P3.101: Monthly Virtual Refresher Sessions for ENC1 with Perinatal Providers in Uzbekistan

Background: Essential Newborn Care 1 (ENC1) is a hands-on training program for birth attendants in resource-limited settings to learn basic neonatal resuscitation. Its impact on neonatal outcomes is well-established globally. However, knowledge and skill retention after initial training declines, with learners’ skills (e.g. bag mask ventilation) tending to deteriorate more. Virtual refreshers for ENC training could expand reach and reduce costs. The feasibility and optimal frequency of delivery of virtual refresher sessions remains unknown.

Methods: In this parallel cluster study, we enrolled perinatal providers from two perinatal hospitals in Uzbekistan. All providers were trained in ENC1 in the traditional manner, and the hospitals were randomized to intervention and control arms. Providers at the intervention site participated in monthly virtual refresher sessions for 6 months, while those at the control site did not. Virtual sessions included brief didactic review and hands-on practice with personalized instruction using a device that provides real-time feedback on ventilation components including airway patency and ventilation rate and force. The primary outcomes to assess feasibility included ability to schedule and administer monthly refreshers, attendance at these sessions, retention of learners, and learner engagement, as assessed by periodic anonymous surveys. At six and twelve months, participants will be assessed in person on didactic and hands-on skills to examine association of our intervention with skills retention.

Results: We recruited a total of 74 providers from the two study sites. Over six months, four of six virtual refresher sessions were successfully held. Attendance at virtual refresher sessions was 67%, with approximately 28% of those attending being part of the initial cohort trained at the intervention site. Due to inconsistencies in dates on attendance sheets, exact retention rate was difficult to determine. Learner survey response rate was approximately 70%. The majority (80%) endorsed strengthening their knowledge during sessions. 41% of submitted responses included feedback that additional sessions, especially practicing hands-on skills on the mannequin, would be beneficial. One response suggested shorter sessions. 35% of responses had no additional feedback and expressed satisfaction with the opportunity to practice skills.

Conclusion: Delivering monthly virtual refresher sessions in a resource-limited setting proved to be feasible with respect to implementation and attendance. The most significant barriers pertained to formally tracking individual participant attendance and consistently ensuring repeat monthly intervention with the initial intervention cohort. Factors contributing to this difficulty included challenges with technology, communication and language barriers, as well as differences in familiarity with research procedures. While learners valued the additional practice, sessions were held with inconsistent cohorts. Therefore, ideal frequency and content of the refreshers requires further evaluation. We plan to assess the efficacy of our intervention when we repeat ENC1 assessment at 6 and 12 months following the initial training sessions at both intervention and control sites.