Abstract:
Objective To assess the impact of mobile virtual
reality (VR) simulations using electronic Helping Babies
Breathe (eHBB) or video for the maintenance of neonatal
resuscitation skills in healthcare workers in resource-scarce
settings.
Design Randomised controlled trial with 6-month
follow-up
(2018–2020).
Setting Secondary and tertiary healthcare facilities.
Participants 274 nurses and midwives assigned to labour
and delivery, operating room and newborn care units were
recruited from 20 healthcare facilities in Nigeria and Kenya
and randomised to one of three groups: VR (eHBB +digital
guide), video (video +digital guide) or control (digital guide
only) groups before an in-person
HBB course.
Intervention(s) eHBB VR simulation or neonatal
resuscitation video.
Main outcome(s) Healthcare worker neonatal
resuscitation skills using standardised checklists in a
simulated setting at 1 month, 3 months and 6 months.
Results Neonatal resuscitation skills pass rates were
similar among the groups at 6-month
follow-up
for bag-and-
mask
ventilation (BMV) skills check (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). Relative to the immediate postcourse
assessments, there was 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 pass rates in
the VR group were numerically higher at 3 months (+4%,
p=0.64) and 6 months (+3%, p=0.74) and lower in the
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). On follow-up
survey, 95%
(n=65) of respondents in the VR group and 98% (n=82)
in the video group would use their assigned intervention
again.
Conclusion eHBB VR training was highly acceptable
to healthcare workers in low-income
to middle-income
countries and may provide additional support for neonatal
