Healthcare workers’ views on the use of continuous positive airway pressure (CPAP) in neonates: a qualitative study in Andhra Pradesh, India

Dewez, Juan, Chellani, H, Nangia, S, Metsis, Katrin, Smith, Helen ORCID: https://orcid.org/0000-0002-6252-3793, Mathai, Matthews ORCID: https://orcid.org/0000-0002-7352-9330 and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2018) 'Healthcare workers’ views on the use of continuous positive airway pressure (CPAP) in neonates: a qualitative study in Andhra Pradesh, India'. BMC Pediatrics, Vol 18, p. 347.

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Abstract

Background
Continuous Positive Airway Pressure (CPAP) is a form of non-invasive ventilatory support which is increasingly used in low- and middle-income countries to treat neonates with acute respiratory distress. However, it may be harmful if used incorrectly. We aimed to explore the experiences of doctors and nurses using CPAP in neonatal units in India and their views on enablers and barriers to implementation of CPAP.
Methods
Participants from 15 neonatal units across Andhra Pradesh were identified through purposive sampling. Eighteen in-depth interviews (IDI) with doctors and eight focus group discussions (FGD) with 51 nurses were conducted. Data were analysed thematically using the framework approach.
Results
Common structural factors that limit the use of CPAP include shortages of staff, consumables and equipment, and problems with regard to the organisation of neonatal units in both district hospitals and medical colleges. This meant that CPAP was often not available for babies who were identified to need CPAP, or that CPAP use was not perceived to be of the highest quality. Providing care under constrained circumstances left staff feeling powerless to provide good quality care for neonates with acute respiratory distress. Despite this, staff were enthusiastic about the use of CPAP and its potential to save lives. CPAP use was mostly perceived as technically easier to provide than ventilation and allowed nurses to provide advanced neonatal care, independently of doctors.
Conclusions
Doctors and nurses embraced CPAP use but identified barriers to implementation which will need to be addressed in order not to impact on safety and quality of care. Ensuring a supportive and enabling environment is in place will be crucial if CPAP is to be scaled-up more widely.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > W 21.5 Allied health personnel. Allied health professions WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services. WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WF Respiratory System > WF 100 General works WF Respiratory System > WF 20 Research (General) WS Pediatrics > WS 100 General works WS Pediatrics > WS 20 Research (General)
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12887-018-1311-8
Depositing User:	Stacy Murtagh
Date Deposited:	19 Nov 2018 11:15
Last Modified:	22 Aug 2019 12:43
URI:	https://archive.lstmed.ac.uk/id/eprint/9636

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