 And I would like to introduce Shafali Shauri who is an assistant professor at the Alice Lee Centre for Nursing Studies in the National University of Singapore and her research area is focused on family and women health. And she's going to talk about a bit of mobile technology which is definitely my thing. So I'm really looking forward to this presentation over to you Shafali. Thank you so much Linda. Once again my heartfelt welcome to each and every one of you. It's really really honoring to see so many of you joining us today on a Saturday. For me it's an afternoon and some of you are even almost midnight and you know 5 p.m. it's Saturday evening you are listening to the presentation today. I'm really really very happy that all of us are so excited about our profession and we are here to learn more. So I'm going to share with you my venture on the mobile health app which I developed and the name of my presentation today is Designing, Developing and Testing. The home but not alone mobile health app for new parents in the early postpartum period. And before I start you can keep on coming bringing in your questions by writing it them on the side along the way I will try to read and answer if not at the end of the session please feel free to ask any questions. I'm also going to leave my email address and I'm also going to share with you my publications. This study has already been published in fact I'm on a follow-up study from this study and please feel free to read and if you have any questions if you are very any interested in this study I would be more than happy to share. And Linda being my facilitator please chipping because you have a lots and lots of experience and share with me if you have any thoughts and how do you think along the way. Yeah without further ado I would like to start my presentation today. Like I said I'm from Singapore and I would like to welcome you all. My presentation is not moving. Linda I can't see the arrows and my presentation is oh okay I got that. Okay all right so welcome from Singapore. This is this here is a Malayan. Malayan is our symbol in Singapore. It's a city of lion and the lion is our symbol so basically we want to associate or rather we are we associate Singapore as a lion city something someone something the people here we believe in self-strength and we believe in working hard in our life and it's a it's a city country and it's a very small we also known as red dot on the on the globe because well we literally we are a dot on on the entire globe because it's so small and in fact in half an hour you can be in car if you're not stuck in a jam you can move from one end of the of the of Singapore to the other end and this particular picture is actually a skyline which is a very popular area and people likes to come to Singapore to visit our attractions some of them are like our island Santosa we have a water park we have our garden by the bay which is concrete it is actually a garden but it's made up of cement and we have artificial flowers and all this is something to for you all to look forward to come and see and please like I said I mean it you're most welcome to visit Singapore and please write to me and I would be very happy to welcome you all so this is the layout of my presentation I'll be sharing with you the introduction all the way to discussion and if you have any questions like I said feel free to ask so basically I'm going to start with about my focus is on a postpartum period being the midwife I worked in a hospital and I deliver babies and then I realized after my stint after in delivery suite I worked for a while in a postpartum ward and I realized that something you need to Singapore which I would like to share with you all which could be something strange to many of you that we do not have continuity of care in the form of community nurses or midwives visiting women at home after they give birth in the hospital 100 percent births are in the hospital we do not have any birth centers home births are not allowed and after women give birth in a hospital she stays there between 24 hours to 36 hours depending upon the type of delivery of course it's the normal delivery some women even less than 24 hours they go home and we have scarcity of bates like anywhere so that's why early discharges are very much common commonly seen in Singapore and sadly once the women they go home the only kind of follow-up care they have is they will come back to see their obstetrician or a baby's doctor within a week if it is a caesarean birth or a month which is for normal delivery mothers and anecdotally from my experience many mothers default their follow-up appointment especially the mothers who have given birth normal vagina delivery by one month time they're kind of more or less okay and they don't come back and see the doctors so we do not know how these mothers are doing and we have no follow-up like I said earlier by any midwife visiting them at home or whatsoever and that was something very strange because I got a chance to actually visit Melbourne and I know Nordic countries even UK you have this follow-up care by the community nurses very very I would say established and you are supporting the parents I personally feel very well so I felt that that is something which is missing in Singapore and that's how I started working on this research to begin with as early as in 2011 and I actually developed a program where I started giving and doing home visits in Singapore now which was very very successful research wise I have published that and personally I felt so fulfilled because I saw happy faces and mothers were actually coming parents were actually coming and thanking me however I didn't get much support from from from the hospitals because rightly it is not easy to send midwives to each and every women's home because logistically is quite stressful and we were looking for the options that how we