Table 3.
A summary of the seven constructs and their corresponding narratives
| Construct | Construct description | Summary of narrative |
|---|---|---|
| Affective attitude | The healthcare workers’ and caregivers’ feelings towards initiating immediate CPAP in the delivery room | Mothers and caregivers |
| Perceived that Immediate CPAP helps babies breathe more effectively | ||
| Observed noticeable differences in outcomes between infants who received immediate CPAP and those who did not | ||
| Valued the urgent medical attention provided through immediate CPAP | ||
| Suggested that acceptability could be enhanced through provision of clear and timely information | ||
| Healthcare workers: | ||
| Expressed overwhelmingly positive views on the role of immediate CPAP in improve the care of preterm infants | ||
| Perceived effectiveness | The extent to which the immediate CPAP is perceived as likely to achieve its purpose | Healthcare Workers |
| Based on their experiences managing RDS in preterm infants, healthcare workers perceived immediate CPAP as effective in reducing the severity | ||
| Viewed immediate CPAP as a critical therapy during inter-facility referral, especially in cases of delay, thereby potentially preventing infant deaths | ||
| Acknowledged that while immediate CPAP does not prevent RDS, it mitigates its severity | ||
| Described immediate CPAP as a prophylactic measure against unpredictable breathing patterns in preterm infants | ||
| Perceived immediate CPAP as contributing to shorter hospital stays, both in high dependency units and on CPAP support | ||
| Mothers and Caregivers | ||
| Perceived immediate CPAP as aiding in the expansion of premature infants’ lungs to facilitate oxygen delivery | ||
| Believed it increases the infant’s chances of survival, particularly during intra-facility transfers or inter-facility referrals | ||
| Burden | The perceived amount of effort required to participate in initiating immediate CPAP | Healthcare Workers |
| Perceived that immediate CPAP can be initiated successfully with a committed neonatal team | ||
| Believed initiation within 15 min is feasible with a multidisciplinary team working in coordination | ||
| Reported that adequate staffing is essential to initiate CPAP within 15 min | ||
| Emphasized the importance of maternal involvement and cooperation for successful immediate CPAP | ||
| Expressed concerns about competing responsibilities, limited staffing, and increased task burden | ||
| Highlighted the need for additional CPAP machines (e.g., in cases of twin deliveries) to ensure timely initiation | ||
| Opportunity costs | The extent to which benefits, advantages, or values must be sacrificed to implement immediate CPAP | Healthcare workers |
| In contexts with limited human resources, health workers reported being forced to choose between attending to the mother or the infant. For midwives, the mother is typically prioritized | ||
| Ethicality | The extent to which immediate CPAP was perceived to be a good fit with the mothers’ value system | Cultural Beliefs |
| Community members associated oxygen therapy with severe illness, impending death, or death itself | ||
| Some mothers believed that oxygen use could harm or kill their baby | ||
| In certain cultures, it is considered inappropriate to place newborn twins on medical equipment | ||
| Religious Beliefs | ||
| Some religious groups rejected medical interventions, believing that divine intervention alone should be relied upon | ||
| Certain religious leaders perceived the initiation of immediate CPAP as a form of spiritual initiation or cult practice | ||
| Fear and Misinformation | ||
| Participants expressed fear and uncertainty related to the use of new or unfamiliar interventions, such as immediate CPAP | ||
| Mitigation Strategy | ||
| Participants emphasized that these concerns could be addressed through in-depth and timely sensitisation of both users and community members, highlighting the purpose of the intervention and its benefits for infant survival | ||
| Intervention coherence | The extent to which the participants understand immediate CPAP, and how it works | Healthcare Workers |
| Demonstrated a clear understanding of how CPAP, including immediate CPAP, functions in the management of RDS | ||
| Mothers and Caregivers | ||
| Showed a good understanding of how CPAP and immediate CPAP support infant breathing | ||
| Self-efficacy | The participants’ confidence in their ability to perform the behaviours necessary to participate in immediate CPAP | Healthcare workers: |
| Reported that effective participation in the implementation of immediate CPAP requires adequate training, sufficient staffing, and the availability of necessary equipment |