FHI 360, Durham NC, USA.
Save the Children, Lilongwe, Malawi.
Glob Health Sci Pract. 2022 Aug 30;10(4). doi: 10.9745/GHSP-D-21-00727.
Kangaroo mother care (KMC) is a critical strategy to care for preterm and low birth weight infants in resource-limited settings. Despite evidence of its effectiveness and low cost, coverage has remained low, largely due to sociocultural barriers. We aimed to better understand social norms and community perceptions of preterm infants and KMC (facility-initiated and community-continued) in Malawi, a country with a high preterm birth rate, to inform a pilot social and behavior change program.
In this qualitative study, we conducted 11 focus group discussions and 20 in-depth interviews. Participants were identified through purposive and snowball sampling and included pregnant women, parents engaged in KMC, health workers, community members, and religious leaders. Audio recordings were transcribed and translated into English. An inductive thematic analysis was applied.
Our analysis revealed 3 key injunctive norms influencing KMC engagement in this setting: (1) a perception that although preterm infants are abnormal, they should still be cared for, (2) an understanding that men should provide for their families while women should care for their families, and (3) families and communities should support one another. These norms operated at the community, family, household, and individual levels. Community members enforced social norms but also offered social support. Family members supported KMC parents as well. Both KMC parents actively engaged in the practice; however, their interest in and ability to manage its demands were influenced by the prevailing social norms, their economic situation, family obligations, and the mother's health status.
KMC efforts can be strengthened by incorporating context-specific actions to bolster social norms that align with KMC and shift those that discourage it. Activities must include a focus on the community and family levels to engender meaningful change at the household level.
袋鼠式护理（KMC）是在资源有限的环境中照顾早产儿和低出生体重儿的重要策略。尽管有证据表明其有效且成本低，但覆盖率仍然很低，主要是由于社会文化障碍。我们旨在更好地了解马拉维早产儿和 KMC（医疗机构发起和社区延续）的社会规范和社区认知，为试点社会和行为改变计划提供信息。
在这项定性研究中，我们进行了 11 次焦点小组讨论和 20 次深入访谈。参与者是通过有目的和滚雪球抽样确定的，包括孕妇、参与 KMC 的父母、卫生工作者、社区成员和宗教领袖。对录音进行了转录并翻译成英文。应用了归纳主题分析。
我们的分析揭示了影响这一环境中 KMC 参与的 3 个主要规范性规范：（1）一种观念，即尽管早产儿不正常，但仍应得到照顾；（2）一种理解，即男性应该养家糊口，而女性应该照顾家庭；（3）家庭和社区应该相互支持。这些规范在社区、家庭、家庭和个人层面上运作。社区成员执行社会规范，但也提供社会支持。家庭成员也支持 KMC 父母。KMC 父母都积极参与实践；然而，他们对管理其需求的兴趣和能力受到普遍社会规范、经济状况、家庭义务和母亲健康状况的影响。
可以通过采取具体的行动来加强 KMC 工作，以增强与 KMC 一致的规范，并改变那些阻碍 KMC 的规范。活动必须侧重于社区和家庭层面，以在家庭层面产生有意义的变化。
