2 • 2019 • Developmental Observer Challenges and Barriers Perceived by Professionals in the Implementation of the NIDCAP Training in a Middle Income Country Charafeddine La, Kurdahi Badr Lb, Masri Sa, Abel Nour Gb, Saad Ab aDepartment of Pediatrics and Adolescent Medicine, American University of Beirut, Lebanon bDepartment of Nursing Services, American University of Beirut, Lebanon Aims/Purpose The purpose of this study is to describe the experience and chal- lenges faced during NIDCAP training and implementation in a middle income country. The research questions were the following: 1) What are the barriers and challenges perceived by profession- als during NIDCAP training and implementation? 2) What is the staff's perception regarding the NIDCAP’s im- pact on infants’ well-being, parental participation and work- ing conditions in the unit? Methods Design: This is a cross sectional survey with descriptive design. Setting: The study is carried out in a level III neonatal Intensive care unit in a middle income country for two months. Participants: All nurses and physicians (50) who worked in the NICU for at least one year prior to and during the implementa- tion of NIDCAP training were invited to participate using an online questionnaire. The Questionnaire: The questionnaire was adapted from a previ- ous Swedish study; it has been used previously to survey staff opinion after NIDCAP implementation in several European countries. The questionnaire is based on the Theory of Planned Behavior (TOPB); it includes 19 questions that measure the perception of staff, and is divided into five factors: attitude (8 items), perceived behavioral control (4 items), subjective norm (4 items), intention (2 items) and behavior (1 item). The items are formulated as statements using a five point Likert scale ranging from 1 (totally disagree) to 5 (totally agree); another six related questions were added to monitor the process of NIDCAP implementation. Questions related to participants’ characteristics and open ended questions were formulated to explore the staff experiences during the NIDCAP training implementation. Procedure: After Institutional Review Board approval his partici- pants were invited to answer an anonymous online survey after being briefed about the study. Statistical Analysis: The Statistical Package for Social Sciences (SPSS), version 24 will be used for quantitative analysis. Mean scores and 95% confidence intervals of the means will be cal- culated for the 19 items measuring the impact of NIDCAP on NICU conditions. Results/Findings The Institutional Review Board approval has been secured. The questionnaire was adapted and piloted by five health care profes- sional for clarity of content and applicability to our setting. They stated the tool is simple, easy to use and applicable to our set- ting; the language is clear and the content is understandable. No modifications to the existing questions were made. Additional questions were added as described above. Analysis will be done after completion of the survey. Results will be compared amongst the different participants’ based on their demographic characteristics. The content of the open ended questions will also br analyzed. Conclusion There is limited research exploring challenges faced by NICU nurses during the implementation of NIDCAP training in a middle income setting. This study will be the first to describe nurses’ perception regarding the impact of NIDCAP training on infant well-being, parental participation and staff development. Understanding barriers in this particular setting of an Arabic speaking country will help translate NIDCAP theory to practice in other settings similar to ours. Findings would serve as grounds for us and others to promote and improve NIDCAP implemen- tation in limited resource areas. A semi-annual publication of the NIDCAP Federation International ©2019. The statements and opinions contained in this newsletter are solely those of the individual authors and contributors and not necessarily of the NIDCAP Federation International. Articles from the Developmental Observer, duly acknowledged, may be reprinted with permission. Please contact us at: developmentalobserver@nidcap.org. Senior Editor Kaye Spence AM Associate Editors Diane Ballweg, APRN, CCNS, Deborah Buehler, PhD, Sandra Kosta, BA gretchen Lawhon, PhD, RN, CBC, FAAN Associate Editor Jeffrey R. Alberts, PhD for Science Contributions We would like to thank all of our individual donors for their generous support of the NFI and its continuing work. Developmental Observer