Facilitators and constraints to family integrated care in low-resource settings informed the adaptation in Uganda.

Publisher: Wiley-Blackwell Country of Publication: Norway NLM ID: 9205968 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1651-2227 (Electronic) Linking ISSN: 08035253 NLM ISO Abbreviation: Acta Paediatr Subsets: MEDLINE

Publication: 2007- : Oslo : Wiley-Blackwell
Original Publication: Oslo : Scandinavian University Press, c1992-

Delivery of Health Care, Integrated*; Humans ; Uganda ; Female ; Adult ; Male ; Infant, Newborn ; Focus Groups ; Health Personnel/psychology ; Developing Countries

Aim: Family Integrated Care (FICare) was developed in high-income countries and has not been tested in resource-poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda.
Methods: Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints.
Results: Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task-shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer-to-peer support to other mothers.
Conclusion: Uganda FICare shares the core values of FICare but was adapted to be feasible in low-resource settings.
(© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

UN inter‐agency Group for Child Mortality Estimation. Levels & Trends in Child Mortality Report 2021. 2021.
Bhutta ZA, Das JK, Bahl R, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014;384(9940):347‐370.
GBD 2019 Human Resources for Health Collaborators. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2022;399(10341):2129‐2154.
Franck LS, O'Brien K. The evolution of family‐centered care: from supporting parent‐delivered interventions to a model of family integrated care. Birth Defects Res. 2019;111(15):1044‐1059.
O'Brien K, Robson K, Bracht M, et al. Effectiveness of family integrated care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster‐randomised controlled trial. Lancet Child Adolesc Health. 2018;2(4):245‐254.
van Veenendaal NR, van der Schoor SRD, Heideman WH, et al. Family integrated care in single family rooms for preterm infants and late‐onset sepsis: a retrospective study and mediation analysis. Pediatr Res. 2020;88(4):593‐600.
Banerjee J, Aloysius A, Mitchell K, et al. Improving infant outcomes through implementation of a family integrated care bundle including a parent supporting mobile application. Arch Dis Child Fetal Neonatal Ed. 2020;105(2):172‐177.
Hei M, Gao X, Li Y, et al. Family integrated Care for Preterm Infants in China: a cluster randomized controlled trial. J Pediatr. 2021;228:36‐43 e2.
Duby J, Kabajaasi O, Muteteri J, et al. Family integrated care in Uganda: a feasibility study. Arch Dis Child. 2022;108(3):180‐184.
Uganda Bureau of Statistics. Uganda Demographic Health Survey 2016. UBOS and ICF; 2018.
The National Health Workforce Accounts Database. Global Health Workforce Statistics 2020. 2020.
O'Brien K, Bracht M, Macdonell K, et al. A pilot cohort analytic study of family integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy Childbirth. 2013;13(Suppl 1):S12.
O'Brien K, Bracht M, Robson K, et al. Evaluation of the family integrated care model of neonatal intensive care: a cluster randomized controlled trial in Canada and Australia. BMC Pediatr. 2015;15:210.
Moore G, Campbell M, Copeland L, et al. Adapting interventions to new contexts‐the ADAPT guidance. BMJ. 2021;374:n1679.
Kananura RM, Tetui M, Mutebi A, et al. The neonatal mortality and its determinants in rural communities of eastern Uganda. Reprod Health. 2016;13:13.
Egesa WI, Odong RJ, Kalubi P, et al. Preterm neonatal mortality and its determinants at a tertiary Hospital in Western Uganda: a prospective cohort study. Pediatric Health Med Ther. 2020;11:409‐420.
Tibaijuka L, Bawakanya SM, Owaraganise A, et al. Incidence and predictors of preterm neonatal mortality at Mbarara regional referral Hospital in South Western Uganda. PLoS One. 2021;16(11):e0259310.
Escoffery C, Lebow‐Skelley E, Udelson H, et al. A scoping study of frameworks for adapting public health evidence‐based interventions. Transl Behav Med. 2019;9(1):1‐10.
Althabe F, Belizán JM, McClure EM, et al. A population‐based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low‐income and middle‐income countries: the ACT cluster‐randomised trial. Lancet. 2015;385(9968):629‐639.
Levin A. The mother‐infant unit at Tallinn Children's hospital, Estonia: a truly baby‐friendly unit. Birth. 1994;21(1):39‐44.
Franck LS, Kriz RM, Bisgaard R, et al. Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi‐site quasi‐experimental clinical trial protocol. BMC Pediatr. 2019;19(1):469.

Faculty of Medicine, McGill University

Keywords: Uganda; family integrated care; intervention adaptation; neonatal intensive care units; parental participation

Date Created: 20240227 Date Completed: 20240711 Latest Revision: 20240711

20240711

10.1111/apa.17182

38411347