Table 3 Characteristics of selected studies

Medhanyie et al. 2019 [24]

Mixed-methods design

Ethopia and India

The aim was to develop and evaluate district-level models for scaling up Kangaroo Mother Care (KMC) in India and Ethopia that could achieve high-population coverage

Sampling of babies with birth weight under 2000 g

The findings identified barriers and contextual factors that affect implementation and utilization of KMC and design to scalable models to deliver KMC across the facility – community continuum. Implementation and evaluation of these models occurred at three levels: pre-KMC facility – to maximize the number of newborns getting to a facility that provides KMC; KMC facility-for initiation and maintenance of KMC, and post – KMC facility-for continuation of KMC at home

Barriers and enablers of SSC in mothers and nurses;

Counselling mothers on SSC and breastfeeding

Nuraini et al. 2019 [25]

Qualitative approach

Indonesia

The aim was to assess the skills of neonatal nurses one year after KMC training in the Pasar Rebo District General Hospital

Purposive sampling

A year after follow-up, there was neither KMC training nor a clear policy. It was mentioned that there was a standard operating procedure (SOP) of KMC and routine transfer of health personnel. However, there were no free KMC gowns to support the training

KMC training Policy and procedure regarding KMC

Sanchez-Espino et al. 2019 [12]

A two-step educational intervention

Mexico

The aim was to assess if a dual educational intervention in a rural hospital in Mexico could modify current practice and accomplish early SSC and early breastfeeding

Labour and birthing staff was sample in the first step. Second step was all pregnant women with uncomplicated pregnancies at 36 weeks’ of gestation

A total of 142 births met inclusion criteria. Of those, 109 received SSC and early breastfeeding. The average time of initiation of SSC in the first and last month of the study was 18.5 and 9.6 min of life. The average duration of SSC in the first and last month was 22 and 40.9 min. The average time of onset of breastfeeding in the first and last month was 48.9 and 34.4 min of life

Educate mothers, registered nurses and midwives on the benefits of early SSC and breastfeeding

Lui et al. 2020

A cross-sectional study

China

The aim was to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in neonatal intensive care units (NICUs)

Eight NICUs were purposively selected

135 preterm infants received KMC, 21,1% of all preterm infants were discharged. 94,8% of parents who participated in the survey indicated that KMC was positively accepted by their family members; 60,4% of the parents claimed that KMC could relieve anxiety, and 57,3% claimed it prompted more interactions with medical staff, while 69.8% suggested it increased parental confidence in their ability to care for their infants

Training and support implementation of SSC:

Information regarding the concept of SSC was given to promote parental knowledge

Maniago et al. 2020 [26]

Integrative literature review

14 diverse Countries (Australia, Brazil, Denmark, Norway, Sweden, Canada, USA, Estonia, Iran, Finland, Norway, Spain, and Sweden)

The aim of the ILR was to critically analyze data extracted from existing primary research and explore nurses’ barriers in implementing KMC in order to illustrate directions for future research. It also explored strategies to reduce barriers to KMC implementation

Purposive sampling of nurses

The search revealed 19 articles from diverse countries. Four main themes generated from the synthesis of the findings: (i) barriers related to nurses perspectives and emotion towards KMC, (ii) healthcare institution barriers towards KMC (iii) barriers related to parental experience in providing KMC and (iv) strategy to improve KMC implementation

Education of mothers on benefits of SSC and implementation of guidelines to promote SSC

Newborn and mothers’ needs Training program to reduce perceived barrier and increase SSC practice

WHO 2020 [3, 27]

Randomized controlled trial

South Asia and sub-Sub-Saharan Africa (Ghana, India, Malawi, Nigeria, and Tanzania)

The aim was to evaluate the safety and efficacy of continuous KMC initiated as soon as possible after birth compared with the current recommendation of initiating continuous KMC after stabilization in neonates with a birth weight between 1,0 and less then 1,8 kg

Eligible participants were randomly assigned to intervention and control group

The intervention resulted in an important enhancement of the LMIC settings in which mothers are not separated from their baby in neonatal intensive care units

Promotion and support for continuous SSC;

provision of health care for both mother and preterm infants;

promotion and support of breastfeeding

Almutairi. 2022 [28]

