Date of Completion


Embargo Period



newborn, resuscitation, developing world, hypoxia, education, videotape, simulations, education, retention

Major Advisor

Regina Cusson

Associate Advisor

Thomas Van Hoof

Associate Advisor

Paula McCauley

Field of Study



Doctor of Nursing Practice

Open Access

Open Access



The Helping Babies Breathe® (HBB®) program is designed to improve neonatal resuscitation knowledge and skills for birth attendants in resource-limited settings.

Purpose and Research Design

This prospective, longitudinal, quasi-experimental study with a control group hold-back design evaluated the effect of HBB® training on resuscitation knowledge and psychomotor skills in healthcare providers in Zambia (N = 52).


The sample included nurses (85%); clinical officers, medical licentiates, and physicians accounted for the remaining 15%.


Resuscitation knowledge and bag-mask ventilation (BMV) skills were measured using the HBB® Multiple Choice Test and the HBB® BMV OSCE. The BMV OSCEs were performed at baseline, 1 and 3 months, using a low-technology simulator (NeoNatalie), videotaped using iPads, and scored by blinded independent raters. The intervention group received a 2.5 day HBB® training post baseline measures.


Baseline knowledge scores (HBB® MCQ) had pass rates of 71%. The baseline HBB® BMV OSCE had a pass rate of 0% (Median = 2.5 of 7 points). To examine the effect of the HBB® training on knowledge, a repeated measures mixed model ANOVA compared the HBB® MCQ scores between subjects (control versus intervention) and within subjects (changes in scores over time; at baseline, 1 month, 3 months) on the M knowledge score. There was a significant effect of group assignment on knowledge (HBB® MCQ scores), F (1,50) = 13.62, p = <0.001 and of group and time on knowledge (HBB® MCQ scores), F (2,50) = 20.76, p = ® MCQ Scores. The intervention group’s knowledge scores increased over time; the control group’s scores did not. The intervention group’s mean scores for the HBB® BMV OSCE increased from 2.8 to 5.8 (p = 0.01) in the post-test period and remained higher (4.6 at 1 month; 5.2 at 3 months); however, competency was not uniformly achieved. Atypical and potentially dangerous resuscitation practices, not previously well described, were noted in 43% of the videos at baseline and persisted in 35% of the videos post-training.

Implications for Practice

This study explores baseline levels of newborn resuscitation knowledge and BMV skills in Zambia. Although the HBB® training improved both knowledge and BMV scores, only two participants demonstrated BMV competancy; niether sustained competent scores over time. Our findings highlight the complexity of both teaching and learning BMV and have practical applications for both the developed and developing world context.