Breastfeeding and kangaroo skin-to-skin care for babies families in neonatal units: evaluation protocol

Evidence into Practice – Breastfeeding and kangaroo skin-to-skin care for babies & families in neonatal units – evaluation protocol

Research Aim

This evaluation will examine the process and impacts of implementing the evidence into practice (EiP) approach, including the barriers and facilitators to the approach in neonatal units (NNUs). Qualitative methods of data collection will be primarily used to systematically gather and then analyse data from key stakeholders, i.e. NNU staff, including managers, and parents whose babies are in the NNUs at the time of the study.  All participation in the study will be voluntary and informed consent will be gained in writing from those individuals who agree to take part.

Realist Evaluation

The evaluation is informed by a realist approach which acknowledges the importance of context in implementing change (Pawson and Tilley, 1997).

Case studies are a commonly adopted methodology within realist evaluations (Emmel, 2013) where they seek to examine in depth the context, mechanisms (of change) and outcomes that either impact or are impacted on when change is introduced.


The study design is primarily a case study approach that will focus on three cases (where cases are defined as neonatal units).  In addition to focussing on three case studies, additional data (mainly interview data) will also be collected from all additional participating NNUs and used to inform the study’s aims and objectives.   Details of the study can be seen in the flowchart below.

Case Studies

In the case study sites, data collection will be conducted via qualitative interviews with staff as well as observations, using a structured proforma, of the frequency and context around the use of skin to skin kangaroo care in the NNU.  Interviews will be conducted at three time points in the case study: at the beginning of the study, at 3-6 months after the start of the study and finally at 12-15 months after the start of the study.

Additionally, in the case study NNUs only, qualitative interviews will be undertaken with a purposive sample of parents.

 Collecting data over the course of the study will allow the research team to describe and understand in detail the process of implementation as it is intended as well as how it is actually implemented. It will also enable an understanding of the factors that influence and impact on implementation as implementation plans progress and are operationalised.  Using this prospective and longitudinal approach will also allow the research team to describe and understand the extent to which implementation of the EiP approach enabled units to change practice successfully and the extent to which these changes were maintained over time and perceived as, or are evidenced to be, sustainable in the NNUs. 

Non-Case Study

In addition to the detailed case study sites, the evaluation will also gather less detailed but equally important data from all participating NNUs in Scotland.

Data will be generated from in-depth interviews with staff, at one time point only – 3-6 months after the start of implementation.


All interview data will be audio recorded, with the consent of participants, and will be transcribed verbatim.  Qualitative data analysis will be conducted using thematic analysis and will be used to examine the context and mechanisms that impact on the successful utilisation of the EiP approach to implementing improvements in the provision of neonatal care.

Quantitative Data

As an additional part of the evaluation, (where possible and with appropriate permissions), secondary data relating to (non-patient identifiable) key clinical outcomes for all NNUs will be accessed and analysed retrospectively.  This will aid with understanding whether over the course of the study there were any changes in outcomes that are known to be enhanced by increasing skin to skin kangaroo care and early breastfeeding.

NHS Ethics and Research and Development Management Approvals

NHS Ethical Approval has been granted for this study by West of Scotland Research Ethics Committee 5. Ethics reference number – 17/WS/0261.  

Local NHS R & D approvals have been sought with individual NHS boards.  Most local NHS board approvals are already in place.  For further details – please contact Dr. Alison Munro