Table 2 Barriers and facilitators according to parents and healthcare providers in TDF domains.
Domain | Barriers | Facilitators |
|---|---|---|
Knowledge | H: Challenges in accurately informing hospital neonatology and nursing staff8 P: Lack of information about duration of treatment51 | H: Careful screening and selection of appropriate candidates for home PT38,41,44 P: Good parent education and availability of (written) information29,38,41,51 |
Skills | P: Difficulties with the equipment, such as struggling to put the eye mask on9,35,51 | H: An option for nurses who may be looking for additional ways to use their skills41 |
Social/professional and role and identity | H: Information dissemination and cultural change across a larger tertiary hospital8 P: Responsible for your own baby without constant medical supervision9 | H: Opportunity to offer additional support to a new family41 H: Opportunity to develop a bond with the family49 H: CHW perception of parental confidence in the provision of home PT49 P: Advice of the physician to start with home PT8 P: Nurse’s daily visit at home29,41,43,49 P: Daily contact with the nurse by phone call8,9 P: Support by midwives31 P: More comfortable contacting the hospital for advice if parents had concerns8,51 |
Beliefs about capabilities | H: Lack of confidence in CHW skills49 | H: Trusting parents38 H: Ensuring parents will cope with home PT38 |
Beliefs about consequences | H: Concerns about potential consequences of community-based care8 H: Concerns about safety38,42,45 H: Concerns about the reliability of home blood testing44 H: Concerns about lack of compliance38,45 H/P: Concerns about equipment failure or damage38,51 H: The sun is more effective42 H: Lack of monitoring38 H: The costs to set-up in the first place38 P: Increased work for mothers29 | H: Staff wellbeing38 H: Workload will decrease38,49 H: Decreased healthcare expenditure38 H: Reduced risks associated with inpatient care38 P: Hold and feed infant during PT at home43 P: Continuing breastfeeding37 |
Reinforcement | ||
Intentions | ||
Goals | H/P: Family centered care8,9,38 H/P: Parent empowerment38 H/P: Parent autonomy38 H/P: Better mother-child bonding8,9,35,42,51 H: Improving flow of patients38 | |
Memory, attention, and decision processes | ||
Environment context and resources | H: Difficulties with blood drawing at home29,44 H: Choosing the location for the therapy is a concern29 H: It is not possible to check bilirubin levels as recommended by guidelines31 H: Administrative difficulties44 H: Insurance reimbursement44,45 H/P: Distance from parental home to hospital35,38 H: Transportation of the PT device is difficult49 P: Having to stay indoors9 | H: Flexibility in the schedules of healthcare providers31,41 |
Social influences | H: Lack of use by colleagues44 | P: Desirable to have to people at home during PT51 |
Optimism | ||
Emotions | H: Fears that parents would not comply with PT38,44 H: Fears that parents would not apply eye shields44 H: Fears of overheating or dehydration44 H: Concerns about parental anxiety44 P: Parental stress51 P: Some parents felt more secure in hospital51 P: Insecure about handling and taking care for own newborn51 | H: Psychological wellbeing of parents: less traumatic, more relaxed, happier38 P: Hospitalization is less traumatic51 P: Lower stress levels of parents23,51 P: Parents felt secure51 |
Behavioral regulation |