can sustain that helpful program and still can reach to the women and support them and that's where the idea of this mobile health app came in so this is a bit of a story about how this project came along so now literature wise we found out both locally and internationally that post-partum period is a stressful period for new parents they faced a lot of challenges and it's not only just for those who are first time parents or the mothers family parents it is also for those those who have given birth before and this has resulted them feeling stressed out and even depression so the further on I did this was based on international research then I did like I said the home visits research and we found out from both mothers and fathers that they feel a lot more stressed out in the early postpartum period something unique to Asian society we have this thing called doing the month or in a very other layman term we use the word kind of confinement practice in that one month postpartum these women will be staying at home and they are not allowed to take shower they have to eat certain things they can't leave the house so and so forth so we used to think that these confinement practices actually support women in the postpartum period but that as we are doing more research and hearing more women and in fact me myself as a mother we realize that yes there is some sort of a support however confinement period can be even a source of added stress for us reason being we have sometimes intrusive in laws we have some intrusive I would say rituals have to follow which like example like we were talking about whether in Singapore imagine in 36 37 38 temperature you're not allowed to take shower for one month I hope you can relate yeah I remember Megan cheese from Alaska just imagine Megan that we have a temperature of 36 and 38 and we can't we are not allowed to take shower so with all these things we have a lot of stress and we also have so-called uh miscommunication sometimes with our world parents and all that because somehow many of them have not rested in the past and and and yes Megan it's not fun at all and that's why it can cause a lot of stress and miscommunication among the new parents and the elderly in the house so these negative emotions can all lead to post-natal depression and that has been shown in the literature so that's why I wanted to focus on something which can enhance parents confidence in a very layman we use the word confidence but in literature I follow this Bandoora self efficacy theory which means a cognitive process by which one feels that that how they can perform a particular task like what Portria is saying that why don't shower for a month Portria since you asked this question just to let you know that we are not allowed to take shower because culturally the belief is that that after giving birth as women pushes her so-called bones and the body opens up and the waters can seep say I know it's funny but that's exactly we've been told that the water can enter the bones and you will have eggs throughout your life and you won't be able to you know look after your child well and you will be a sick mother basically yeah but I know there's no research evidence for that and like I said self efficacy is a cognitive process which will be able to evaluate the ability towards the performance of a given task and locally for my previous research we have found that self efficacy is associated with social support and post-natal depression and that's why I come up with the theoretical framework which was depression social support and PSE which is parenting self efficacy they are interrelated and we have to take care of each and every one of them so that eventually we can focus in enhancing parenting satisfaction I can understand cultural shock Portria there's many more things I can share with you yes it's culture that's that's the reason of having today's session isn't it we are so diverse we are but we are all connected being from same profession a midwife and honestly even in Singapore we are a multi-racial society like I'm Indian we have Chinese we have Malays and all of us have different different rituals to follow so yeah it can be culturally shocking I can understand literature has shown that a recent randomized control trial which was done by me in Singapore that parenting self efficacy social support and depression they are interrelated and we found out that yes that program was successful but it was not easy to reach to all the parents because of logistics reason and we also do some interviews from the parents and ask them what could be the alternate what would what I mean of course they all prefer home visits but when we ask them what could be the next best approach and then they all say that the online resources could be a next best approach which they would like to like to access to get some support and that's where the idea of this mobile health app came about and and that's how we aim this study which was to effectiveness of home but not alone now this is something I want to share with you all that why I come up with the title of home but not alone why I just didn't say the effectiveness of a mobile health based educational program so so and so forth because I personally feel that you know home but not alone that's one month that four weeks of our so-called confinement in a home or at a home where we are not allowed to go out even though we are there we feel very lonely because sometimes we we can't like you know we have so many restrictions that we have to wear certain things we have to do certain things and we used to feel lonely despite all being surrounded by all our loved ones so that's why I felt that and I'm talking from my personal experience too and the mothers I have interviewed and that's why I wanted to let them know that this app is for you when you're at home but you won't be alone because she will be or the app will be