Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review

Abstract

Kangaroo Mother Care (KMC) is an evidence-based intervention that reduces neonatal morbidity and mortality. However, adoption among health systems has varied. Understanding the interaction between health system functions—leadership, financing, healthcare workers (HCWs), technologies, information and research, and service delivery—and KMC is essential to understanding KMC adoption. We present a systematic review of the barriers and enablers of KMC implementation from the perspective of health systems, with a focus on HCWs and health facilities. Using the search terms ‘kangaroo mother care’, ‘skin to skin (STS) care’ and ‘kangaroo care’, we searched Embase, Scopus, Web of Science, Pubmed, and World Health Organization Regional Databases. Reports and hand searched references from publications were also included. Screening and data abstraction were conducted by two independent reviewers using standardized forms. A conceptual model to assess KMC adoption themes was developed using NVivo software. Our search strategy yielded 2875 studies. We included 86 studies with qualitative data on KMC implementation from the perspective of HCWs and/or facilities. Six themes emerged on barriers and enablers to KMC adoption: buy-in and bonding; social support; time; medical concerns; training; and cultural norms. Analysis of interactions between HCWs and facilities yielded further barriers and enablers in the areas of training, communication, and support. HCWs and health facilities serve as two important adopters of Kangaroo Mother Care within a health system. The complex components of KMC lead to multifaceted barriers and enablers to integration, which inform facility, regional, and country-level recommendations for increasing adoption. Further research of methods to promote context-specific adoption of KMC at the health systems level is needed.

Factors that have an impact on knowledge, attitude and practice related to kangaroo care: National survey study among neonatal nurses

“…When deficiencies in practice were identified, lack of knowledge was often a contributing factor (Higman, Wallace, Law, Bartle, & Blake, ). A recent systematic review showed that lack of professional education and training was one of the major barriers for nurses to initiate neonatal care (Chan, Bergelson, Smith, Skotnes, & Wall, ). Nursing staff are important advocates in the utilisation of neonatal care intervention.…”

“…Chan, Bergelson, Smith, Skotnes, & Wall, 2017). Nursing staff are important advocates in the utilisation of neonatal care intervention.…”

The evolution of family‐centered care: From supporting parent‐delivered interventions to a model of family integrated care

“…KMC was also found to increase infant growth (Bera et al, 2014;Lumbanraja, 2016), breast feeding (Conde-Agudelo & Díaz-Rossello, 2016; Luong, Nguyen, Thi, Carrara, & Bergman, 2016), mother-infant attachment (Boundy et al, 2016;Cho et al, 2016;Conde-Agudelo & Díaz-Rossello, 2016;Feldman, Rosenthal, & Eidelman, 2014), and infant neurodevelopment (Akbari et al, 2018;Charpak et al, 2017). Despite the strong evidence and establishment of KMC Centers of Excellence in many countries (Sarfo, 2018), significant barriers to implementation persist at all levels: organizations, clinical teams and families (Chan, Bergelson, Smith, Skotnes, & Wall, 2017).…”

The biological embedding of neonatal stress exposure: A conceptual model describing the mechanisms of stress‐induced neurodevelopmental impairment in preterm infants

“…Researchers have found that breastfeeding decreases behavioral and physiologic signs of stress in response to painful procedures (Weissman et al, ). Similarly, SSC is an evidence‐based practice that increases physiologic stability (Chi Luong, Long Nguyen, Huynh Thi, Carrara, & Bergman, ), decreases stress responses (Gao et al, ), and improves long‐term neurodevelopment in preterm infants (Feldman et al, ); however, significant organizational barriers and concerns regarding infant toleration of SSC limit nurses’ facilitation of this intervention (Chan, Bergelson, Smith, Skotnes, & Wall, ; Kymre, ). Empirically‐based rationales for the promotion of SSC in the NICU, such as that provided by the NSE model might increase rates of SSC, as educational programs for NICU nurses on the importance of SSC have increased nurses’ competence in facilitating SSC and increased rates of SSC among mothers of preterm infants (Hendricks‐Munoz & Mayers, ).…”

“…Researchers have found that breastfeeding decreases behavioral and physiologic signs of stress in response to painful procedures (Weissman et al, 2009). Similarly, SSC is an evidence-based practice that increases physiologic stability (Chi Luong, Long Nguyen, Huynh Thi, Carrara, & Bergman, 2016), decreases stress responses (Gao et al, 2015), and improves long-term neurodevelopment in preterm infants (Feldman et al, 2014); however, significant organizational barriers and concerns regarding infant toleration of SSC limit nurses' facilitation of this intervention (Chan, Bergelson, Smith, Skotnes, & Wall, 2017;Kymre, 2014 (Keunen, van Elburg, van Bel, & Benders, 2015), may interrupt the causal pathway between stress exposure and neurodevelopmental impairment. However, such interventions require more rigorous testing.…”