Pilot Testing the Effectiveness and Stability of a Structured Curriculum for Newborn Resuscitation - Helping Babies Breathe® - Using Videotaped Simulations

Introduction The Helping Babies Breathe® (HBB®) program is designed to improve neonatal resuscitation knowledge and skills for birth attendants in resource-limited settings. Purpose and Research Design This prospective, longitudinal, quasi-experimental study with a control group hold-back design evaluated the effect of HBB® training on resuscitation knowledge and psychomotor skills in healthcare providers in Zambia (N = 52). Subjects The sample included nurses (85%); clinical officers, medical licentiates, and physicians accounted for the remaining 15%. Methods Resuscitation knowledge and bag-mask ventilation (BMV) skills were measured using the HBB® Multiple Choice Test and the HBB® BMV OSCE. The BMV OSCEs were performed at baseline, 1 and 3 months, using a low-technology simulator (NeoNatalie), videotaped using iPads, and scored by blinded independent raters. The intervention group received a 2.5 day HBB® training post baseline measures. Results Baseline knowledge scores (HBB® MCQ) had pass rates of 71%. The baseline HBB® BMV OSCE had a pass rate of 0% (Median = 2.5 of 7 points). To examine the effect of the HBB® training on knowledge, a repeated measures mixed model ANOVA compared the HBB® MCQ scores between subjects (control versus intervention) and within subjects (changes in scores over time; at baseline, 1 month, 3 months) on the M knowledge score. There was a significant effect of group assignment on knowledge (HBB® MCQ scores), F (1,50) = 13.62, p = \u3c0.001 and of group and time on knowledge (HBB® MCQ scores), F (2,50) = 20.76, p = ® MCQ Scores. The intervention group’s knowledge scores increased over time; the control group’s scores did not. The intervention group’s mean scores for the HBB® BMV OSCE increased from 2.8 to 5.8 (p = 0.01) in the post-test period and remained higher (4.6 at 1 month; 5.2 at 3 months); however, competency was not uniformly achieved. Atypical and potentially dangerous resuscitation practices, not previously well described, were noted in 43% of the videos at baseline and persisted in 35% of the videos post-training. Implications for Practice This study explores baseline levels of newborn resuscitation knowledge and BMV skills in Zambia. Although the HBB® training improved both knowledge and BMV scores, only two participants demonstrated BMV competancy; niether sustained competent scores over time. Our findings highlight the complexity of both teaching and learning BMV and have practical applications for both the developed and developing world context