your companion so this was the hypothesis that means my main import primary outcome was parenting self-efficacy and the secondary outcomes were social support parental satisfaction and of course depression and like I said in the beginning I want to just give you a bit of an idea about the routine care the standard care what happens in Singapore like the birds are in the centres or rather in the hospitals and we stay in the hospitals between about 12 to 72 hours and the only follow-up support we have is one to six weeks follow-up appointment there is no home visits or any other sort of follow-up care in the community for the new parents and that's why we come away the home but not alone this app and it has certain features which I would like to highlight to you one of the features is a push notification so for about a one week period these parent mothers were receiving notifications telling them your baby is today one day old and you should be expecting this today is day two today is day three like day three four we were talking about that you know your your hind milk should come in day five we talk about you know your baby maybe with john day so and so far so kind of giving them a little bit of a milestones what are expected in the first one week after delivery they also had an opportunity to have asynchronous communication that means they can write questions and which will be answered by a midwife once a day plus they can actually communicate with similar other parents so if they have any questions they can ask though midwife was answering them once a day but in between if any other mother knew the answer she will answer them so it's kind of becoming an online community among the parents then of course we had educational contents and this is just to share with you how the educational content was delivered and I remember Portia just wrote that it's a cultural shock I'm going to give you some another cultural shock now which is that though we have PDF files available and even the books are written and given to the mothers but many of them are not allowed to read during the confinement period because they say your eyesight will go weak so that's why that was the reason the same PDF files were then converted to audio files so what mothers will do like we all are doing now they will put up a microphone and the same content they will listen right so that was the reason of having audio files for them is basically just replica of PDF files everything whatever we have like on baby care newborn care whatever the five six topics we covered everything was delivered both in a written as well as in audio forms now the videos nothing new I didn't reinvent the wheel that by saying that my videos were something which nobody has covered honestly the videos were just simple thank you sherry for your acknowledgement yes and for the videos what we did was we actually come up with the topics on like baby bathing best reading changing diapers one so far now the reason of coming up with these videos you must be thinking why are you usually wasting your time and energy and money and creating those videos why didn't you take those videos which are so fabulous available free of charge online this was based on my interviews qualitative descriptive qualitative interviews I did with the mothers and they found that many videos are available however there are few reasons one most of the videos are developed in the west so as you can see from my accent it's not as beautiful as what Linda has so they wanted to relate to someone Asian accent so that they can understand them well and especially more I would say a singlish accent because we like to say words like okay la I think everything will be fine la you know so people wanted to relate to something very localized so we wanted to contextualize those videos and at the same time we also wanted to show local babies and so that the parents can relate to them and very strangely or rather that's something amused me was when I did interviews they say yes the videos are very good but how we know those videos are good we have to go through 50 to 100 of those comment session to see how people are commenting upon those videos in youtube so that they can realize themselves that whether that video is good or not you know so that's the reason they wanted our having a video from professionals like us in that app so this is just a dummy of the app how it appeared so this is a so-called the online the first screen session and then the query sessions then content was like this video pdf and audio and of course push notifications as well as the messages parents were receiving so the content which I was mentioning to you this is the book I wrote in 2012 for my previous study where I did home visits and of course we we kind of I would say enhance the content and that particular topics in that book was topics like on breastfeeding on baby care so and so forth I think the new things which I added in this mobile health app was a rule of fathers because we found from our previous research that our focus always remain on mother and baby and fathers are somebody who felt left out and I just want to and I always share this with everybody whenever I present anything about perinatal care my research that local fathers they share things like people see us like a lamp post people see us like a bystander and they feel that it is very strange that the whole focus remain on mother and baby and when I am in the room same room when a nurse or a midwife come to educate my wife we are always so-called not paid attention to so imagine that is something our local fathers were saying so that's why I felt it's very important we can share that how fathers can support to the mothers and yes thank you very much that it's a challenge when you have a non-constructualized videos and yes you need some money right not proposal if you need any help with me I want to I will