JMIR Publications

ABSTRACT

Background:

Lack of trained healthcare workers and non-adherence to neonatal care clinical guidelines are key barriers to achieving high quality newborn care in healthcare facilities in low- and middle-income countries (LMIC). Traditional didactic approaches addressing these barriers fail to account for high-staff turnover rates and often result in temporary behavior change. NoviGuide, a clinical decision support software designed to standardize neonatal care delivery through point-of-care assessments, has potential to align bedside clinical practice to national guidelines in settings lacking subspecialty neonatal health providers

Objective:

To determine the adaptation, adoption, feasibility, acceptability and sustainability of NoviGuide, and its impact on healthcare worker knowledge, in a rural district hospital in eastern Uganda

Methods:

This mixed-methods observational study was guided by Proctor framework. Experts reviewed NoviGuide’s clinical content to ensure fidelity to Uganda neonatal care clinical guidelines. We enrolled nurses and midwives providing newborn care at Tororo District Hospital, trained them on NoviGuide use, and followed them for 12 months. We assessed adoption, feasibility, acceptability and sustainability by analyzing NoviGuide usage data, comparing it with maternity registry data and administering System Usability Scale (SUS) and Center for Health Care Evaluation (CHCE-PSQ) questionnaires. We also assessed impact on neonatal knowledge by comparing mean knowledge assessment scores at baseline, 6 and 12 months

Results:

Five Ugandan experts suggested two minor changes to NoviGuide’s decision trees; inclusion of unsterile birth environment as an indication for empiric antibiotics and addition of a reminder to follow-up newborns with temperature between 37.7-37.90 C. We enrolled 19 nurse-midwives in February 2017. Of these, 14(73.7%) completed study follow up in March 2018. The participants entered a total of 1705 assessments of varying newborn characteristics into NoviGuide, throughout the day, evening and night nursing shifts. SUS score at the end of the study was very high 93.5 (above the average of 68). The participants had a positive perception about NoviGuide reporting that NoviGuide saved time (mean = 5 (SD-0)), prevented mistakes (5 (0)), and that they felt more confident taking care of newborns when they used NoviGuide (5 (0)). The participants were highly satisfied with NoviGuide (4.86 (0.36)) although they reported that they lacked medical supplies and materials needed to follow all NoviGuide recommendations (3. 3 (1.22)). The participants’ knowledge in basic newborn care improved from 10.5 (1.97) at baseline, to 14.06 (2.21) and 17.19 (1.56) at 6 and 12 months respectively.

Conclusions:

NoviGuide was easily adapted to the Uganda clinical guidelines. Ugandan nurse-midwives used the NoviGuide frequently reporting high levels of satisfaction despite challenges with medical supplies and high staff turnover. NoviGuide improved knowledge and confidence in newborn care without in-person didactic training. NoviGuide use has the potential to scale up quality newborn care by facilitating adherence to neonatal care clinical guidelines.