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Effect of External Facilitation on Kangaroo Mother Care Implementation in Sweden

This study examines the impact of external facilitation on the implementation of Kangaroo Mother Care (KMC) guidelines in Sweden, focusing on patient outcomes. The intervention included the promotion of skin-to-skin contact, breastfeeding support, and family assistance. The findings suggest that the guidelines significantly increased the duration of skin-to-skin contact, while facilitation had no additional effect. Factors such as unit design and implementation of "co-care" were found to influence the success of the intervention.

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Effect of External Facilitation on Kangaroo Mother Care Implementation in Sweden

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  1. KANGAROO MOTHER CARE IN SWEDEN –Results of a trial on facilitation support for guideline implementation Lars Wallin RN, PhD Women health and pediatric division Uppsala University Hospital KU05 Melbourne

  2. Aim of the study • To investigate the effect of external facilitation in the implementation of KMC guidelines on patient outcomes

  3. Intervention I: KMC guidelines • Continuous and prolonged skin-to-skin contact between the parents and the infant • Promotion of breastfeeding • Supporting the family • Humanization of neonatal care WHO 2003

  4. Intervention II: Facilitation • Guiding model from Royal College of Nursing Institute (UK) • Appointed role • Helping and enabling • Support change and learning • Flexible structure and focus Harvey et al, Journal of Advanced Nursing, 2002

  5. Study overview Dissemination of KMC guidelines – all units Start of group focused facilitation – intervention End of facilitation Intervention 2 sites Pre-intervention 6 months Intervention 8 months Post-intervention 6 months Control 2 sites Participants recruited throughout the whole study period November 2002 447 infants/368 mothers Start of Data collection April 2001

  6. duration skin-to-skin first time skin–to-skin length of stay infant growth incidence of breastfeeding parental satisfaction with care parental experience of interaction with their infant parental stress Patient outcomes

  7. Skin-to-skin contact all study phases Facilitation blue and green

  8. Effects (after accounting for covariates) • Guidelines 1.37 0.0003 • Facilitation 0.97 0.821 • “Post-facilitation” 0.99 0.928 • Guidelines + facilitation 1.34 0.010 Multiplicative effect P-value

  9. Skin-to-skin contact all study phases “Co-care” blue and red

  10. Interaction effect guidelines and co-care • Because of the steep increase of the time s-t-s in units with “co-care” we developed a model with interaction effects • Guidelines without co-care 1.15 0.225 • Guidelines with co-care 1.51 0.018 Multiplicative effect P-value

  11. Conclusion • Guidelines increased duration skin-to-skin • Facilitation no additional effect • Only two units continue to improve during post-intervention - the “co-care” units with best facilities for parents • Guidelines and unit design prominent impacting factors on time skin-to-skin

  12. Context measurement QWC 2001 QWC 2002 Intervention 2 sites Baseline 1 6 months Baseline 2 8 months Baseline 3 6 months Control 2 sites Focus groups

  13. Skin-to-skin contact all study phases “Co-care” blue and red

  14. Outcomes on each unit 2001 and 2002

  15. Unit C (control) A change team was established late. No significant activities were carried out during the study period.

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