Barriers and enablers of community-based Kangaroo Mother Care (cKMC) practice: a mixed methods systematic review

Kangaroo Mother Care (KMC) is an essential practice that can save the lives of preterm and low birth weight neonates. However, there is limited implementation at home and in the community. This systematic review aims to identify and synthesise the barriers and enablers of KMC in home and community settings. A mixed-methods systematic review was conducted using the JBI Convergent Integrated Approach to investigate the barriers and enablers associated with the implementation of Community-based Kangaroo Mother Care (cKMC). The review included qualitative, quantitative, and mixed-methods studies, with all quantitative findings transformed into qualitative narratives through a process of data “qualitisation”, allowing for the integration of diverse forms of evidence into a cohesive thematic synthesis. A comprehensive search strategy was applied across eight electronic databases, covering literature published in English from January 2003 to July 2024. Study selection and methodological appraisal were conducted independently by two reviewers, with disagreements resolved through discussion with a third reviewer. The methodological quality of all included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) (Hong et al., Educ Info 34:285-91, 2018). Thirty-four studies met the inclusion criteria for this review. Key barriers to cKMC included environmental constraints, limited knowledge, modesty concerns, sociocultural attitudes, lack of family support, and absence of follow-up systems. Enablers included peer support, advocacy by elders, postpartum rest, and healthcare provider involvement. There is a limited body of high-quality evidence on the barriers and enablers of KMC in home and community settings. Tailored strategies addressing sociocultural, practical, and knowledge-related barriers are needed. Further research should focus on cKMC to develop effective and sustainable approaches that enhance KMC practices in the community and home environments, and further exploration is required on the role of healthcare workers in sustaining practice outside healthcare facility settings.