Barriers and enablers of health system adoption of kangaroo mother care: a systematic review of caregiver perspectives

Smith, Emily R.; Bergelson, Ilana; Constantian, Stacie; Valsangkar, Bina; Chan, Grace J.

doi:10.1186/s12887-016-0769-5

Table 3 Studies included in the systematic review of barriers and enablers (n = 98)

From: Barriers and enablers of health system adoption of kangaroo mother care: a systematic review of caregiver perspectives

Author	Year	Title	Country	Rural or Urban	Study design	Sample Size	Newborn Description
Bergh	2014	Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa	Malawi, Mali, Rwanda, and Uganda	Urban	Facility evaluation, Focus group/interview	39 facilities	N/A
Morelius	2015	Neonatal nurses’ beliefs about almost continuous parent-infant skin-to-skin contact in neonatal intensive care	Sweden	Urban	Survey	129 nurses	All newborns
Nahidi	2014	Opinions of the midwives about enabling factors of skin-to-skin contact immediately after birth: A descriptive study	Iran	Urban	Questionnaire	292 midwives	N/A
Zwedberg	2015	Midwives’ experiences with mother-infant skin-to-skin contact after a caesarean section: ‘fighting an uphill battle’	Sweden	Urban	Focus group/interview	8 midwives	N/A
Abul-Fadl	2012	Evaluation of mothers’ knowledge, attitudes, and practice towards the ten steps to successful breastfeeding in Egypt	Egypt	Mixed	Pop based surveillance, facility evaluation	1052 Mothers	All ages
Alves	2007	Early weaning in premature babies participants of the Kangaroo Mother Care	Brazil	Mixed	Chart review, Focus group/interview	33 Dyads	Premature; N/A cutoff
Araújo	2010	Mother Kangaroo Method: an investigation about the domestic practice	Brazil	Urban	Focus group/interview	30 Parents	Premature, ≥2000 g
Arivabene	2010	Kangaroo mother method: Mothers’ experiences and contributions to nursing	Brazil	Urban	Focus group/interview	13 Mothers	N/A
Bazzano	2012	Introducing home based skin-to-skin care for low birth weight newborns: a pilot approach to education and counseling in Ghana	Ghana	Rural	Focus group/interview	9 Mother, 23 HCWs	LBW; N/A cutoff
Bergh	2008	Scaling up kangaroo mother care in South Africa: ‘on-site’ versus ‘off-site’ educational facilitation	South Africa	Mixed	RCT	36 Facilities	N/A
Bergh	2012	Progress in the implementation of kangaroo mother care in 10 hospitals in Indonesia	Indonesia	Urban	Facility evaluation	10 Facilities	N/A
Bergh	2012	Translating research findings into practice—the implementation of kangaroo mother care in Ghana	Ghana	N/A	Pop based surveillance, facility evaluation	38 Facilities	N/A
Bergh	2013	Progress with the implementation of kangaroo mother care in four regions in Ghana	Ghana	N/A	Facility evaluation	38 Facilities	N/A
Bergh	2007	Retrospective Evaluation of Kangaroo Mother Care Practices in Malawian Hospitals	Malawi, South Africa	N/A	Facility evaluation	6 Facilities	N/A
Bergh	2009	Scaling up Kangaroo Mother Care in Ghana	Ghana	N/A	Facility evaluation	4 Regions (out of 10)	N/A
Bergh	2012	Evaluation of Kangaroo Mother Care Services in Malawi	Malawi	N/A	Facility evaluation	14 facilities	N/A
Bergh	2012	Evaluation of Kangaroo Mother Care Services in Mali	Mali	N/A	Facility evaluation	7 Facilities	N/A
Bergh	2012	Evaluation of Kangaroo Mother Care Services in Rwanda	Rwanda	N/A	Facility evaluation	7 Facilities	N/A
Bergh	2012	Evaluation of Kangaroo Mother Care Services in Uganda	Uganda	N/A	Facility evaluation	11 Facilities	N/A
Blencowe	2005	Setting up Kangaroo Mother Care at Queen Elizabeth Hospital, Blantyre–A practical approach	Malawi	Urban	Facility evaluation	1 Facility	<2000 g
Blencowe	2009	Safety, effectiveness and barriers to follow-up using an ‘early discharge’ Kangaroo Care policy in a resource poor setting	Malawi	Urban	Prospective cohort	272 Newborns	<2000 g
Blomqvist	2011	Swedish mothers’ experience of continuous Kangaroo Mother Care	Sweden	Urban	Focus group/interview	23 Dyads	All ages
Blomqvist	2013	Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents	Sweden	N/A	Focus group/interview	76 Mother, 74 Fathers	28–33 weeks, 740–2920 g
Boo	2007	Short duration of skin-to-skin contact: Effects on growth and breastfeeding	Malaysia	Urban	RCT	126 Dyads	<1501 g
Brimdyr	2012	A Realistic Evaluation of Two Training Programs on Implementing Skin-to-Skin as a Standard of Care	Egypt	N/A	Focus group/interview	40 Nurses and HCWs	N/A
