Title : Feasibility study on parental involvement in facility-based neonatal care in Pakistan
Abstract:
Aims and Objective: Neonatal care within health facilities is primarily provided by healthcare professionals (HP), often limiting direct parental involvement. This separation may adversely affect both infant outcomes and parental emotional well-being. This study aimed to assess the feasibility and acceptability of actively engaging parents in neonatal units (NNU) within the public sector.
Methods: A two-phase sequential mixed-methods feasibility study was conducted in a public-sector neonatal unit. The ethics approaval was obtained from Pakistan National Bioethics Committee (NBC-No.4-87/NBC-824/22/646) and Liverpool School of Tropical Medicine (LSTM-22-018). Phase 1, intervention was developed through qualitative interviews, observations, and consensus exercise using nominal group technique. In Phase 2, a total of 65 mother-baby pairs (Pte-intervention cohort, n= 30, post-intervention cohort n= 35), with neonates admitted for over seven days, were recruited. In both cohorts, parental psychological well-being was assessed using the Parental Stress Scale (PSS) at recruitment and discharge, and the Edinburgh Postnatal Depression Scale (EPDS) at 6-12 weeks post-discharge. Following completion of phase 1 and the pre-intervention cohort, intervention training was delivered to HP (n=15). Culturally adapted easy to read educational booklets in Sindhi and Urdu were provided to parents and their content was explained by clinical and research staff. As part of process evaluation of the intervention, semi-structured interviews were conducted with parents (n=17), family members (n=4), and HP (n=9) to explore experiences, acceptability, and perceived barriers.
Results: Framework analysis of qualitative interview, consensus meetings and data from observations informed the development of key components of intervention: parental engagement and education, improved parent and HP communication, and counseling skills training for HP. Preliminary findings from post-intervention cohort indicate that parents and HP found the intervention acceptable. Improved communication helped parents better understand their newborns' conditions. The booklet was particularly effective in reducing anxiety by clarifying the function of medical equipment and procedures. Participants recommended translating the booklet into more regional languages for wider reach. HP reported several challenges including language barriers , low parental health literacy, staff shortages , and time constraints.
An alarming 14 neonatal deaths (adverse events) were reported during the study period, highlighting the urgent need for improved post-discharge care and follow-up systems. Despite this all participants in both cohorts (except for those who experienced adverse events) completed all follow-up assessments, suggesting potential acceptability of the intervention.
Conclusion: The study supports the feasibility of implementing structured family-centered neonatal care in Pakistan. Parental interventions such as Kangaroo Mother Care, improved communication strategies and culturally adapted educational resources, may enhance neonatal outcomes. Continuous stakeholder engagement is essential for designing effective, context-sensitive interventions to reduce neonatal mortality.
