Related Barriers Research Articles

Assessing the functionality of an emergency obstetric referral system and continuum of care among public healthcare facilities in a low resource setting: an application of process mapping approach

BackgroundWeak referral systems remain a major concern influencing timely access to the appropriate level of care during obstetric emergencies, particularly for Low-and Middle-Income Countries, including Ghana. It is a serious factor threatening the achievement of the maternal health Sustainable Development Goal. The objective of this study is to establish process details of emergency obstetric referral systems across different levels of public healthcare facilities to deepen understanding of systemic barriers and preliminary solutions in an urban district, using Ablekuma in Accra, Ghana as a case study.MethodsThe study is an analytical cross-sectional study. Nine [1] targeted interviews were carried out for a three-week period in June and July 2019 after informed written consent with two [2] Obstetrics & Gynaecology consultants, two [2] Residents, one family physician, and four [3] Midwives managing emergency obstetric referral across different levels of facilities. Purposeful sampling technique was used to collect data that included a narration of the referral process, and challenges experienced with each step. Qualitative data was transcribed, coded by topics and thematically analysed. Transcribed narratives were used to draft a process map and analyze the defects within the emergency obstetric referral system.ResultsOut of the 34 main activities in the referral process within the facilities, the study identified that 24 (70%) had a range of barriers in relation to communication, transport system, resources (space, equipment and physical structures), staffing (numbers and attitude), Healthcare providers (HCP) knowledge and compliance to referral policy and guideline, and financing for referral. These findings have implication on delay in accessing care. HCP suggested that strengthening communication and coordination, reviewing referral policy, training of all stakeholders and provision of essential resources would be beneficial.ConclusionOur findings clearly establish that the emergency obstetric referral system between a typical teaching hospital in an urban district of Accra-Ghana and peripheral referral facilities, is functioning far below optimum levels. This suggests that the formulation and implementation of policies should be focused around structural and process improvement interventions, strengthening collaborations, communication and transport along the referral pathway. These suggestions are likely to ensure that women receive timely and quality care.

Assessing sexual dysfunction among stroke survivors and barriers to address this issue by physicians at a Latin American reference hospital

BackgroundSexual dysfunction affects at least one half of patients after a stroke. Problems related to sexual function are rarely assessed or addressed by physicians. ObjectiveTo determine the frequency and factors associated with sexual dysfunction among stroke survivors and self-reported barriers of physicians to discuss sexual dysfunction during regular consultation. MethodsWe administered a questionnaire to a cross-sectional sample of stroke survivors to assess the frequency and factors associated with sexual dysfunction and the aspects of sexuality most commonly affected by stroke in a reference hospital in Peru. A qualitative approach was used to determine the willingness to address sexual issues and related barriers among neurology physicians participating in the study. ResultsAmong 150 patients, sexual dysfunction was identified in 89 (59%). Only 10% self-reported their sexual function as optimal. Markedly decreased frequency of sexual encounters (49%) and markedly decreased sexual desire (33%) were the aspects of sexual function most commonly reported by patients after a stroke. Fear of having a new stroke [OR:3.2, 95% CI (1.5–6.3)], depression [OR:2.1, 95% CI (1.0–4.3)], and self-perception of having impaired motor function [OR:2.5, 95% CI (1.2–5.0)] were significantly associated with sexual dysfunction. In the qualitative assessment of physicians (N = 15), when asked how often they addressed sexual aspects during regular consultation with a stroke survivor, none answered “very often”, and only 8 (51%) answered “sometimes”. At the end of the study, 10 (66%) physicians verbalized the perception that addressing this issue encouraged their patents to be more open to personal concerns and prompted a stronger doctor-patient relationship. ConclusionSexual dysfunction affected more than a half of stroke survivors, and was significantly associated with depression, fear of having a new stroke, and with the self-perception of impaired motor function. Addressing sexual issues during the regular consult by physicians was infrequent. Barriers reported by physicians included limited time during regular consultation and the belief that this issue should be addressed under the scope of other specialties.

