Feasibility of implementing the General Movement Assessment in a Neonatal Intensive Care Unit in Malawi: a qualitative study of caregivers and healthcare worker experiences

Early identification of infants at risk of neurodevelopmental disability is increasingly becoming possible, through the use of novel early identification tools. However, in Malawi and other low-resource settings, there is a critical gap in the implementation of standardized early detection tools for infants at risk of cerebral palsy. In this study, we sought to explore healthcare workers' and caregivers' experiences in the Neonatal Intensive Care Unit at Queen Elizabeth Central Hospital regarding the General Movement Assessment to understand the best ways to implement the tool. A phenomenological qualitative design was used to explore caregivers’ and health workers' experiences. The sample size was guided by the principle of data saturation, ensuring that recruitment continued until no new information emerged. We conducted in-depth interviews to caregiver and healthcare workers using translated and piloted topic guides. Thematic analysis was used to analyse the data. The overarching themes were caregiver and healthcare worker support, health system barriers, limited awareness and inconsistent referral process, teamwork and stereotypical perceptions. These themes highlight key factors to consider before implementing standardized interventions. There is a need for structured staff training in early detection interventions, implementing caregiver engagement initiatives to strengthen awareness and participation, and to develop clear referral guidelines embedded with the current routines. Implementing these measures can effectively reduce the current gap and improve long-term outcomes for infants at risk of cerebral palsy.