A Novel Mobile Health Tool for Home-Based Identification of Neonatal Illness in Uganda: Formative Usability Study

Abstract

Background While early identification of neonatal illness can impact neonatal mortality rates and reduce the burden of treatment, identifying subtle clinical signs and symptoms of possible severe illness is especially challenging in neonates. The World Health Organization and the United Nations Children’s Fund developed the Integrated Management of Neonatal Childhood Illness guidelines, an evidence-based tool highlighting seven danger signs to assess neonatal health. Currently, many mothers in low-resource settings rely on home visits from community health workers (CHWs) to determine if their baby is sick. However, CHWs visit infrequently, and illness is often detected too late to impact survival. Thus, delays in illness identification pose a significant barrier to providing expedient and effective care. Neonatal Monitoring (NeMo), a novel neonatal assessment tool, seeks to increase the frequency of neonatal screening by task-shifting identification of neonatal danger signs from CHWs to mothers. Objective This study aimed to explore the usability and acceptability of the NeMo system among target users and volunteer CHWs by assessing ease of use and learnability. Methods Simulated device use and semistructured interviews were conducted with 32 women in the Iganga-Mayuge districts in eastern Uganda to evaluate the usability of the NeMo system, which involves a smartphone app paired with a low cost, wearable band to aid in identification of neonatal illness. Two versions of the app were evaluated using a mixed methods approach, and version II of the app contained modifications based on observations of the first cohort’s use of the system. During the posed scenario simulations, participants were offered limited guidance from the study team in order to probe the intuitiveness of the NeMo system. The ability to complete a set of tasks with the system was tested and recorded for each participant and closed- and open-ended questions were used to elicit user feedback. Additionally, focus groups with 12 CHWs were conducted to lend additional context and insight to the usability and feasibility assessment. Results A total of 13/22 subjects (59%) using app version I and 9/10 subjects (90%) using app version II were able to use the phone and app with no difficulty, despite varying levels of smartphone experience. Following modifications to the app’s audio instructions in version II, participants’ ability to accurately answer qualitative questions concerning neonatal danger signs improved by at least 200% for each qualitative danger sign. All participants agreed they would trust and use the NeMo system to assess the health of their babies. Furthermore, CHWs emphasized the importance of community sensitization towards the system to encourage its adoption and regular use, as well as the decision to seek care based on its recommendations. Conclusions The NeMo system is an intuitive platform for neonatal assessment in a home setting and was found to be acceptable to women in rural Uganda.

Mobile applications as a strategy to support parents in the care of newborns: a scoping review

“…The narrative synthesis of the 16 studies selected points to the main theme addressed: support for the parents of NBs, care of NBs ( 15 – 21 ) , breastfeeding (BF) ( 22 – 25 ) , fever ( 26 , 27 ) , child development ( 28 ) , growth ( 29 ) , and identification of neonatal diseases ( 30 ) . In addition, 11 scientific productions were presented in the form of articles and 5 dissertations and were published between 2017 and 2021.…”

Acceptability and operational feasibility of community health worker-led home phototherapy treatment for neonatal hyperbilirubinemia in rural Bangladesh

“…Their assessments of danger signs and decision-making for home phototherapy or referral were facilitated by an mHealth platform which was designed to limit mistakes, prevent assessments from being missed, and facilitated treatment and referral decisions. Other studies showed mHealth to be an effective tool in home-based identification of neonatal illness and in supporting clinical decision-making [ 48 – 51 ]. A nested study conducted under this trial showed that CHW identification of neonatal danger signs aided by mHealth showed moderate to high validity (sensitivity 93.3% and specificity 96.2%) in comparison to physician assessment [ 34 ].…”

Acceptability and operational feasibility of community health worker-led home phototherapy treatment for neonatal hyperbilirubinemia in rural Bangladesh

“…Other studies showed mHealth to be an effective tool in home-based identi cation of neonatal illness and in supporting clinical decision-making. [31][32][33][34] A nested study conducted under this trial showed that CHW identi cation of neonatal danger signs aided by mHealth showed moderate to high validity (sensitivity 93.3% and speci city 96.2%) in comparison to physician assessment. [25] mHealth platforms may reduce CHW training requirements and while maintaining performance.…”