Development, implementation, and evaluation of web-based decision support application for developmental care of preterm infants: a multi-phase study

Abstract

Developmental care is a critical component of high-quality neonatal services for preterm infants. However, variability in gestational age assessment and inconsistencies in translating assessment findings into care practices can compromise developmental outcomes. Digital clinical decision support systems may enhance standardization and improve the quality of neonatal care. This study aimed to develop, implement, and evaluate a web-based decision support application based on the Ballard assessment to support gestational age determination and developmental care planning. A multi-phase study was conducted, including development, implementation, and evaluation of a web-based clinical decision support application. The system was developed using the Waterfall model and integrated evidence-based developmental care recommendations linked to gestational age scoring. The evaluation phase employed a quasi-experimental pre-post design in a neonatal intensive care unit in Tehran, Iran. Fifty nurses participated. Developmental care performance was assessed using a validated researcher-developed tool before and eight weeks after implementation. User satisfaction was measured using the Mobile App Rating Scale. Data were analyzed using descriptive statistics and paired t-tests, with a significance level of 0.05. Following implementation, nurses’ performance improved significantly across all developmental care domains ( p < 0.001). The most substantial improvements were observed in gestational age determination (effect size (Cohen’s d) = 2.25), protected sleep, and family-centered care domains. Overall developmental care scores increased significantly from pre-test to post-test. User satisfaction scores indicated high acceptability, particularly in information quality and functionality domains. The web-based decision support application was feasible, acceptable, and effective in improving nurses’ performance in gestational age assessment, and the quality of developmental care delivery in a real-world neonatal setting. Digital decision support tools may contribute to standardizing neonatal care practices and strengthening evidence-based nursing care for preterm infants.