Preclinical usability evaluation of the Liveborn app: A mobile health application that provides feedback for neonatal resuscitation

Neonatal mortality, particularly due to failure to breathe at birth, remains a significant challenge in low- and middle-income countries (LMICs). Effective neonatal resuscitation is essential to improving survival, but is challenging to implement consistently at the bedside. The Liveborn mobile health application for newborn resuscitation was developed to provide real-time guidance and support debriefing for healthcare workers in LMICs. Liveborn allows an observer to document the timing of key actions during a resuscitation; it then compares the observer data to recommended care and provides data-driven feedback. This study aimed to evaluate the usability of Liveborn in simulated resuscitations. We conducted two rounds of simulated resuscitations using Liveborn with midwives at one health facility in the Democratic Republic of Congo. Each round included ten simulations, with half testing real-time guidance and half focusing on debriefing. Between rounds, Liveborn was iteratively refined based on analysis of video-recordings of the simulations and participant surveys. Midwives’ perceptions of usability and feasibility were assessed using previously validated survey tools including the System Usability Scale (SUS) with a score >68 considered above average, and the Feasibility of Intervention Measure (FIM) with a score >12 considered above neutral. Round 1 of testing identified several key usability issues including difficulty accurately recording events, poor adherence to audio guidance that was insufficiently specific, and poor flow of debriefing for intrapartum stillbirth cases. The Liveborn app, after iterative refinement, demonstrated excellent usability (median SUS score of 90 [Q1, Q3: 85, 95]) and excellent feasibility (median FIM score of 19 [16, 20]). Further research is needed to assess Liveborn’s effectiveness in real clinical settings and its impact on neonatal outcomes in LMICs.Author summary: Birth asphyxia (i.e., failure to breathe at birth) is one of the top three causes of death for newborns worldwide. The vast majority of these deaths happen in low-resource settings. We developed a mobile health application called Liveborn that supports health workers in low-resource settings who are helping a newborn breathe at birth. An observer uses the app to record what is happening during a resuscitation. Using this data, the app gives audio guidance to the health worker during a resuscitation (real-time guidance) and helps them reflect on their care after a resuscitation (debriefing). We tested the usability of the app with midwives in the Democratic Republic of the Congo using a newborn manikin. In the first round of simulations, we found that it was challenging to accurately record events with the app, some of the audio guidance was not specific enough, and the screens for debriefing were not relevant for stillborn cases. We refined the app accordingly and tested it again in simulations. The refined version of Liveborn demonstrated excellent usability and feasibility. Further research is needed to assess Liveborn’s effectiveness in real clinical settings and its impact on neonatal outcomes.