say this at the end of the day that I would be happy that this or this so-called mobile health app which I have developed it can be tested in many other countries and I'll be more than happy if you have any information to ask about and this was one of the screenshot from the video but this was me few years I mean last year my hairstyle was a bit different so anyway this is my introductory video and then I have given them video on baby bathing and we have one breastfeeding so and so forth so these are some of the screenshots from those videos now we didn't just come up with whatever the educational program that one day we did a literature or we hear from the mothers and we were done with it in order for us to have a buy-in from our clinical partners we wanted to have our so-called educational program standardized as well as evidence-based so that's why we come up with the protocol and that was endorsed by a professor in psychoeducation, pediatric nursing, senior consultant was on board of course midwives me and one of my other colleagues and we also bring lay mothers in to hear from them what they feel about that educational program so we kind of pilot tested it and of course coming back to the technicalities this study was randomized controlled pre-test and post-test trial and we tested on the participants from one of the public hospitals it's a single-centers trial and we didn't just wanted to have a randomized controlled trial we also wanted to hear from the parents how they feel about it so we did a qualitative interviews on that this was an inclusion-exclusion criteria I'm mindful of the time I'm sure Linda gonna tell me soon Shafali you are taking a lot of time so hurry up just to let you know inclusion criteria it was all healthy parents with healthy babies something to could be strange to many of you that why the age is 21 and not 18 because in Singapore the legal age is 21 again probably culture shock to many of you and the focus was on first time as well as experienced parents able to speak English and those who gonna stay and use this app in the next four weeks and we estimated sample size based on cohort and medium size effect we needed about 100 couples and eventually 125 couples total 250 subjects participated in this study and at the end of the randomized controlled trial I also did the interviews with the parents to understand from them qualitatively how they feel about this intervention or other app and 15 of them were invited so these are the outcome measures these are different tools we use like parenting self-efficacy social support depression which was measured by Edinburgh post-retro depression scale and parenting satisfaction all these tools have been locally validated and tested for the reliability and validity and like I said we use the randomized controlled trial so parents were randomized into slow down sorry Sheila some echo which makes it difficult to pick up okay I'm sorry dear okay let me slow down so data was collected from a single public hospital and we randomly assigned parents and they also need to have a gadget we didn't give them three hand phones or whatever so one of the inclusion criteria was that they must own our smartphones so that they can download the app and also parents in the control group they didn't receive the intervention but they receive oh thank you Linda to receive the routine care and of course the intervention was delivered for week that means all the parents were given an access to this app for one month I hope my speed is okay now all right and of course we get the ethics approval and informed written consent was taken thanks Linda and we analyze the data using advanced statistics we actually use linear mixed model if those who are doing phd or those who are new to statistics just to let you know that if you see it's a two group test study and because it has few outcome measures you can actually use enkova or mankova but because it's a couple study and we know as a couple they are not just one entity one of them can affect the other so this is something I learned from a statistician that we have to have linear mixed model so that we can so-called statistically control the influence of each parent on each other as one participant yeah and this is a consort diagram we assessed for eligibility about 360 couples eventually 251 were approached and we randomized 125 couples and then they were randomized into can intervention and control group eventually we have some follow uh sorry attrition rate which was within 11 percent we had 50 couples at the end of one month stayed with us who use the intervention and two fathers and one mother see how strange it is we never just lose the entire kind of a couple diet itself we have 50 couples but sometimes we like for example we lose two mothers but we our father so we have even father or mother still stayed with us all the way until and then of course in control group we had 53 couples and those for publications those who write papers you will know that for us those who do our cities we must have our intention to treat analysis which is a goal standard before we can analyze the data and these are the results from my demographics just a quick one our age was about 30 to 33 that was the kind of our demographic age in the parents who are giving birth to their first to second child and major ethnicity was Chinese again this is according to Singapore's demographic profile our major ethnicity is Chinese followed by Malay and Indian so what I want to show share here is that even though it was a single center study but the representation was something like our our local demographic data but most of the parents were from university degree so that means it was the kind of the hospital where I did my study most of the parents who visit there was those who were better educated and of course a normal delivery was the main form of delivery or mode of delivery and