Table 4 Summary of feedback for HBB Prompt during Phase 1b

Likes

Content flows well and is consistent with the HBB curriculum

Can complement use of the HBB flip chart during HBB training

Can serve well as a refresher training program

Included additional practical recommendations, such as, when to refer infants for advanced care, how to cut and trim the cord length, how to keep the baby warm

“You can use it on a daily basis and at any time. You don’t have to wait for a workshop, or organized day.”

“I am satisfied that this is a dream come true. The last time we met, we had ideas but did not know how that would be incorporated in an app, and I am hoping the developers carry it farther, and avail it as quickly as they could.”

Training videos comprehensive, realistic and highlighted relevant materials from HBB

Supplemented training videos with text to facilitate review

Demonstration in video of preparation for birth and testing of equipment in front of family—helps promote transparency and confidence in newborn resuscitation process

Kept this video as a part of the app to help encourage this process of transparency

Quizzes were useful for review, gave immediate feedback and can be useful tool for teaching

Random order of questions helped users not relying on memory alone

Some technical flaws noted that were fixed, for example unsaved answers and needing to redo the entire quiz when users tapped the screen in any incorrect place

Added a review feature where answers that are correct and answers that were marked are shown to provide feedback to users

Simulation mode was helpful for self-practice and group practice

Audio and visual prompts were effective

Fixed flaws in orientation of images and timing of prompts

“Yes, it will help us practice with our colleagues. For instance, if you are helping someone who does not know, the video guides you and helps you know what do to next, if you forget. It also helps to time you.”

“I think the videos helped us, because it directs you on what to do. Because if they kept saying the baby is not breathing, you would know what to do and keep doing it, ‘till the baby breathes.”

Dislikes

Lack of consistency throughout the app (e.g. how prompts are given, audio for crying, where the baby is being resuscitated in the videos)

Modified videos and simulations to use the same prompts

In the HBB curriculum timing of cutting the cord, and location of where the baby should be during ventilation (near mother, or on a separate surface) is left up to the discretion of the facilitators teaching in their own setting. For simplicity, decision made to only show ventilation near the mother rather than specifying location depending on the status of the baby

Some aspects of the training videos were not as realistic, such as the timing with certain actions being too slow

Modified videos to be more realistic and modified timing of transitions in simulation mode

Font size and menu options at times not clear

Modified text size and colour scheme to improve visibility

Navigation—suggestion for a restart button in simulation mode

Added pause button (restart feature with back button)

General comments and suggestions

Using the same HBB curriculum colour scheme of Green, Yellow and Red may help reinforce learning by means of a visual prompt

Added HBB colour scheme in different parts of HBB Prompt content

For training videos different viewing angles to better capture the details of the actions (e.g. mask seal in bagging)

Decision made not to re-film the videos due to time constraints in filming and editing

For the Dashboard, use of real names vs. aliases was debated

Consensus was to use real names

Customizability

Consideration of creating animated videos rather than filming individuals—may allow more flexibility if the app scales to different settings

Not feasible to create animations to address this need within the study time line available

Including locally relevant practices even if it is not a part of the standard HBB protocol—e.g. asking birth attendants to have bed sheets available for baby in the preparation for birth section as this is common place throughout Uganda, but may not be in other settings

Decision made not to add customized recommendations and adhere to what is presented in the HBB curriculum