Vol. 2, Issue 1, Part A (2025)

Background: Family-centered neonatal intensive care (FCC) is widely recognized as a key strategy for improving neonatal outcomes through active parental involvement. While its benefits are well established in high-resource settings, implementation in low-resource environments remains inconsistent due to systemic, infrastructural, and cultural barriers. Objective: This study aimed to identify and analyze the barriers and enablers influencing FCC implementation in low-resource neonatal intensive care units (NICUs), and to evaluate their impact on neonatal and family outcomes. Methods: A descriptive, exploratory, mixed-methods study was conducted in three tertiary-level NICUs in resource-constrained settings. Quantitative data were collected from 345 parents and 173 healthcare providers through structured questionnaires, while qualitative insights were obtained from interviews and focus group discussions. Statistical analyses included ANOVA, chi-square tests, and multivariable regression models to identify predictors of FCC implementation and exclusive breastfeeding at discharge. Results: Mean FCC implementation scores differed significantly across sites, with higher scores associated with shorter lengths of stay, higher exclusive breastfeeding rates, and lower parental stress. Major barriers identified included staff workload, space constraints, restrictive policies, and cultural norms, while enablers included kangaroo mother care (KMC) access and staff training. Regression analyses indicated that better nurse-to-infant ratios, positive staff attitudes, and KMC access significantly predicted higher FCC scores. Similarly, higher FCC scores and KMC access were associated with increased odds of exclusive breastfeeding at discharge. Conclusion: FCC implementation in low-resource NICUs is shaped by a combination of infrastructural and organizational factors. Strengthening human resources, integrating KMC, optimizing space, revising restrictive policies, and enhancing staff training can effectively enable family participation and improve neonatal outcomes. Context-specific strategies that combine structural improvements with cultural and organizational change are essential for sustainable FCC integration in resource-limited settings.