The intention to use Kangaroo Mother Care among first-time mothers 15-24 years in Kinshasa, DRC: An application of the Integrated Behavioral Model

Abstract Background Kangaroo mother care (KMC) is a low-cost, safe, and simple method that has proven efficacious at improving neonatal health outcomes, including mortality, in low-income countries. While beneficial for all newborns, the World Health Organization (WHO) recommends KMC specifically for low birthweight (LBW) and premature infants. This study, guided by a modified Integrated Behavioral Model (IBM) framework, examined whether attitudes, norms, and personal agency predicted KMC intentions among first-time mothers (FTMs) 15-24 years old in Kinshasa, the Democratic Republic of Congo (DRC). Methods This study used secondary data from the 2020 Momentum Project endline survey, a quasi-experimental design in three intervention and three comparison health zones in Kinshasa, DRC. The association between IBM components and KMC intentions was tested using multivariate logistic regression. The total sample consisted of 1,918 adolescent and young first-time mothers (FTMs) from six health zones. Results About half of the respondents stated that they were very likely to practice KMC if they had a LBW or preterm baby. Approval of KMC, normative expectations, descriptive norms, self-efficacy, and autonomy were all positively associated with the intent to practice KMC. Age was also found to be a significant predictor; the odds of KMC intentions were 90% higher (95% CI=(1.11-3.24)) for women 20-24 years compared to women 15-19 years. The association between autonomy and KMC intentions was moderated by age. Marginal effects of the interaction found that the probability of intending to practice KMC for respondents 20-24 years was constant regardless of autonomy level, while autonomy significantly increased the probability of KMC intentions for younger women 15-19 years. Conclusions Results suggest that KMC intentions among first-time mothers 15-24 years are influenced by multiple factors simultaneously. Programs seeking to improve KMC intentions among this population should consider implementing age-specific empowering and norms-based strategies.