Article Text

Download PDFPDF

Designing and evaluating a novel mobile application for Helping Babies Breathe skills retention in Uganda: comparative study protocol
  1. Hasan Shamsh Merali1,2,
  2. Natalie Hoi-Man Chan2,3,
  3. Niraj Mistry4,
  4. Ryan Kealey5,
  5. Douglas Campbell6,7,
  6. Shaun K Morris2,8,
  7. Santorino Data9
  1. 1Division of Pediatric Emergency Medicine, McMaster Children’s Hospital, Hamilton, Ontario, Canada
  2. 2Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
  3. 3Division of Neonatalogy, University of California Davis Children’s Hospital, Sacramento, California, USA
  4. 4Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  5. 5Interactive Media Lab, University of Toronto, Toronto, Ontario, Canada
  6. 6Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
  7. 7Division of Neonatology, St. Michael’s Hospital, Toronto, Ontario, Canada
  8. 8Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
  9. 9Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
  1. Correspondence to Dr Santorino Data; sdata{at}


Introduction Over 600 000 newborns die each year of intrapartum-related events, many of which are preventable in the presence of skilled birth attendants. Helping Babies Breathe (HBB) is a neonatal resuscitation training programme designed for low-resource settings that can reduce both early neonatal mortality and stillbirths. However, as in other similar educational programmes, knowledge and skill retention deteriorate over time. This trend may be counteracted by strategies such as regular simulated exercises. In this study, a mobile application (app) ‘HBB Prompt’ will be developed to assist providers in retaining HBB knowledge and skills.

Methods and analysis This is a comparative study in Uganda with two phases: an app development phase and an assessment phase. In the first phase, HBB trainers and providers will explore barriers and facilitators to enhance learning and maintenance of HBB skills and knowledge through focus group discussions (FGDs). The FGDs are designed with a human factors perspective, enabling collection of relevant data for the prototype version of HBB Prompt. The app will then undergo usability and feasibility testing through FGDs and simulations. In the second phase, a minimum of 10 healthcare workers from two district hospitals will receive HBB training. Only the intervention hospital will have access to HBB Prompt. All participants will be asked to practise HBB skills every shift and record this in a logbook. In the intervention site, app usage data will also be collected. The primary outcome will be comparing skills retention 12 months after training, as determined by Objective Structured Clinical Examination B scores.

Ethics and dissemination This study received ethics approval from The Hospital for Sick Children and Mbarara University of Science and Technology. The authors plan to publish all relevant findings from this study in peer-reviewed journals.

Trial registration number NCT03577054

  • newborn resuscitation
  • Helping Babies Breathe
  • mobile application
  • Uganda
  • simulation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors NH-MC, SD, HSM and SKM conceived of the study. HSM drafted the manuscript. All authors participated in the design of the study, revised the manuscript critically for intellectual content, and have read and approved the final manuscript.

  • Funding This study is funded by Grand Challenges Canada Stars in Global Health project number: R-ST-POC-1707-07454. Contact:

  • Competing interests SD is a co-creator of the Augmented Infant Resuscitator. All other authors declare that they have no competing interests.

  • Patient consent for publication Obtained.

  • Ethics approval This study received approval from the Research Ethics Board at The Hospital for Sick Children (Sickkids) (REB no. 1000059992) and Mbarara University of Science and Technology (REC no. 16/09-17).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available on reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.