The NeoRoo mobile app: Initial design and prototyping of an Android-based digital health tool to support Kangaroo Mother Care in low/middle-income countries (LMICs)

Premature birth and neonatal mortality are significant global health challenges, with 15 million premature births annually and an estimated 2.5 million neonatal deaths. Approximately 90% of preterm births occur in low/middle income countries, particularly within the global regions of sub-Saharan Africa and South Asia. Neonatal hypothermia is a common and significant cause of morbidity and mortality among premature and low birth weight infants, particularly in low/middle-income countries where rates of premature delivery are high, and access to health workers, medical commodities, and other resources is limited. Kangaroo Mother Care/Skin-to-Skin care has been shown to significantly reduce the incidence of neonatal hypothermia and improve survival rates among premature infants, but there are significant barriers to its implementation, especially in low/middle-income countries (LMICs). The paper proposes the use of a multidisciplinary approach to develop an integrated mHealth solution to overcome the barriers and challenges to the implementation of Kangaroo Mother Care/Skin-to-skin care (KMC/STS) in LMICs. The innovation is an integrated mHealth platform that features a wearable biomedical device (NeoWarm) and an Android-based mobile application (NeoRoo) with customized user interfaces that are targeted specifically to parents/family stakeholders and healthcare providers, respectively. This publication describes the iterative, human-centered design and participatory development of a high-fidelity prototype of the NeoRoo mobile application. The aim of this study was to design and develop an initial (“A”) version of the Android-based NeoRoo mobile app specifically to support the use case of KMC/STS in health facilities in Kenya. Key functions and features are highlighted. The proposed solution leverages the promise of digital health to overcome identified barriers and challenges to the implementation of KMC/STS in LMICs and aims to equip parents and healthcare providers of prematurely born infants with the tools and resources needed to improve the care provided to premature and low birthweight babies. It is hoped that, when implemented and scaled as part of a thoughtful, strategic, cross-disciplinary approach to reduction of global rates of neonatal mortality, NeoRoo will prove to be a useful tool within the toolkit of parents, health workers, and program implementors.Author summary: We aim to leverage the promise of digital health to overcome barriers and challenges to neonatal care, particularly thermal care, vital signs monitoring, and Kangaroo Mother Care/Skin-to-skin care (KMC/STS), in low/middle-income countries. Our multidisciplinary team has developed an integrated mHealth platform, composed of a wearable biomedical device called NeoWarm, which is a self-warming swaddling pouch plus baby carrier with sensors for automated vital signs monitoring, combined with a mobile app called NeoRoo. NeoRoo is a permission-based app with two user interfaces, customized for parents/family stakeholders and healthcare providers of premature and low birthweight babies. The app provides information, support, and resources designed to equip and empower adult stakeholders of prematurely born babies to more effectively adopt and implement KMC/STS, an evidence-based neonatal intervention that has been shown to significantly reduce the incidence of neonatal hypothermia and improve survival among premature infants. Using a human-centered and participatory design approach, we performed iterative development efforts for the open-source NeoRoo app from August 2020 to February 2021. This resulted in a high-fidelity prototype with features and functions for automated vital signs monitoring, communication between parents and health workers, shared goal-setting and tracking for key KMC/STS metrics, and educational resources.