Identification of stakeholder related barriers in sustainable manufacturing using Social Network Analysis

Sustainable manufacturing (SM) is crucial for our future manufacturing and it starts to have an evolutionary development. However, manufacturing industries are difficult to adopt sustainability measures because of considerable barriers under the triple bottom line (TBL): economy, environment and people. Previous research works mainly focused on the originality and the definitions of the barriers in SM, they seldomly consider the stakeholder-related affairs on SM and the causal relationships between the barriers in SM. Therefore, this study aims to propose a comprehensive analysis of barriers in SM using social network analysis (SNA), with detailed consideration of stakeholder concerns in terms of TBL. This study applies SNA to recognize and investigate the underlying stakeholder-related barriers and their causal relationships in SM, and the suggestions were provided upon the findings of SNA to help for mitigating the negative influences from critical barriers to SM. The validation is provided by showing the effectiveness of suggestions in which decreases in the network density and average geodesic distance simultaneously after the modification. This study contributes to not only displaying the efficient way to probe the stakeholder-related barriers in SM, but also offering the guideline to support the measures proposing in the future by using the same analytic technique in SNA which is demonstrated in this study.

School Nurse Poverty Education: Why It Is Important to Your Practice.

School nurses are seeing increased numbers of children who are living in poverty. The Missouri Community Action Program Poverty Simulation was presented to school nurses to increase their awareness of what it might be like to live in poverty and the related healthcare barriers. Participants shared their reactions and knowledge gained in the simulation in a postparticipation survey with the simulation facilitators. Some participants shared practice changes that they made as a result of their participation in the simulation, which included use of additional referral resources, being less judgmental, and increased empathy.

Historico-cultural recontextualization in translating ancient classics: a case study of Gopal Sukhu's The Songs of Chu

ABSTRACT Adequate historico-cultural recontextualization promotes the reception and transmission of translations of ancient classics, highlighting the importance of translators’ recontextualization of ancient classics in target texts. Combining thick translation and paratextual theory, we first propose a theoretical model for recontextualizing ancient classics. Then, we summarize cultural recontextualization approaches and the use of paratexts as recontextualizing strategies via a case study of Gopal Sukhu's translation of the Chuci (楚辞), a classic of ancient Chinese literature. Finally, we compare translations by Sukhu and others to explore the strengths of Sukhu's version, delineating implications for ancient classics translation more generally. We then offer two significant conclusions. Firstly, translators recontextualize source texts through various paratexts, including introduction, note, appendix, and index, in order to remove historico-culturally related reading barriers, helping readers develop a thorough understanding of the source text. Secondly, a multimodal approach combining research and translation benefits the reader by rendering ancient classics accessible through thick translations rich with paratexts.

Factors affecting seniors’ decision to relocate to senior living communities

Abstract This study aimed to investigate the influence of push and pull factors and perceived barriers on seniors’ intention to relocate to senior living communities (SLC). The mediating role of perceived barriers on the proposed relationships were also examined. The data was collected from 363 seniors. Structural equation modeling analysis was conducted to test the study hypotheses. The results indicated that health-related, social and family/friend related, housing and property related push factors, and facility related pull factor positively; and family related, economic, socio-psychological, and knowledge and information barriers negatively influenced seniors’ relocation intention. The study results further indicated that the relationship between health-related push factors and intention to relocate was mediated by family related and socio-psychological barriers, and the relationship between facility related pull factors and intention to relocate was mediated by socio-psychological and economic barriers. The findings provide valuable implications for academicians, SLC operators, health care facilitators and government agencies.

Pharmacy Practice in High-Volume Community Settings: Barriers and Ethical Responsibilities.

Pharmaceutical care describes a philosophy and practice paradigm that calls upon pharmacists to work with other healthcare professionals and patients to achieve optimal health outcomes. Among the most accessible health professionals, pharmacists have responsibilities to individual patients and to public health, and this has been especially evident during the COVID-19 pandemic. Pharmacists in high-volume community settings provide a growing number of clinical services (i.e., immunizations and point-of-care testing), but according to job satisfaction and workplace survey data, demands related to filling prescriptions, insufficient staffing, and working conditions are often not optimal for these enhanced responsibilities and lead to job dissatisfaction. Professional codes of ethics require a high level of practice that is currently difficult to maintain due to a number of related barriers. In this paper, we summarize recent changes to the scope of practice of pharmacists, cite ethical responsibilities from the American Pharmacists Association Code of Ethics, review data and comments from workplace surveys, and make a call for change. Corporate managers, state boards of pharmacy, and professional organizations have a shared responsibility to work with community pharmacists in all settings to find solutions that ensure optimal and ethical patient care. Attention to these areas will enhance patient care and increase job satisfaction.

"The Problem Is that We Hear a Bit of Everything…": A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy.

