Infectious Diseases Research Collaboration, Kampala, Uganda
Global Strategies, Albany, California, USA.
BMJ Open. 2024 Nov 25;14(11):e081088. doi: 10.1136/bmjopen-2023-081088.
To evaluate acceptability and effectiveness of midwives as trainers for NoviGuide, a neonatal clinical decision support system (CDSS).
A 20-months, mixed-methods open cohort study.
Nurse-midwives at four rural health facilities in eastern Uganda.
We developed a midwife-led trainer programme and instructed two midwives as NoviGuide Trainers in three 3-hour-long sessions. Trainers trained all nurse-midwives at each site in single 3-hour-long sessions. Using the Kirkpatrick model, we evaluated acceptability at level 1 for participant's reaction and level 3 for participant's attitudes towards the programme. We evaluated effectiveness at level 2 for newly learnt skills, and level 3 for participant's uptake of NoviGuide and perception of newborn care practices. We used surveys and focus groups at baseline, 3 months and 6 months and viewed usage data from September 2020 through May 2022.
All 49 participants were female, 23 (46.9%) owned smartphones, 12 (24.5%) accessed the internet daily and 17 (34.7%) were present by study end following staff changes. All participants perceived the use of midwives as NoviGuide Trainers to be an acceptable approach to introduce NoviGuide (mean 5.9 out of 6, SD 0.37). Participants reported gaining new skills and confidence to use NoviGuide; some, in turn, trained others. Participants reported improvement in newborn care. Uptake of NoviGuide was high. Of 49 trained participants, 48 (98%) used NoviGuide. A total of 4045 assessments of newborns were made. Of these, 13.8% (558/4045) were preterm, 17.5% (709/4045) weighed under 2.5 kg and 21.1% (855/4045) had a temperature <36.5°C.
This midwife-led programme was acceptable and led to self-reported improvement in newborn care and high uptake of NoviGuide among nurse-midwives. Task shifting CDSS expert roles to midwives could facilitate large-scale implementation. However, resources like internet coverage, reliable electricity and mobile devices should be considered in low-resource settings.
评估助产士作为新生儿临床决策支持系统（CDSS）NoviGuide 培训师的可接受性和有效性。
一项为期 20 个月的混合方法开放队列研究。
乌干达东部四个农村卫生机构的护士助产士。
我们开发了一种助产士主导的培训师计划，并在三个 3 小时的课程中指导两名助产士成为 NoviGuide 培训师。培训师在每个地点的单个 3 小时课程中培训所有护士助产士。使用柯克帕特里克模型，我们在第 1 级评估了参与者的反应，在第 3 级评估了参与者对该计划的态度。我们在第 2 级评估了新习得的技能，在第 3 级评估了参与者对 NoviGuide 的采用和对新生儿护理实践的看法。我们在基线、3 个月和 6 个月使用了调查和焦点小组，并查看了 2020 年 9 月至 2022 年 5 月的数据。
所有 49 名参与者均为女性，23 名（46.9%）拥有智能手机，12 名（24.5%）每天上网，17 名（34.7%）在工作人员变动后仍参加研究。所有参与者都认为使用助产士作为 NoviGuide 培训师是引入 NoviGuide 的一种可接受的方法（平均 6 分，标准差 0.37）。参与者报告说他们获得了使用 NoviGuide 的新技能和信心；一些人反过来又培训了其他人。参与者报告说新生儿护理有所改善。NoviGuide 的采用率很高。在 49 名接受培训的参与者中，有 48 名（98%）使用了 NoviGuide。共对 4045 名新生儿进行了评估。其中，13.8%（558/4045）为早产儿，17.5%（709/4045）体重不足 2.5 公斤，21.1%（855/4045）体温<36.5°C。
这种由助产士主导的方案是可以接受的，并导致自我报告的新生儿护理改善和护士助产士对 NoviGuide 的高采用率。将 CDSS 专家角色转移给助产士可以促进大规模实施。然而，在资源匮乏的环境中，应该考虑互联网覆盖、可靠的电力和移动设备等资源。
