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Background <p>Preterm infants are at high risk for neurodevelopmental delays, and hence habilitation in the Neonatal Intensive Care Unit (NICU) in a timely manner is a priority. In India, however, standardized habilitation pathways are underdeveloped, and the role of neonatal therapists, particularly physiotherapists is discrepant and ill-defined. There is scarce literature from the ground-level perception of therapists on providing structured development care, especially in resource-limited NICU settings. This study aims to explore therapist-informed barriers and context-specific solutions affecting the provision of habilitation services for preterm infants in Indian NICUs.</p> Methods <p>This qualitative study follows a constructivist paradigm. In-depth semi-structured interviews were conducted with 16 NICU physiotherapists from diverse backgrounds across India. Thematic analysis was performed with Braun and Clarke's six-phase reflexive framework. Codes were inductively established and themes iteratively refined.</p> Results <p>The two overall themes were: (1) Practice-Informed Barriers, including fractured professional identity, institutional bounds, poor training, and maternal disempowerment; and (2) Therapist-Driven Solutions, consisting of mother-inclusive graduated engagement, culture-congruent approaches, streamlined gestational protocols, and urgent appeals for curriculum and policy change. The therapists portrayed the necessity for habilitation practices to be salient, collaborative, and consistent with Indian contextual realities.</p> Conclusion <p>Despite systemic constraints, Indian NICU physiotherapists reflect adaptive, culturally appropriate approaches to facilitate early habilitation. Overcoming structural barriers and institutionalization of therapist roles in interdisciplinary NICU teams are essential steps toward equitable and developmentally beneficial care for preterm infants. These findings provide a foundational input into the development of India-specific early stimulation protocols based on practice realities.</p> Trial registration <p>The trial has been registered under Clinical Trials Registry-India (CTRI/2025/02/081483) on February 28 2025.</p>

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Practice-informed barriers and contextual solutions in neonatal habilitation across Indian Neonatal Intensive Care Units: A qualitative exploration of therapists’ perspectives

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  • 发表日期：

    2026年1月31日

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  • Abishek J. R.,
  • Vadivelan Kanniappan

摘要

Background

Preterm infants are at high risk for neurodevelopmental delays, and hence habilitation in the Neonatal Intensive Care Unit (NICU) in a timely manner is a priority. In India, however, standardized habilitation pathways are underdeveloped, and the role of neonatal therapists, particularly physiotherapists is discrepant and ill-defined. There is scarce literature from the ground-level perception of therapists on providing structured development care, especially in resource-limited NICU settings. This study aims to explore therapist-informed barriers and context-specific solutions affecting the provision of habilitation services for preterm infants in Indian NICUs.

Methods

This qualitative study follows a constructivist paradigm. In-depth semi-structured interviews were conducted with 16 NICU physiotherapists from diverse backgrounds across India. Thematic analysis was performed with Braun and Clarke's six-phase reflexive framework. Codes were inductively established and themes iteratively refined.

Results

The two overall themes were: (1) Practice-Informed Barriers, including fractured professional identity, institutional bounds, poor training, and maternal disempowerment; and (2) Therapist-Driven Solutions, consisting of mother-inclusive graduated engagement, culture-congruent approaches, streamlined gestational protocols, and urgent appeals for curriculum and policy change. The therapists portrayed the necessity for habilitation practices to be salient, collaborative, and consistent with Indian contextual realities.

Conclusion

Despite systemic constraints, Indian NICU physiotherapists reflect adaptive, culturally appropriate approaches to facilitate early habilitation. Overcoming structural barriers and institutionalization of therapist roles in interdisciplinary NICU teams are essential steps toward equitable and developmentally beneficial care for preterm infants. These findings provide a foundational input into the development of India-specific early stimulation protocols based on practice realities.

Trial registration

The trial has been registered under Clinical Trials Registry-India (CTRI/2025/02/081483) on February 28 2025.