Calais	2010	Skin-to-skin contact of full term infants: an explorative study of promoting and hindering factors in two Nordic childbirth settings	Sweden, Norway	Urban	Focus group/interview	117 Mother, 107 Fathers	Full term
Castiblanco López	2011	Vision of mothers in care of premature babies at home	Colombia	Urban	Focus group/interview	8 Mothers	<36 weeks, 2320 g
Charpak	2006	Resistance to implementing Kangaroo Mother Care in developing countries, and proposed solutions	15 developing countries	Mixed	Focus group/interview	17 KMC co-ordinators, 15 Facilities	N/A
Chia	2006	The attitudes and practices of neonatal nurses in the use of kangaroo care	Australia	Urban	Focus group/interview	34 Nurses	N/A
Chisenga	2015	Kangaroo Mother Care: A review of mothers’ experiences at Bwaila hospital and Zomba Central hospital (Malawi)	Malawi	Urban	Focus group/interview	113 mothers	N/A
Colameo	2006	Kangaroo Mother Care in public hospitals in the State of Sao Paulo, Brazil: an analysis of the implementation process	Brazil	Mixed	Cross sectional	28 Facilities	LBW; N/A cutoff
Cooper	2014	Close to me: enhancing kangaroo care practice for NICU staff and parents	USA	Mixed	Pre-post	48 nurses and 101 parents	N/A
Crenshaw	2012	Use of a video-ethnographic intervention (PRECESS Immersion Method) to improve skin-to-skin care and breastfeeding rates	USA	N/A	Descriptive	261 Dyads	Full term
Dalal	2014	A cross-sectional study on knowledge and attitude regarding kangaroo mother care practice among health care providers in Ahmedabad district	India	Mixed	Cross sectional	145 HCPs	N/A
Dalbye	2011	Mothers’ experiences of skin-to-skin care of healthy full-term newborns–A phenomenology study	Sweden, Norway	Urban	Focus group/interview	20 Mothers	Full term
Darmstadt	2006	Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India	India	Rural	Intervention	2063 Mothers	All ages
Duarte	2001	Kangaroo mother care: experience report	Brazil	Urban	Focus group/interview	1 Mother	Premature; N/A cutoff
Eichel	2001	Kangaroo care: Expanding our practice to critically iII neonates	USA	Urban	Facility evaluation	1 Facility	N/A
Engler	2002	Kangaroo care: national survey of practice, knowledge, barriers, and perceptions	USA	Mixed	Facility evaluation	537 Facilities	N/A
Ferrarello	2014	Barriers to skin-to-skin care during the postpartum stay	USA	Urban	Focus group/interview	15 Mother, 14 Nurses	N/A
Flynn	2010	Neonatal nurses’ knowledge and beliefs regarding kangaroo care with preterm infants in an Irish neonatal unit	Ireland	Urban	Focus group/interview	62 HCWs	N/A
Furlan	2003	Perception of parents in experiencing the kangaroo mother method	Brazil	Urban	Focus group/interview	10 Parents	Premature; N/A cutoff
Gontijo	2010	Evaluation of implementation of humanized care to low weight newborns: the Kangaroo Method	Brazil	Mixed	Facility evaluation	293 Facilities	N/A
Gonya	2013	Factors associated with maternal visitation and participation in skin-to-skin care in an all referral level IIIc NICU	USA	Urban	Focus group/interview	32 Mothers	<27 weeks
Haxton	2012	Implementing skin-to-skin contact at birth using the Iowa model: applying evidence to practice	USA	Urban	Intervention, qualitative	30 Mothers	All ages
Heinemann	2013	Factors affecting parents’ presence with their extremely preterm infants in a neonatal intensive care room	Sweden	N/A	Focus group/interview	7 Mother, 6 Fathers	<27 weeks
Hendricks-Munoz	2013	Maternal and Neonatal Nurse Perceived Value of Kangaroo Mother Care and Maternal Care Partnership in the Neonatal Intensive Care Unit	USA	Urban	Focus group/interview	143 Mother, 42 HCWs	<34 weeks
Hendricks-Munoz	2014	A Neonatal Nurse Training Program in Kangaroo Mother Care (KMC) Decreases Barriers to KMC Utilization in the NICU	USA	Urban	Prospective cohort	30 nurses	N/A
Hennig	2006	Health professional’s knowledge and practices about KMC	Brazil	Mixed	Cross sectional	148 Doctors and nurses, 11 Facilities	LBW; N/A cutoff
Higman	2015	Assessing clinicians’ knowledge and confidence to perform kangaroo care and positive touch in a tertiary neonatal unit in England using the Neonatal Unit Clinician Assessment Tool (NUCAT)	England	Urban	Focus group/interview	6 nurses and 51 clinicians	N/A
