Usability-Focused Development and Usage of NeoTree-Beta, an App for Newborn Care in a Low-Resource Neonatal Unit, Malawi

Background: Neonatal mortality is high in low-resource settings. NeoTree is a digital intervention for neonatal healthcare professionals (HCPs) aiming to achieve data-driven quality improvement and improved neonatal survival in low-resource hospitals. Optimising usability with end-users could help digital health interventions succeed beyond pilot stages in low-resource settings. Usability is the quality of a user's experience when interacting with an intervention, encompassing their effectiveness, efficiency, and overall satisfaction. Objective: To evaluate the usability and usage of NeoTree beta-app and conduct Agile usability-focused intervention development. Method: = 8 and 8). During the pilot, real-world user-feedback and user-data were gathered. Feedback notes were subjected to thematic analysis within an Agile "product backlog." For usage, number of users, user-cadre, proportion of admissions/outcomes recorded digitally, and median app-completion times were calculated. Results: Twelve overarching usability themes generated 57 app adjustments, 39 (68%) from think aloud analysis and 18 (32%) from the real-world testing. A total of 21 usability themes/issues with corresponding app features were produced and added to the app. Six themes relating to data collection included exhaustiveness of data schema, prevention of errors, ease of progression, efficiency of data entry using shortcuts, navigation of user interface (UI), and relevancy of content. Six themes relating to the clinical care included cohesion with ward process, embedded education, locally coherent language, adaptability of user-interface to available resources, and printout design to facilitate handover. SUS scores were above average (88.1 and 89.4 at 1 and 6 months, respectively). Ninety-three different HCPs of 5 cadres, recorded 1,323 admissions and 1,197 outcomes over 6 months. NeoTree achieved 100% digital coverage of sick neonates admitted. Median completion times were 16 and 8 min for admissions and outcomes, respectively. Conclusions: This study demonstrates optimisation of a digital health app in a low-resource setting and could inform other similar usability studies apps in similar settings

Agile software development · Digital health · End user · Health care · Human–computer interaction · Psychological intervention · Public health · Qualitative research · Thematic analysis · Think aloud protocol · Usability · World Wide Web · Computer Science · Electronic Health Records Systems · Global Maternal and Child Health · Medicine · Mobile Health and mHealth Applications · Nursing · Psychology · Health Informatics

• An Empirical Evaluation of the System Usability Scale

  Aaron Bangor, Philip Kortum et al.•International Journal of…•2008

  Incluir item

• The Person-Based Approach to Intervention Development

  Open Access•Liz Yardley, Linda Morrison et al.•Journal of Medical Internet…•2015

  Incluir item

• Health worker motivation in Africa

  Open Access•Inke Mathauer, Ingo Imhoff•Human Resources for Health•2006

  Incluir item

• Nurse Motivation, Engagement and Well-Being before an Electronic Medical Record System Implementation

  Open Access•Rebecca M Jedwab, Alison M Hutchinson et al.•International Journal of…•2021

  Incluir item

• Using thematic analysis in psychology

  Open Access•Braun, Virginia Braun et al.•Qualitative Research in Psychology•2006

  Incluir item