Developing scalable strategies for early essential newborn care: A network-driven qualitative analysis

Abstract

Background

The World Health Organization's early essential newborn care package is an evidence-based intervention proven to reduce neonatal mortality and improve maternal-newborn outcomes. Nevertheless, a significant evidence-practice gap hinders its implementation in the real world.

Purpose

We aimed to demonstrate the application of two analytical approaches to characterize early essential newborn care implementation in China, to identify barriers and facilitators influencing early essential newborn care implementation, and to propose possible strategies for its effective scaling-up and promotion.

Methods

In this descriptive qualitative study, we performed semi-structured interviews with 33 healthcare professionals from six tertiary hospitals in China. Data were analyzed through deductive thematic coding based on the consolidated framework for implementation research, followed by computational network analysis to examine the interactions among these factors and identify pivotal implementation strategies.

Results

We identified a comprehensive set of 11 barriers and 39 facilitators associated with early essential newborn care implementation across all five domains in the consolidated framework for implementation research. The prominent barriers included safety concerns among healthcare providers, lack of unified implementation standards, resource limitations (staffing and equipment), and incompatibility with existing workflows. The key facilitators comprised knowledge acquisition, positive belief changes, leadership support, and organizational support system. Correspondingly, four key strategies were developed: initial implementation of early essential newborn care, leadership support, unified standards for implementation, and feedback & quality control.

Conclusions

The implementation of early essential newborn care is shaped by a complex and interrelated set of determinants. To move from insight to action, this study pinpoints four high-leverage strategies: initiating early essential newborn care, securing leadership support, establishing unified standards, and implementing continuous feedback & quality control. These strategies provide a practical, adaptable framework to overcome implementation challenges, scale up effective care, and ultimately improve outcomes for newborns and mothers.

Study registration

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