{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T22:05:42Z","timestamp":1786745142868,"version":"build-2736575974"},"reference-count":46,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2021,10,17]],"date-time":"2021-10-17T00:00:00Z","timestamp":1634428800000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Alberta Innovates \u2013 Health Solutions, Partnership for Innovation in Health Services Research","award":["201400399"],"award-info":[{"award-number":["201400399"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,9,27]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the barriers and facilitators to implementing Alberta Family Integrated Care (AB-FICare [2019 Benzies]), a model of care for integrating parents into level II neonatal intensive care units (NICUs) care teams, from the perspective of healthcare providers (HCP) and hospital administrators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Qualitative process evaluation substudy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Ten level II NICUs in six cities across Alberta, Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>HCP and hospital administrators (n=32) who were involved in the cluster-randomised controlled trial of AB-FICare in level II NICUs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Post-implementation semi-structured interviews were conducted via phone or in-person. The Consolidated Framework for Implementation Research was used to develop interview guides, code transcripts and analyse data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Key facilitators to implementation of AB-FICare included (1) a receptive<jats:italic>implementation climate,<\/jats:italic>(2)<jats:italic>compatibility<\/jats:italic>of the intervention with individual and organisational practices, (3)<jats:italic>available resources<\/jats:italic>and<jats:italic>access to knowledge and information<\/jats:italic>for HCP and hospital administrators, (4) engagement of<jats:italic>key stakeholders<\/jats:italic>across the organisation, (5) engagement of and outcomes for<jats:italic>intervention participants,<\/jats:italic>and (6)<jats:italic>reflecting and evaluating<\/jats:italic>on implementation progress and patient and family outcomes. Barriers were (1)<jats:italic>design quality and packaging<\/jats:italic>of the intervention, (2)<jats:italic>relative priority<\/jats:italic>of AB-FICare in relation to other initiatives, and (3)<jats:italic>learning climate<\/jats:italic>within the organisation. Mixed influences on implementation depending on contextual factors were coded to eight constructs:<jats:italic>intervention source, cost, peer pressure, external policy and incentives, staff needs and resources, structural characteristics, organisational incentives and rewards,<\/jats:italic>and<jats:italic>knowledge, beliefs and attitudes<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The characteristics of an organisation and the implementation process had largely positive influences, which can be leveraged for implementation of AB-FICare in the NICU. We recommend site-specific consultations to mitigate barriers and assess how swing factors might impact implementation given the local context, with the goal that strategies can be put in place to manage their influence on implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT02879799\">NCT02879799<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-054938","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T05:01:27Z","timestamp":1634619687000},"page":"e054938","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":40,"title":["Facilitators and barriers to implementation of Alberta family integrated care (FICare) in level II neonatal intensive care units: a qualitative process evaluation substudy of a multicentre cluster-randomised controlled trial using the consolidated framework for implementation research"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct02879799","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2289-125X","authenticated-orcid":false,"given":"Pilar","family":"Zanoni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5811-7661","authenticated-orcid":false,"given":"Natalie V","family":"Scime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9090-2395","authenticated-orcid":false,"given":"Karen","family":"Benzies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah A","family":"McNeil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Mrklas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,10,18]]},"reference":[{"key":"2024102817415350000_11.10.e054938.1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-3084"},{"key":"2024102817415350000_11.10.e054938.2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002169"},{"key":"2024102817415350000_11.10.e054938.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.pedn.2009.01.006"},{"key":"2024102817415350000_11.10.e054938.4","doi-asserted-by":"publisher","DOI":"10.1097\/JPN.0b013e31821a6706"},{"key":"2024102817415350000_11.10.e054938.5","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-011-0751-7"},{"key":"2024102817415350000_11.10.e054938.6","article-title":"Family-centred care for children in hospital","volume":"1","author":"Shields","year":"2007","journal-title":"Cochrane Database Syst Rev"},{"key":"2024102817415350000_11.10.e054938.7","doi-asserted-by":"publisher","DOI":"10.1111\/hex.12104"},{"key":"2024102817415350000_11.10.e054938.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2010.05.005"},{"key":"2024102817415350000_11.10.e054938.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2011.05768.x"},{"key":"2024102817415350000_11.10.e054938.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2007.01967.x"},{"key":"2024102817415350000_11.10.e054938.11","doi-asserted-by":"publisher","DOI":"10.1177\/1074840713508224"},{"key":"2024102817415350000_11.10.e054938.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2006.01591.x"},{"key":"2024102817415350000_11.10.e054938.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2006.01928.x"},{"key":"2024102817415350000_11.10.e054938.14","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jnn.2009.01.006","article-title":"Room for family-centered care \u2013 a qualitative evaluation of a neonatal intensive care unit remodeling project","volume":"15","author":"Beck","year":"2009","journal-title":"Journal of Neonatal Nursing"},{"key":"2024102817415350000_11.10.e054938.15","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.2003.02930.x"},{"key":"2024102817415350000_11.10.e054938.16","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.2003.02765.x"},{"key":"2024102817415350000_11.10.e054938.17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2006.03755.x"},{"key":"2024102817415350000_11.10.e054938.18","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-13-S1-S12","article-title":"A pilot cohort analytic study of family integrated care in a Canadian neonatal intensive care unit","volume":"13 Suppl 1","author":"O'Brien","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"key":"2024102817415350000_11.10.e054938.19","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S2352-4642(18)30039-7","article-title":"Effectiveness of family integrated care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial","volume":"2","author":"O'Brien","year":"2018","journal-title":"Lancet Child Adolesc Health"},{"key":"2024102817415350000_11.10.e054938.