Adapting a digital quality improvement system (Neotree) for newborn care in primary health centres and community...

Digital innovations incorporating clinical digital support can improve the delivery of perinatal and postnatal care, yet few interventions exist in primary care settings.

We aimed to adapt a digital quality improvement system (Neotree) from tertiary facilities to lower-level facilities providing Level 1 newborn care.

We conducted a mixed method stepwise study using the ADAPT framework. We conducted a needs and technology assessment of eight facilities in Lilongwe district, Malawi. We next adopted a user-centred approach to modify the clinical decision support and data capture functionalities to fit the new context. We completed 'think aloud' usability testing with six prospective users to refine the system, alongside qualitative research informed by behavioural science frameworks with 10 healthcare professionals to identify potential barriers and facilitators to implementation. Finally, we carried out a stakeholder assessment to identify a potential pathway to scale.

The adapted application was highly usable achieving a mean System Usability Scale (SUS) score of 92.5 among prospective users during the final round of testing. Our qualitative findings indicated Neotree was anticipated to be acceptable among healthcare professionals. We found high levels of motivation to implement Neotree, but key perceived implementation barriers included psychological and physical capability (such as skills and knowledge in neonatal care), as well as physical opportunity (e.g. human resources, equipment and adequate space for newborn care).

Using a stepwise user-centred approach, we successfully adapted a digital quality improvement intervention (Neotree) ready for real-world piloting in community hospital and primary health centres in Malawi.