Table_1_Perceptions and experiences of Congolese midwives implementing a low-cost battery-operated heart rate meter during newborn resuscitation.DOCX

Background900,000 newborns die from respiratory depression each year; nearly all of these deaths occur in low- and middle-income countries. Deaths from respiratory depression are reduced by evidence-based resuscitation. Electronic heart rate monitoring provides a sensitive indicator of the neonate's status to inform resuscitation care, but is infrequently used in low-resource settings. In a recent trial in the Democratic Republic of the Congo, midwives used a low-cost, battery-operated heart rate meter (NeoBeat) to continuously monitor heart rate during resuscitations. We explored midwives' perceptions of NeoBeat including its utility and barriers and facilitators to use.
MethodsAfter a 20-month intervention in which midwives from three facilities used NeoBeat during resuscitations, we surveyed midwives and conducted focus group discussions (FGDs) regarding the incorporation of NeoBeat into clinical care. FGDs were conducted in Lingala, the native language, then transcribed and translated from Lingala to French to English. We analyzed data by: (1) coding of transcripts using Nvivo, (2) comparison of codes to identify patterns in the data, and (3) grouping of codes into categories by two independent reviewers, with final categories determined by consensus.
ResultsEach midwife from Facility A used NeoBeat on an estimated 373 newborns, while each midwife at facilities B and C used NeoBeat an average 24 and 47 times, respectively. From FGDs with 30 midwives, we identified five main categories of perceptions and experiences regarding the use of NeoBeat: (1) Providers' initial skepticism evolved into pride and a belief that NeoBeat was essential to resuscitation care, (2) Providers viewed NeoBeat as enabling their resuscitation and increasing their capacity, (3) NeoBeat helped providers identify flaccid newborns as liveborn, leading to hope and the perception of saving of lives, (4) Challenges of use of NeoBeat included cleaning, charging, and insufficient quantity of devices, and (5) Providers desired to continue using the device and to expand its use beyond resuscitation and their own facilities.
ConclusionMidwives perceived that NeoBeat enabled their resuscitation practices, including assisting them in identifying non-breathing newborns as liveborn. Increasing the quantity of devices per facility and developing systems to facilitate cleaning and charging may be critical for scale-up.

研究背景：
每年有90万名新生儿因呼吸抑制（respiratory depression）死亡，其中几乎所有案例均发生在中低收入国家。基于证据的复苏术（evidence-based resuscitation）可降低呼吸抑制导致的死亡风险。电子心率监测（electronic heart rate monitoring）能够灵敏反映新生儿（neonate）状态，为复苏救治提供决策依据，但在资源匮乏地区（low-resource settings）的应用并不普遍。近期在刚果民主共和国开展的一项试验中，助产士使用一款低成本、电池供电的心率监测仪（NeoBeat）在复苏过程中持续监测新生儿心率。本研究旨在探讨助产士对NeoBeat的认知，包括其应用价值以及使用过程中的障碍与促进因素。

研究方法：
在为期20个月的干预阶段中，三家医疗机构的助产士在复苏救治过程中使用了NeoBeat。随后我们对助产士开展了问卷调查，并围绕将NeoBeat纳入临床护理的相关话题进行了焦点小组讨论（FGDs）。焦点小组讨论以当地语言林加拉语（Lingala）开展，随后完成转录，并依次从林加拉语译为法语、再译为英语。我们通过以下步骤分析数据：（1）使用Nvivo质性分析软件（Nvivo）对转录文本进行编码；（2）对比编码结果以识别数据中的潜在模式；（3）由两名独立评审员将编码归类，最终分类通过共识确定。

研究结果：
据估算，A机构的每名助产士使用NeoBeat监测了约373名新生儿，而B、C两家机构的每名助产士平均使用次数分别为24次和47次。通过对30名助产士开展的焦点小组讨论，我们归纳出关于使用NeoBeat的五大类认知与体验：（1）助产士最初的怀疑态度逐渐转变为自豪感，并认为NeoBeat是复苏救治不可或缺的工具；（2）助产士认为NeoBeat助力其复苏救治工作，提升了自身救治能力；（3）NeoBeat帮助助产士识别出肌张力低下的新生儿为活产儿，这给他们带来了希望，并切实感受到成功挽救了生命；（4）NeoBeat的使用挑战包括设备清洁、充电及设备数量不足；（5）助产士希望继续使用该设备，并将其应用范围拓展至复苏救治以外的场景及自身所在机构之外。

研究结论：
助产士认为NeoBeat助力其复苏救治实践，包括协助其识别无呼吸的活产新生儿。增加每家医疗机构的设备数量，并建立便于清洁和充电的配套机制，对该设备的规模化推广至关重要。