Womens’ experience on barriers and facilitators for implementation with Kangaroo Mother Care at Mbarara Regional Referral Hospital, Uganda: a qualitative study

Abstract

Background: Kangaroo Mother Care (KMC) is a proven cost-effective intervention for preterm and low-birth-weight infants, to provide warmth and secondary health effects. In Uganda, despite a high burden of prematurity, resource constraints limit the delivery of cost-effective interventions. Objective(s): This study aimed to identify barriers and enablers for implementing KMC, explore mothers’ experience of KMC and apply the-i-PARIHS framework to understand why implementation was, or was not, successful at Mbarara Regional Referral Hospital. Methods: This study was conducted in a rural referral hospital in Uganda with semi-structured interviews with mothers (n = 14) in the KMC ward. Interviews were then translated into English, and the transcripts were subjected to qualitative content analysis using inductive coding. Each code was further grouped into subcategories corresponding to barriers or facilitators. The results were interpreted using the-i-PARIHS framework to evaluate why treatment implementation was or was not successful. Results: Kangaroo Mother Care was found to be largely acceptable and implemented by most participants. Barriers and facilitators were identified within the areas of i) healthcare system, social support, finances, knowledge and beliefs as well as the health of newborns and motivation. Primary barriers included insufficient healthcare facilities, lack of material resources, lack of education on KMC, and lack of adaptation to twins. Facilitators included supportive healthcare staff, learning tools, and the positive effects of KMC as motivation. Conclusions: Barriers and facilitators for Kangaroo Mother Care are multifaceted. To increase implementation for all patients, targeted interventions may need to reach beyond the hospital, addressing social and financial factors.