{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:47:42Z","timestamp":1785934062206,"version":"3.56.0"},"reference-count":34,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007941","name":"Addis Ababa University","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100007941","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,15]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the barriers and facilitators influencing the implementation of continuous positive airway pressure from the perspective of healthcare providers (HCPs) in primary hospitals of four regions in Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative descriptive study employing thematic analysis of data collected through in-depth interviews from the perspective of HCPs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted in twelve selected primary hospitals in four regions of Ethiopia: Oromia, Amhara, Tigray and Sidama.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>28 HCPs who worked in neonatal intensive care units (NICUs) and delivery rooms, including nurses, midwives, general practitioners, coordinators and medical directors, were interviewed in person and in-depth. Additionally, to ensure a diverse range of viewpoints, participants were identified in collaboration with hospital management and interviewed until data saturation was reached.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key areas of exploration<\/jats:title>\n                    <jats:p>The study explored participants\u2019 comprehensive experiences concerning the barriers to and facilitators of the implementation of CPAP, as well as their suggestions for enhancing its adoption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven all-encompassing themes emerged: (1) providers\u2019 knowledge and experience, (2) training and mentorship, (3) communication, (4) perceptions of CPAP, (5) equipment availability and accessibility of CPAP, (6) management and infrastructure and (7) provider-driven recommendations. Significant barriers included inadequate and inconsistent training, staff rotation, limited mentorship opportunities, poor interdepartmental communication, misconceptions regarding oxygen requirements, equipment and supply shortages, unreliable power sources and inadequate managerial backing. Facilitators included improved provider familiarity with CPAP indications, structured mentorship initiatives, internal case discussions, backup power allocation to NICUs and prioritisation strategies for critically ill neonates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CPAP implementation in primary hospitals is influenced by interconnected individual, institutional and systemic factors. Sustainable scale-up in resource-limited settings requires practical training, mentorship, staff retention, dedicated funding and infrastructure and strong institutional and external partnerships.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120412","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:55:26Z","timestamp":1785930926000},"page":"e120412","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and facilitators to implementing continuous positive airway pressure (CPAP) in primary hospitals in Ethiopia: a qualitative study of healthcare providers\u2019 perspectives"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2657-2659","authenticated-orcid":false,"given":"Hana Abera","family":"Hailemariam","sequence":"first","affiliation":[{"name":"College of Health Sciences School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia"},{"name":"School of Nursing, Saint Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7768-0196","authenticated-orcid":false,"given":"Endalew Gemechu","family":"Sendo","sequence":"additional","affiliation":[{"name":"College of Health Sciences School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abebe Gebremariam","family":"Gobezayehu","sequence":"additional","affiliation":[{"name":"School of Nursing, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"2026080504551389000_16.8.e120412.1","unstructured":"WHO . 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