Healthcare workers' views on the use of continuous positive airway pressure (CPAP) in neonates: a qualitative study in Andhra Pradesh, India

Juan Emmanuel Dewez, Harish Chellani, Sushma Nangia, Katrin Metsis, Helen Smith, Matthews Mathai, Nynke van den Broek

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


BACKGROUND: Continuous Positive Airway Pressure (CPAP) is a form of non-invasive ventilatory support which is increasingly used in low- and middle-income countries to treat neonates with acute respiratory distress. However, it may be harmful if used incorrectly. We aimed to explore the experiences of doctors and nurses using CPAP in neonatal units in India and their views on enablers and barriers to implementation of CPAP.

METHODS: Participants from 15 neonatal units across Andhra Pradesh were identified through purposive sampling. Eighteen in-depth interviews (IDI) with doctors and eight focus group discussions (FGD) with 51 nurses were conducted. Data were analysed thematically using the framework approach.

RESULTS: Common structural factors that limit the use of CPAP include shortages of staff, consumables and equipment, and problems with regard to the organisation of neonatal units in both district hospitals and medical colleges. This meant that CPAP was often not available for babies who were identified to need CPAP, or that CPAP use was not perceived to be of the highest quality. Providing care under constrained circumstances left staff feeling powerless to provide good quality care for neonates with acute respiratory distress. Despite this, staff were enthusiastic about the use of CPAP and its potential to save lives. CPAP use was mostly perceived as technically easier to provide than ventilation and allowed nurses to provide advanced neonatal care, independently of doctors.

CONCLUSIONS: Doctors and nurses embraced CPAP use but identified barriers to implementation which will need to be addressed in order not to impact on safety and quality of care. Ensuring a supportive and enabling environment is in place will be crucial if CPAP is to be scaled-up more widely.

Original languageEnglish
Pages (from-to)347
JournalBMC Pediatrics
Issue number1
Publication statusPublished - 6 Nov 2018


  • Academic Medical Centers
  • Attitude of Health Personnel
  • Continuous Positive Airway Pressure/instrumentation
  • Equipment and Supplies, Hospital/supply & distribution
  • Female
  • Focus Groups
  • Hospitals, District
  • Humans
  • India
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Interviews as Topic
  • Male
  • Medical Staff, Hospital
  • Nursing Staff, Hospital
  • Qualitative Research
  • Respiratory Distress Syndrome, Newborn/therapy


Dive into the research topics of 'Healthcare workers' views on the use of continuous positive airway pressure (CPAP) in neonates: a qualitative study in Andhra Pradesh, India'. Together they form a unique fingerprint.

Cite this