Hill	2010	Keeping newborns warm: beliefs, practices and potential for behavior change in rural Ghana	Ghana	Mixed	Focus group/interview	635 Mother, 14 Villages	All ages
Hunter	2014	Newborn care practices in rural Bangladesh: Implications for the adaptation of kangaroo mother care for community-based interventions	Bangladesh	Rural	Focus group/interview	121 participants	N/A
Ibe	2004	A comparison of kangaroo mother care and conventional incubator care for thermal regulation of infants < 2000 g in Nigeria using continuous ambulatory temperature monitoring	Nigeria	Urban	Crossover	13 Newborns, 11 Mothers and female relatives	1200–1999 g
Johnson	2007	Factors influencing implementation of kangaroo holding in a Special Care Nursery	USA	Peri-urban/Slum	Focus group/interview	17 Nurses	N/A
Johnston	2011	Paternal vs. maternal kangaroo care for procedural pain in preterm neonates: a randomized crossover trial	Canada	N/A	RCT crossover	62 Newborns	28–36 weeks
Kambarami	2002	Caregivers’ perceptions and experiences of ‘kangaroo care’ in a developing country	Zimbabwe	Urban	Focus group/interview	40–48 mothers (4 focus groups with 10–12 participants per group)	LBW: N/A cutoff
Keshavarz	2010	Effects of kangaroo contact on some physiological parameters in term neonates and pain score in mothers with cesarean section	Iran	Urban	RCT	160 Dyads	Full term
Kymre	2013	Balancing preterm infants’ developmental needs with parents’ readiness for skin-to-skin care: A phenomenological study	Sweden, Norway, Denmark	N/A	Focus group/interview	18 Nurses	N/A
Lee	2012	Clinician perspectives on barriers to and opportunities for skin-to-skin contact for premature infants in neonatal intensive care units	USA	Mixed	Focus group/interview	69 HCPs, 11 Facilities	N/A
Legault M	1995	Comparison of kangaroo and traditional methods of removing preterm infants from incubators	Canada	Urban	RCT, pre-post, cross over	61 Dyads	Premature: N/A cutoff 1000–1800 g
Lemmen	2013	Kangaroo care in a neonatal context: parents’ experiences of information and communication of nurse-parents	Sweden	N/A	Focus group/interview	12 Families	24–35 weeks
Leonard	2008	Parents’ Lived Experience of Providing Kangaroo Care to their Preterm Infants	South Africa	Urban	Focus group/interview	6 Parents	Premature: N/A cutoff
Lincetto	1998	Impact of season and discharge weight on complications and growth of Kangaroo Mother Care treated low birth weight infants in Mozambique	Mozambique	Urban	Prospective cohort	246 Newborns	<2000 g
Maastrup	2012	Breastfeeding Support in Neonatal Intensive Care: A National Survey	Denmark	N/A	Facility evaluation	19 Facilities	N/A
Mallet	2007	[Skin to skin contact in neonatal care: knowledge and expectations of health professionals in 2 neonatal intensive care units]	France	N/A	Focus group/interview	121 Doctors and paramedical staff	N/A
Martins	2008	Living in the other side of kangaroo method: the mother’s experience	Brazil	Urban	Focus group/interview	5 Mothers	N/A
McMaster	2000	Kangaroo care in Port Moresby, Papua New Guinea	Papua New Guinea	Urban	Chart review, facility evaluation	109 Newborns	<1500 g
Moreira	2009	Kangaroo mother program and the relationship mother-baby: qualitative research in a public maternity of Betim city	Brazil	Urban	Focus group/interview	8 Mothers	30–32 weeks, <2000 g
Namazzi	2015	Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda	Uganda	Rural	RCT	20 health facilities	All newborns
Neu	1999	Parents’ perception of skin-to-skin care with their preterm infants requiring assisted ventilation	N/A	Urban	Focus group/interview	8 Mothers, 1 Father	Premature; N/A cutoff
Nguah	2011	Perception and practice of Kangaroo Mother Care after discharge from hospital in Kumasi, Ghana: a longitudinal study	Ghana	Urban	Prospective cohort	195 Dyads	1000–2000 g
Niela-Vilen	2013	Early physical contact between a mother and her NICU-infant in two university hospitals in Finland	Finland	Urban	Prospective cohort, qualitative	170 Mothers, 381 Staff	all NICU newborns
Nyqvist	2008	Application of the baby friendly hospital initiative to neonatal care: suggestions by Swedish mothers of very preterm infants	Sweden	N/A	Focus group/interview	13 Mothers	<32 weeks
Parmar	2009	Experience with Kangaroo mother care in a neonatal intensive care unit (NICU) in Chandigarh, India	India	Urban	Retrospective cohort	135 Newborns	26–37 weeks, 550–2500 g
