Identifying the facilitators and barriers to the use of postnatal care services by postpartum mothers who cannot care for their infants

Abstract

Objective

The public postpartum care services (sango kea jigyou), was designed for use by mothers and their babies and excluded the use by only mothers. However, over time the Japanese government began to encourage municipalities to allow mothers exclusive use of the services. Unfortunately, this service has not been widely implemented. Therefor the purpose of this study was to identify facilitators and barriers to implementing the public postpartum care services exclusively for mothers.

Methods

This was a qualitative descriptive study. Participants were recruited from directors of midwifery birth centers and nurse managers of obstetrics and gynecology at postpartum care service facilities commissioned by the Tokyo Metropolitan Government. They all had experience accepting users of the postpartum care services exclusively for mothers. Semi-structured interviews provided data and were analyzed based on the Consolidated Framework for Implementation Research (CFIR).

Results

Participants (N=6) were from midwifery birth centers. Nine facilitators and seven barriers were identified across the four domains and ten constructs of CFIR. Facilitators related to the characteristics of the ‘innovation’ included the fact that “financial aid reduces the economic burden on users compared to other support methods.” Barriers included “the use of postpartum care services exclusively for mothers does not meet the usage criteria of municipalities.” Facilitators related to the ‘outer setting’ included “close coordination with municipalities on a daily basis,” while barriers included “the lack of a system to support mothers who cannot care for their infants with diverse needs through multidisciplinary teams”. Facilitators related to the ‘inner setting’ included “providing care that respects the diverse needs of mothers.” ‘Individual-level’ facilitators included “midwives at postpartum care service facilities understand the purpose of related laws and policies and have the ability to negotiate with municipalities,” while barriers included “feelings such as not knowing what to do during support arise.”

Conclusion

Nine facilitators and seven barriers were identified across the four domains and ten constructs of CFIR. In order to comprehensively identify facilitators and barriers, it is necessary to also survey users and stakeholders.