Context Matters: Examining Factors in Implementing Evidence-Based Family Systems Care for Small and Sick Newborns along the Care Continuum

Christina Schuler ^1,2* Faith Agbozo ³ Emmanuel Bansah ⁴ Barbara Preusse-Bleuler ¹ Richard Owusu ³ Riccardo E. Pfister ⁵

• ¹ Zurich University of Applied Sciences, Winterthur, Zürich, Switzerland
• ² Institut de Santé Globale, Faculté de Médecine, Université de Genève, Geneva, Geneva, Switzerland
• ³ Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Volta, Ghana
• ⁴ Volta Regional Hospital, Ho-Gh, Volta, Ghana
• ⁵ Neonatal and Pediatric Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland

Health and well-being of small/sick newborns and families can be enhanced through Family Systems Care (FSC) along the care continuum. FSC is broader than family-centered care. FSC identifies individual and family strengths while acknowledging illness-related suffering and providing expertise to help soften it through relational family systemic interventions. Contextual factors of the targeted healthcare setting need to be understood to implement FSC. This study aims to assess healthcare professionals' perceptions of health system features that may influence a successful contextadapted implementation of FSC into the care continuum of small/sick newborns and their families in the Ghanaian healthcare setting.Cross-sectional data was collected among 143 healthcare professionals, comprising nurses, midwives and physicians who provide maternal and newborn care at a secondary facility and 13 primary health facilities in the Hohoe Municipality, Ghana. The Context Assessment for Community Health (COACH) instrument, employing Likert scales ranging from 1 to 5, and questions on training history, collects data on FSC through self-administered interviews. Data were analyzed using descriptive statistics with STATA.While 48.9% of healthcare professionals reported having never received any didactic or school-based training, the majority (96.5%) indicated a need for in-service training in FSC. From a highest score of 5, the COACH dimension on organizational resources had the lowest score (2.8). Community engagement, commitment to work, monitoring services for action and informal payment reported scored between 3.7 to 3.9 The highest scores were in the leadership and work culture dimension, scoring 4.1 and 4.2, respectively. Among the different units of the care continuum, the largest variations were in the subdimension of organizational resources 2.5 to 3.4 and informal payment 3.6 to 4.4.The COACH tool provided contextual guidance for developing training strategies to implement a contextually appropriate FSC program in Ghana that is likely to be adaptable and relevant in other LMICs. Healthcare professionals consider themselves as committed, with a favorable work culture and positive perception towards their leaders but report limited resources and challenges with access to knowledge sources. These findings indicate a readiness for FSC training along the continuum of care in the perinatal period.