The role of implementation climate in shaping early essential newborn care practice: Insights from a multi-center cross-sectional study in China

by Hongxiao He, Jiahe Li, Junying Li, Hong Lu, Jie Lu, Linlin Cao, Luxia Gong, Ruyan Pang, Xiu Zhu

Background

The World Health Organization (WHO) recommends Early Essential Newborn Care (EENC) to improve newborn outcomes. However, uptake remains suboptimal in many low-resource settings. Organisational factors, such as implementation climate, are crucial but understudied in relation to EENC implementation.

Objective

To explore how implementation climate mediates the relationship between knowledge, attitudes, and EENC practices.

Design

Multi-site, cross-sectional study.

Setting

Twelve tertiary maternity hospitals in China (December 2022–April 2023).

Participants

433 nurse-midwives.

Methods

Validated questionnaires were use to assess knowledge, attitudes, practices, and perceived implementation climate related to EENC. Path analysis and logistic regression were employed to explore direct and indirect relationships.

Results

A total of 69.3% participants reported good EENC practice. Significant predictors included good knowledge (adjusted odds ratio [AOR] = 2.75; 95% confidence interval [CI]: 1.76–4.31), positive attitudes (AOR = 2.00; 95% CI: 1.17–3.41), in-service training (AOR = 1.88; 95% CI: 1.17–3.02), holding a middle leadership role (AOR = 2.24; 95% CI: 1.20–4.17), and perceived workload. Nurse-midwives who reported heavier workloads were 48% less likely to hold positive attitudes towards EENC (AOR = 0.52; 95% CI: 0.28–0.94), which subsequently affected their EENC practice. The mean score of implementation climate was moderately favorable (3.30 ± 0.77), with the lowest in the rewards domain (3.02 ± 1.11). A one-point increase in climate score was associated with significantly higher odds of a positive attitude (AOR = 4.56; 95% CI: 2.98–6.99). Implementation climate influenced EENC practice indirectly through attitudes (RMSEA = 0.039).

Conclusions

This study highlights the importance of both individual factors and organizational climate in shaping EENC practices. To improve EENC implementation, healthcare systems should prioritize enhancing the implementation climate through leadership support, establishing appropriate reward systems, and addressing workload challenges. Additionally, integrating EENC training into continuous professional development programs and strengthening support for mid-level leadership are key strategies.

Barriers and facilitators in implementing early essential newborn care of well‐born babies in low‐ and middle‐income countries: A mixed‐method systematic review

Abstract

Background

Evidences have demonstrated the effectiveness of early essential newborn care. However, the implementation of early essential newborn care is suboptimal. The aim is to identify and synthesise the barriers and facilitators impacting the implementation of early essential newborn care in low- and middle-income countries.

Data Sources

PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, CNKI, Wan Fang Data, SinoMed and Google Scholar.

Methods

Two authors independently screened, performed quality assessment using the Mixed Methods Appraisal Tool and extracted data. This review includes papers that reported the barriers and facilitators of implementing early essential newborn care in low- and middle-income countries from the view of healthcare providers. Barriers and facilitators were coded according to the consolidated framework for implementation research in a deductive way and then been inducted into five common themes. This review followed synthesis without meta-analysis reporting guideline.

Results

A total of 28 studies were included. Five inductive common themes influencing implementing early essential newborn care in low- and middle-income countries were system-level healthcare factors, healthcare providers’ knowledge and beliefs, the requirements of mothers or families, adapting to routine practice and the working climate of organisation.

Conclusion

The factors were from system level, facility level and individual level and were inducted into five themes. Based on this review, decision-makers could tailor implementing strategies to narrow the gap between the evidence and implementation.

Relevance to Clinical Practice

The study offers guidance for health professionals to identify barriers and facilitators in implementing early essential newborn care and make tailored strategies when implementing early essential newborn care.

Patient or Public Contribution

No patient or public contributions.