# Barriers and facilitators to the implementation of the kangaroo mother care in NICUs of high-income and low- and middle-income countries: a scoping review

## TL;DR

This study reviews barriers and facilitators to kangaroo mother care in neonatal units in high- and low-income countries.

## Contribution

The first scoping review to synthesize and compare KMC barriers and facilitators in high-income and low- and middle-income countries.

## Key findings

- Barriers like lack of KMC knowledge and safety concerns were reported mainly in low- and middle-income countries.
- Facilitators such as comfortable facilities and maternity leave were found primarily in high-income countries.
- The study highlights differences in KMC implementation factors between high-income and low- and middle-income countries.

## Abstract

We aim to conduct an overview of barriers and facilitators to implementing kangaroo mother care (KMC) in neonatal intensive care units (NICUs) across different countries.

This study was guided by Arksey and O’Malley’s framework.

We searched the following databases on 15 December 2024: PubMed, Scopus, CINAHL, and Embase. We restricted the searches to articles between 1987 and the search date. The starting year was included because KMC was initiated in 1987.

A standardized data extraction form was developed and tested by the team. Data extraction was completed by Author 1 and Author 2. A table was used to extract data and synthesize results.

A total of 1,975 papers were yielded from the database search. We finally included 16 studies for narrative synthesis, executed in five high-income countries (HICs) and 11 in low- and middle-income countries (LMICs): 11 qualitative and four quantitative studies and one mixed-method study. We identified four themes, including hospital factors, parental factors, social-cultural factors, and financial factors, from the included articles. A total of 30 items of barriers and 25 items of facilitators were summarized. Parental lack of KMC knowledge or practice, shortage of medical staff, parental reluctance to participate in KMC, safety concerns on infants of healthcare providers (HCPs), reluctance to allow KMC of HCPs, limited knowledge or practice on KMC of HCPs, social-cultural factors including religious beliefs, gender inequality or lack of women empowerment, and financial factors including no cost-sharing mechanism were all reported only in LMICs. Comfortable facilities, maternity leave, and financial resources were mentioned as facilitators only in HICs. Availability of space or beds, preparation for KMC implementation, localized KMC practice, obliging and competent staff, and recognition of low-birth-weight (LBW) infants were only found as facilitators in LMICs.

Different influencing factors to implement KMC were reported in HICs and LMICs. A better understanding of the key factors can help hospitals and government leadership make related policies to promote KMC practice. We recommend that decision makers design strategies and adopt interventions that specifically address these barriers and facilitators to better uptake of KMC.

At present, no studies have identified and synthesized barriers and facilitators of KMC practice, and described different features between HICs and LMICs. In this review, we synthesized barriers and facilitators reported in studies. This scoping review provides government and hospital leaders with evidence to make policies to promote KMC practice.