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-020-02438-6","article-title":"Effectiveness of Alberta family integrated care on infant length of stay in level II neonatal intensive care units: a cluster randomized controlled trial","volume":"20","author":"Benzies","year":"2020","journal-title":"BMC Pediatr"},{"key":"2024102817415350000_11.10.e054938.21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1510059"},{"key":"2024102817415350000_11.10.e054938.22","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-017-2181-3","article-title":"Family integrated care (FICare) in level II neonatal intensive care units: study protocol for a cluster randomized controlled trial","volume":"18","author":"Benzies","year":"2017","journal-title":"Trials"},{"key":"2024102817415350000_11.10.e054938.23","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-50"},{"key":"2024102817415350000_11.10.e054938.24","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50"},{"key":"2024102817415350000_11.10.e054938.25","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2024102817415350000_11.10.e054938.26","unstructured":"Government of Alberta . Population statistics, 2021. Available: https:\/\/www.alberta.ca\/population-statistics.aspx#population-estimates"},{"key":"2024102817415350000_11.10.e054938.27","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.191362"},{"key":"2024102817415350000_11.10.e054938.28","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-316435"},{"key":"2024102817415350000_11.10.e054938.29","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2017-313282"},{"key":"2024102817415350000_11.10.e054938.30","doi-asserted-by":"crossref","first-page":"E12","DOI":"10.1097\/ANC.0000000000000443","article-title":"Exploring parental and staff perceptions of the family-integrated care model: a qualitative focus group study","volume":"17","author":"Broom","year":"2017","journal-title":"Adv Neonatal Care"},{"key":"2024102817415350000_11.10.e054938.31","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-019-4256-1","article-title":"Key factors supporting implementation of a training program for neonatal family- centered care - a qualitative study","volume":"19","author":"Toivonen","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2024102817415350000_11.10.e054938.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2006.03.002"},{"key":"2024102817415350000_11.10.e054938.33","doi-asserted-by":"publisher","DOI":"10.1177\/136749350000400203"},{"key":"2024102817415350000_11.10.e054938.34","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.iccn.2018.05.001","article-title":"The health care system is making 'too much noise' to provide family-centred care in neonatal intensive care units: Perspectives of health care providers and hospital administrators","volume":"50","author":"Benzies","year":"2019","journal-title":"Intensive Crit Care Nurs"},{"key":"2024102817415350000_11.10.e054938.35","unstructured":"Canadian Premature Babies Foundation . Premature birth in Canada: an environmental scan. research power Inc. for Canadian premature babies Foundation, 2014. Available: https:\/\/www.cpbf-fbpc.org\/premature-birth-in-canada"},{"key":"2024102817415350000_11.10.e054938.36","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/NMC.0000000000000061","article-title":"Nurses' perspectives on the close collaboration with parents training program in the NICU","volume":"39","author":"Axelin","year":"2014","journal-title":"MCN Am J Matern Child Nurs"},{"key":"2024102817415350000_11.10.e054938.37","doi-asserted-by":"crossref","DOI":"10.1186\/s13052-017-0352-1","article-title":"Supporting parents in taking care of their infants admitted to a neonatal intensive care unit: a prospective cohort pilot study","volume":"43","author":"De Bernardo","year":"2017","journal-title":"Ital J Pediatr"},{"key":"2024102817415350000_11.10.e054938.38","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4017-1"},{"key":"2024102817415350000_11.10.e054938.39","doi-asserted-by":"crossref","first-page":"222","DOI":"10.3389\/fped.2020.00222","article-title":"Factors influencing implementation of family-centered care in a neonatal intensive care unit","volume":"8","author":"Oude Maatman","year":"2020","journal-title":"Front Pediatr"},{"key":"2024102817415350000_11.10.e054938.40","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2012.04138.x"},{"key":"2024102817415350000_11.10.e054938.41","first-page":"31","article-title":"Implementing family-centred care: an exploration of the beliefs and practices of paediatric nurses","volume":"23","author":"Paliadelis","year":"2005","journal-title":"Aust J Adv Nurs"},{"key":"2024102817415350000_11.10.e054938.42","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1080\/17482620600979195","article-title":"Health care professionals\u2019 experiences of parental presence and participation in neonatal intensive care unit","volume":"2","author":"Wigert","year":"2007","journal-title":"Int J Qual Stud Health Well-being"},{"key":"2024102817415350000_11.10.e054938.43","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-6712.2009.00697.x"},{"key":"2024102817415350000_11.10.e054938.44","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181e1709c"},{"key":"2024102817415350000_11.10.e054938.45","doi-asserted-by":"crossref","unstructured":"Fixsen D , Blase K , Metz A . Implementation science. In: Wright JD , ed. International encyclopedia of the social & behavioral sciences. 2nd ed. Amsterdam: Elsevier, 2015: 695\u2013702.","DOI":"10.1016\/B978-0-08-097086-8.10548-3"},{"key":"2024102817415350000_11.10.e054938.46","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-020-01344-3"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-054938","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,29]],"date-time":"2024-10-29T00:47:01Z","timestamp":1730162821000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-054938"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":46,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,18]]},"published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1136\/bmjopen-2021-054938"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-054938","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10]]}}}