Exploring acceptability and feasibility of a wearable device to facilitate home phototherapy treatment for newborn jaundice in rural Scotland: an interpretive description study.

Lironi, Jo

Abstract

Jaundice is a common condition in newborn infants, turning skin colour yellow due to the build-up of bilirubin. Internationally, jaundice continues to result in newborn infants' hospital admission, forcing separation of family units at the pivotal point for breastfeeding initiation and bonding. The aim of this research was to explore - with healthcare professionals and parents - the acceptability and feasibility of a wearable device to facilitate home phototherapy treatment for newborn jaundice in rural Scotland. The research was undertaken through qualitative interviews, using Interpretive Description to accommodate various perspectives influencing acceptability and feasibility of a wearable device to facilitate home phototherapy treatment. Participants were recruited via purposive sampling from one NHS board in Scotland. Semi- structured interviews were used with parental dyads (n=4) and mothers (n=6). Healthcare professionals (n=9) were recruited onto two focus groups conducted in different geographical locations (an urban and regional hospital) in NHS Grampian. The Framework approach was used to thematically analyse the data. Miranda Fricker's concept of epistemic injustice, which proposes inequity due to unequal power dynamics between people or systems, provided a theoretical perspective to interpret key findings. The study found that, although parents expressed a desire for wearable phototherapy devices to facilitate breastfeeding and comfort for the newborn infant, they primarily wanted home-based phototherapy treatment. Study participants described a 'one-size-fits-all' focus for newborn jaundice, centred around quickly reducing serum bilirubin levels. Furthermore, healthcare professionals assumed that parents would agree that the use of overhead phototherapy devices was worthwhile despite the distress to mothers and newborn infants, because it was an effective means of lowering serum bilirubin levels and facilitating timely discharge from care. Parents perceived postnatal care of newborn infants with jaundice to be paternalistic, which was interpreted by parents as being evidence of healthcare professionals' lack of trust in their parental capabilities. Moreover, healthcare professionals did not trust their clinical judgement to assess and manage newborn jaundice, due to the fear that they would be held clinically accountable for serum bilirubin levels not improving. This affected healthcare professionals' ability to trust parental capabilities. As a result, the rural aspect of the study became inconsequential. The study concluded that parents were willing to compromise on size, functions, and usability of phototherapy devices to facilitate home-based phototherapy treatment in the short term. However, epistemic injustice towards parents and midwives impacted shared decision-making within care teams, which in turn obstructed the acceptability and feasibility of both home-based phototherapy in general, and more specifically a wearable device that could facilitate home-based phototherapy.

Citation

LIRONI, J. 2021. Exploring acceptability and feasibility of a wearable device to facilitate home phototherapy treatment for newborn jaundice in rural Scotland: an interpretive description study. Robert Gordon University, MRes thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-1678027

• Thesis Type: Thesis
• Deposit Date: Jun 1, 2022
• Publicly Available Date: Jun 1, 2022
• DOI: https://doi.org/10.48526/rgu-wt-1678027
• Keywords: Jaundice in infants; Phototherapy; Post-natal care; Health services
• Public URL: https://rgu-repository.worktribe.com/output/1678027
• Award Date: Nov 30, 2021