在中国资源有限地区开展袋鼠式护理对早期基本新生儿护理的初步研究：实施的促进因素和障碍。
A pilot study of Kangaroo mother care in early essential newborn care in resource-limited areas of China: the facilitators and barriers to implementation.
机构信息
Vanke School of Public Health, Tsinghua University, Beijing, China.
Institute for Hospital Management, Tsinghua University, Guangdong, China.
出版信息
BMC Pregnancy Childbirth. 2023 Jun 17;23(1):451. doi: 10.1186/s12884-023-05720-4.
BACKGROUND
Implementation of Kangaroo Mother Care (KMC) in resource-limited areas of China may face unique barriers, such as a lack of resources, geographic location and more traditional culture among others. This qualitative study analyses the facilitators and barriers to implementing KMC in county-level health facilities in resource-limited areas of China for the promotion of KMC on a larger scale.
METHODS
Participants from 4 of the 18 pilot counties where early essential newborn care was implemented through the Safe Neonatal Project and 4 control counties not enrolled in Safe Neonatal Project were selected using purposive sampling. A total of 155 participants were interviewed, including stakeholders of the Safe Neonatal Project such as national maternal health experts, relevant government officials and medical staff. Thematic analysis was used to process and analyse the interview content in order to summarise the facilitators and barriers to implementing KMC.
RESULTS
KMC was accepted in the pilot areas but still faced certain challenges due to institutional regulation, resource provision and the perceptions of health staff, postpartum mothers and their families as well as COVID-19 prevention and control regulations. The facilitators identified were government officials and medical staff acceptance and the incorporation of KMC into routine clinical care. The barriers identified were a lack of dedicated funding and other resources, the present scope of health insurance and KMC cost-sharing mechanism, providers' knowledge and practical abilities, parental awareness, postpartum discomfort, fathers' inadequate involvement, and the impact from COVID-19.
CONCLUSION
The Safe Neonatal Project pilot experience indicated the feasibility of implementing KMC in more areas of China. Optimising institutional regulations, providing necessary supporting resources and enhancing education and training may help to refine the implementation and scale-up of KMC practice in China.
背景
在资源有限的中国地区实施袋鼠式护理（KMC）可能面临独特的障碍，例如缺乏资源、地理位置和更传统的文化等。本定性研究分析了在中国资源有限的县级卫生机构中实施 KMC 的促进因素和障碍因素，以更大规模地推广 KMC。
方法
从通过安全新生儿项目实施早期基本新生儿护理的 18 个试点县中的 4 个县和未参加安全新生儿项目的 4 个对照县中选择了具有目的性的参与者。共对 155 名参与者进行了访谈，包括安全新生儿项目的利益相关者，如国家孕产妇健康专家、相关政府官员和医务人员。使用主题分析对访谈内容进行处理和分析，以总结实施 KMC 的促进因素和障碍因素。
结果
KMC 在试点地区得到了认可，但由于制度规定、资源提供以及卫生人员、产后母亲及其家庭以及 COVID-19 防控规定的看法，仍然面临一定的挑战。确定的促进因素是政府官员和医务人员的接受程度以及将 KMC 纳入常规临床护理。确定的障碍是缺乏专门的资金和其他资源、现有的医疗保险范围和 KMC 成本分担机制、提供者的知识和实践能力、父母的意识、产后不适、父亲的参与不足，以及 COVID-19 的影响。
结论
安全新生儿项目试点经验表明，在中国更多地区实施 KMC 是可行的。优化制度规定、提供必要的支持资源以及加强教育和培训可能有助于完善中国 KMC 实践的实施和推广。
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