trials-registry/NCT03577054 .

Keywords: Helping babies breathe; Human factors; Mobile application; Newborn resuscitation; Simulation; Uganda; User-centred design; mHealth.

Conflict of interest statement

Santorino Data is a co-creator of the Augmented Infant Resuscitator, which is used in Phase 2 of this study. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overview of HBB Prompt study. The HBB Prompt study is divided into Phase 1, where there were iterative UCD cycles to develop HBB Prompt and Phase 2, where the HBB Prompt app will be piloted. During Phase 1, HBB trainers formed one focus group (FGD 1) and HBB providers formed the second focus group (FGD 2). Each group went through Phase 1a and 1b separately to facilitate UCD of HBB Prompt
Fig. 2
Fig. 2
Insights about the timeline in HBB learning and skills maintenance during Phase 1a. Themes from FGDs with HBB trainers and providers regarding their thought process in relationship to the timing of HBB training
Fig. 3
Fig. 3
HBB Prompt v1.0 screenshots. a different scenarios users can choose from in Simulation Mode. b Performance checklist that appears once a simulation is complete. c Beginning of a simulation. Note the two countdown timers from the time the simulation begins and the time when the simulated infant is born. d Sample of dashboard statistics

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