ArticleBMJ open2026
Barriers and facilitators to implementing continuous positive airway pressure (CPAP) in primary hospitals in Ethiopia: a qualitative study of healthcare providers' perspectives.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo explore the barriers and facilitators influencing the implementation of continuous positive airway pressure from the perspective of healthcare providers (HCPs) in primary hospitals of four regions in Ethiopia.
designA qualitative descriptive study employing thematic analysis of data collected through in-depth interviews from the perspective of HCPs.
settingThe study was conducted in twelve selected primary hospitals in four regions of Ethiopia: Oromia, Amhara, Tigray and Sidama.
participants28 HCPs who worked in neonatal intensive care units (NICUs) and delivery rooms, including nurses, midwives, general practitioners, coordinators and medical directors, were interviewed in person and in-depth. Additionally, to ensure a diverse range of viewpoints, participants were identified in collaboration with hospital management and interviewed until data saturation was reached. KEY AREAS OF EXPLORATION: The study explored participants' comprehensive experiences concerning the barriers to and facilitators of the implementation of CPAP, as well as their suggestions for enhancing its adoption.
resultsSeven all-encompassing themes emerged: (1) providers' knowledge and experience, (2) training and mentorship, (3) communication, (4) perceptions of CPAP, (5) equipment availability and accessibility of CPAP, (6) management and infrastructure and (7) provider-driven recommendations. Significant barriers included inadequate and inconsistent training, staff rotation, limited mentorship opportunities, poor interdepartmental communication, misconceptions regarding oxygen requirements, equipment and supply shortages, unreliable power sources and inadequate managerial backing. Facilitators included improved provider familiarity with CPAP indications, structured mentorship initiatives, internal case discussions, backup power allocation to NICUs and prioritisation strategies for critically ill neonates.
conclusionsCPAP implementation in primary hospitals is influenced by interconnected individual, institutional and systemic factors. Sustainable scale-up in resource-limited settings requires practical training, mentorship, staff retention, dedicated funding and infrastructure and strong institutional and external partnerships.
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