Understanding the factors that contribute to women’s alcohol use in pregnancy is critical to supporting women’s health and wellness and preventing Fetal Alcohol Spectrum Disorder. A systematic review of qualitative studies involving pregnant and recently postpartum women was undertaken to understand the barriers and facilitators that influence alcohol use in pregnancy (PROSPERO: CRD42018098831). Twenty-seven (n = 27) articles were identified through EMBASE, CINAHL, PsycINFO, PubMed and Web of Science. The included articles were thematically analyzed using NVivo12. The analysis was informed by Canada’s Action Framework for Building an Inclusive Health System to articulate the ways in which stigma and related barriers are enacted at the individual, interpersonal, institutional and population levels. Five themes impacting women’s alcohol use, abstention and reduction were identified: (1) social relationships and norms; (2) stigma; (3) trauma and other stressors; (4) alcohol information and messaging; and (5) access to trusted equitable care and essential resources. The impact of structural and systemic factors on prenatal alcohol use was largely absent in the included studies, instead focusing on individual choice. This silence risks perpetuating stigma and highlights the criticality of addressing intersecting structural and systemic factors in supporting maternal and fetal health.

Place and policy barriers of rural Nigeria's small and medium enterprises' internationalization

AbstractDespite internationalization theory's recognition that place and policy constitute fundamental barriers for the internationalization of small and medium enterprises (SMEs), research into rural‐based firms from the developing world is a much underdeveloped and neglected area. To address the need to examine this gap, the purpose of this study is to identify and compare place and policy challenges of rural SMEs' internationalization in Nigeria. We have developed a model that extends internationalization theory's overemphasis on the structural aspects of these barriers and thereby provide a resolution tool for managers. By using partial least squares (PLS) path modeling methodology, we also administered 403 questionnaires in six of Nigeria's geopolitical zones. Our three‐stage analyses reveal findings that the physical and geographical (or place barrier) challenges account for 90% whilst the traditionally neglected aspects of legal and regulatory barriers score 85%. Therefore, place related barriers should be given slightly higher priority if it is not possible to be given equal recognition in internationalization theory. These findings provide new insights into a more complex picture of SMEs' internationalization in emerging economies. It is recommended that our Human‐centric Hierarchical Model could help inform managers' decision‐making processes on what human aspects they need to prioritize when faced with policy and place barriers. It is also recommended that our model adds social value to SME businesses and provides a new lens for scholars to investigate place and policy related barriers to rural Nigeria's SMEs.

Assessment of the barriers of natural gas market development and implementation: A case of developing country

Natural gas considers as the fuel for the 21st century and is expected to play an important role in the developing countries' energy mix due to clean fuel, environmental, climate goals and sustainability issues. India too is striving for increasing the natural gas share from 6.2% in 2019 to 15% by 2030. Government of India is also stressing to boost natural gas share in the country's energy mix, which is still below the desired level and presence of the barriers makes it difficult to establish natural gas as preferred fuel in this country. Therefore, it is imperative to analyze the criticality of the barriers to understand how they impact on the natural gas market of India. The study employs a two-phase methodology to identify and analyze the critical barriers restricting the natural gas demand in India by employing novel hybrid best-worst method (BWM). The results indicate that operational and supply related barriers are the two most critical out of the identified categories. The findings of the developed framework could be used by the policymakers, strategists and the managers, which will help them to reduce and eliminate the barriers and promote natural gas as the preferred fuel.

Determinants of attitude and intention towards private health insurance: a comparison of insured and uninsured young adults in Australia

BackgroundSince the introduction in 1984 of Australia’s publicly-funded universal healthcare system, Medicare, healthcare financing has relied on a mix of public and private sources to meet the needs of the population (Sowa et al., Appl Health Econ Health Policy 15:31–41, 2018). However, in recent years, there has been a decline in the number of Australians choosing to purchase private health insurance (PHI), particularly within the young adult age group with the proportion of insurance customers aged 20 to 29 falling from 10.3 to 9.4% between 2012 and 2017 (Sivey, The Conversation, 2017). Young adults are critical to private health insurance funding models as their involvement offsets the drawdown by older adults (Dalzell and Borys, ABC News, 2019). While this issue is widely reported in the Australian media, few empirical studies have explored the factors that enable or constrain young adults’ enrolment in PHI.MethodsTo address the scarcity of research about the motivational factors behind young adult decision-making, this study conducted a survey of 594 Australian young adults aged between 18 and 30 years. Within this age group, the survey sought an equal split of participants who were members and non-members of PHI schemes.ConclusionThe findings identified perceived value and trust in insurers as additional motivational factors alongside traditional measures of recognition of the problem and involvement in the problem. Differences between the insured and uninsured groups were identified which help to shape a more holistic understanding of the key motivational factors and barriers in relation to Australian young adults’ enrolment in PHI.

