探究影响袋鼠式育儿法普及的因素:对父母的关键信息提供者访谈

03 October 2023


Wai Cheng Foong, Siew Cheng Foong, Jacqueline J Ho, Divya Gautam, Jen Jen Leong, Pek Yong Tan, Mehala Baskaran

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摘要

Background: 

The updated World Health Organization (WHO) guideline recommends immediate kangaroo mother care (KMC) for all infants, particularly those born preterm. However, its uptake and sustainability have been unsatisfactory. Therefore, we aimed to gain deeper insight into factors influencing the uptake of KMC practice in our setting, and thereby identify possible solutions for the development of relevant interventions to improve its adoption and make KMC a routine practice for all infants.

Methods:

Using the Triandis model of social behaviour as our framework, we conducted key informant interviews with parents and healthcare providers. Trained interviewers conducted interviews with nine parents, recruited via purposive sampling. These parents were parents of preterm infants who had been introduced to KMC. Data was transcribed and analysed based on Triandis' Theory of Interpersonal Behaviour. This paper only reports the results of the parent interviews.

Results: 

Major findings were how positive feelings like warmth and contentment, the sense of parenthood with KMC, the benefits of KMC for their infant and parents being enablers for KMC uptake. Conversely, the lack of KMC awareness, the initial negative feelings such as fear, uncertainty and embarrassment, the prioritization of time for milk expression, overcrowding in the ward, lack of space and privacy, limited visiting hours, lack of support and poor communication resulting in misapprehension about KMC were major barriers.

Conclusion: 

A deeper understanding of the factors influencing the uptake of KMC using the Triandis behavioural model provided a way forward to help improve its uptake and sustainability in our settings.