just a quick one I won't go into the technical details here that for all the outcome variables from self-efficacy social support and social support we divided into two because this scale it measures social support from loved ones as well as from the hospital people rather health care professionals posted to depression and satisfaction for each and every scale we had positive p value that means statistical significant value except for the PND which I share with you why we ended up having no so-called effect the statistical significant effect on PND then we also did the analysis that the previous analysis was on a parent as a diet yeah as a group of parents and then we also did for mothers and we also did for fathers and for all we find out same as for parent that there was a statistical statistical significant difference between self-efficacy social support and satisfaction except for the depression so I also did like I said interviews with the parents to find out from them and we did a thematic analysis on our interviews the interviews lasted about 30 to about 60 minutes and we hear from them what they found was so-called strengths or weaknesses of this app and they found a lot of positive features in the app like they found the information content was good they find like this audio video and push notification things and they say it was easy to access they love their advice from the midwife and especially they felt that the midwife was very upbeat and providing them reassurances and all that and they found there was somebody there to help them with the prompt availability and they felt that the experiences they gain more it was like a friend to them I would like to share with you one information one of which I have also put in this quote in my paper which is published in midwifery that one of the mothers said that because at night she will be the only one who will wake up to breastfeed her baby and she feels that at that time she will feel that she's alone she wants to talk to someone so she will go into the app and look at the questions or the queries asked by the parents so then she will scroll through it whatever happened in the daytime so she said it was like a friend the app was like a friend to her I thought that was very beautiful to hear from someone and they felt that it helped to enhance their confidence so and so forth and of course they gave some recommendation because we had some technical hiccups and all that so I'm just finishing my slides in the end in these few slides with a discussion that we felt that one of the reason I felt that the funny work was I'm relating it to Bandura self-efficacy theory according to Bandura they are four main factors which enhances someone's self-efficacy and one of the first factor is mastery experience that means if you give someone experience of performing a task they with practice then will be able to perform it better each time is same thing like when we present first time we are hesitant we are scared so and so forth the moment practice become more confident so something like this is called mastery experiences and we felt that our our instructional videos our so-called knowledge content and all that it helped them that all these things will be the part of you know building up their confidence and they were also able to hear from other similar others people for example other mothers who were able to do things and sometimes some mothers ask question then they feel oh they are not alone because other mothers are asking the same questions so they felt that you know a kind of a vicarious experience from others similar others they also receive verbal persuasions from the parents for example if a woman is doing something midwife will tell her this is the right way blah and blah and at the same time other parents were chipping in and saying that I do the same way too so that kind of give them assurance that they are not alone when they're doing certain things and of course people were able to exchange their experiences thank you yes portrays exactly like a companionship and of course push notifications it was giving them a milestones because like I said they don't have any continuity of care they have no midwife coming to their house and telling them that you know this is something expected simple thing when baby hiccups they all panic so in our milestones when we write down and send them a message it's okay if your baby is showing some hiccups and always a normal process they felt reassured you know and with those automated messages and of course they felt the kind of a virtual community like they had like I say like a friend they were able to relate to others they were able to feel that they're not alone exactly what was the main aim of my my at home but not alone right so they were able to have some social interactions and that helped them to reduce a little bit of their stress and anxiety now here I would like to highlight to you yeah yes it helped them to have enhanced self efficacy social support they were very satisfied as parents they feel good but somehow even though I don't have a statistical significant difference in depression which is very very I think relatable reason being you all I'm advised I'm sure you've been reading a literature on that that I did a follow-up that means post-test data collection one month after delivery and if we want to understand depression we have to do a follow-up data collection longitudinally at least three months to six months because that is the time depression shows its signs so that's why we felt that that you know in our next study which I'm doing now that I have to have a longitudinal follow-up data collection so like I said they felt that they they're able to solve their problems the solutions to the problems were given they had a higher satisfaction self-efficacy and that lead to their better parenting satisfaction like I said earlier PND didn't show