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

Abstract

Background: Helping Babies Breathe (HBB) is a newborn resuscitation training program designed to reduce neonatal mortality in low- and middle-income countries. However, skills decay after initial training is a significant barrier to sustained impact.

Objective: To test whether a mobile app, HBB Prompt, developed with user-centred design, helps improve skills and knowledge retention after HBB training.

Methods: HBB Prompt was created during Phase 1 of this study with input from HBB facilitators and providers from Southwestern Uganda recruited from a national HBB provider registry. During Phase 2, healthcare workers (HCWs) in two community hospitals received HBB training. One hospital was randomly assigned as the intervention hospital, where trained HCWs had access to HBB Prompt, and the other served as control without HBB Prompt (NCT03577054). Participants were evaluated using the HBB 2.0 knowledge check and Objective Structured Clinical Exam, version B (OSCE B) immediately before and after training, and 6 months post-training. The primary outcome was difference in OSCE B scores immediately after training and 6 months post-training.

Results: Twenty-nine HCWs were trained in HBB (17 in intervention, 12 in control). At 6 months, 10 HCW were evaluated in intervention and 7 in control. In intervention and control respectively, the median OSCE B scores were: 7 vs. 9 immediately before training, 17 vs. 21 immediately after training, and 12 vs. 13 at 6 months after training. Six months after training, the median difference in OSCE B scores was -3 (IQR -5 to -1) in intervention and -8 (IQR -11 to -6) in control (p = 0.02).

Conclusion: HBB Prompt, a mobile app created by user-centred design, improved retention of HBB skills at 6 months. However, skills decay remained high 6 months after training. Continued adaptation of HBB Prompt may further improve maintenance of HBB skills.

Fig 1. Screenshot from HBB Prompt app.

Main menu screen for HBB Prompt showing the four main app features: Training mode, Simulation Mode, Quizzes/Knowledge check and Scoreboard/Dashboard.

Fig 2. Participant flow diagram.

Fig 3. Comparison of distribution of OSCE B scores immediately before and after training, and six months after training.

(A) Both groups had significantly improved scores immediately after training (p = 0.0003 in intervention, p = 0.002 in control). (B) When those lost-to follow-up were excluded, both groups still had significantly improved scores immediately after training. Within each group, there was also a significant decrease in scores six months post-training when compared with immediately after training (p = 0.006 in intervention, p = 0.02 in control). The intervention group showed less skills decay after six months, as indicated by smaller change in median difference of OSCE B scores (p = 0.02).

Fig 4. Comparison of distribution of knowledge check scores immediately before and after training, and six months after training.

Both groups showed improvement in knowledge after training (p = 0.004 in intervention, p = 0.003 in control). In contrast to skills retention, knowledge retention remained high in both groups with no significant decay (p = 1 in intervention, p = 0.66 in control).

Fig 5. HBB Prompt usage over the duration of the intervention period.

(A) Usage by login frequency per user and (B) usage over time, by months since HBB training.

Fig 6. Proportion of app usage by app feature.