# An innovative, digital approach to training district health care providers on essential newborn care skills: findings from a pilot cluster-randomised trial in Lao People’s Democratic Republic

## TL;DR

A digital training method using mobile phones helped maintain newborn care skills among health providers in Laos, showing promise for future use.

## Contribution

A novel mobile phone-based supportive supervision method to sustain essential newborn care skills post-training.

## Key findings

- Intervention arm providers showed higher knowledge and skill scores compared to the control group.
- Both providers and facilitators viewed the digital intervention positively despite time constraints.
- The study suggests the method may help maintain clinical performance but confidence in sustainability was low.

## Abstract

In Lao People’s Democratic Republic, the skills of newborn care providers at district hospitals degrades soon after training due to lack of regular supervision and/or refresher training. This pilot trial evaluated the potential effectiveness and acceptability of the novel intervention to maintain providers’ early essential newborn care (EENC) knowledge and skills.

This was a parallel, cluster-randomised pilot trial with embedded focus group discussions in Lao People’s Democratic Republic. Newborn care providers at four district hospitals (clusters) in two provinces participated. The four clusters were randomised into two arms, within each province. Both arms initially received standard EENC coaching. The intervention arm used repeated self-practise combined with mobile phone-based supportive supervision from EENC facilitators, while the control arm received no additional support. The primary outcome, a standardised assessment of provider’s EENC knowledge and skills measured at three months post-randomisation, was analysed by intention-to-treat. Qualitative data underwent thematic analysis.

Forty-four providers were recruited: 22 in each arm. Thirty-seven providers and 19 facilitators completed data collection and participated in focus group discussions. The knowledge and skill scores at three months were 0.59 points (95% confidence interval (CI) = −1.40, 2.52) and 3.67 points (95% CI = −2.90, 10.24) higher in the intervention arm than in the control arm, after adjusting for baseline scores. Both providers and facilitators viewed the intervention positively, though time constraints limited self-practise sessions. While they believed it could improve their clinical performance, confidence in sustaining the intervention was low.

Though not powered for statistical significance, this study showed the intervention may help maintain newborn care skills and was well accepted. A definitive trial is warranted to evaluate its effectiveness on clinical practice and health outcomes, along with further investigation into factors that support sustainability.

This trial was registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12623000957695).