# Barriers and facilitators to implementing parent-led infant pain care in rural settings: A qualitative descriptive study using the Theoretical Domains Framework and COM-B Model

## TL;DR

This study explores what helps or hinders parents from managing infant pain in rural areas, using interviews with health providers and parents.

## Contribution

The study identifies barriers and facilitators to parent-led infant pain care in rural settings using the COM-B Model and TDF.

## Key findings

- Thirty-two themes were identified across capability, opportunity, and motivation domains of the COM-B Model.
- Environmental context, resources, and social factors influence the use of breastfeeding and skin-to-skin contact for infant pain.
- Health system and parent participants reported similar barriers and facilitators to parent-led infant pain care.

## Abstract

To support the implementation of parent-led infant pain care by identifying barriers and facilitators during acute procedures.

We conducted a qualitative descriptive study guided by the Theoretical Domains Framework (TDF) and COM-B Model. We completed individual, virtual, semi-structured interviews with health system participants (hospital and community-based health care providers, clinical leaders, and administrators; n = 10) and parent participants (who had used hospital or community-based perinatal services in the last 12 months; n = 14) and analyzed the data using deductive-inductive qualitative content analysis.

Thirty-two themes were identified across the capability (9 themes), opportunity (13 themes), and motivation (10 themes) domains of the COM-B Model. Participants emphasized the influence of environmental context, resources, and social factors on the use of breastfeeding and skin-to-skin contact to manage infant pain across rural acute and community care settings. Health system and parent participants described similar barriers and facilitators, highlighting the inconsistent implementation of parent-led infant pain care.

The barriers and facilitators identified in this study will inform the development of theory-informed, contextually relevant implementation interventions to support the use of best practice infant pain care in rural contexts.