Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit

Lewis, Todd P.; Andrews, Kathryn; Shenberger, Elyse; Betancourt, Theresa S.; Fink, Günther; Pereira, Sunita; McConnell, Margaret

doi:10.1186/s12884-019-2363-y

Cited by 72 publications

(74 citation statements)

References 51 publications

(59 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Currently, KMC is considered one of the most cost-effective interventions to promote the wellbeing of preterm infants, and has been widely adopted in many countries, such as in Africa, Asia, America, Europe, and Latin American and the Caribbean [6][7][8]. It was estimated that KMC was practiced in some form (mostly intermittent) in 82% of all neonatal intensive care units (NICUs) in the United States [9].…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study

Yue

Williams

et al. 2020

BMC Public Health

View full text Add to dashboard Cite

Background: Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn't adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. Methods: We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system's readiness and families' willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent-and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context. Results: Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents' resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parentallevel barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. Conclusions: We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.

show abstract

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study

Yue

Williams

et al. 2020

BMC Public Health

View full text Add to dashboard Cite

show abstract

“…Currently, KMC is considered one of the most cost-effective interventions to promote the well-being of preterm infants, and has been widely used including in high-income countries. It was estimated that KMC was practiced in some form (mostly intermittent) in 82% of all neonatal intensive care units (NICUs) in the United States [8].…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators of Kangaroo Mother Care Adoption in Five Chinese Hospitals: a Qualitative Study

Yue

Williams³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Kangaroo mother care (KMC) has been proved to be a safe and cost-effective intervention for preterm babies. Despite this evidence and global guidelines promoting KMC, it has not been widely adopted in China. In this study, we aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. Methods We conducted clinical observation and semi-structured interviews in seven NICUs and postnatal wards housed in five hospitals from different provinces in China between August and September 2018. We conducted interviews with pediatricians, obstetricians, nurses and parents who performed KMC to understand their perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system’s readiness and families’ willingness to adopt KMC following its introduction in pilot hospitals. We coded data for emerging themes related to perceived barriers and facilitators of KMC adoption, specifically those unique in the Chinese context and less commonly reported in previous systematic reviews from other countries. Results Five hospitals were included for clinical observation and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with postpartum confinement (Zuo-yue-zi) and grandparents’ resistance, while strong family support enabled KMC adoption. Parents may feel anxious and guilty about having a preterm baby, this is a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded KMC implementation, and hospital-led supportive community and peer group contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. Conclusions Barriers and facilitators exist across cultural, hospital, parental and financial levels. While several factors were common in other study settings, there are also barriers and facilitators unique to Chinese context, e.g. concerns with postpartum confinement (Zuo-yue-zi), grandparents’ resistance and staff’s fear of nosocomial infection. We recommend interventions specificially targeting these barriers and facilitators including family and peer support for improved KMC adoption in China. We also recommend that specific barriers and challenges to KMC in particular settings be identified and be taken into account prior to KMC uptake in other settings.

show abstract

“…The present findings reveal that both family SES and family language should be individual targets for programmatic interventions to reduce disparities in KC. Recent studies have shown that both disadvantaged individual (e.g., psychological and physical wellness) and systemic (e.g., parental leave policies) factors impede the frequency and duration of KC provided by parents in the NICU 25,26 . Barriers to KC may also overlap with those known to impede parental visitation, such as unemployment or low income, lack of support for other children (e.g., childcare), health insurance, marital status, parents' age, transportation, and work or household responsibilities 39,40 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite the many apparent benefits of KC, however, several barriers may reduce opportunities for such practice, including parental factors (e.g., rates of visitation, family comfort with the practice) and health system factors (e.g., unit design, adequate staff support, parent educational programs, access to translators) 3,[20][21][22][23][24][25][26][27][28] . Parents and health care providers are also susceptible to cultural norms and personal beliefs that affect the frequency and amount of KC 20,21,25 .…”

Section: Introductionmentioning

confidence: 99%

Disparities in Kangaroo Care for Premature Infants in the Neonatal Intensive Care Unit

Brignoni-Pérez

Scala

Feldman

et al. 2020

Preprint

View full text Add to dashboard Cite

OBJECTIVESThe aim of this study was to investigate whether preterm infants whose families have lower socioeconomic status (SES) or communicate with clinical staff in a language other than English experience differences in the total amount, frequency, and duration of Kangaroo Care (KC) compared to preterm infants of higher SES or primarily English-speaking families.METHODSParticipants were infants born <32 weeks gestational age (GA), N=116. We defined family SES by the infants’ health insurance (private/higher vs. public/lower) and family language by the language mothers used to communicate with clinical staff (English vs. Other language). Family SES or family language groups were compared on: (1) the total amount of KC infants experienced during hospitalization; (2) frequency of KC per visitation days; and, (3) duration of KC events per day.RESULTSInfants in the lower SES and Other language groups experienced KC in reduced amounts, lower frequencies, and shorter durations than infants in either the higher SES or English language groups. SES and language group differences remained significant after controlling for family visitation and GA at birth. After controlling for SES, language group differences in KC duration remained significant.CONCLUSIONSOur findings revealed disparities in the total amount, frequency, and duration of KC in the neonatal intensive care unit as a function of both family SES and language families used to communicate with clinical staff. These disparities reduced infants’ access to this developmental care practice shown to stabilize clinical status and promote neurodevelopment. We recommend that hospital nurseries implement policies that minimize such disparities.Table of Contents SummaryTotal amount, frequency, and duration of Kangaroo Care for preterm infants in the NICU varied as a function of family’s socioeconomic status and language.What’s Known on This SubjectIn the United States, disparities in health care delivery and medical outcomes have been identified on the basis of patient or family socioeconomic status and the language patients or families use to communicate with clinical staff.What This Study AddsExtending to the NICU, the amount, frequency, and duration of Kangaroo Care experienced by preterm infants differed both by family’s socioeconomic status and the language families use to communicate with clinical staff. Policy changes are needed to reduce these disparities.Contributors’ Statement PageDr. Brignoni-Pérez conceptualized and designed the study, acquired data from the electronic medical record, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Scala, Marchman, Feldman, and Travis conceptualized and designed the study, supervised data abstraction and analysis, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

show abstract

Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit

Cited by 72 publications

References 51 publications

Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study

Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study

Barriers and Facilitators of Kangaroo Mother Care Adoption in Five Chinese Hospitals: a Qualitative Study

Disparities in Kangaroo Care for Premature Infants in the Neonatal Intensive Care Unit

Contact Info

Product

Resources

About