Jun Liu's research while affiliated with Beijing Medical University and other places

Background Evidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. In this study, we used kangaroo mother care (KMC) as an example of an evidence-based neonatal intervention recently introduced in selected Chinese hospitals, to identify the factors that influenced its successful implementation. We also explored the utility of the PARIHS framework in China and investigated how important each of its constructs (evidence, context and facilitation) and sub-elements were perceived to be to successful implementation of EBIs in a Chinese setting. Method We conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from “low (weak)”, “moderate” or “high (strong)” highlighting the ones considered most influential for hospital level implementation by study participants. Results Using KMC as an example, our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level. Conclusion Based on our findings examining KMC implementation as a case example, the PARIHS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it’s sub-elements should be assessed and adapted to the implementation setting.

Objective To describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC project. Design A concurrent mixed-methods approach incorporating quantitative maternal questionnaires and qualitative semistructured interviews. Setting Four postnatal wards in level-III hospitals based in different provinces of Southeast and Northwest China. Participants All 752 mothers who provided intermittent KMC to their late preterm newborns in the four participating postnatal wards consented to participate in the study (quantitative component), as well as six nurses, two obstetricians and two mothers from two of the participating postnatal wards (qualitative component). Outcome measures Maternal KMC experiences during a hospital stay, patients’ perceptions of KMC initiation, processes, benefits and challenges. Results Most mothers had not heard of KMC before being introduced to it in the postnatal ward. On average, mothers and newborns stayed in postnatal wards for 3.6 days; during their stay, mothers provided an average of 3.5 KMC sessions, which is an average of 1.1 sessions a day. Each KMC session lasted an average of 68 min, though there was much variation in the length of a session. Common reasons given for discontinuing a KMC session included restroom use, infant crying and perceived time limitations. Some mothers would have preferred to provide KMC for longer periods of time and nurses encouraged this. Most mothers experienced no difficulty providing KMC, received support from family and medical staff and intended to continue with KMC postdischarge. Conclusion In order to improve the maternal experience of KMC, it is recommended that raising awareness of KMC should be included in antenatal care and after birth. Longer periods of KMC provision should be encouraged, greater privacy should be provided for mothers providing KMC in postnatal wards and family members should be encouraged to support KMC.

Background Evidence based interventions (EBIs) can improve patient care and outcomes. Understanding the process for successfully introducing and implementing EBIs can inform effective roll-out and scale up. The Promoting Action on Research Implementation in Health Services (PARIHS) framework can be used to evaluate and guide the introduction and implementation of EBIs. To gain an understanding of the utility of the PARIHS framework in China and investigate how important each of its constructs (evidence, context and facilitation) and sub-elements are perceived to be to successful implementation of EBIs in a Chinese setting, we used the framework to assess the implementation of an evidence-based neonatal intervention (kangaroo mother care, KMC) recently introduced in selected Chinese hospitals. Method We conducted clinical observations and semi-structured interviews with 10 physicians and 18 nurses in five tertiary hospitals implementing KMC. Interview questions were organized around issues including knowledge and beliefs, resources, culture, implementation readiness and climate. We used directed content analysis to analyze the interview transcript, amending the PARIHS framework to incorporate emerging sub-themes. We also rated the constructs and sub-elements on a continuum from “low (weak)”, “moderate” or “high (strong)” highlighting the ones considered most influential for hospital level implementation by study participants. Results Our finding suggest that clinical experience, culture, leadership, evaluation, and facilitation are highly influential sub-elements for EBI implementation in China. External evidence had a moderate impact, especially in the initial awareness raising stages of implementation and resources were also considered to be of moderate importance, although this may change as implementation progresses. Patient experience was not seen as a driver for implementation at hospital level. Conclusion The PHARIS framework can be a useful tool for planning and evaluating EBI implementation in China. However, it’s sub-elements should be assessed and adapted to the implementation setting.

Objective: To describe how mothers of late preterm infants experienced provision of intermittent kangaroo mother care (KMC) on four postnatal wards in different hospitals in China under a pilot KMC project. Methods: We used a concurrent mixed-methods approach incorporating quantitative and qualitative data. We collected quantitative data covering delivery and maternal experience of and attitude to KMC from 752 mothers who provided KMC to their late preterm newborns on the postnatal wards of four hospitals in different provinces of China. We gathered data from hospital records and maternal questionnaires. Qualitative data was collected from ten semi-structured interviews with nurses, obstetricians, and mothers from two of the participating postnatal wards. We used descriptive analysis for quantitative data and general inductive analysis for qualitative data. Results: Most mothers had not heard of KMC before being introduced to it on the postnatal ward. On average, mothers and newborns stayed on postnatal wards for 3.6 days: during their stay mothers provided an average of 3.5 KMC sessions, an average of 1.1 sessions a day. Each KMC session lasted an average of 68 minutes though there was much variation in length. Common reasons given for discontinuing a KMC session included restroom use, infant crying, and perceived time limitations. Some mothers would have preferred to provide KMC for longer periods of time and nurses encouraged this. Most mothers experienced no difficulty providing KMC, received support from family and medical staff and intended to continue KMC post discharge. Conclusion: In order to improve maternal experience of KMC it is recommended that awareness raising of KMC be included in antenatal care and after birth, longer periods of KMC provision be encouraged, greater privacy be provided for mothers providing KMC on postnatal wards and family members be encouraged to support KMC.

