1. KANGAROO MOTHER CARE IN SWEDEN – Results of a trial on facilitation support for guideline implementation Lars Wallin RN, PhD Women health and pediatric division Uppsala University Hospital KU05 Melbourne

2. Lars Wallin KU05 Aim of the study  To investigate the effect of external facilitation in the implementation of KMC guidelines on patient outcomes

3. Lars Wallin KU05 Intervention I: KMC guidelines  Continuous and prolonged skin-to-skin contact between the parents and the infant  Promotion of breastfeeding  Supporting the family  Humanization of neonatal care WHO 2003

4. Lars Wallin KU05 Intervention II: Facilitation  Guiding model from Royal College of Nursing Institute (UK)  Appointed role  Helping and enabling  Support change and learning  Flexible structure and focus Harvey et al, Journal of Advanced Nursing, 2002

5. Lars Wallin KU05 Study overview Intervention 2 sites Control 2 sites Dissemination of KMC guidelines – all units Start of group focused facilitation – intervention Pre-intervention 6 months Intervention 8 months Post-intervention 6 months End of facilitation Start of Data collection April 2001 Participants recruited throughout the whole study period November 2002 447 infants/368 mothers

6. Lars Wallin KU05 Patient outcomes  duration skin-to-skin  first time skin–to-skin  length of stay  infant growth  incidence of breastfeeding  parental satisfaction with care  parental experience of interaction with their infant  parental stress

7. Lars Wallin KU05 Skin-to-skin contact all study phases Facilitation blue and green

8. Lars Wallin KU05 Effects (after accounting for covariates)  Guidelines1.370.0003  Facilitation0.970.821  “Post-facilitation”0.990.928  Guidelines + facilitation1.340.010 Multiplicative effect P-value

9. Lars Wallin KU05 Skin-to-skin contact all study phases “Co-care” blue and red

10. Lars Wallin KU05 Interaction effect guidelines and co-care  Because of the steep increase of the time s-t-s in units with “co-care” we developed a model with interaction effects  Guidelines without co-care 1.150.225  Guidelines with co-care 1.510.018 Multiplicative effect P-value

11. Lars Wallin KU05 Conclusion  Guidelines increased duration skin-to-skin  Facilitation no additional effect  Only two units continue to improve during post- intervention - the “co-care” units with best facilities for parents  Guidelines and unit design prominent impacting factors on time skin-to-skin

12. Lars Wallin KU05 Context measurement Intervention 2 sites Control 2 sites QWC 2001 Baseline 1 6 months Baseline 2 8 months Baseline 3 6 months QWC 2002 Focus groups

13. Lars Wallin KU05 Skin-to-skin contact all study phases “Co-care” blue and red

14. Lars Wallin KU05 Outcomes on each unit 2001 and 2002

15. Lars Wallin KU05 Unit C (control) A change team was established late. No significant activities were carried out during the study period.