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Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study.
BMC Public Health. 2020 Aug 13; 20(1):1234.BP

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.

Authors+Show Affiliations

Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.Save the Children UK, London, UK.Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.Nuffield Department of Medicine, University of Oxford, Oxford, UK.Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.Save the Children, Chengdu, China.Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.Save the Children Saving Newborn Lives, Washington, DC, USA.Save the Children Saving Newborn Lives, Washington, DC, USA.Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China. zhaogengli@sina.com.Department of International Health, School of Nursing and Health studies, Georgetown University, Washington, DC, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32791972

Citation

Yue, Jieya, et al. "Barriers and Facilitators of Kangaroo Mother Care Adoption in Five Chinese Hospitals: a Qualitative Study." BMC Public Health, vol. 20, no. 1, 2020, p. 1234.
Yue J, Liu J, Williams S, et al. Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study. BMC Public Health. 2020;20(1):1234.
Yue, J., Liu, J., Williams, S., Zhang, B., Zhao, Y., Zhang, Q., Zhang, L., Liu, X., Wall, S., Wetzel, G., Zhao, G., & Bouey, J. (2020). Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study. BMC Public Health, 20(1), 1234. https://doi.org/10.1186/s12889-020-09337-6
Yue J, et al. Barriers and Facilitators of Kangaroo Mother Care Adoption in Five Chinese Hospitals: a Qualitative Study. BMC Public Health. 2020 Aug 13;20(1):1234. PubMed PMID: 32791972.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study. AU - Yue,Jieya, AU - Liu,Jun, AU - Williams,Sarah, AU - Zhang,Bo, AU - Zhao,Yingxi, AU - Zhang,Qiannan, AU - Zhang,Lin, AU - Liu,Xin, AU - Wall,Stephen, AU - Wetzel,Greta, AU - Zhao,Gengli, AU - Bouey,Jennifer, Y1 - 2020/08/13/ PY - 2020/03/28/received PY - 2020/08/03/accepted PY - 2020/8/15/entrez PY - 2020/8/15/pubmed PY - 2020/10/21/medline KW - China KW - Implementation research KW - Kangaroo mother care KW - Qualitative SP - 1234 EP - 1234 JF - BMC public health JO - BMC Public Health VL - 20 IS - 1 N2 - 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. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/32791972/Barriers_and_facilitators_of_kangaroo_mother_care_adoption_in_five_Chinese_hospitals:_a_qualitative_study_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09337-6 DB - PRIME DP - Unbound Medicine ER -