Barriers and facilitators to utilisation of KMC among preterm babies on CPAP

Abstract

Preterm births are a leading cause of death and illness, with rates rising in Uganda. CPAP helps with respiratory problems, and kangaroo mother care (KMC) stabilises temperature, encourages bonding, and supports health. Yet, KMC for preterm infants on CPAP is rarely used in countries like Uganda. This study explores challenges and enablers for KMC in these cases. The study used a cross-sectional design with qualitative methods at St. Francis Hospital Nsambya. NICU healthcare workers were conveniently sampled and interviewed until saturation. Data was transcribed, coded, and analysed thematically in Atlas.ti Version 9. The study included 8 respondents with an average age of 34 years (range: 26–48 years). Barriers and facilitators were categorised into factors related to parents, babies, health workers, and health systems. A total of 22 themes and 20 subthemes emerged, covering both barriers and facilitators. Key barriers included issues such as mothers being sick, misinformation about KMC and CPAP, lack of maternal knowledge, negative attitudes towards KMC, and maternal fear. Additional barriers involved critically ill babies, poor attitudes and limited knowledge among health workers, absence of protocols, staffing shortages, equipment limitations, and timing of KMC. Facilitator themes highlighted paternal involvement and awareness efforts, such as education and counselling to improve maternal knowledge; fostering positive health worker attitudes; training; incentives; functional systems; access to information; early CPAP application; availability of KMC spaces in neonatal units; and integrating KMC into routine quality improvement projects. Multiple barriers categorised as health worker, baby, maternal, and health system factors still hinder the effective implementation of KMC among preterm babies on CPAP. Understanding these factors and developing category-specific interventions can enhance the utilisation of KMC, thereby improving outcomes for preterm babies. Not applicable.