Characteristics of the respondents

The questionnaire was distributed among 18 hospitals and 132 community midwifery practices, yielding responses from 114 individuals. A total of eight respondents discontinued participation after completing the initial section on background information and were consequently excluded. This led to the inclusion of 106 individuals in the study, resulting in a response rate of 71%. A total of six respondents partially completed the questionnaire, and their responses were included up to the point of discontinuation. Among the respondents, there were 16 pediatricians and 90 community midwives. The median age of the respondents was 40 years (Interquartile range (IQR) 35–48), with 98% identifying themselves as female. Median work experience was 14 years (IQR 8–18). The majority (n = 71, 67%) of the respondents worked in the Southwest region of the Netherlands.

The questionnaire for MCAs yielded responses from 693 individuals. A total of 179 respondents discontinued participation after completing the initial section on background information or did not complete the informed consent form, and were consequently excluded. This led to the inclusion of 514 out of the potential 7000 MCAs (response rate 7%). A total of 111 individuals partially completed the questionnaire, and their responses were included up to the point of discontinuation. There was no multiple participation identified. MCAs had a median age of 54 years (IQR 19–77), with 99.5% identifying themselves as female. Median work experience was 20 years (IQR 6–30), and representation was noted from all twelve provinces in the Netherlands.

Experience with PT at home

A total of 85 HCPs (14%; 4 pediatricians, 13 community midwives and 68 MCAs) reported having prior experience with PT at home, and subsequently completed the section on ‘Experience with PT at home’. The duration of this experience varied, with about one third having less than one year of experience. HCPs indicated to have experience with either the BiliCocoon Bag (NeoMedLight, Villeurbanne, France) or the Bilisoft blanket (GE Healthcare, Chicago). Respondents highlighted several benefits of PT at home (Fig. 1). Among pediatricians and community midwives, the most commonly cited benefits (mentioned by >70%) included reduced travel between home and hospital for parents and newborn (n = 16, 94%), the ability for parents/caregivers and newborns to return home (n = 15, 88%), more tranquility during the postpartum period (n = 12, 71%), and decreased strain on hospital capacity (n = 12, 71%). For MCAs, the primary benefits (mentioned by >70%) were identified as reduced travel between home and hospital for parents and newborn (n = 49, 72%), the ability for parents/caregivers and newborns to return home (n = 61, 90%), more tranquility (n = 58, 85%) and less stress (n = 59, 87%) during the postpartum period for parents/caregivers and newborn, continuing daily activity for parents/caregivers (n = 51, 75%), improved bonding (n = 57, 84%) and increased likelihood of successful breastfeeding (n = 55, 81%).

Fig. 1: Potential benefits of phototherapy at home.

Multiple answers were possible; MCA maternity care assistant, PT phototherapy.

The 85 respondents with experience were queried about possible problems or challenges they encountered with PT at home. 41% of respondents with experience reported no problems or challenges (Fig. 2). Pediatricians and community midwives who encountered issues mentioned difficulties in coordination and collaboration with other HCPs (n = 4, 24%) and insufficient or absent financial compensation (n = 6, 35%). All six respondents who identified financial compensation as a potential challenge were community midwives. Among MCAs, most frequently mentioned challenges included anxiety, uncertainty and stress for parents/caregivers (n = 11, 16%) and a lack of knowledge (n = 8, 12%).

Fig. 2: Potential problems or challenges of phototherapy at home.

Multiple answers were possible, MCA maternity care assistant, PT phototherapy.

The majority of 85 respondents with experience expressed satisfaction with the implementation of PT at home (pediatricians and community midwives: n = 12, 71%; MCAs: n = 46, 69%). Most participants believed that newborns should have the possibility to receive treatment at home, deeming it both feasible and valuable for their respective organizations (Supplemental information 2).

Interest and motivation

The section addressing interest and motivation involved the participation of 89 (84%) pediatricians and community midwives and 449 (87%) MCAs lacking prior experience with PT at home. Pediatricians, community midwives and MCAs identified similar advantages associated with PT at home compared to those with prior experience (Fig. 1). However, it is noteworthy that most respondents without prior experience foresee problems or challenges, which were not generally perceived by those with experience. Potential challenges mentioned by more than 40% of pediatricians and community midwives were anxiety, insecurity or stress experienced by parents (n = 46, 52%), parents not adhering to scheduled appointments (n = 38, 43%), problems with executing controls (n = 45, 51%) and concerns related to insufficient or a lack of financial compensation (n = 39, 44%). The latter concern was predominately expressed by community midwives. Problems or challenges mentioned by more than 40% of MCAs were anxiety, insecurity or stress experienced by parents (n = 206, 46%) and parents not adhering to scheduled appointments (n = 201, 45%). A total of 2 (2%) pediatricians and midwives and 56 (13%) MCAs expected no problems or challenges.

The majority of 538 respondents without experience expressed agreement with the notion that newborns with hyperbilirubinemia should have the possibility of receiving treatment at home (pediatricians and community midwives: n = 71, 80%; MCAs: n = 350, 78%). Additionally, most respondents concurred that the introduction of PT at home is both feasible and worthwhile for their respective healthcare organizations (Supplemental information 2).

