Family involvement along the care continuum for small and sick newborns – attitudes and skills of healthcare providers in Ghana

The high social and emotional burden on families with small or sick newborns necessitates family-focused care. Positive attitudes towards family involvement and skilled healthcare providers are crucial for improving the health and well-being of small/sick newborns and their families. While family systems care (FSC) has been explored and implemented in high-income countries, it is rarely reported in low- and middle-income countries. This study aims to assess knowledge, attitudes and skills of healthcare providers on FSC and the family care practices, interactions, and reciprocity in the provider-family relationship throughout the care continuum of sick/small infants and their families. A cross-sectional survey involved healthcare providers offering maternal and newborn care at secondary and primary-level facilities. Participants were sampled from one secondary-level hospital and 13 primary health facilities in the Hohoe Municipality of Ghana. The survey instruments included the standardized and validated instruments ‘Family Importance in Care - Nurses’ attitudes’ (FINC-NA) and ‘Family Nursing Practice Scale’ (FNPS), which measure healthcare providers’ attitudes and skills in working with families, alongside four open-ended questions. Quantitative data were analyzed using descriptive statistics, while answers to open-text components were categorized thematically. Overall, 143 healthcare providers, comprising nurses, midwives and physicians, participated in the study. The median score of FINC-NA was 93 (83–99), while the FNPS was 30 (24–35). Most healthcare providers had a positive attitude towards family involvement in care, whereas practice skills were moderate. From the open-ended questions, care providers’ perceptions and actions in relation to family care practices were communication difficulties, intra-family challenges and confidentiality concerns. They also reported reduced workload, stronger healthcare provider-family relationship and improved quality of care through increased family collaboration and support. Overall, healthcare providers valued family involvement in the care but had only moderate skills in working with them. Advocacy for the inclusion of family systems care in healthcare education, in-service training and policy development in Ghana is warranted. This will support healthcare providers to deliver high-quality care to families with small or sick newborns from pregnancy to post-discharge.