Simulation Round 2: key findings and solutions.

Neonatal mortality, particularly due to failure to breathe at birth, remains a significant challenge in low- and middle-income countries (LMICs). Effective neonatal resuscitation is essential to improving survival, but is challenging to implement consistently at the bedside. The Liveborn mobile health application for newborn resuscitation was developed to provide real-time guidance and support debriefing for healthcare workers in LMICs. Liveborn allows an observer to document the timing of key actions during a resuscitation; it then compares the observer data to recommended care and provides data-driven feedback. This study aimed to evaluate the usability of Liveborn in simulated resuscitations. We conducted two rounds of simulated resuscitations using Liveborn with midwives at one health facility in the Democratic Republic of Congo. Each round included ten simulations, with half testing real-time guidance and half focusing on debriefing. Between rounds, Liveborn was iteratively refined based on analysis of video-recordings of the simulations and participant surveys. Midwives’ perceptions of usability and feasibility were assessed using previously validated survey tools including the System Usability Scale (SUS) with a score >68 considered above average, and the Feasibility of Intervention Measure (FIM) with a score >12 considered above neutral. Round 1 of testing identified several key usability issues including difficulty accurately recording events, poor adherence to audio guidance that was insufficiently specific, and poor flow of debriefing for intrapartum stillbirth cases. The Liveborn app, after iterative refinement, demonstrated excellent usability (median SUS score of 90 [Q1, Q3: 85, 95]) and excellent feasibility (median FIM score of 19 [16, 20]). Further research is needed to assess Liveborn’s effectiveness in real clinical settings and its impact on neonatal outcomes in LMICs.新生儿死亡率，尤其是因出生时窒息导致的新生儿死亡，仍是低收入和中等收入国家（low- and middle-income countries, LMICs）面临的重大公共卫生挑战。有效的新生儿复苏是提升新生儿存活率的核心手段，但在临床床旁场景中难以实现标准化、一致性的实施。专为该类地区医护人员开发的Liveborn新生儿复苏移动医疗应用，旨在为其提供实时操作指导与复苏复盘支持。该应用允许观察员记录复苏过程中关键操作的时间节点，随后将观察员记录的数据与临床推荐诊疗方案进行比对，并提供基于数据的反馈意见。本研究旨在评估Liveborn在模拟新生儿复苏场景中的可用性。研究团队在刚果民主共和国的一家医疗机构内，针对助产士开展了两轮基于Liveborn应用的模拟复苏演练：每轮演练包含10场模拟复苏，其中一半用于测试实时指导功能，另一半聚焦于复盘环节。两轮演练之间，研究团队基于模拟演练的录像分析与参与者问卷反馈，对Liveborn应用进行了迭代优化。研究采用经过验证的标准化问卷工具评估助产士对该应用的可用性与可行性感知：其中系统可用性量表（System Usability Scale, SUS）得分高于68分即视为高于平均水平，干预可行性量表（Feasibility of Intervention Measure, FIM）得分高于12分即视为优于中性评价。首轮测试发现了多项关键可用性问题：包括难以精准记录事件、音频指导缺乏足够针对性导致依从性不佳，以及产时死胎案例的复盘流程不够顺畅。经迭代优化后的Liveborn应用展现出优异的可用性（系统可用性量表得分中位数为90，四分位距Q1~Q3：85~95）与可行性（干预可行性量表得分中位数为19，四分位距Q1~Q3：16~20）。未来仍需开展进一步研究，以评估Liveborn在真实临床场景中的应用效果，以及其对低收入和中等收入国家新生儿结局的影响。