Perceptions and Attitudes of Parents and Healthcare Professionals about the Option of Using Infant Massage in Neonatal Intensive Care Units

Background: Infant moderate pressure massage is an effective evidence-based intervention that counters the consequences of prematurity and exposure to the Neonatal Intensive Care Unit (NICU) environment. This touch-based therapy reduces physiological stress and improves physical, cognitive and neurological development in stable preterm and low birth weight (LBW) infants. Currently, little is known about the barriers and facilitators that surround its implementation.Aims: This study explored the cultural, organisational and contextual factors perceived by parents and healthcare professionals (HCPs) about the option of implementing infant massage in the Lebanese context.Methods: A qualitative exploratory approach informed by normalisation process theory (NPT) was used; 22 parents and 38 HCPs were recruited from three university hospitals over 7-month period. COREQ guidelines were used to inform reporting and as a quality appraisal checklist. Framework approach was used for data analysis of the focus groups (seven with parents, six with HCPs) and non-participant observation. The four constructs of NPT guided data collection and analysis, interpretation of the findings and understanding of the implementation issues.Findings: Four themes emerged: understanding infant massage; perception of massage benefits and risks; perceived barriers for engaging in the practice of massage, and strategies to facilitate future implementation. Participants were accepting of the massage concept. However, HCPs were concerned that workload and lack of time would make implementation difficult and interfere with daily care. Both groups highlighted parental fear and anxiety, entry to NICU, and space availability as main contextual and organisational implementation barriers. Communication, gradual implementation, encouragement and support were potential facilitators perceived by parents while adequate preparation, commitment, and establishing protocol and guidelines were the identified facilitators for HCPs.Conclusion: Study findings provide important insights into the barriers and facilitators for the implementation of massage to assist in future evidence-based interventions within and beyond the Lebanese NICU context.