# Facilitators and Barriers to the Implementation of Family Integrated Care in Ontario Level II Neonatal Intensive Care Units

## TL;DR

This study explores what helps and hinders the adoption of Family Integrated Care in Ontario's NICUs.

## Contribution

It identifies specific facilitators and barriers to implementing FICare in Level II NICUs using the CFIR framework.

## Key findings

- Leadership interest and available staff are key facilitators for FICare implementation.
- Financial constraints and skepticism about cost savings are major barriers.
- NICUs vary in readiness due to differences in population and geography.

## Abstract

What are the main findings?

CFIR was a useful framework for the identification of facilitators and barriers to implementing FICare in Ontario’s Level II NICUs.

There is variability in the readiness of Level II NICUs to implement FICare based on NICU preparedness, capacity, population served, and geographical distribution.

What is the implication of the main finding?

The knowledge gained using the CFIR framework will guide the implementation of FICare in Ontario.

Implementation of FICare will require specific attention to the context of NICUs in the province, such as the population served and the geographical situation.

Background/Objectives: In Ontario, approximately 8% (11,000) of infants are born preterm (22–<37 weeks gestation) each year. Many of these infants are cared for in a Level II Neonatal Intensive Care Unit (NICU). Family Integrated Care (FICare), an innovative model of care, aims to facilitate the involvement of parents in the care of their infants in NICUs. The aim of this study was to gain a better understanding of the general and specific needs of Level II NICUs in Ontario prior to implementation of FICare. Methods: Using a cross-sectional study design, two surveys (leadership and site resources) were developed using the Consolidated Framework for Implementation Science Research’s innovation, inner setting, and outer setting constructs and distributed to Level II NICUs medical and nursing leaders. Results: The surveys were sent to 44 Level II NICUs in Ontario, of which 24 hospitals (55%) responded. Key facilitators to implementation of FICare in Level II hospitals in Ontario were leadership interest, availability of staff and parent volunteers, and existing policies to support implementation. The identified barriers were lack of financial resources for new initiatives, skepticism in FICare’s ability to save costs, need for tailored implementation due to variability in NICU characteristics, and the lack of environmental support for prolonged parental presence. Conclusions: This study has confirmed the interest of many Ontario level II NICUs in implementing FICare and variability in their readiness for implementation based on the identified facilitators and barriers.