Table 2 Barriers and facilitators according to parents and healthcare providers in TDF domains.

From: Home phototherapy for neonatal hyperbilirubinemia: a mixed methods systematic review and meta-analysis

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

P: Demonstration on how to use the equipment9,38

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

P: Equipment was easy to use9,34,51

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

P: Parental incapability to comply with instructions38,42

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

H/P: Reduced costs35,42,44

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

H: Getting well babies out of the hospital38,44

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

H/P: Home environment is good9,45,47,51

P: Freedom9,51

P: Maintaining routine at home9,51

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/P: Parental anxiety44,45,51

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

  
  1. P parents, H healthcare professionals, CHW community health workers, PT phototherapy.