The feasibility of implementing the General Movement Assessment tool in the Neonatal Intensive Care Unit of a Tertiary Hospital in Malawi: A qualitative study of caregivers and healthcare workers’ experiences.

Abstract Background: Early identification of infants at risk of neurodevelopmental disability is increasingly becoming possible, through the use of novel early identification tools. In this study, we sought to explore the views of healthcare workers and caregivers on their experiences in the Neonatal Intensive Care Unit around the time of early diagnosis using the General Movement Assessment to understand the best ways to implement the tool. Methods. We conveniently sampled 15 caregivers with infants at high risk of CP as well as ten health care workers from a tertiary hospital in Blantyre, Malawi. We conducted in-depth interviews using a translated and piloted topic guide in Chichewa (caregivers) and English (health workers), audio-recorded and transcribed verbatim. Transcripts were then inductively coded and placed within themes aimed at understanding barriers and facilitators to implementation. Results . Major themes identified from caregiver interviews included: spirituality as a source of strength and acceptance, the power of social support, fragile trust in healthcare workers' provider systems, economic strain during admission, gaps and strengths in health education and communication, and limited awareness of CP and its causes. Healthcare workers' themes included: limited awareness of early identification tools for CP, uncertainty and hierarchy in providing CP diagnosis, informal and inconsistent referral process, low familiarity and mixed perception about the GMA and teamwork as a coping mechanism amid resource constraints. Conclusion. Implementing GMA in Malawi requires a trusting environment between caregivers and healthcare workers, a better understanding of the importance of early identification tools and strengthening capacity within neonatal units. Furthermore, parents need to receive clear, accessible information to support their willingness to participate and improve their experience with early CP screening.