NURSE-DRIVEN PATHWAYS TO ENHANCING KANGAROO MOTHER CARE: A SYSTEMATIC REVIEW OF KNOWLEDGE, FACILITY DYNAMICS, CULTURAL BARRIERS, AND COMMUNITY INTEGRATION

Abstract Background: Kangaroo mother care (KMC) is a proven, low-cost intervention for improving outcomes in preterm and low-birth-weight (LBW) infants. It involves skin-to-skin contact, exclusive breastfeeding, and early discharge with follow-up. Despite global recommendations, KMC implementation remains inconsistent, particularly in resource-limited settings. This systematic review aimed to synthesize current evidence on the knowledge, practices, barriers, and facilitators affecting KMC delivery, with emphasis on the role of neonatal nurses and system-level factors. Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies published between 2002 and 2024. Inclusion criteria focused on original studies examining KMC-related knowledge, implementation strategies, outcomes, and nurse education. Ten studies were included in the review, encompassing cross-sectional surveys, randomized trials, and qualitative research. Findings were thematically synthesized and supported by additional evidence from seven key studies. Results: The review identified significant variability in nurses’ knowledge and confidence regarding KMC. Barriers included insufficient staff training, lack of institutional policies, and maternal hesitation influenced by sociocultural norms. Educational interventions improved nurses’ competencies and attitudes toward family-centered care. Community-initiated KMC models, as demonstrated in large-scale randomized trials, effectively reduced neonatal mortality but required structured follow-up and family support. Contextual challenges such as stigma, resource limitations, and communication gaps were also prevalent. Studies emphasized that provider encouragement and culturally adapted strategies enhance maternal engagement and continuity of care. Conclusion: KMC implementation is a multifactorial process influenced by provider preparedness, institutional readiness, and community dynamics. Strengthening nurse education, developing clear protocols, and fostering family involvement are critical for sustainable KMC adoption. A coordinated approach involving health systems and communities is essential to improving neonatal survival and bridging the gap between evidence and practice.