Barriers and Enablers of Kangaroo Mother Care Practice: A Systematic Review

Abstract

Kangaroo mother care (KMC) is an evidence-based approach to reducing mortality and morbidity in preterm infants. Although KMC is a key intervention package in newborn health initiatives, there is limited systematic information available on the barriers to KMC practice that mothers and other stakeholders face while practicing KMC. This systematic review sought to identify the most frequently reported barriers to KMC practice for mothers, fathers, and health practitioners, as well as the most frequently reported enablers to practice for mothers. We searched nine electronic databases and relevant reference lists for publications reporting barriers or enablers to KMC practice. We identified 1,264 unique publications, of which 103 were included based on pre-specified criteria. Publications were scanned for all barriers / enablers. Each publication was also categorized based on its approach to identification of barriers / enablers, and more weight was assigned to publications which had systematically sought to understand factors influencing KMC practice. Four of the top five ranked barriers to KMC practice for mothers were resource-related: “Issues with the facility environment / resources,” “negative impressions of staff attitudes or interactions with staff,” “lack of help with KMC practice or other obligations,” and “low awareness of KMC / infant health.” Considering only publications from low- and middle-income countries, “pain / fatigue” was ranked higher than when considering all publications. Top enablers to practice were included “mother-infant attachment” and “support from family, friends, and other mentors.” Our findings suggest that mother can understand and enjoy KMC, and it has benefits for mothers, infants, and families. However, continuous KMC may be physically and emotionally difficult, and often requires support from family members, health practitioners, or other mothers. These findings can serve as a starting point for researchers and program implementers looking to improve KMC programs.

Neonatal intensive care nurses’ knowledge and beliefs regarding kangaroo care in China: a national survey

“…The systematic review by Seidman et al 25 proposed that resource-related barriers (eg, lack of guidelines/education) and sociocultural barriers (eg, concerns about medical conditions/care) negatively affected nurses; our study supports these points. Furthermore, other studies also proposed that lack of knowledge and skills were main barriers to KC implementation,23 26–29 as well as medical staff reluctance to allow KC 10 28–30.…”

Kangaroo mother care for clinically unstable neonates weighing ≤2000 g: Is it feasible at a hospital in Uganda?

“…Other studies in low-resource settings have also reported knowledge of these benefits [56][57][58]. In particular, the effect of KMC on parent-infant bonding has been widely reported [9, [59][60][61][62][63]. In this study, most parents stated that the mother is the KMC provider.…”

Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: a retrospective cohort study

“…Findings from one of the most recent and comprehensive systematic reviews of the barriers and promoters of SSC (included in the complete package known as Kangaroo Mother Care)23 identified over 35 factors involved in integrating SSC into the NICU environment. The top three barriers to SSC were issues with the NICU physical facility, negative impressions by the staff about the practice and fear of injuring the infant during SSC.…”