Evaluating factors that influenced the successful implementation of an evidence-based neonatal care intervention in Chinese hospitals using the PARIHS framework

Abstract

Background Evidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. In this study, we used kangaroo mother care (KMC) as an example of an evidence-based neonatal intervention recently introduced in selected Chinese hospitals, to identify the factors that influenced its successful implementation. We also explored the utility of the PARIHS framework in China and investigated how important each of its constructs (evidence, context and facilitation) and sub-elements were perceived to be to successful implementation of EBIs in a Chinese setting. Method We conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from “low (weak)”, “moderate” or “high (strong)” highlighting the ones considered most influential for hospital level implementation by study participants. Results Using KMC as an example, our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level. Conclusion Based on our findings examining KMC implementation as a case example, the PARIHS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it’s sub-elements should be assessed and adapted to the implementation setting.

Neonatal Intensive Care Unit Nurses’ Knowledge and Use of Sucrose for Neonatal Pain Management in Saudi Arabia

“…Previous research shows many factors influencing the use evidence-based interventions among neonates including patients, healthcare professionals, and organizational factors ( Cheng et al, 2017 ; Ismail, 2016 ). For example, a study from China found that clinical experience of healthcare professionals, culture of work, leadership characteristics, existence of evaluation and facilitation processes have impact on the implementation of evidence-based interventions such as interventions related to neonatal pain management ( Yue et al, 2022 ). Even though the use of oral sucrose 24% is considered standard practice in many countries, NICU nurses in Saudi Arabia reported minimal use of sucrose.…”

What influences the implementation of kangaroo mother care? An umbrella review

“…In other words, although policymakers and decision-makers tried to provide assistance and intervention programs for healthcare workers, they did not anticipate these barriers to attendance. Of course, the support from hospital administrators and leadership could provide more space and human resources to provision KMC, optimize or update the staffing configuration of neonatal care nurses, strengthen the professionalization of neonatal care by healthcare workers, and improve healthcare staff’s attitudes towards and perceptions of KMC [ 43 , 51 ].…”

A Narrative Review of NICU Implementation of Evidence-Based Early Relational Health Interventions

“…The authors stated that due to lack of space, during the study period of March 2019 to July 2020, only 209 of the eligible 319 infants were admitted into the KMC area. 20 Physical space limitations were also identified as a barrier for implementing KMC, [22][23][24][25] FICare, 21 , 26 NIDCAP, 27 , 28 and infant massage. 29 Another commonly cited barrier to implementation of ERH interventions was the already heavy workloads of healthcare providers (HCPs), which included physicians, nurses, and therapists.…”

“…A positive relationship and communication between parent and staff were facilitators toward the implementation of FICare 21,32 and KMC. 19,20,22 HCPs perceiving the intervention as beneficial to patients and families was also a facilitator to implementation. In a study of implementing a FICare/ zero-separation NICU model in the Netherlands, the authors found that the staff's understanding of the importance of the zero-separation, parent- involved model of NICU care was a facilitator and helped them coach and encourage parents.…”

“…20 , 22 , 24 , 33 Finally, strong support from the unit or hospital leadership was found to be a major facilitator toward implementation. Participants in Yue et al's 22 study agreed, stating that it was a "pre-requisite, especially to tackle organizational resistance to change." KMC implementors 20,24 and FICare implementation investigators 21,32 also listed strong leadership as a facilitator toward successful implementation.…”