eHBB: a randomized controlled trial of virtual reality or video for neonatal resuscitation recovery training in health workers in resource-poor environments

BMJ Open. August 25, 2021; 11 (8): e048506. doi: 10.1136 / bmjopen-2020-048506.


OBJECTIVE: To evaluate the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in health care workers in resource-poor environments.

DESIGN: Randomized controlled trial with 6-month follow-up (2018-2020).

SET: Secondary and tertiary sanitary facilities.

PARTICIPANTS: 274 nurses and midwives were recruited for childbirth and childbirth, operating room and newborn care units in 20 health centers in Nigeria and Kenya and randomized to one of three groups: VR (eHBB + digital guide), video (video + digital guide)) or control groups (digital guide only) before an HBB face-to-face course.

INTERVENTIONS: eHBB VR simulation or neonatal resuscitation video.

MAIN RESULTS: Neonatal resuscitation skills of health care workers using standardized checklists in a simulated environment at 1, 3, and 6 months.

RESULTS: Neonatal resuscitation skills approval rates were similar between groups at a 6-month follow-up for bag and mask ventilation skills testing (VR 28%, video 25%, control 22% , p = 0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p = 0.78) and OSCE B (VR 62%, video 60%, control 49% , p = 0.18). In relation to immediate post-course assessments, there was a greater retention of BMV skills at 6 months in the VR group (-15% VR, p = 0.10; -21% video, p <0.01, - 27% control, p = 0.001). OSCE B approval rates in the VR group were numerically higher at 3 months (+ 4%, p = 0.64) and 6 months (+ 3%, p = 0.74) and lower at video (-21% at 3 months, p <0.001; -14% at 6 months, p = 0.066) and control groups (-7% at 3 months, p = 0.43; -14% at 6 months, p = 0.10). In the follow-up survey, 95% (n = 65) of the VR group respondents and 98% (n = 82) of the video group would use the assigned intervention again.

CONCLUSION: Training in eHBB VR was highly acceptable for health workers in low-income and middle-income countries and may provide additional support for the retention of neonatal resuscitation skills compared to other digital interventions.

PMID: 34433598 | DOI: 10.1136 / bmjopen-2020-048506

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