Peking University First Hospital, 1 Xi'anmen St, Xicheng, Beijing, China.
Save the Children UK, London, UK.
BMC Public Health. 2020 Aug 13;20(1):1234. doi: 10.1186/s12889-020-09337-6.
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.
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.
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.
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.
袋鼠式护理（KMC）已被证明是一种安全且具有成本效益的早产儿护理标准。直到最近，中国才广泛采用 KMC 实践。我们旨在评估在中国新生儿重症监护病房（NICU）和产后病房中采用 KMC 的障碍和促进因素。
我们于 2018 年 8 月至 9 月期间，在 7 家 NICU 和 5 家医院的产后病房中对进行 KMC 的护士、医生和父母进行了临床观察和半结构化访谈。访谈提供了利益相关者对 KMC 实施和可持续性的障碍和促进因素的第一手观点。我们进一步探讨了卫生系统对 KMC 引入后的准备情况以及家庭对维持 KMC 实践的意愿。我们针对与财务障碍、父母和医院层面的感知障碍以及 KMC 采用的促进因素相关的主题进行了编码，这些主题在中国背景下是独特的。
选择了 5 家开展 KMC 试点项目的医院进行临床观察，并进行了 38 次半结构化访谈。常见的文化障碍包括担心与传统的产后禁闭（坐月子）实践和祖父母的抵制相冲突，而强大的家庭支持是 KMC 采用的促进因素。一些父母报告说，由于有早产儿，他们感到焦虑和内疚，这可能是父母层面采用 KMC 的障碍。医院层面的因素，如对院内感染的恐惧以及人员和空间短缺，阻碍了 KMC 的实施，而医院组织的社区和同伴支持有助于 KMC 的采用。财务障碍包括照顾者的住宿费用和医院的供应费用。
我们提供了一份关于中国 KMC 障碍和促进因素的全面深入报告。我们建议采取具体的政策干预措施，专门解决这些障碍和促进因素，并增加家庭和同伴的支持，以提高中国 KMC 的采用率。我们还建议在 KMC 采用之前，应进行精心设计的本地文化、经济可行性和可接受性研究。
