Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States.
School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
JMIR Mhealth Uhealth. 2019 Aug 15;7(8):e14540. doi: 10.2196/14540.
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.
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.
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.
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.
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.
虽然早期识别新生儿疾病可以影响新生儿死亡率并减轻治疗负担，但识别新生儿可能患有严重疾病的微妙临床症状和体征尤其具有挑战性。世界卫生组织和联合国儿童基金会制定了《新生儿和儿童期疾病综合管理指南》，这是一个基于证据的工具，强调了七个危险信号，用于评估新生儿健康状况。目前，许多资源匮乏环境下的母亲依赖社区卫生工作者（CHWs）的家访来确定她们的宝宝是否患病。然而，CHWs 的家访频率较低，往往等到疾病严重到无法挽救时才被发现。因此，疾病识别的延迟对提供及时有效的护理构成了重大障碍。新生儿监测（NeMo）是一种新的新生儿评估工具，它试图通过将识别新生儿危险信号的任务从 CHWs 转移到母亲手中，增加新生儿筛查的频率。
本研究旨在通过评估易用性和可学习性，探索 NeMo 系统在目标用户和志愿 CHWs 中的可用性和可接受性。
在乌干达东部伊甘加-马尤盖区对 32 名妇女进行了模拟设备使用和半结构化访谈，以评估 NeMo 系统的可用性，该系统涉及一款与低成本可穿戴带配对的智能手机应用程序，以帮助识别新生儿疾病。使用混合方法评估了两个版本的应用程序，根据对第一组使用系统情况的观察，对应用程序的第二个版本进行了修改。在模拟场景中，研究小组只向参与者提供了有限的指导，以探究 NeMo 系统的直观性。为每位参与者测试并记录了使用系统完成一组任务的能力，并使用封闭和开放式问题来征求用户反馈。此外，还与 12 名 CHWs 进行了焦点小组讨论，为可用性和可行性评估提供了更多的背景和见解。
尽管智能手机使用经验不同，但使用应用程序 I 的 22 名受试者中有 13 名（59%）和使用应用程序 II 的 10 名受试者中有 9 名（90%）能够毫不费力地使用手机和应用程序。在应用程序 II 中对音频说明进行修改后，每个定性危险信号的参与者准确回答有关新生儿危险信号的定性问题的能力至少提高了 200%。所有参与者都表示他们会信任并使用 NeMo 系统来评估他们宝宝的健康状况。此外，CHWs 强调了需要对该系统进行社区宣传，以鼓励其采用和定期使用，以及根据其建议决定寻求护理。
NeMo 系统是一种用于家庭环境中新生儿评估的直观平台，在乌干达农村地区的妇女中被认为是可以接受的。