Responsibility, logistics and collaboration

All respondents were queried about topics related to responsibility, logistics and collaboration, resulting in responses from 106 pediatricians and community midwives and 501 MCAs (13 MCAs opted out of the questionnaire at the start of this section). Most respondents suggested that the pediatrician should hold responsibility for PT at home (pediatricians and community midwives: n = 82, 77%, MCAs: n = 281, 56%), along with the community midwife (pediatricians and community midwives: n = 59, 56%; MCA n = 373, 75%). Regarding blood sampling, half of the respondents identified the community midwife as the responsible party (pediatricians and community midwives: n = 54, 51%; MCA: n = 269, 54%), while others mentioned the pediatrician (pediatricians and community midwives: n = 29, 27%; MCA: n = 82, 16%) or the laboratory (pediatricians and community midwives: n = 23, 22%; MCA: n = 150, 30%).

The majority of respondents indicated that community midwives should be routinely consulted in PT at home care decisions (pediatricians and community midwives: n = 91, 86%; MCA: n = 416, 88%). This consideration was based on factors such as midwives’ understanding of families and practical feasibility of the intervention. In addition, many respondents indicated that MCAs should routinely participate (pediatricians and community midwives: n = 40, 38%; MCA: n = 267, 57%) or at least be informed about this decision (pediatricians and community midwives: n = 85, 80%; MCA: n = 404, 86%). This was motivated by MCAs’ knowledge of families and the need for organizations to ensure the assignment of experienced MCAs. Nevertheless, only half of pediatricians and community midwives who had prior experience with PT at home reported actual consultations between pediatricians and midwives, and only a minority reported actual consultation with MCAs. Moreover, MCAs also were generally not informed about the decision to treat a newborn at home.

Knowledge and information provision

All respondents where queried about topics related to knowledge and information provision, resulting in responses from 102 pediatricians and community midwives and 464 MCAs (4 pediatricians and community midwives and 37 MCAs opted out of the questionnaire before this section). Both HCPs with and without prior experience with PT at home expressed a need for additional information regarding PT at home. Most respondents indicated a desire for more information on how the PT device operates (pediatricians and community midwives n = 89, 88%; MCAs n = 425, 91%) and the required assessments of the newborn (pediatricians and community midwives n = 82, 80%; MCAs n = 422, 91%). Respondents without prior experience with PT at home also expressed a need for information regarding the benefits of PT at home and its logistical aspects. Pediatricians and community midwives, regardless of their experience, expressed a need for information on financial compensation (Supplemental information 3). Pediatricians and community midwives indicated a preference for online meetings or e-learnings, while MCAs favored in-person meetings in combination with e-learnings (Supplemental information 3).

Indications and contraindications

The section on indications and contraindications was exclusively presented to pediatricians. A total of 15 pediatricians, both with and without prior experience, completed this section. There was no consensus with respect to the gestational age and age at which treatment at home should be offered. Contra-indications for PT at home that were mentioned by at least half of the respondent include a pathological cause for hyperbilirubinemia (n = 13, 87%), language barrier of the parents (n = 11, 73%), parental difficulty in understanding the treatment (n = 15, 100%), intellectual disability of parents (n = 9, 60%), parental preference for hospital care (n = 10, 67%) and hesitation expressed by midwives or doctors (n = 13, 87%; Supplemental information 4).

Financial aspects and implementation readiness

All respondents where queried about topics related to financial aspects and implementation, resulting in responses from 100 pediatricians and community midwives and 403 MCAs (2 pediatricians and community midwives and 61 MCAs opted out of the questionnaire before this section). Among the 15 pediatricians and community midwives with prior experience, eight stated that they do not receive any financial compensation for PT at home. Five respondents expressed uncertainty about the compensation, while two mentioned receiving compensation that falls short of covering all costs. Nonetheless, the majority of community midwives with experience (n = 10, 83%) and one pediatrician (n = 1, 33%) acknowledged that PT at home demands additional time. Pediatricians and community midwives without experience anticipated that PT at home would require additional time (n = 70, 82%) and indicated that it necessitates financial compensation (n = 74, 87%).

In total, 66 pediatricians and community midwives and 211 MCAs with and without prior experience with PT at home responded to the open-ended question about prerequisites for implementing PT at home. Each response generated one or more open codes, resulting in a total of 236 codes for pediatricians and community midwives and 490 codes for MCAs. Based on the analyses, five core themes were established: (1) financial compensation, (2) education and information provision, (3) responsibility and clear agreements, (4) collaboration, and (5) logistics. Respondents expressed a need for information and training about PT at home. In addition, financial compensation emerged as an important theme with the majority of pediatricians and community midwives mentioning that the implementation of PT at home requires financial compensation for community midwives. Among the MCAs, financial compensation also emerged as an important theme with many MCAs mentioning that the increase in responsibility would require a higher salary for MCAs (Fig. 3).

Fig. 3: Qualitative analyses of questions about requirements and needs among pediatricians and community midwives.

PT phototherapy, MCA maternity care assistant.

Respondents were surveyed about their readiness for implementing PT at home using the Organizational readiness for implementing change (ORIC) questionnaire. The majority indicated agreement or partial agreement with all statements on implementation readiness (Supplemental information 5).