Table 1 Overview of the study design

Intervention

Study design

Participatory action research

Before-after comparison of non-C-KMC and C-KMC neonates

Aim

To implement continuous KMC in the study setting and identify barriers / challenges to the implementation of C-KMC

To investigate the effectiveness of C-KMC

Hypothesis

Not applicable

Continuous KMC:

1. reduces the length of hospital stay of preterm neonates / neonates <2500g

2. increases the rate of exclusive breastfeeding at discharge

Study setting

Participants

• Mothers with preterm neonates

• Nurses and midwives

• Managers and health policy makers

• Preterm neonates

Sampling

• Purposive sampling

• Sample size: until data saturation is reached

• Consecutive sample (before and after C-KMC implementation)

• Sample size: 208 = 104 per group

Data collection tools

1. Interview guide (for focus group discussions and individual interviews)

2. Standardized progress-monitoring tool:

• Observations of service provision, care and records

• Interviews with health care providers (nurses, doctors, etc.)

Data collection sheet (questionnaire):

• Length of hospitalization (total and length of days in C-KMC)

• Feeding method(s) at discharge

• Other characteristics (e.g. gestational age and sex) – see Table 2 for details

Data collection process

• Focus group discussions (health care providers and managers) and individual interviews (mothers)

• Application of the progress-monitoring tool

Completion of the data collection sheet using data from the neonates’ medical file

Data analysis

• Qualitative content analysis

• Software: MAXQDA10

• Data with normal distribution: paired t-test; Pearson correlation coefficient; ANOVA

• Paired nominal data: McNemar’s test

• Software: SPSS version 24

Ethical considerations

Written consent from participants before interviews and focus groups

Consent from parents or hospital management to use data