Design and Implementation of Continues Kangaroo Mother Care (C-KMC): A Participatory Action Research

Abstract

Abstract Background Kangaroo mother care (KMC) is a healthcare strategy for premature and low birth weight infants that includes skin-to-skin contact between mother and infant, exclusive breastfeeding and appropriate follow-up after hospital discharge. Regarding the administrative problems, in spite of the recommendations of the World Health Organization (WHO) and UNICEF in Iran, continuous kangaroo mother care (C-KMC) is not done for infants admitted to hospitals. This study aimed to develop the implementation design and evaluation of continuous kangaroo mother care using a participatory action research approach to promote and improve the health of premature infants in the educational and medical center of Taleghani Hospital in Tabriz. Methods The study followed a repetitive cycle in the course of three stages for 17 months – from April 2019 to December 2020. Participants included the hospital director, neonatologist, matrons, midwives, and nurses working in the neonatal and Neonatal intensive care unit (NICU) wards, and mothers with premature infants hospitalized. In this study, based on the action research cycle, the three main stages of the continuous kangaroo mother care unit were designed, implemented, and evaluated. So that obstacles and needs of continuous kangaroo mother care implementation were identified using focused group discussions, individual interviews, and numerous observations. Essential infrastructure was provided, the program was designed and implemented. In the rethinking sessions, implementation issues and problems were discussed. The deficiencies and problems of the preliminary implementation were eliminated and the final correction was made and the program reached the final stage and was assessed. A descriptive study was performed to investigate the effect of continuous kangaroo mother care on infant nutritional status at discharge and duration of infant hospitalization days in two groups before and after continuous kangaroo mother care. Results Four themes on potential barriers to implementation emerged from the analysis of the staff interviews, namely barriers associated with the mother, father, physician and the health system. Mothers’ experiences of barriers were grouped into five themes: own discomforts, fear, healthcare provider attitudes and actions, infrastructure and family matters. The results of the action research stages evaluation revealed that continuous kangaroo mother care in the hospital has been improved and upgraded and continuous kangaroo mother care has been institutionalized in the care of premature infants. In the findings of the quantitative section, there was a significant relationship between continuous kangaroo mother care receiving an exclusive feeding with the mother’s milk. In the group receiving continuous kangaroo mother care, 88%, but in the group not receiving continuous kangaroo mother care, 68% of the infants had exclusive breastfeeding at the time of discharge from the hospital(p=0.001). In the group receiving continuous kangaroo mother care, the duration of hospitalization was 4.2±3.1 longer than the group not receiving continuous kangaroo mother care (2.88 ± 2.34). (p=0.001) Conclusion Continuous kangaroo mother care was institutionalized as part of routine neonatal care. To facilitate continuous kangaroo mother care, emphasis should be placed on educating parents, physicians, nurses, and health care personnel. Moreover, in some cases, the need for reforms in the payment system and patient insurance is essential.