depression didn't show any statistical significance one of the reason is because the data was finished only at baseline and four weeks so one month three months data collection was something which literature has shown that they started showing some signs and that's why my new research what I'm doing now with parents we are doing longitudinal data collection so some of the strengths of the study the reason why the study it worked because we use theoretical framework based on Pandora's self-efficacy theory we use valid and reliable instruments sample size was adequate we had internal validity of the study we had a group of people who actually like experts as well as novice who endorse the content of the of this app and also we use intention to treat analysis which is kind of a statistical but we do have limitations in this study first it was just a single center study and you only focus on the English speaking parents which which could be you know I'm not sure whether you're able to relate like I said earlier we have multiracial society and generally people like to speak Chinese and and at the same time they were able to they also speak Indian they also speak we call it Tamil and Malay so that's why we feel that you know the content should reach to all the parents in different languages so hopefully in future we can do that I will give you the answer and I'll analyze soon what are those instruments and then the process evaluation from intervention group was done it should be good to do it from both intervention and control group so that we can also hear from control group that what they're actually lacking and study was not blinded and before I share with you implications for future research maybe I share about the instruments since you have asked yes five minutes I'll be able to finish it up Linda for parenting self-efficacy we use a parenting self-efficacy scale for the development for social support we measure we measure we use sorry parenting social support scale for depression we use adding both postnatal depression scale and for parenting satisfaction we use what being the parent of a baby like WBPL scale so this is all mentioned in my publications I will share in my next few slides soon and you'll be able to find that more so implications for research which is the future research should evaluate the intervention on the diverse population and we should blind the study and most importantly test the cost effectiveness of the study so that we can tell the policy makers that please help us or rather support us to have mobile health app for the parents and of course nurses and midwives they will they can you should be able to integrate the technology in the in the early postpartum period and we should focus on family-centered educational programs not just focusing on baby and mothers and these are the publications I would spend a little bit of a time on this papers have been published in Journal of Advanced Nursing and Journal of Advanced Nursing Journal of Advanced Nursing Journal of Child and Family Studies and this is JMIR which is Journal of Medicine and International Research so all these papers have been published in there we also get a fair bit of kind of a recognition we got a media coverage for this app we were in the newspapers our local newspaper where you know because parents they actually wrote to the community leaders that you know they are benefiting from this app and we wish that we can get more support for this app so with this I would like to end my presentation you guys have been awesome with all your queries coming in I really enjoy sharing this session I would like to have Q&A now formally if you have any questions feel free to ask this is my email address please send me an email I can send you the copy of my research and I really hope that I can test this app in many other countries so over to you Linda and I am looking forward to the questions please put the slide back with the publication so okay sure Hazel if you can write me an email I can send you all the papers because I'm not sure whether you will have an access to all the papers might take you off on that one Shafali this is a fabulous study and it's a very good thought for your particular culture well done Linda I'm not able to hear you well Linda we could hear you Linda but you are not so loud so yes now I can hear yeah can you hear me now then yes we can yes we can this happened at the last one and I thought oh why is that happening that was a fabulous presentation Shafali very interesting and you know this is something that we probably could use in other countries where we do do postnatal care because for example in the UK we've always called postnatal care the Cinderella of the services because we don't have enough people to go and visit our women often enough and for long enough to support them something like this may well be worth using although I can imagine a lot of people would say that's not what we are about but still so questions what questions we have valid instrument what is a valid instrument what are them thank you Sherry and Megan and yeah I think that'd be great that if we can work together I'm going to bring in also the slide for the valid instruments I know I rushed through that the instrument details on that slide I'm going to bring that but at the same time like you said in USA that is a follow-up is even though there is a follow-up I think we need more interactive and detailed follow-up with the parents and I'll be very happy to share the details of this app in fact there are few people who are interested after my publication and I think that'd be great that we can test it over different populations so these are the these are the you can take a picture these are the instruments parenting efficacy scale by lurks and Crockenburg social support scale by lurks post-natal depression adding bug by cox and parenting satisfaction what being the