Cited by: 3 articles PMID: J Perinat Neonatal Nurs , 24 1 , 01 Jan Gale G , Brooks A. Adv Neonatal Care , 6 1 , 01 Feb Cited by: 30 articles PMID: Bozzette M. J Perinat Neonatal Nurs , 25 2 , 01 Apr Adv Neonatal Care , 9 4 , 01 Aug Contact us. Europe PMC requires Javascript to function effectively. Recent Activity. Search life-sciences literature Over 39 million articles, preprints and more Search Advanced search. Bell RP ,. McGrath JM. Affiliations All authors 1. Share this article Share with email Share with twitter Share with linkedin Share with facebook.
Abstract Kangaroo care or skin-to-skin holding of preterm infants requires consistent implementation for best outcomes with infants and families. Results: Progress in terms of national policy and advocacy appeared to occur quite quickly and evenly across the six priority countries, despite being at different stages during the first assessment.
In the areas of country implementation support and research, progress occurred more slowly and results were more variable across countries. It was noted that the number of health facilities offering KMC services increased in all six priority countries, but coverage of KMC was difficult to estimate, demonstrating the ongoing challenges in the area of monitoring and evaluation despite progress made in integrating KMC indicators into national health information systems in five countries.
Some of the more common forms of resistance mentioned by participants are scepticism of healthcare providers regarding the benefits of KMC; reluctance to change existing arrangements related to space; staff allocations; family visits and other entrenched newborn care policies; misperceptions about additional work for staff and additional costs; and fear about the safety of the infant if more care responsibilities are given to the mother and other family members.
According to participants, medical practitioners are often sceptical about introducing KMC, as it is perceived as a lower level of technology. It was also considered important to reflect on the hierarchical power relations that may exist among different health professions, which could hamper KMC implementation and education and training efforts. Furthermore, institutional cultures vary and implementation plans often have to be adapted to local circumstances. Some training programmes sensitise trainees on prevailing misperceptions and possible arguments they may hear about issues related to KMC and reasons why it should not be implemented.
Because attitudes may be slow to change, the repetition of important messages was deemed essential. The collection of good-quality data that show the results of KMC practice 39 was considered an indispensable part of the change process as well.
Participants also referred to piloting and evaluating the initiation of KMC so that practices could be modified and improved before institutionalisation or scaling up occurs.
A gradual process of this nature could facilitate the acceptance of the new practice and the reduction of resistance. When a country opts for a policy approach to KMC implementation, several additional aspects require consideration. Implementation could evolve from the bottom up, from the top down, or as a combination of the two approaches. In some countries implementation starts in an individual healthcare facility that also serves as an education and training centre, possibly with the gradual spread of KMC to other facilities e.
Botswana, Cameroon, Ecuador, Ethiopia, Malawi, Mali, Rwanda, Uganda, Vietnam ; in other countries implementation is scaled up under the direction of a national, provincial or regional health authority e. Education and training play an important role in all implementation processes.
The gradual introduction of KMC, supported by appropriate educational strategies, may lead to broader acceptance, less resistance and better results in the long term.
Some countries have no guidelines to support the implementation of KMC. When KMC is not recognised by policy makers as a beneficial and cost-effective intervention, implementation efforts are observed to be fragmented and lacking co-ordination. On the other hand, a strong, committed national team of dedicated persons, working in unison with professional trainers, facilitates the scaling up of KMC.
Colombia was one of the first countries to create a multidisciplinary team of paediatricians, epidemiologists, nurses, auxiliary nurses, psychologists and lawyers when the Kangaroo Foundation was established in As teaching hospitals are often central in nationwide implementation processes in countries or regions where KMC is not yet practised, some participants considered a first possible step to be the establishment of a centre of excellence in KMC that would take responsibility for further education and training Fig.
Suggestions regarding such centres included certification of neonatal intensive care units according to uniform criteria and certification of individuals working in neonatal units.
The sustainability of centres of excellence as training facilities is largely dependent on the continuation of funding, 38 , 40 and ideally funding should be included in the government budget. It was also perceived that with this approach the availability of sufficient resources would boost the education and training needed to implement KMC on a large scale and address lack of resources as an obstacle.
What is valued as the optimal type of training material for each particular setting? Education and training on their own are unlikely to lead to the successful implementation of KMC. In order to make a contribution to change, educators need to ensure that their activities include a thorough understanding of the following: management of change; the theory behind KMC; good practical application and counselling techniques; and acquisition of persuasive language and skill in the implementation of KMC.
The combination that seems to produce benefits is one that involves changing attitudes while at the same time providing hands-on experience supported by policy. Although there are universal aspects of KMC, and countries and institutions could learn from one another with regard to the ways education and training in KMC are conducted, pedagogy and materials should be locally applicable and appropriate. Education and training should be based on the evidence produced by research and conducted according to current best practice in education.
Finally, two further major challenges for KMC education and training for the future are the following:. Author contribution. A-MB was responsible for the conceptualisation of the initial workshop and served as the contact person in the interchanges between participants. All four of the other authors were present at the initial workshop and made substantial contributions to the conceptualisation and finalisation of the report. All authors read and approved the final manuscript.
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