Abstract
Substandard delivery care has been widely documented as a major cause of maternal mortality in health facilities globally. Health worker learning via mobile devices is increasing rapidly; however, there is little evidence of mLearning effectiveness. This study sought to determine the feasibility, acceptability, and potential effect of the Safe Delivery App (SDA) on health workers' practices in basic emergency obstetric and newborn care (BEmONC) in the Democratic Republic of the Congo (DRC). The Theoretical Domains Framework was used to guide this research. Eight BEmONC facilities in central DRC were randomized to either an mLearning intervention or to standard practice (control). Maternal and newborn health workers in intervention facilities (n=64) were trained on the use of smartphones and the French version of the SDA. The SDA is an evidence-based BEmONC training resource with visual guidance using animated videos and clinical management instructions developed by the Maternity Foundation and the Universities of Copenhagen and Southern Denmark. Knowledge on postpartum hemorrhage (PPH) and neonatal resuscitation (NR) and self-confidence in performing 12 BEmONC procedures were assessed at baseline and at 3 months post-intervention. Eighteen qualitative interviews were conducted with app users and key stakeholders to assess feasibility and acceptability of mLearning and the use of the SDA. Maternal mortality was compared in intervention and control facilities using a smartphone-based Open Data Kit (ODK) data application. One smartphone with SDA and ODK was entrusted to intervention facilities for the study period, whereas control facilities received smartphones with ODK only. The analysis included 62 heath workers. Knowledge scores on postpartum hemorrhage and neonatal resuscitation increased significantly from baseline among intervention participants compared with controls at 3 months post-intervention (mean difference for PPH knowledge, 17.4 out of 100; 95% confidence interval [CI]=10.7 to 24.0 and 19.4 for NR knowledge; 95% CI=11.4 to 27.4), as did self-confidence scores on 12 essential BEmONC procedures (mean difference, 4.2 out of 48; CI=0.7 to 7.7). Increases were unaffected by health worker cadre and previous smartphone use. Qualitative interviews supported the feasibility and acceptability of the SDA and mLearning, and the potential for it to impact maternal and neonatal mortality in the DRC. Use of the Safe Delivery App supported increased health worker knowledge and self-confidence in the management of obstetric and newborn emergencies after 3 months. SDA and mLearning were found to be feasible and acceptable to health workers and key stakeholders in the DRC.
Highlights
Health worker clinical performance is often inadequate in low- and middle-income countries (LMICs).[1]
We found a significant association between the Safe Delivery App (SDA) intervention and health care workers’
Interviewees noted that even for those who have been trained in the past, the SDA and mLearning offer the opportunity to learn important knowledge and skills and change behavior via the use of a more modern, more captivating approach that appeals to all health personnel. This reinforces our quantitative results of significantly increased knowledge and self-confidence scores across all 3 health professional cadres (MDs, nurses, midwives) after 3 months of SDA use
Summary
Health worker clinical performance is often inadequate in low- and middle-income countries (LMICs).[1] Substandard services in delivery and emergency obstetric and newborn care (EmONC) have been widely documented as a major cause of maternal and newborn mortality in health facilities globally.[2] Worldwide, mLearning in the DRC Using the Safe Delivery App www.ghspjournal.org. The Democratic Republic of the Congo (DRC), the largest country in sub-Saharan Africa, has one of the highest maternal mortality ratios in Africa (846 maternal deaths per 100,000 live births).[6] A woman’s lifetime risk of maternal death, or the probability that a 15-year-old woman will eventually die from a maternal cause, is estimated to be 1 in 24 in the DRC, compared with 1 in 3,300 in high-income countries.[5] Neonatal deaths, or deaths before days of life, are estimated at per 1,000 live births in the DRC.[4] Worldwide, disparities in maternal and child health outcomes largely reflect inequalities in access to quality health services.[3]. The Theoretical Domains Framework was used to guide this research
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