A cross-sectional correctional descriptive study

Saudi Arabia

The aim was to describe the nurses’ knowledge, education, belief/attitudes, and implementation of SSC as well as to determine any relationships between them

Convenience sampling

Findings showed that nurses had a moderate level of knowledge, positive attitudes/beliefs, moderate education, and moderate implementation levels. The findings also revealed a significant association between nurse’s knowledge, attitude/beliefs, education about SSC, and nurses’ perceptions towards SSC implementation in a tertiary hospital

SSC knowledge, attitudes, and belief;

SSC education;

SSC implementation

Fatma et al. 2022 [29]

A quasi-experimental design

Egypt

The aim was to evaluate the effect of a kangaroo care educational program for mothers on weight gain of premature neonates in neonatal intensive care units

Purposive sampling of 50 mothers of preterm infants

88% of mothers in the study had an unsatisfactory level of knowledge in the pre-educational program, while 96% of them had a satisfactory level of knowledge in the post-educational program. 64% of the mothers had incompetent practices in the pre-educational implementation, while 58% of them had competent practices in the post-educational program implementation

Identify the importance of KMC

Apply KMC steps

Apply daily routine care (umbilical cord care)

Muttau et al. 2022 [30]

Prospective descriptive study, using qualitative and quantitative methods

Zambia

The aim of the study was to describe the implementation of a KMC model among preterm infants and its impact on neonatal outcomes at a tertiary hospital in Lusaka, Zambia

None

A total of 573 neonates were enrolled into the study. 13 extremely low-weight preterm infants who were admitted to the KMC room graduated to Group A (1000 g-1499 g with a median weight gain of 500 g. Of the 419 very-low-weight neonates, 290 remained in Group A, while 129 improved to Group B (1500 g-24999 g) with a median weight gain of 280 g. Of the remaining 89 low-weight neonates, one regressed to Group A, while 77 remained in Group B, and 11 improved to group C (> 2500 g) with a median weight gain of 100 g

Benefits of KMC;

Appropriate KMC techniques;

Position of newborn during breastfeeding;

Importance of practicing good hygiene;

Individual support

Habte et al. 2023 [31]

Cross-sectional study

Southern Ethopia

The aim of the study was to assess the compliance of postnatal mothers toward World Health Organization-recommended elements of KMC in Southern Ethopia

Mothers who gave birth to preterm or low-birth-weight infants were purposively sampled, using a single population proportion formula with a margin error of 5% and a 95% confidence interval

The mean practice score of KMC item was 5.12 with 2 and 10 as the minimum and maximum item scores. Place of residence, mode of delivery, birth preparedness and complication readiness plan, maternal knowledge of KMC, and place of delivery were identified as significant predictors of compliance towards key elements of KMC

KMC technique practice;

Adequate exclusive breastfeeding;

Placing the baby in SSC position;

Maintaining good personal hygiene;

Observing the baby;

Gaining family support

Moran et al. 2023 [32]

A mixed-methods systematic review

High-income settings

The aim of this study was to explore the content, experiences and outcomes of an intervention designed to increase early SSC in high-income settings

A narrative synthesis used to synthesize both qualitative and quantitative findings was used

Database searches generated 1221 sources and two studies were identified via hand-search. Ten studies were included; (n = 7) were designed to improve SSC, following a caesarean section. The studies explored SSC prevalence and duration (n = 7), breastfeeding prevalence (n = 4), while six studies considered mothers and health professionals’ experiences of the intervention

PRECESS approach (Practice, Reflection, Education, and training, Combined with Ethnography for Sustainable Success) educational posters and weekly email reminders about the benefits and recommendations of SSC were distributed

Orientation training was provided to mothers regarding SSC

Samsidin et al. 2023 [17]

A quasi-experimental and longitudinal study with pre and post-intervention design

Malaysia

The aim of the study was to investigate the effects of a locally contextualized, structured kangaroo care education program on weight gain, breastfeeding rate, and length of hospitalization for premature infants

Forty-eight mother-infant dyads were purposively enrolled in the control and experimental groups

The kangaroo care hours performed by mothers at baseline in the experimental and control group was 4.12 and 0.55 h per week. At three months post-discharge, the experimental group had significantly higher weight gain, higher breastfeeding rates, and shorter lengths of hospitalization than the control group

Theoretical and practical demonstration of SSC practice;

Provision of educational materials, for example, pamphlets