参考资料

  1. Jamehdar, M., Nourizadeh, R., Divband, A., Valizadeh, L., Hosseini, M., & Hakimi, S. (2022). KMC by surrogate can have an effect equal to KMC by mother in improving the nutritional behavior and arterial oxygen saturation of the preterm infant: Results of a controlled randomized clinical trial. BMC Pediatrics, 22(1), Article 242. https://doi.org/10.1186/s12887-022-03316-z
  2. Conde-Agudelo, A., & Díaz‐Rossello, J. L. (2016). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews, 2016(8), Article CD002771. https://doi.org/10.1002/14651858.CD002771.pub4
  3. World Health Organization. (2003). Kangaroo mother care: A practical guide (Report No. 9241590351). https://www.who.int/maternal_child_adolescent/documents/9241590351/en/
  4. World Health Organization. (2022). WHO recommendations for care of the preterm or low birth weight infant. https://www.who.int/publications/i/item/9789240058262
  5. World Health Organization. (2023). Kangaroo mother care - Implementation strategy for scale-up adaptable to different country contexts. https://apps.who.int/iris/handle/10665/367625
  6. World Health Organization. (2023). Kangaroo mother care: A transformative innovation in health care. Maternal, Newborn, Child & Adolescent Health & Ageing, Newborn Health, Strategic and Technical Advisory Group of Experts (STAGE) for Maternal, Newborn, Child and Adolescent Health and Nutrition. https://apps.who.int/iris/handle/10665/367626
  7. Leonard, A., & Mayers, P. (2008). Parents’ lived experience of providing kangaroo care to their preterm infants. Health SA Gesondheid, 13(4), 13–28. https://doi.org/10.4102/hsag.v13i4.401
  8. Ndiaye, S., Bosowski, J., Tuyisenge, L., Penn-Kekana, L., Thorogood, N., Moxon, S. G., ... & Sayinzoga, F. (2020). Parents as carers on a neonatal unit: Qualitative study of parental and staff perceptions in a low-income setting. Early Human Development, 145, Article 105038. https://doi.org/10.1016/j.earlhumdev.2020.105038
  9. Seidman, G., Unnikrishnan, S., Kenny, E., Myslinski, S., Cairns-Smith, S., Mulligan, B., ... & Wall, S. (2015). Barriers and enablers of kangaroo mother care practice: A systematic review. PLOS ONE, 10(5), Article e0125643. https://doi.org/10.1371/journal.pone.0125643
  10. Monash University. (2011–2015). SEA-URCHIN (South East Asia: Using Research for Change in Neonatal health) [Project web page]. https://research.monash.edu/en/projects/sea-urchin-south-east-asia-using-researc...
  11. Jeffery, H. E., Henderson-Smart, D. J., & Hill, D. A. (1996). Competency-based learning in neonatology. Medical Education, 30(6), 440–444. https://doi.org/10.1111/j.1365-2923.1996.tb00865.x
  12. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
  13. Triandis, H. C. (2001). Individualism-collectivism and personality. Journal of Personality, 69(6), 907–924. https://doi.org/10.1111/1467-6494.696169
  14. Lemmen, D., Fristedt, P., & Lundqvist, A. (2013). Kangaroo care in a neonatal context: Parents’ experiences of information and communication of nurse-parents. The Open Nursing Journal, 7, 41–48. https://doi.org/10.2174/1874434601307010041
  15. Lindberg, B., & Öhrling, K. (2008). Experiences of having a prematurely born infant from the perspective of mothers in northern Sweden. International Journal of Circumpolar Health, 67(5), 461–471. https://doi.org/10.3402/ijch.v67i5.18353
  16. Charpak, N., & Ruiz-Peláez, J. G. (2006). Resistance to implementing Kangaroo Mother Care in developing countries, and proposed solutions: Resistance to Kangaroo Mother Care. Acta Paediatrica, 95(5), 529–534. https://doi.org/10.1542/peds.100.4.682
  17. Foong, S. C., Tan, Low, M. L., Foong, W. C., Ho, J. J., & Rahim, F. F. (2021). Comparing breastfeeding experiences between mothers spending the traditional Chinese confinement period in a confinement centre and those staying at home: A cohort study. International Breastfeeding Journal, 16(1), Article 4. https://doi.org/10.1186/s13006-020-00353-1
  18. Chisenga, J. Z., Chalanda, M., & Ngwale, M. (2015). Kangaroo Mother Care: A review of mothers’ experiences at Bwaila Hospital and Zomba Central Hospital (Malawi). Midwifery, 31(2), 305–315. https://doi.org/10.1016/j.midw.2014.04.008
  19. Finlayson, K., Crossland, N., Bonet, M., & Downe, S. (2020). What matters to women in the postnatal period: A meta-synthesis of qualitative studies. PLOS ONE, 15(4), Article e0231415. https://doi.org/10.1371/journal.pone.0231415
  20. Lydon, M., Longwe, M., Likomwa, D., Lwesha, V., Chimtembo, L., Donohue, P., ... & Lufesi, N. (2018). Starting the conversation: Community perspectives on preterm birth and kangaroo mother care in southern Malawi. Journal of Global Health, 8(1), Article 010703. https://doi.org/10.7189/jogh.08.010703
  21. Van Schalkwyk, E., Gay, S., Miller, J., & Matthee, E. (2020). Perceptions of mothers with preterm infants about early communication development: A scoping review. The South African Journal of Communication Disorders, 67(1), Article e1-e8. https://doi.org/10.4102/sajcd.v67i1.640
  22. Valois, P., Desharnais, R., & Godin, G. (1988). A comparison of the Fishbein and Ajzen and the Triandis attitudinal models for the prediction of exercise intention and behavior. Journal of Behavioral Medicine, 11(5), 459–472. https://doi.org/10.1007/BF00844839
  23. Charpak, N., Ruiz-Peláez, J. G., Figueroa de Calume, Z., & Charpak, Y. (1997). Kangaroo mother versus traditional care for newborn infants. Pediatrics, 100(4), 682–688. https://doi.org/10.1111/j.1651-2227.2006.tb02279.x
  24. Smith, E. R., Bergelson, I., Constantian, S., Valsangkar, B., & Chan, G. J. (2017). Barriers and enablers of health system adoption of kangaroo mother care: A systematic review of caregiver perspectives. BMC Pediatrics, 17(1), Article 35. https://doi.org/10.1186/s12887-016-0769-5
