Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study
Abstract 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 pos...
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doaj-7562d2b543f04b24bb57ee21647290602020-11-25T03:48:12ZengBMCBMC Public Health1471-24582020-08-0120111110.1186/s12889-020-09337-6Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative studyJieya Yue0Jun Liu1Sarah Williams2Bo Zhang3Yingxi Zhao4Qiannan Zhang5Lin Zhang6Xin Liu7Stephen Wall8Greta Wetzel9Gengli Zhao10Jennifer Bouey11Peking University First HospitalPeking University First HospitalSave the Children UKPeking University First HospitalNuffield Department of Medicine, University of OxfordPeking University First HospitalSave the ChildrenPeking University First HospitalSave the Children Saving Newborn LivesSave the Children Saving Newborn LivesPeking University First HospitalDepartment of International Health, School of Nursing and Health studies, Georgetown UniversityAbstract 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 parental-level 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.http://link.springer.com/article/10.1186/s12889-020-09337-6Kangaroo mother careQualitativeImplementation researchChina |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jieya Yue Jun Liu Sarah Williams Bo Zhang Yingxi Zhao Qiannan Zhang Lin Zhang Xin Liu Stephen Wall Greta Wetzel Gengli Zhao Jennifer Bouey |
spellingShingle |
Jieya Yue Jun Liu Sarah Williams Bo Zhang Yingxi Zhao Qiannan Zhang Lin Zhang Xin Liu Stephen Wall Greta Wetzel Gengli Zhao Jennifer Bouey Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study BMC Public Health Kangaroo mother care Qualitative Implementation research China |
author_facet |
Jieya Yue Jun Liu Sarah Williams Bo Zhang Yingxi Zhao Qiannan Zhang Lin Zhang Xin Liu Stephen Wall Greta Wetzel Gengli Zhao Jennifer Bouey |
author_sort |
Jieya Yue |
title |
Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study |
title_short |
Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study |
title_full |
Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study |
title_fullStr |
Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study |
title_full_unstemmed |
Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study |
title_sort |
barriers and facilitators of kangaroo mother care adoption in five chinese hospitals: a qualitative study |
publisher |
BMC |
series |
BMC Public Health |
issn |
1471-2458 |
publishDate |
2020-08-01 |
description |
Abstract 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 parental-level 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. |
topic |
Kangaroo mother care Qualitative Implementation research China |
url |
http://link.springer.com/article/10.1186/s12889-020-09337-6 |
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