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Stakeholder perceptions of an early essential newborn care simulation-based training in western China: a qualitative study
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DOI：10.1186/s12889-026-28900-1.png)
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Abstract
En 中文
Neonatal mortality remains a global concern, especially in China, where regional disparities persist. Early essential newborn care (EENC) consists of a set of evidence-based and cost-effective interventions, including but not limited to, skin-to-skin contact, neonatal resuscitation when needed, early breastfeeding initiation, delayed umbilical cord clamping and proper care, and kangaroo mother care for premature and low-birthweight infants to prevent or treat the major causes of neonatal morbidity and mortality. This study aimed to explore the facilitators and barriers to an EENC simulation-based training by examining the perspectives of different stakeholders participating in EENC training and coaching activities in western China. This qualitative study was conducted between December 2020 and April 2021. A total of 190 participants across 15 health facilities were recruited from four western provinces in China. Seven in-depth interviews with national-level experts, 35 in-depth interviews with postpartum mothers who were still hospitalised on the day of the interview, and 21 focus group discussions with 54 policymakers including county mayors in charge of health, county mayors in charge of finance, hospital medical directors, and 94 healthcare providers including obstetricians, paediatricians, nurses, and midwives from different hospitals were conducted to collect data. The number of participants per FGD ranged from 4 to 9, with a total number of 148 participants participating in all FGDs. The interview transcripts were organised and coded by the research team. We used a hybrid inductive-deductive thematic analysis to generate themes. Two main themes and four sub-themes emerged from the data. Following training, healthcare providers reported that the delivery approach and content of the EENC training were acceptable, and postpartum mothers reported satisfaction with the service they received. Facilitators to successful training were the use of an evidence-based approach, practical, skill-based training, and multidisciplinary engagement. Barriers included variations in trainer quality, and staff shortages in county-level hospitals. This study provides insights into stakeholders’ perceptions of EENC training implementation in western China. Participants perceived the training as valuable for enhancing knowledge, skills, and confidence in recommended EENC practices. The findings suggest that the current training model is well accepted and may support the adoption of EENC practices. Future efforts should strengthen post-training quality monitoring, trainer development, and workforce support to facilitate the sustained implementation of EENC recommendations.
Keywords:
Newborn care
Training
Qualitative research
Stakeholder perspective
China
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