Background: Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn't adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. Methods: We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system's readiness and families' willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent- and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context. Results: Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents' resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. Conclusions: We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.

Background: China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China. Methods: Intermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the "KMC group", those who did not were enrolled in the "No KMC group". Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates. Results: Among the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 h before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR = 2.15 (95% CI 1.53, 3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR = 1.61 (95% CI 1.15, 2.25)), be exclusive breast milk feeding at follow-up (OR = 2.55 (95% CI 1.81, 3.61)), and use breastfeeding method at follow-up (OR = 2.09 (95% CI 1.44, 3.02)). Conclusions: Intermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.

Background Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn’t adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. Methods We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system’s readiness and families’ willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent- and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context. Results Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents’ resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. Conclusions We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.

Background Kangaroo mother care (KMC) has been proved to be a safe and cost-effective intervention for preterm babies. Despite this evidence and global guidelines promoting KMC, it has not been widely adopted in China. In this study, we aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. Methods We conducted clinical observation and semi-structured interviews in seven NICUs and postnatal wards housed in five hospitals from different provinces in China between August and September 2018. We conducted interviews with pediatricians, obstetricians, nurses and parents who performed KMC to understand their perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system’s readiness and families’ willingness to adopt KMC following its introduction in pilot hospitals. We coded data for emerging themes related to perceived barriers and facilitators of KMC adoption, specifically those unique in the Chinese context and less commonly reported in previous systematic reviews from other countries. Results Five hospitals were included for clinical observation and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with postpartum confinement (Zuo-yue-zi) and grandparents’ resistance, while strong family support enabled KMC adoption. Parents may feel anxious and guilty about having a preterm baby, this is a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded KMC implementation, and hospital-led supportive community and peer group contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. Conclusions Barriers and facilitators exist across cultural, hospital, parental and financial levels. While several factors were common in other study settings, there are also barriers and facilitators unique to Chinese context, e.g. concerns with postpartum confinement (Zuo-yue-zi), grandparents’ resistance and staff’s fear of nosocomial infection. We recommend interventions specificially targeting these barriers and facilitators including family and peer support for improved KMC adoption in China. We also recommend that specific barriers and challenges to KMC in particular settings be identified and be taken into account prior to KMC uptake in other settings.

Background Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn’t adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. Methods We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system’s readiness and families’ willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent- and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context. Results Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents’ resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. Conclusions We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.

Background China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate of babies born extremely or very preterm. However, there is limited evidence of intermittent KMC’s effect on exclusive breastfeeding in late preterm. Using hospital discharge and follow-up data collected from four postnatal wards, we investigated the association between intermittent KMC and breastfeeding practice for late preterm babies in China. Methods Intermittent KMC was recommended to the mothers of all preterm babies admitted between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the “KMC group”, those who did not in the “no-KMC group”. Basic maternal socio-demographic information was collected, feeding outcome and method were recorded daily whilst in hospital and a follow-up survey of feeding practice was conducted 42 days post-discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates. Results Among the 844 participants in the analysis, 627 (74.3%) chose to perform KMC. More mothers who provided KMC were exclusively breastmilk feeding their newborn in the 24 hours before discharge (54.6%) and at follow-up (57.3%), compared with mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the no-KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the no-KMC group, mothers who provided KMC were twice as likely to be providing their newborns with exclusive breastmilk feeding at discharge (OR=2.15 (1.53-3.02)), use breast feeding method at discharge (OR=1.61 (1.15-2.25)), provide exclusive breastmilk feeding at follow-up (OR=2.55 (1.81-3.61)), and use breast feeding method at follow-up (OR=2.09 (1.44-3.02)). Conclusions Intermittent KMC was associated with a nearly doubled increase in exclusive breastmilk feeding (outcome) and breast feeding (method) at both discharge and 42 days after discharge for late preterm babies. Intermittent KMC has the potential to increase exclusive breastfeeding rates amongst late preterm infants.