Assessing the potential use of blockchain technology to improve the sharing of public health data in a western Canadian province.

This exploratory, qualitative study set out to identify the encountered and perceived barriers to public health (PH) data sharing in a Canadian province with a view to assessing blockchain technology as a potential solution. A topic guide was developed, based on previous research in the area. This was then utilised for ten in-depth, semi-structured interviews with PH professionals between 27 May and 18 June 2019. Each stage of research was congruent with the philosophical underpinning of Gadamerian hermeneutic phenomenology. The major themes that emerged from the data collected were related to the information systems in use, data quality and ownership, as well as client identity management. The recurring core theme throughout all interviews was related to ineffective leadership and management, contributing to each major theme. Overwhelmingly the results show that the majority of barriers faced in this province are human-related. It is concluded that while blockchain technology shows promise for enhancing data sharing in healthcare, it is still many years away from being implemented in this Canadian province. As the results of this study indicate, there are human related barriers that could be addressed in the meantime, which are outside the scope of a technical solution. Future work should explore the perspectives of other stakeholders, such as the provincial government to fully understand the potential for using blockchain to share PH data in this province.

Examining barriers to harm reduction and child welfare services for pregnant women and mothers who use substances using a stigma action framework.

Pregnant women and mothers who use substances often face significant barriers to accessing and engaging with substance use services. A scoping review was conducted in 2019 to understand how stigma impacts access to, retention in and outcomes of harm reduction and child welfare services for pregnant women and mothers who use substances. The forty‐two (n = 42) articles were analysed using the Action Framework for Building an Inclusive Health System developed by Canada's Chief Public Health Officer to articulate the ways in which stigma and related health system barriers are experienced at the individual, interpersonal, institutional and population levels. Many articles highlighted barriers across multiple levels, 19 of which cited barriers at the individual level (i.e., fear and mistrust of child welfare services), 18 at the interpersonal level (i.e., familial and relational influence on accessing substance use treatment), 30 at the institutional level (i.e., high organisational expectations on women) and 17 at the population level (i.e., negative stereotypes and racism). Our findings highlight the interconnectedness of stigma and related barriers and the ways in which stigma at the institutional and population levels pervasively influence individual and interpersonal experiences of stigma. Despite a wealth of literature on barriers to treatment and support for pregnant women and mothers who use substances, there has been minimal focus on how systems can address these formidable barriers. This review highlights the ways in which the barriers are connected and identifies opportunities for service providers and policymakers to better support pregnant women and mothers who use substances.

Reproductive health at conflict borders: a cross-sectional survey of human rights violations and perinatal outcomes at the Thai-Myanmar border

BackgroundHuman rights violations (HRVs) are common in conflict and displacement contexts. Women are especially vulnerable to HRVs in these contexts, and perinatal health is acutely sensitive to related stressors and health care barriers. However, how HRVs affect immediate and long-term perinatal health in chronic displacement settings has not been closely investigated. Furthermore, it remains unclear whether and how HRVs in these contexts are tied directly to displacement circumstances or other marginalizing factors affecting local migrant and minority populations generally.MethodsWe investigated these questions using novel survey data from 577 women at the northern Thai-Myanmar border, where thousands of people have fled conflict in Shan State, Myanmar, for refuge in a range of precarious settings in Thailand, including unofficial refugee camps, villages, and worksites. We compared HRV exposures by ethnicity, country of birth, legal documentation, and residential setting. We then analyzed perinatal outcomes associated with HRV frequency, timing, and type.ResultsBirth in Myanmar, and ethnic minority and precarious legal status more broadly, predicted higher HRV prevalence. HRV frequency significantly predicted unmet antenatal care and lower birth weight, along with HRVs related to labor exploitation and violence or conflict. HRVs timed closer to pregnancies were more adversely associated with perinatal outcomes. Resource/property deprivation was the strongest predictor of pregnancy complications.ConclusionsHuman rights must be urgently attended to, through expanded HRV screenings and responsive care, and policy changes to further protect migrant workers, displaced persons, and others in precarious legal status situations.

Barriers and facilitators to breastfeeding support practices in a neonatal intensive care unit in Colombia.

