Kangaroo Mother Care (KMC) is the treatment of preterm infants by their mothers, who make skin-to-skin contact with the infants.1 KMC improves growth, reduces morbidity, and decreases the duration of hospitalization.2,3 It also increases the compatibility between the mothers’ and infants’ saliva levels 4and results in a significant improvement in vital physiological parameters.5 KMC is an alternative to conventional care; it is affordable, simple, acceptable, and feasible for the mothers.6–8

In KMC practices involving mothers, children, and health workers, a comprehensive approach is needed. One important aspect involves the devices that support this activity and enable it to run effectively and efficiently. The availability of devices and other items that support KMC depends on the commitment from hospital directors and senior staff.9 The appropriate equipment or devices can overcome problems related to safety, health, and efficiency by improving the conditions under which the KMC activities are conducted.10 The aim of the present study was to provide an overview of the equipment currently available to support continuous KMC, focusing on the ability of the equipment to extend the duration of the KMC, maintain the mother's comfort, and support the growth and development of low-birthweight infants.

This review adopted a five-stage methodological framework that included: 1) identification of the research question, 2) identification of relevant studies, 3) study selection, 4) charting the data, and 5) collating, summarizing, and reporting on the results of the studies.11 In the first stage, we developed the following research question: What is the extent of the information available regarding the devices available to support continuous KMC? We then established the keywords for our search strategy by combining relevant keywords (“kangaroo mother care” OR “kangaroo care” OR “kangaroo-mother care” OR KMC) AND (equipment OR device OR appliances).

In the second stage, involving identification of relevant studies, we searched for research evidence using Medline with the full-text EBSCO, Scopus, Science Direct, ProQuest, PubMed, Springer Link, IEEE, AMSE, and Google Scholar databases. Only articles written in English and Indonesian and published between January 2008 and July 2020 were included. Bibliographies were searched by hand to include other studies that related to our topic. This searching mechanism produced a total of 161 references. These articles were then screened and were included in the study if they met the following criteria: a) the documents were published in an academic journal or proceedings; b) they described at least one of the following: KMC, Kangaroo care, appliances, products, or equipment; c) they were conducted anywhere around the world; and d) they were either quantitative or qualitative studies. This screening yielded 73 articles for possible inclusion in the study.

In the data charting stage, we recorded information about the author(s), country, study design, setting, subject (sample), intervention, and outcome. In the collating, summarizing, and reporting stage, we provided an overview of the reviewed material that related to devices that supported KMC.

The basic KMC unit must meet a minimum number of requirements, namely the availability of space for beds or armchairs for mothers or families, good sanitation and hygiene, clean water facilities, environmental modifications to facilitate the transition from hospital to home, nurse or midwife rooms for documentation, and equipment that supports breastfeeding.9 However, one of the barriers in the implementation of KMC is a lack of facility readiness, including supporting devices for practicing KMC.29–31

The results shown in the selected articles indicate that the availability of support equipment increases the effectiveness and efficiency of KMC implementation. Most of the equipment had a positive impact on mothers, babies, and nurses. However, little is known about the ergonomic aspects of this equipment. Ergonomics in health care, and especially in KMC, is pivotal. Numerous health care studies have shown a positive impact on the quality of patient safety and quality of care following the application of ergonomic interventions32–36

The ergonomic aspect of the equipment can help mothers maintain their normal and comfortable posture, which can extend the duration of the KMC and thereby support the growth and development of the low-birthweight infants. This certainly supports continuous KMC, because the longer a person maintains skin-to-skin contact, the faster is the growth and development of low-birthweight infants.37

Ergonomics is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system.38 In health care settings, ergonomics consists of three areas. First is physical ergonomics, which is concerned with physical activity and includes the design of health care facilities, equipment used in health care, and patient spaces that consider the patients’ physical strength and limitations. The second is cognitive ergonomics, which is related to psychological processes, including interface designs that can be used for health information technologies and other programs, such as training. The third is organizational ergonomics, which is related to the overall work design system in an organization or a sociotechnical system and the interaction of various elements in the system, including the working hours of health care workers.39

Health equipment with a physical ergonomic approach is needed to avoid various health complaints of mothers and of health care workers. One issue is musculoskeletal complaints experienced by health care workers when conducting medical interventions on patients. Musculoskeletal complaints also can be felt by mothers, caused by factors such as the unnatural position of the mother and the health care staff during KMC. The body position when performing KMC activities is analogous to that when working. The unnatural body position is generally due to the demands of the task and to the use of equipment, including chairs or sofas, that is not suitable for mothers doing KMC.40,41 Ergonomics is therefore very useful for analyzing, preventing, and mitigating medical errors. An ergonomic work style is recommended to reduce musculoskeletal complaints,42,43 included those occurring during KMC.

In KMC, the design of equipment can facilitate or simulate various aspects of KMC by exposing infants to parental stimuli or parents and infants to familiar stimuli, and through designs that facilitate communication between the parent and the infant. KMC is beneficial for enhancing the bonding between the parent and infant.10,44

This study provides information about equipment that supports KMC. Most of the equipment is effective and efficient and improves the quality of KMC.

Further research into the use of an ergonomic sofa to improve the sitting posture and reduce the risk of musculoskeletal complaints among mothers performing KMC is urgently needed to extend the duration of KMC and maintain the mother's comfort.

The study design and procedures were approved by the Research Ethics Committee of the Faculty of Public Health, Universitas Indonesia (Approval number: 668/UN2.F10//PPM.00.02/2019).

The authors declare that they have no conflicts of interest in this study.