Seidman Gabriel, Unnikrishnan Shalini, Kenny Emma, Myslinski Scott, Cairns-Smith Sarah, Mulligan Brian, Engmann Cyril
Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
Boston Consulting Group, Boston, Massachusetts, United States of America.
PLoS One. 2015 May 20;10(5):e0125643. doi: 10.1371/journal.pone.0125643. eCollection 2015.
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.
袋鼠式护理（KMC）是一种基于证据的降低早产儿死亡率和发病率的方法。尽管袋鼠式护理是新生儿健康倡议中的一项关键干预措施，但关于母亲和其他利益相关者在实施袋鼠式护理时所面临的障碍，系统信息有限。本系统综述旨在确定母亲、父亲和医护人员在实施袋鼠式护理时最常报告的障碍，以及母亲实施护理最常报告的促进因素。我们在九个电子数据库和相关参考文献列表中搜索了报告袋鼠式护理实施障碍或促进因素的出版物。我们识别出了共1264份独特的出版物，其中103份根据预先设定的标准被纳入。对这些出版物进行扫描以查找所有障碍/促进因素。每个出版物还根据其识别障碍/促进因素的方法进行分类，对于那些系统地试图了解影响袋鼠式护理实施因素的出版物给予更大权重。母亲实施袋鼠式护理的前五大障碍中有四个与资源相关：“设施环境/资源问题”、“对工作人员态度或与工作人员互动的负面印象”、“实施袋鼠式护理或履行其他义务时缺乏帮助”以及“对袋鼠式护理/婴儿健康的认识不足”。仅考虑低收入和中等收入国家的出版物时，“疼痛/疲劳”的排名比考虑所有出版物时更高。实施护理的主要促进因素包括 “母婴依恋” 以及 “家人、朋友和其他指导者的支持”。我们的研究结果表明，母亲能够理解并享受袋鼠式护理，而且这对母亲、婴儿和家庭都有益处。然而，持续进行袋鼠式护理在身体和情感上可能具有挑战性，并且通常需要家庭成员、医护人员或其他母亲的支持。这些研究结果可以为希望改进袋鼠式护理项目的研究人员和项目实施者提供一个起点。
