666 - “The weight has increased, and the love has increased”: Mothers’ Perspectives on Community-Based Kangaroo Care after NICU Discharge in Gujarat, India

Publication Number: 3645.666

Nisha Fahey, University of Massachusetts Medical School, Worcester, MA, United States; Priyanka Amit. Parikh, University of Massachusetts Medical School, Worcester, MA, United States; Samhitha Satish Kumar, UMass Chan Med School, Worcester, MA, United States; Czenilriene J. Santander, University of Massachusetts Medical School, Stoneham, MA, United States; Jaishree Ganjiwale, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India; Julia Ferranto, University of Massachusetts Medical School, Somerville, MA, United States; Aditya H. Bhatt, Bhaikaka University, Vadodara, Gujarat, India; Reshma Pujara, Shree Krishna Hospital, Pramukhswami Medical College, Karamsad, Lambhvel, Anand, Gujarat, India; Dipen Vasudev Patel, Bhaikaka University, Anand, Gujarat, India; Arvin Garg, UMass Memorial Children's Medical Center, Worcester, MA, United States; Margaret Parker, UMass Chan School of Medicine, Worcester, MA, United States; Kallol Roy, Amrita Patel Centre for Public Health, Bhaikaka University, Karamsad, Gujarat, India; Somashekhar Nimbalkar, University, Anand, Gujarat, India

Background: Kangaroo Care (KC) is an intervention for preterm and low-birth-weight infants that improves maternal and infant outcomes. KC is often initiated in the Neonatal Intensive Care Unit (NICU) and remains a beneficial intervention until infants reach 2500g or 40 weeks corrected gestational age. Many infants are discharged from the NICU before meeting these milestones. There is limited understanding of barriers to the continuation of KC at home after NICU discharge in rural India.

Objective: To understand mothers’ perspectives, barriers, and facilitators to continuing KC at home after NICU discharge

Design/Methods: Using the Theory of Planned Behavior framework, we conducted a focus group with 8 mothers of low-birth-weight infants who were recently discharged from a NICU in Gujarat, India to understand practices, barriers, facilitators, and strategies for KMC at home. We performed deductive thematic analysis by iteratively developing codes and identifying themes guided by the Theory of Planned Behavior domains of attitudes, social norms, perceived control, and self-efficacy. This study was approved by US and Indian Institutional Review Boards.

Results: Attitudes: Mothers believed that KC at home is beneficial to both infants and mothers individually as well as collectively though bonding. Social norms: Mothers and families primarily learned about KC from healthcare providers in the NICU and in the community. They may also learned about it through the experiences of their family and community members. Perceived control: The physical environment and competing priorities in the home limited mothers’ ability to do KC, but, with support from family, they were able to find ways to do KC. Family beliefs and knowledge impact mothers and surrogates doing KC at home. Self-efficacy: Prior experience doing KC in the NICU was essential to build confidence to do KC at home. Mothers believed that KC is an important aspect of infant care that they are equipped to do. Encouragement and positive reinforcement from village health workers and others helped motivate mothers to continue KC at home.

Conclusion(s): Mothers believed in the benefits of KC for both themselves and their infant. The KC education and experience they received in the NICU was critical for them to continue KC at home. Family support was important to overcome barriers in the home environment. It is both acceptable and feasible for KC to continue at home after NICU discharge in rural India and future efforts should focus on culturally adapted interventions to overcome barriers.

Table 1: Themes and Supporting Quotations Using the Theory of Planned Behavior Framework
Mothers Table 1.pdf