This cross-sectional study applied the Kano model to analyze the attributes and priorities of home care needs reported by primary caregivers of premature infants discharged within the previous six months. The goal was to identify which needs are fundamental versus those that enhance satisfaction when provided, thereby informing targeted nursing service plans to improve home care quality and infant outcomes.
The survey was conducted between November 1, 2024 and January 31, 2025 using convenience sampling at a Grade A tertiary hospital in Hubei Province. The NICU in the study hospital admits predominantly moderate-to-late preterm infants and operates a closed management system; during hospitalization caregivers are not involved in routine daily care. Inclusion criteria for infants were gestational age < 37 weeks and discharge within six months. Exclusion criteria removed infants with severe complications, genetic disorders, inter-hospital transfers, or discharge against medical advice. Primary caregivers were family members (parents or grandparents) who provided at least six hours of daily care and met age and cognitive criteria.
A 27-item home care needs questionnaire was developed through literature review, qualitative interviews with 25 caregivers, and expert review by 21 senior clinical nursing experts. Items were categorized according to ERG theory (Existence, Relatedness, Growth). Each item was phrased in both positive and negative forms per Kano questionnaire conventions. Pretesting led to iterative wording revisions. Psychometric testing reported strong internal consistency (Cronbach’s α of 0.932 for the positive version and 0.940 for the negative), satisfactory content validity (I-CVI 0.71–1.00, S-CVI 0.93), and acceptable factor structure from exploratory and confirmatory factor analyses.
The study used the Kano attribute classification matrix to categorize each need into one of five attributes: Must-be, One-dimensional, Attractive, Indifferent, or Reverse. The Maximum Frequency Method determined the final attribute for each item. To refine prioritization where attributes or frequencies were similar, the study applied the Better–Worse coefficients (Satisfaction/Better = (A + O)/(A + O + M + I); Dissatisfaction/|Worse| = |(O + M)/(A + O + M + I)|) and ranked needs by quadrant and by Average Satisfaction Coefficient (ASC = (Better + |Worse|)/2). When ASC values were equal, the item with the larger absolute Worse value was prioritized.
Based on Kendall’s guideline, the target sample range was approximately 150–300 considering questionnaire length and a 10% invalid-response estimate. Paper questionnaires were distributed at follow-up clinics; home visits were used when caregivers could not attend clinic appointments. Data entry used double entry with cross-verification in EpiData 3.1 and analysis with SPSS 26.0. Researchers received standardized training, pilot surveys were conducted, and on-site checks ensured completeness. For participants with low literacy or advanced age, items were read aloud by researchers and responses recorded.
A total of 220 questionnaires were distributed and 201 valid responses were returned, yielding an effective response rate of 91.36%. Ninety-eight preterm infants met inclusion criteria and were included in the infant-level description. Valid responses were defined as questionnaires with complete responses to the 27 Kano items and no contradictory positive/negative item responses.
Using the Maximum Frequency Method, the 27 items were classified into three attribute groups:
Must-be attributes (3 items): These basic expectations, if unmet, sharply reduce satisfaction. The three identified Must-be needs related to feeding: informing timing and method of formula transition; informing medication usage and related precautions; and guiding assessment of feeding timing and amount.
One-dimensional attributes (6 items): Provision of these services is linearly associated with satisfaction. These included knowledge about growth and development patterns; guidance on early intellectual care training; identification of abdominal distension and abnormal jaundice; management of vomiting and choking; and guidance on first aid for choking and suffocation.
Attractive attributes (18 items): These services exceed expectations and substantially enhance satisfaction. Examples reported included education on normal urination and defecation, techniques to promote intestinal gas relief, and guidance on maintenance for home oxygen therapy or tube feeding.
Detailed item-level results were presented in the source tables.
Better–Worse coefficient analysis provided quantitative prioritization beyond categorical attributes. The item with the highest Better score was "teaching caregivers techniques to promote intestinal gas relief" (Better = 0.925), indicating a strong potential to increase satisfaction when provided. The item with the largest absolute Worse value was "informing caregivers about medication usage and related precautions" (|Worse| = 0.751), indicating substantial dissatisfaction if this need is unmet. Needs were ranked by quadrant (Quadrant IV highest priority, then I, II, III) and within quadrants by ASC values as described in methods.
Care needs among primary caregivers of premature infants at home were generally high, with survival- and feeding-related needs identified as most urgent. The Kano classification highlights that some needs (Must-be: feeding and medication information) are foundational and require priority fulfillment to avoid caregiver dissatisfaction, while many other needs are Attractive and, if addressed, will substantially boost satisfaction. The combination of attribute classification and numeric prioritization supports the design of targeted, resource-efficient home nursing interventions—prioritizing mandatory feeding and medication guidance, addressing one-dimensional health-recognition and first-aid training, and adding attractive supportive services where feasible to improve caregiver confidence and infant outcomes.
The study received initial ethics approval from the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology and subsequent review and approval from the Medical Ethics Committee of Yichang Central People’s Hospital (waiver of written informed consent for this anonymous, low-risk survey). The authors reported no specific funding and no competing interests. The manuscript and supporting information contain the study data. The source article presented the methodology, classification results, and prioritization metrics; further details (for example, full item-by-item ASC ranks) are available in the published tables.