Barriers and Facilitators of Kangaroo Mother Care Adoption in Five Chinese Hospitals: a Qualitative Study

Abstract Background Kangaroo mother care (KMC) has been proved to be a safe and cost-effective intervention for preterm babies. Despite this evidence and global guidelines promoting KMC, it has not been widely adopted in China. In this study, we aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. Methods We conducted clinical observation and semi-structured interviews in seven NICUs and postnatal wards housed in five hospitals from different provinces in China between August and September 2018. We conducted interviews with pediatricians, obstetricians, nurses and parents who performed KMC to understand their perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system’s readiness and families’ willingness to adopt KMC following its introduction in pilot hospitals. We coded data for emerging themes related to perceived barriers and facilitators of KMC adoption, specifically those unique in the Chinese context and less commonly reported in previous systematic reviews from other countries. Results Five hospitals were included for clinical observation and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with postpartum confinement (Zuo-yue-zi) and grandparents’ resistance, while strong family support enabled KMC adoption. Parents may feel anxious and guilty about having a preterm baby, this is a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded KMC implementation, and hospital-led supportive community and peer group contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. Conclusions Barriers and facilitators exist across cultural, hospital, parental and financial levels. While several factors were common in other study settings, there are also barriers and facilitators unique to Chinese context, e.g. concerns with postpartum confinement (Zuo-yue-zi), grandparents’ resistance and staff’s fear of nosocomial infection. We recommend interventions specificially targeting these barriers and facilitators including family and peer support for improved KMC adoption in China. We also recommend that specific barriers and challenges to KMC in particular settings be identified and be taken into account prior to KMC uptake in other settings.