Facilitators and Barriers to Skin-to-Skin Care for Preterm Infants in a Neonatal Intensive Care Unit: An Integrative Review.

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Skin-to-skin care (SSC) improves health outcomes in preterm infants. Given its benefits, it is crucial to understand the facilitators and barriers that influence its implementation within the socio-ecological model (SEM), which considers the intrapersonal, interpersonal, institutional, community, and policy-level factors. This integrative review employed the SEM for synthesis and evaluation of the evidence surrounding facilitators and barriers for providing SSC with preterm infants and parents in the NICU. PubMed, PsycINFO, CINAHL, and EMBASE were searched for relevant studies among mothers of preterm infants (<37weeks' gestation). All information was extracted for analysis and synthesized in alignment within the levels of the SEM. This review identified 5 levels of influence that either promote or hinder SSC in NICUs: (1) Intrapersonal, including maternal stress and infant characteristics such as weight and gestational age; (2) Interpersonal, focusing on family support and peer interactions; (3) Institutional, addressing the impact of hospital facilities and space limitations; (4) Community, considering cultural beliefs and societal norms; and (5) Public Policy, highlighting guidelines and policies. To improve SSC implementation in NICUs, it is essential that health care providers focus on individualized care, privacy, cultural sensitivity, and staff education. Future research needs to focus on implementation strategies facilitating SSC while decreasing barriers, as well as outcomes associated with SSC across diverse NICU settings.