  25. Chan, G. J., Labar, A. S., Wall, S., & Atun, R. (2016). Kangaroo mother care: A systematic review of barriers and enablers. Bulletin of the World Health Organization, 94(2), 130–141J. https://doi.org/10.2471/blt.15.157818
  26. Griffin, T. (2013). A family-centered “visitation” policy in the neonatal intensive care unit that welcomes parents as partners. The Journal of Perinatal & Neonatal Nursing, 27(2), 160–165. https://doi.org/10.1097/JPN.0b013e3182907f26
  27. Slota, M., Shearn, D., Potersnak, K., & Haas, L. (2003). Perspectives on family-centered, flexible visitation in the intensive care unit setting. Critical Care Medicine, 31(5 Suppl), S362–S366. https://doi.org/10.1097/01.Ccm.0000065276.61814.B2
  28. Linnér, A., Lode Kolz, K., Klemming, S., Bergman, N., Lilliesköld, S., Markhus Pike, H., ... & Westrup, B. (2022). Immediate skin-to-skin contact may have beneficial effects on the cardiorespiratory stabilisation in very preterm infants. Acta Paediatrica, 111(8), 1507–1514. https://doi.org/10.1111/apa.16371
  29. Jamali, Q. Z., Shah, R., Shahid, F., Fatima, A., Khalsa, S., Spacek, J., ... & Soofi, S. B. (2019). Barriers and enablers for practicing kangaroo mother care (KMC) in rural Sindh, Pakistan. PLOS ONE, 14(6), Article e0213225. https://doi.org/10.1371/journal.pone.0213225
  30. Pallás-Alonso, C. R., Losacco, V., Maraschini, A., Greisen, G., Pierrat, V., Warren, I., ... & EuroNeoStat II Project. (2012). Parental involvement and kangaroo care in European neonatal intensive care units: A policy survey in eight countries. Pediatric Critical Care Medicine, 13(5), 568–577. https://doi.org/10.1097/PCC.0b013e3182417959
  31. Klaus, M. H., Jerauld, R., Kreger, N. C., McAlpine, W., Steffa, M., & Kennell, J. H. (1922). Maternal attachment. New England Journal of Medicine, 286(9), 460–463. https://doi.org/10.1056/nejm197203022860904
  32. Blomqvist, Y. T., Rubertsson, C., Kylberg, E., Jöreskog, K., & Nyqvist, K. H. (2012). Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role. Journal of Advanced Nursing, 68(9), 1988–1996. https://doi.org/10.1111/j.1365-2648.2011.05886.x
  33. Vogl, J., Dunne, E., Liu, C., Bradley, A., Rwei, A., Lonergan, E., ... & Newcomb, D. (2021). Kangaroo father care: A pilot feasibility study of physiologic, biologic, and psychosocial measures to capture the effects of father–infant and mother–infant skin-to‐skin contact in the Neonatal Intensive Care Unit. Developmental Psychobiology, 63(5), 1431–1443. https://doi.org/10.1002/dev.22100
  34. Johnston, C. C., Campbell-Yeo, M., & Filion, F. (2011). Paternal vs maternal kangaroo care for procedural pain in preterm neonates: A randomized crossover trial. Archives of Pediatrics & Adolescent Medicine, 165(9), 792–796. https://doi.org/10.1001/archpediatrics.2011.130
  35. Alderdice, F., & Kelly, L. (2019). Stigma and maternity care. Journal of Reproductive and Infant Psychology, 37(2), 105–107. https://doi.org/10.1080/02646838.2019.1589758
  36. Henderson, J., Carson, C., & Redshaw, M. (2016). Impact of preterm birth on maternal well-being and women’s perceptions of their baby: A population-based survey. BMJ Open, 6(10), Article e012676. https://doi.org/10.1136/bmjopen-2016-012676
  37. Franck, L. S., & O’Brien, K. (2019). The evolution of family-centered care: From supporting parent-delivered interventions to a model of family integrated care. Birth Defects Research, 111(15), 1044–1059. https://doi.org/10.1002/bdr2.152
  38. Lewis, T. P., Andrews, K. G., Shenberger, E., Betancourt, TS., Fink, G., Pereira, S., ... & McConnell, M. (2019). Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy and Childbirth, 19(1), Article 227. https://doi.org/10.1186/s12884-019-2363-y
  39. World Health Organization. (2022). Kangaroo Mother Care (KMC) for pre-term and low-birthweight babies [Video]. YouTube. https://youtu.be/XFH8IsYreE0?si=pDXzcDdhdFuOVmmT2022
  40. Pinchevski-Kadir, S., Shust-Barequet, S., Zajicek, M., Leibovich, M., Strauss, T., Leibovitch, L., ... & Shinwell, E. S. (2017). Direct feeding at the breast is associated with breast milk feeding duration among preterm infants. Nutrients, 9(11), Article 1202. https://doi.org/10.3390/nu9111202
  41. Pineda, R. (2011). Direct breast-feeding in the neonatal intensive care unit: Is it important? Journal of Perinatology, 31(8), 540–545. https://doi.org/10.1038/jp.2010.205
  42. Cooper, S., Schmidt, B. M., Sambala, E. Z., Swartz, A., Colvin, C. J., Leon, N., ... & Wiysonge, C. S. (2021). Factors that influence parents’ and informal caregivers’ views and practices regarding routine childhood vaccination: A qualitative evidence synthesis. Cochrane Database of Systematic Reviews, 2021(10), Article CD013265. https://doi.org/10.1002/14651858.CD013265.pub2
  43. Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981–1988. https://doi.org/10.1056/NEJMsa0806477
  44. Gill, V. R., Liley, H. G., Erdei, C., Sen, S., Davidge, R., Wright, A. L., ... & Newborn Skin-to-Skin Contact Global Committee. (2020). Improving the uptake of Kangaroo Mother Care in neonatal units: A narrative review and proposed conceptual framework. Acta Paediatrica, 110(6), 1735–1743. https://doi.org/10.1111/apa.15705

引用

Foong, W. C., Foong, S. C., Ho, J. J., Gautam, D., Leong, J. J., Tan, P. Y., & Baskaran, M. (2023). Exploring factors influencing the uptake of kangaroo mother care: key informant interviews with parents. BMC pregnancy and childbirth23(1), 706. https://doi.org/10.1186/s12884-023-06021-6

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