RT Journal Article SR Electronic T1 Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP e2100727 DO 10.9745/GHSP-D-21-00727 VO 10 IS 4 A1 Megan M. Lydon A1 Victoria Lwesha A1 Dyson Likomwa A1 Lydia Chimtembo A1 Tanya Guenther A1 Monica Longwe YR 2022 UL http://www.ghspjournal.org/content/10/4/e2100727.abstract AB Key FindingsThis analysis identified 3 major injunctive norms that influence behavior at the community, family, household, and individual levels, and have both positive and negative effects on parent engagement with kangaroo mother care (KMC) in Malawi.Proposed areas for intervention to promote KMC include (1) emphasizing the value of life and working to shift community attitudes about preterm infants, (2) encouraging family and community support systems, (3) highlighting the discrepancy between perceived and actual male KMC involvement, (4) sharing strategies that support collaborative participation in KMC among both parents, and (5) developing or strengthening efforts to provide economic relief to KMC parents.Key ImplicationsBecause KMC requires significant caregiver involvement, a well-informed, context-specific social behavior change strategy is critical to increasing uptake and continuation.Successful promotion efforts will build upon social norms that support KMC and aim to shift those that limit it, with actions focusing on multiple social levels.Introduction:Kangaroo mother care (KMC) is a critical strategy to care for preterm and low birth weight infants in resource-limited settings. Despite evidence of its effectiveness and low cost, coverage has remained low, largely due to sociocultural barriers. We aimed to better understand social norms and community perceptions of preterm infants and KMC (facility-initiated and community-continued) in Malawi, a country with a high preterm birth rate, to inform a pilot social and behavior change program.Methods:In this qualitative study, we conducted 11 focus group discussions and 20 in-depth interviews. Participants were identified through purposive and snowball sampling and included pregnant women, parents engaged in KMC, health workers, community members, and religious leaders. Audio recordings were transcribed and translated into English. An inductive thematic analysis was applied.Results:Our analysis revealed 3 key injunctive norms influencing KMC engagement in this setting: (1) a perception that although preterm infants are abnormal, they should still be cared for, (2) an understanding that men should provide for their families while women should care for their families, and (3) families and communities should support one another. These norms operated at the community, family, household, and individual levels. Community members enforced social norms but also offered social support. Family members supported KMC parents as well. Both KMC parents actively engaged in the practice; however, their interest in and ability to manage its demands were influenced by the prevailing social norms, their economic situation, family obligations, and the mother’s health status.Conclusion:KMC efforts can be strengthened by incorporating context-specific actions to bolster social norms that align with KMC and shift those that discourage it. Activities must include a focus on the community and family levels to engender meaningful change at the household level.