154 - Digital Education in Essential Newborn Care: Lessons Learned from "ENC Now!" Implementation Pilots

Poster Number: 154
Publication Number: 154.112

Sara Berkelhamer, University of Washington School of Medicine, Seattle, WA, United States; Emily Ahn, New York-Presbyterian Komansky Children’s Hospital, New York, NY, United States; Robert B. Clark, Brigham Young University, Salem, UT, United States; Danielle Ehret, The University of Vermont Children's Hospital, Burlington, VT, United States; Allison Judkins, University of Utah School of Medicine, Salt Lake City, UT, United States; Hasan Merali, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada; Casey Lowman, American Academy of Pediatrics, Chicago, IL, United States; Monika S. Patil, Baylor College of Medicine, Houston, TX, United States; Renate D. Savich, University of New Mexico, Albuquerque, NM, United States; Sithembiso Velaphi, Chris Hani Baragwanath Academic Hospital, Johannesburg, Gauteng, South Africa; Michael K. Visick, University of Utah School of Medicine, Logan, UT, United States; Susan Niermeyer, University of Colorado School of Medicine, Denver, CO, United States

Background: Essential newborn care (ENC) teaches life-saving interventions and initial care for all births; however, the COVID-19 pandemic has disrupted both professional education and service provision globally.

Objective: To pilot the delivery of ENC content (based on Helping Babies Breathe and World Health Organization (WHO) guidelines) to health care workers (HCW) using a digital platform and remote facilitation.

Design/Methods: The WHO ENC Basic Course was available as a digital flipchart or interactive online platform (ENC Now!). Technical advisors (TAs) oriented in-country master trainers and facilitators who then taught frontline HCW. Process evaluation included TA focus group, survey, and participant evaluation.

Results: Implementation pilots occurred in 11 sites from January to December 2021 (Fig 1). Each pilot included at least one TA and in-country facilitators. Content was presented through video conferencing and group messaging (Fig 2).  Flexible learning formats allowed for remotely led and hybrid remote and in-person facilitation. Focus groups noted that embedded clinical videos proved technically challenging to transmit via internet, but stimulated valuable reflection among HCW. Integrated quality improvement segments prompted examination of current practices, deepened the evidence base, and laid the foundation for follow-up actions. Limitations of connectivity (internet access or data cost) prolonged overall course duration and prompted innovation in sharing downloaded course materials over phone-based group messaging applications. TAs (Nf12) agreed with statements that remote facilitation allowed adequate discussion and skills demonstration. There was less agreement with statements that remote training allowed adequate feedback, engagement and interaction with facilitators (Fig 3), highlighting the value of the face-to-face component with local facilitators.Conclusion(s): Digital materials and remote facilitation can revitalize professional education in ENC, even under pandemic constraints. Advantages include clinical videos, standardized skill demonstrations and cues for discussion. Ongoing remote access to experienced facilitators can deepen the evidence base and stimulate quality improvement actions; however, skills acquisition and practice are optimized with on-site facilitation. Limitations of connectivity remain a challenge and demand further development of interactive, downloadable resources for individual and small group learning.
Figure 1: Implementation Pilot Countries11 countries participated in pilots. Technical advisors participated from Canada, Denmark, Spain, Sweden, Norway and the United States (light blue). Several of the implementation countries also provided technical advisors.
Figure 2: Communication by WhatsAppProgram content, links to assessments, simulation practice cards and online links were shared via WhatsApp along with logistics.