Priya	2004	Kangaroo care for low birth weight babies	India	N/A	Crossover	30 Dyads	LBW; N/A cutoff
Quasem	2003	Adaptation of kangaroo mother care for community-based application	Bangladesh	Urban	Focus group/interview	35 Mothers	All ages
Ramanathan	2001	Kangaroo Mother Care in very low birth weight infants	India	N/A	RCT	28 Newborns	<1500 g
Roller	2005	Getting to know you: mothers’ experiences of kangaroo care	USA	N/A	Focus group/interview	10 Mothers	32–37 weeks
Sá	2010	Interpersonal relationships between professionals and mothers of premature from Kangaroo-Unit	Brazil	Urban	Focus group/interview	10 Mothers, 7 HCPs	Premature; N/A cutoff
Sacks	2013	Neonatal care in the home in northern rural Honduras: a qualitative study of the role of traditional birth attendants	Honduras	Rural	Focus group/interview	48–72 TBAs (6 focus groups with 8–12 participants per group)	N/A
Santos	2013	Maternal perception of the skin to skin contact with premature infants through the kangaroo position	Brazil	Urban	Focus group/interview	12 Mothers	Premature, LBW; N/A cutoff
Shamba	2014	Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change	Tanzania	Mixed	Focus group/interview	57 mothers and 14 TBAs	N/A
Silva	2008	Perceptions and neonatal care behavior of women in a Kangaroo-mother Care Program	Brazil	Urban	Focus group/interview	5 Dyads	Premature: N/A cutoff, <1000–1550 g
Silva	2014	Conhecimento de técnicos de enfermagem sobre o método canguru na unidade neonatal; Nursing technicians? knowledge of the Kangaroo-Mother Care method in the neonatal unit; Conocimiento de técnicos de enfermería sobre el método Canguro en la unidad neonatal	Brazil	Urban	Focus group/interview	20 nursing technicians	N/A
Sinha	2014	Newborn care practices and home-based postnatal newborn care programme–Mewat, Haryana, India, 2013	India	Rural	Focus group/interview	320 mothers, 61 Accredited Social Health Activists, 19 home visits	N/A
Sloan	2008	Community-based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial	Bangladesh	Rural	Cluster RCT	39,888 Mothers	All ages
Solomons	2012	Knowledge and attitudes of nursing staff and mothers towards kangaroo mother care in the eastern sub-district of Cape Town	South Africa	Urban	Cross sectional	30 Mothers, 15 Nurses	<2500 g
Stikes	2013	Applying the plan-do-study-act model to increase the use of kangaroo care	USA	Urban	Focus group/interview	56 Nurses	N/A
Strand	2014	Kangaroo mother care in the neonatal intensive care unit: staff attitudes and beliefs and opportunities for parents	Sweden	N/A	Facility evaluation	126 Staff	N/A
Tessier	1998	Kangaroo mother care and the bonding hypothesis	Colombia	Urban	RCT	488 Newborns	<2001 g
Toma	2003	Kangaroo Mother Care: the role of health care services and family networks in a successful program	Brazil	Urban	Focus group/interview	14 Mothers, 7 Fathers	Premature: N/A cutoff, 1150–2300 g
Toma	2007	Maternal perception of low birth weight babies before and following the implementation of the Kangaroo Mother Care in a public hospital, in the city of São Paulo, Brazil	Brazil	Urban	Focus group/interview	41 Mothers	<2000 g
Undefined author: Save the Children	2011	Scaling Up Kangaroo Mother Care, Report of Country Survey Findings	Ethiopia, Malawi, Mali, Mozambique, Nigeria, Tanzania, Uganda, Bolivia, Indonesia, Nepal, Vietnam	N/A	Facility evaluation	12 Countries	N/A
Vesel	2013	Promoting skin-to-skin care for low birth weight babies: findings from the Ghana Newhints cluster-randomized trial	Ghana	Rural	Cluster RCT	98 Zones	All ages
Waiswa	2010	‘I never thought that this baby would survive; I thought that it would die any time’: perceptions and care for preterm babies in eastern Uganda	Uganda	Rural	Focus group/interview	30 HCW and mothers, 16 Facilities	Premature; N/A cutoff
Waiswa	2015	Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial	Uganda	Rural	Cluster RCT	395 women	All newborns
Wobi	2010	Report on the Kangaroo Mother Care Project at Komfo Anokye Teaching Hospital in Kumasi, Ghana	Ghana	Urban	Facility evaluation	2 Facilities	N/A
Zhang	2014	Evidence utilization project: implementation of kangaroo care at neonatal ICU	Singapore	Urban	Facility evaluation	1 ICU	<34 weeks; < 1500 g

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