Background An estimated 70% of newborn lives could be saved globally if evidence-based interventions were successfully implemented. The ‘NeoTree’ application (app) addresses the need for quality care for sick newborns in resource-poor settings, particularly where care is nurse-led, by providing an integrated electronic platform for three functions;
1) immediate digital data capture on admission,
2) clinical decision support according to evidence-based clinical guidelines, and
3) newborn education. Here, we develop the first two functions and test the acceptability, feasibility and usability of The NeoTree in a district hospital, Malawi.
Methods A mixed methods intervention development study was conducted with facility-based health care workers (HCWs) to co-develop and test the app. Methods included Focus Groups (FGs) exploring the acceptability and feasibility of digital health solutions, one-to-one usability workshops and a one-month ward-based usability study. Quantitative usability data (systems usability score – SUS) were collected before and after the ward study. Finally, end-line qualitative FGs were completed.
Results Digital aids, specifically the NeoTree were reported to be acceptable, feasible and a potential facilitator to quality newborn care. Identified factors predicted to aid the success of the NeoTree included a positive staff attitude, training, strong leadership, teamwork and staff engagement. SUS score was high at baseline (under workshop conditions) and following the ward study (>68/100 average) and HCWs reported high perceptions of improved quality of care after embedding NeoTree into routine practice (see table 1).
Conclusions The NeoTree has the potential to address multiple Malawian and global policy directives around improving quality of care and outcomes for newborns. It is an acceptable, feasible and highly usable tool. Co-production and user-focused, mixed methods iterative development have been key to its success thus far. The next phase of development will focus on the educational function and data linkage with national systems.
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