Objective.To assess breastfeeding support practices and related barriers and facilitators in a large Intensive Care Unit, Neonatal (NICU) in Medellín, Colombia, as part of a broader quality improvement initiative to enhance breastfeeding support.Methods.A mixed-methods descriptive design was used to collect data on care practices and outcomes related to NICU breastfeeding support. Data sources included the Neo-BFHI’s self-assessment questionnaire of breastfeeding policies and practices, clinical observations, and a retrospective review of 51 patient charts.Results.Of the 51 charts reviewed, 98% of the infants received breastmilk during their hospitalization but the majority (84%) also received formula and only 8% of infants were exclusively breastfed at the time of NICU discharge. All NICU staff received education on mother and baby-friendly care, and the unit complied with the International Code of Marketing of Breast-milk substitutes. However, resources to support lactation (e.g., access to breastfeeding specialists, breast pumps, written teaching materials for parents) were limited, and infants were only allowed to consume milk expressed within the hospital. Mother-infant separation, as well as staff beliefs and care routines, also limited important breastfeeding support practices such as skin-to-skin care and early initiation of direct breastfeeding.Conclusion.The self-assessment questionnaire and observations revealed a high value for breastfeeding and a family-centered approach to care in the NICU. Key challenges to sustaining breastfeeding in the NICU included a lack of facilities for supporting parental presence, barriers to expression and provision of mother’s milk, and a high rate of bottle-feeding with formula.

Abstract P203: Assessing Sexual Dysfunction Among Stroke Survivors and Barriers to Address This Issue by Healthcare Providers at a Latin American Reference Hospital

Background: Sexual dysfunction affects at least one half of patients after a stroke. Problems related to sexual function are rarely assessed or addressed by physicians. Objective: To determine the frequency and factors associated with sexual dysfunction among stroke survivors and self-reported barriers of physicians to discuss sexual dysfunction during regular consultation. Methods: We administered a questionnaire to a cross-sectional sample of stroke survivors to assess the frequency and factors associated with sexual dysfunction and the aspects of sexuality most commonly affected by stroke. A qualitative approach was used to determine the willingness to address sexual issues and related barriers among physicians participating in the study. Results: Among 150 patients, sexual dysfunction was identified in 89 (59%). Only 10% self-reported their sexual function as optimal. Markedly decreased frequency of sexual encounters (49%) and markedly decreased sexual desire (33%) were the aspects of sexual function most commonly reported by patients after a stroke. Fear of having a new stroke [OR:3.2, 95% CI (1.5 – 6.3)], depression [OR:2.1, 95% CI (1.0– 4.3)], and self-perception of having impaired motor function [OR:2.5, 95% CI (1.2 – 5.0)] were significantly associated with sexual dysfunction. In the qualitative assessment of physicians (N= 15), when asked how often they addressed sexual aspects during regular consultation with a stroke survivor, none answered “very often”, and only 8 (51%) answered “sometimes”. At the end of the study, 10 (66%) physicians verbalized the perception that addressing this issue encouraged their patents to be more open to personal concerns and prompted a stronger doctor-patient relationship. Conclusion: Sexual dysfunction affected more than a half of stroke survivors, and was significantly associated with depression, fear of having a new stroke, and with the self-perception of impaired motor function. Addressing sexual issues during the regular consult by physicians was infrequent. Barriers reported by physicians included limited time during regular consultation and the belief that this issue should be addressed under the scope of other specialties.

Exploring Barriers to Effective Implementation of Public Health Measures for Prevention and Control of COVID-19 Pandemic in Gamo Zone of Southern Ethiopia: Using a Modified Tanahashi Model.

BackgroundSince the occurrence of the COVID-19 pandemic, different public health measures have been implemented to prevent and control the further spread of the disease. However, barriers that influence the effective implementation of public health measures were not explore in Ethiopia especially in study Area. Therefore, this study tried to fill this gap by exploring the barriers to effective implementation of public health measures for prevention and control of the COVID-19 pandemic in the Gamo Zone of southern Ethiopia.MethodsThe study employed a qualitative study with a phenomenology approach among purposely selected 30 individuals in the community and selected institutions. Key informant interview was used to collect the data. The data were transcribed verbatim and translated into the English language. The transcribed data were read several times to clearly understand the content for further analysis. The analysis of the data was conducted based on the modified Tanahashi framework.ResultsThe study identified different barriers under five main themes: accessibility, acceptability, availability, contact and use, and effective implementation of public health measures related to barriers. The main barriers to effective implementation of public health measures were resistance to change, negligence, lack of community engagement, insufficient training for front line workers, poor supportive supervision, poor law enforcement, and lack of continuous community awareness creation. Beside, acceptability related barriers like cultural and religious norms and availability related barriers like shortage of personal protective equipment and shortage of skilled health professional have also lion share barriers for implementation of the public health measures.ConclusionThe study identified different personal, institutional, and societal level barriers for effective implementation of public health measures for the COVID-19 pandemic. Therefore, proper and targeted continuous community awareness creation with further mandatory law enforcement activities should be implemented by the concerned bodies to mitigate individual and societal level barriers. In addition, the government with relevant stakeholders should give due attention to equip and protect the frontline professionals by availing the necessary logistic and provision of continuous capacity-building activities.