parent of a baby like by pre-otherm so these like you can take a picture these are all instruments which I have used and it has been validated in our local context true you still hear me I'll turn myself off a bit am I too loud now no problem and Megan is there any way the community that is developed between the family continue after oh yes uh Megan hello yeah so I think that's a very good question you have asked Megan sadly because the contact was given to the parents just for a month and they were able to communicate through the app and the access was cut off after one month how a reason being because I have funds only to do you know it's it's not just is of course it's expensive to develop an app but so also you need a money to sustain the app okay so I didn't have funds to sustain the app beyond one month because it was just a research study that's the reason in my implications I have written that if policy makers can help us to fund such things and they see the need that these kind of apps are helpful I'm bringing into my implication slices in case you're worried why I'm jumping on my slides I feel that if we can pay the money our hospitals can help us to sustain this app parents can continue to have this community of you know community of so-called friendship or rather you know continuous talking or rather support system with each other so that's what I meant thank you Sheila I think one of the questions can you hear me all right yeah I think one of the questions that comes from there is is there any way that the parents can talk to each other you know a bit like um uh antinatal classes where they develop friendships which continue through the pregnancy through the labor through the postpartum they meet the coffee they're very much supportive is there any way that these parents can actually talk to each other through the app that's definitely uh these parents they have there's a button there where they can do a public talk that means whatever they write can be like exactly what we are seeing at this big button here blue button that you everybody can see your questions and answer queries or they can do one to one with each other which only for example I can only speak to Linda and Linda with me so we can have that closer interaction like I mentioned earlier in Linda for this app it was possible only for a month so it would be nice that such apps can be sustained for a period of time so that these parents can continue to have that friendship and when they actually exchanging so-called personal uh text with each other they can actually ask each other's number if they want to have that sustained relationship or friendship with each other so it's very much possible so do you know if any of them have done this in fact Megan has made the point that um they could perhaps get together and have a Facebook group yes that's right and that's exactly Megan and that's exactly um Linda I'm doing it in my current study I've actually uh gotten some another funds and I'm actually uh enhancing this app where I'm going to have this so called the focus group among parents I'm going to have that that so called the button or the facility so that they are able to communicate with each other before I missed that question Hazel has asked that how I got that app developed I'm a true blue midwife I have no technical information so I actually like I said it was a funded study so I actually worked with the developers I paid their money and they helped me to develop this app that is amazing and the comments been made here we need it for midwifery students too what do you mean Megan Megan do you mean that they need the postpartum advice or do you mean that a similar app for support for education probably could you could actually take the mic if you wanted to I think I like the interaction aspect of you thank you thank you uh Ana Lois I'm sorry you're from not pronouncing your name well they need support through their program I agree with you Megan actually in fact yeah that's true that we all need that small community so that we can support each other but I know maybe developing the app could be could be expensive it's not cheap I think what we all can do is I'm not sure in different parts of the world how we are doing in Singapore is we have this small community called WhatsApp communities we some people I was in Japan they use this app called Line some in China are using WeChat so these are the small these are something which are the free available apps and these can help to support I'm not sure Megan in I remember Megan is from Alaska I'm not sure in Alaska you have any you know available app which you all can create your own community and work with I think we don't use social media enough yeah it's been a bit of a for a long time the social media has been a bit of a no-no because um professionally our professional organizations felt that it was too life with issues of confidentiality and and whatever yeah very slow to come to realize that actually it's a bad way of getting communication going and anyway all the other people in the world are on social media somewhere other so we as midwives need to meet them there they will come find us we need to go there yeah this has become more more understood now yeah that's true I agree with you Linda and like you said you have a closed Facebook group yes you can have such a Facebook line WeChat WhatsApp yeah all these things helps a lot in Singapore that's what our students are doing so we do need support for each other because otherwise it can be very stressful and lonely okay so I think we need to kind of close up now because we're going to close the room in a couple of minutes okay so I will just bring that back to me yeah I can play with your slides please do there you go and quickly go these yes I agree I love all this some idea of the combination of the education etc and culturally specific videos which are very important