Crehan, Caroline;
(2023)
Optimising and Evaluating Usability, Acceptability and Feasibility of a Neonatal Digital Health System in a Low-Resource Setting: The NeoTree Case-Study.
Doctoral thesis (M.D(Res)), UCL (University College London).
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Abstract
Background: Neonatal mortality remains high in low resource settings. Digital data-capture and quality improvement systems for neonatal healthcare professionals (HCP), such as NeoTree, may improve facility-based newborn care. Objective: To evaluate usability, usage, acceptability, and feasibility of NeoTree-beta during a 6-month mixed-methods intervention-development study, including dashboard prototyping and usability-focused optimisation of both app and dashboard components in Kamuzu Central Hospital, Malawi. Methods: Think-aloud usability interviews with six neonatal nurses and real-world feedback informed app optimisation. Usability data were analysed using rapid-agile analysis. NeoTree-beta was embedded into usual newborn care. System Usability Scale (SUS) scores were collected, at baseline (eight nurses) and six months (eight nurses). Usage data were exported (93 HCPs, 1323 neonates). A data-dashboard was prototyped with user-centred design cycles including stakeholder meetings (31 HCPs) and content analysis for Audit and Feedback (A&F) features. This was refined according to feedback from ten usability interviews and a real-world pilot (~140 HCPs). Two acceptability and feasibility focus groups with six and eight nurses, at one month and six months, were analysed using behaviour change frameworks: Theoretical Framework of Acceptability and Theoretical Domains Framework. Data were triangulated and recommendations made. Results: Twelve usability themes and 57 app adjustments arose from usability testing. Quantitative usability was high (mean SUS 88.3, 89.3). Digital NeoTree admissions exceeded numbers logged by the ward clerk. Fourteen A&F characteristics guided alpha-dashboard configuration. 33 usability insights informed iteration to beta-dashboard and perceived potential for A&F was evident. Acceptability enablers included good understanding of functions (Intervention coherence) and potential impact (Perceived effectiveness); barriers included interface inflexibilities (Burden). Feasibility issues included resource limitations (Environmental context and resources) and reduced rapport with mothers (Social influences). Need for printer and dashboard refinement and training were highlighted. Conclusion: Digital health interventions can be optimised combining agile user-focused methods with behaviour change frameworks. This approach has produced a highly usable and largely acceptable and feasible intervention with the potential to improve newborn care.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | Optimising and Evaluating Usability, Acceptability and Feasibility of a Neonatal Digital Health System in a Low-Resource Setting: The NeoTree Case-Study |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10165521 |
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