Knowledge management for innovation in agri-food systems: a conceptual framework

ABSTRACT Knowledge is a critical enabling factor for healthy agri-food innovation systems (AIS). AIS and related knowledge management (KM) frameworks face significant implementation challenges. We review applications of KM to AIS, the current state of the art and shortcomings and present a new KM framework, Agricultural Knowledge Management for Innovation (AKM4I). Previous agricultural KM frameworks do not integrate innovation pragmatically, use linear, reductionist, top-down pathways to innovation, and do not explicitly incorporate issues of power, politics, ownership, and trust when combining scientific and local knowledge across multiple stakeholders. The AKM4I framework addresses systemic interactions favouring innovation outcomes by formalising flows and management of information and knowledge between diverse sets of stakeholders; and explicitly considering previously unresolved practical and relational barriers aiming to facilitate more equitable, rapidly evolving, and actionable knowledge generation and management for innovation and transformational change. An agricultural case study serves as an example of the implementation of AKM4I.

The systematic development of a mobile phone–delivered brief intervention for hazardous drinking in India

BackgroundThe treatment gap for alcohol use disorders (AUD) in India is the highest among all mental health and substance use disorders. Despite evidence of the cost effectiveness of brief interventions (BIs) for hazardous drinking, implementation in low- and middle-income countries (LMICs) is rare due to several human resource–related barriers. This paper describes the processes and outputs of a study aimed at systematically developing a mobile phone–delivered BI to overcome such barriers. MethodsThis is a mixed methods study with four steps: (1) Review of existing relevant evidence base by extracting data from studies cited in two recent, relevant and high-quality systematic reviews; (2) In-depth interviews (IDIs) with 11 national experts in addictions research and practice, and 22 hazardous drinkers; (3) Delphi survey (2 rounds) to identify components for the intervention package through consensus building; and (4) Content and intervention development workshops with a range of stakeholders to develop the intervention package. ResultsThe research team sourced 72 journal articles from two selected systematic reviews. Key content areas extracted from the studies included facts and statistics about health related to drinking behavior, self-reflection, goal-setting messages, motivational messages, and skills to manage risky situations. The IDIs with experts and hazardous drinkers endorsed most of these content areas as well. The Delphi survey achieved consensus on 19 content areas, which included targeted recommendations, personalized feedback and information, goal management, and coping skills. The content and intervention development workshops resulted in an intervention package delivered over 8 weeks, with the following seven themes guiding the content of the weekly messages: safe drinking/health education, alcohol reduction, drinking and risk management, drinking alternatives, situational content, urge management, and maintenance and relapse prevention. ConclusionThe research team designed this study to consider contextual factors while developing the intervention, which is important to ensure acceptability and feasibility of the intervention. Interestingly, the contextually informed intervention components had several commonalities with BIs developed and tested in high-income countries.

Implementation Barriers for Practicing Continuous Kangaroo Mother Care from the Perspective of Neonatologists and Nurses.

Introduction: Kangaroo mother care (KMC), as a complement to incubator care, is one of the ten recommendations of the World Health Organization (WHO) for the care of preterm infants. The KMC stabilizes the heart rate, improves oxygen saturation, makes weight gain better, and reduces crying in the infant. In order to launch KMC unit, the barriers for implementing this type of care should be recognized. Methods: This qualitative research was conducted using a focus group discussion and individual semi-structured interview with nurses, doctors, executive and management staff of a neonatal unit of a third level teaching hospital in Tabriz, northwest Iran. The participants were selected using purposeful sampling. Content analysis was used for analyzing data. Data were analyzed by MAXQDA 10 software. Results: After analyzing data, four main themes were extracted including mother-related barriers, father-related barriers, physician- related barriers, and system-related barriers. Conclusion: Based on the findings of the research, it seems that in order to facilitate practicing continuous KMC, much emphasis should be placed on training the parents and health care providers. Furthermore, in some cases, reforming the payment system for physicians, providing an instruction for performing continuous KMC, and continuous assessment of hospitals annually are necessary.