Table 2.

Matrix of enablers and barriers to KMC from the mother, father, and family perspective

	The Intervention				Health System	Broad Context
	Buy-in and Bonding	Social Support	Time	Medical Concerns	Access to Care	Cultural Norms
Barriers	KMC felt forced · Were unaware of the benefits of KMC · Were expected to perform KMC with little or no instruction · Could not see newborn during KMC · Did not feel a bond with the infant · Perceived newborn did not enjoy KMC	Support from Society · Fear, guilt doing KMC publically · Felt KMC was role of mother · Mothers did not want father to perform KMC	· Caregivers unable to devote time · Other responsibilities at home or work interfered · Mothers lonely and depressed in KMC ward · Time needed to commute from home to hospital was too much	Mothers · Fatigue · Postpartum depression · Pain hindered KMC, particularly after a C-section · Discomfort sleeping upright	Financing · Cost associated with travel, food, lodging, parking, clinical fees · Lack of transport and distance to facility	Traditional Newborn Care · Infants traditionally carried on back, thus carrying on the front seemed odd · Bathing practices interfered · If breast feeding not pursued KMC less likely to continue · Considered unclean where diapers not used Gender Roles Stigma
		Support from HCWs · Did not respect family privacy · Unsupportive, loud, uncaring			Service Delivery · Lack of privacy · Lack of necessary resources
	Stigma · Mothers reported shame of having a preterm infant · Caregivers lied about carrying a newborn on their chest · Others presumed the newborn was ill or deformed	Support from Family · Mothers-in-law and grandmothers did not approve · Bad attitudes and peer pressure negatively influenced desire to perform KMC
Enablers	Benefits For Newborns · Slept longer, less anxious, happier, more willing to feed	Support from Society · Societal acceptance of paternal involvement	· Parents preferred to practice KMC at home than at the facility to at tend to other responsibilities · Unlimited visitation hours at health facility	Mothers · KMC helped mother’s recover from post-partum depression · KMC helped to relieve stress and promote emotional well-being	Financing · Belief that KMC cut down hospital bills due to early discharge · Assumed to be a cheaper than incubator care · Parents more likely to stay if services were free Service Delivery · Private, quiet spaces for KMC	Gender Roles · Normalization of paternal involved in child care
	Benefits For Caregivers · KMC was calming, relaxing, comforting, natural, instinctive, secure, logical, healing · Created a family bond, inspired caregiver confidence · Sped emotional and physical recovery of mother · Made caregivers feel useful	Support from HCWs · Mothers less apprehensive to practice KMC. Best results with continuous training and support Support from Family · Grandmothers, sisters, others helping with chores increased uptake and duration of KMC · Paternal support crucial to success of KMC, they alleviate workload, support, encourage, increase mother’s confidence · More likely to understand and respond well if mother explained KMC