From: Kangaroo mother care: using formative research to design an acceptable community intervention
Issues | Role of formative Research in Shaping Intervention Package for the RCT |
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How long to practice KMC and for how many days | Scientific guidance on optimal duration of practicing KMC per day (in hours) and the total duration (in days) was lacking. We advised mothers to give KMC, preferably for 24Â h in a day and continue giving till 28Â days of infant age or till the baby wriggles out (whichever was earlier). Both these suggestions emerged feasible and acceptable in the formative research. These findings served as an input in the main RCT |
Position of mother in SSC | Supine and semi-reclining positions were most comfortable and preferred. The same were advised in the main trial |
Use of Binders | Women were not comfortable or confident moving around or doing household chores, with baby in SSC supported by binders, feared that baby will fall. Binders therefore, were decided to be provided to only those who ask for them |
Use of Diapers | Diapers were considered unhygienic and thought to cause skin rash. Also, it was believed that they increase the gap between baby’s legs leading to deformity. Therefore, it was planned to offer only to those who asked for. |
Personnel to deliver the intervention | SSC initiation and support for initial few days required skilled counselling, effective demonstration, persistent encouragement, empathy and problem solving ability to bring about behaviour change activation. ANM like workers, with higher education and skills were considered appropriate for initiation; ASHAs were able to support mothers during follow up visits |
Frequency of visit | Frequent visits needed initially, could be reduced later. Substantial support and encouragement needed during first 3 to 4Â days. Less frequent visits needed subsequently once the mother was comfortable doing KMC. |
Weight cut off for enrolment | Babies with birth weight ≥ 1500 to ≤2250 g were planned to be included in the study, as babies weighing > 2250 g did not stay in SSC for more than 4 to 5 days (wriggled out earlier) and those weighing < 1500 g required hospital care. |
Age cut off for enrolment | Very early enrolment would not be feasible for facility births. A window period of 72Â h of birth was considered feasible to initiate KMC at home |
Involvement of male members in providing KMC to the baby | Male family members participated enthusiastically in providing SSC; they were planned to be involved from the outset in the RCT |