---
title: "Care needs of primary caregivers of premature infants at home: Kano model analysis and priorities"
id: "plos-one-4-analysis-of-care-needs-for-primary-caregivers-of-premature-infants-at-home"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-4-analysis-of-care-needs-for-primary-caregivers-of-premature-infants-at-home"
content_type: "clinical_feed_article"
specialty: "Pediatrics"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393"
published_at: "2026-10-08T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Care needs of primary caregivers of premature infants at home: Kano model analysis and priorities
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-4-analysis-of-care-needs-for-primary-caregivers-of-premature-infants-at-home
- **Specialty:** [Pediatrics](https://medichelpline.com/clinical-feed/pediatrics.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393)
- **Published At:** 2026-10-08T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This cross-sectional study used the **Kano model** to classify and prioritize home care needs of primary caregivers for premature infants discharged within six months. The survey collected 201 valid questionnaires from caregivers between November 1, 2024 and January 31, 2025. - The final instrument included 27 care-need items across three dimensions (Existence, Relatedness, Growth) validated by experts and pilot testing; internal consistency was high (Cronbach’s α ~0.93–0.94). - Participant sample comprised 98 preterm infants and 201 primary caregivers; 220 questionnaires were distributed with an effective response rate of 91.36%. - Kano attribute classification (Maximum Frequency Method) grouped needs into: 3 **Must-be** attributes (feeding-related: formula transition timing/method, medication usage/precautions, assessment of feeding timing/amount), 6 **One-dimensional** attributes (health issues and early training: growth/development knowledge, early intellectual care, recognition/management of abdominal distension, abnormal jaundice, vomiting/choking, first aid for choking), and 18 **Attractive** attributes (additional services such as normal urination/defecation education, techniques to relieve intestinal gas, and guidance for home oxygen/tube feeding maintenance). - Prioritization used Better–Worse coefficients and Average Satisfaction Coefficient (ASC). The highest Better score was for teaching intestinal gas relief (0.925). The highest absolute Worse score was for informing medication usage and precautions (0.751). - Study implications: caregivers’ needs are generally high with survival- and feeding-related needs most urgent. Findings support prioritizing targeted, attribute-informed home nursing interventions to optimize care quality and outcomes for **premature infants** after discharge. - Ethical approvals were obtained from relevant committees; data are reported in the manuscript and supporting files. No specific funding was declared and authors reported no competing interests.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0360393) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0360393#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0360393#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0360393#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0360393#citedHeader) * 10 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0360393#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0360393#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0360393#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0360393#discussedHeader) Open Access Peer-reviewed Research Article # Analysis of care needs for primary caregivers of premature infants at home based on the Kano model: A cross-sectional study * Fenfen Lan, Roles Data curation, Investigation, Software, Validation, Writing – original draft, Writing – review & editing Affiliation Department of Neonatology, Affiliated Central People’s Hospital, China Three Gorges University (Yichang Central People’s Hospital), Yichang, China ⨯ * Jiaohua Yu , Roles Conceptualization, Data curation, Methodology, Project administration, Supervision, Validation, Writing – review & editing * E-mail: yujiaohua2008@126.com Affiliation Nursing Department, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0008-9002-5370 ](https://orcid.org/0009-0008-9002-5370 "ORCID Registry") ⨯ * Zhaohua Huo, Roles Data curation, Investigation, Software, Validation Affiliation Department of Neonatology, Affiliated Central People’s Hospital, China Three Gorges University (Yichang Central People’s Hospital), Yichang, China ⨯ * Yuanyuan Wang, Roles Investigation, Software, Validation Affiliation Department of Neonatology, Affiliated Central People’s Hospital, China Three Gorges University (Yichang Central People’s Hospital), Yichang, China ⨯ * Qiaoyun Shi, Roles Data curation, Investigation, Software Affiliation Department of Neonatology, Affiliated Central People’s Hospital, China Three Gorges University (Yichang Central People’s Hospital), Yichang, China ⨯ * Yuanyu Liao, Roles Formal analysis, Software, Validation, Visualization Affiliation Department of Emergency Medicine, Shenzhen Hospital of Southern Medical University, Shenzhen, China ⨯ * Juan Liu Roles Formal analysis, Validation Affiliation Department of Neonatology, Affiliated Central People’s Hospital, China Three Gorges University (Yichang Central People’s Hospital), Yichang, China ⨯ # Analysis of care needs for primary caregivers of premature infants at home based on the Kano model: A cross-sectional study * Fenfen Lan, * Jiaohua Yu, * Zhaohua Huo, * Yuanyuan Wang, * Qiaoyun Shi, * Yuanyu Liao, * Juan Liu ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: October 8, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0360393) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0360393) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0360393) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0360393) * [Peer Review](https://journals.plos.org/plosone/article/peerReview?id=10.1371/journal.pone.0360393) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#sec005) * [Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#sec006) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#sec022) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#sec031) * [Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#sec039) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#sec040) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0360393) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393) ## Abstract ### Objective This study applied the Kano model to analyze the attributes of care needs among primary caregivers of discharged premature infants(up to 6 months post discharge), identify priority needs, and provide a foundation for developing targeted nursing service plans. ### Methods Between November 2024 and January 2025, a cross-sectional survey was conducted using convenience sampling. Primary caregivers of premature infants discharged within the previous six months from a Grade A tertiary hospital in Hubei Province were recruited. A self-designed questionnaire based on the Kano model was administered to evaluate the attributes and priorities of caregivers’ needs. The questionnaire consisted of 27 care-need items. Kano attribute classification used the Maximum Frequency Method, and needs were prioritized using Better–Worse coefficients and the Average Satisfaction Coefficient (ASC). ### Results A total of 201 valid questionnaires were collected. Analysis using the Kano model revealed that, among the 27 care needs, three were classified as “Must-be attributes” (related to infant feeding), six as “One-dimensional attributes” (related to health issues of premature infants), and 18 as “Attractive attributes.”. ### Conclusion The care needs of primary caregivers of premature infants at home are generally high, with survival needs being the most urgent. Targeted support should be provided based on the priority of needs and attributes to optimize home care services and improve both the quality of care and health outcomes of premature infants. ## Figures ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.t004) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.t003) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.t004) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0360393.t003) **Citation:** Lan F, Yu J, Huo Z, Wang Y, Shi Q, Liao Y, et al. (2026) Analysis of care needs for primary caregivers of premature infants at home based on the Kano model: A cross-sectional study. PLoS One 21(10): e0360393. https://doi.org/10.1371/journal.pone.0360393 **Editor:** Jing He, Sichuan Provincial People's Hospital: Sichuan Academy of Medical Sciences and Sichuan People's Hospital, CHINA **Received:** January 22, 2026; **Accepted:** September 27, 2026; **Published:** October 8, 2026 **Copyright:** © 2026 Lan et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** All relevant data are within the manuscript and its [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#sec040) files. **Funding:** The author(s) received no specific funding for this work. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction Premature birth is a significant public health challenge worldwide, with an incidence rate of approximately 10%. In China, the preterm birth rate is approximately 6%, while the number of preterm births ranks fourth globally [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref001)]. Preterm infants are susceptible to complications such as respiratory diseases, hyperbilirubinemia, feeding difficulties, and hypoglycemia, which often lead to prolonged hospitalization and markedly higher readmission rates [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref002)]. Studies indicate that the readmission rate within two years after discharge can reach 56% among preterm infants, with late-preterm infants (34–36 weeks of gestation) facing twice the risk of readmission within 30 days compared to full-term infants [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref003)]. Due to their organ immaturity, preterm infants often require admission to the Neonatal Intensive Care Unit (NICU), where they receive multidisciplinary professional care and continuous life support. Separation from their primary caregivers during hospitalization can disrupt the continuity of parent–infant bonding, impede the acquisition of care-related knowledge and skills, and delay the development of caregiving competence [[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref004)]. Consequently, families face multiple challenges after discharge, including insufficient caregiving capacity due to delayed adaptation to caregiving roles; anxiety and depression arising from uncertainties about the infant’s prognosis and development; fatigue caused by long-term, demanding care tasks; and isolation resulting from stigma or misconceptions [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref005)]. In addition, primary caregivers are under considerable pressure to facilitate catch-up growth in preterm infants. The early postnatal period—particularly the first 6–12 months—represents a critical window for compensatory growth [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref006)]. Providing scientifically informed and appropriate care during this crucial phase is essential for improving the quality of life for preterm infants. Therefore, post-discharge care is a long-term and complex process that requires caregivers to rapidly acquire the necessary competencies, imposing substantial demands and psychological pressure. When confronted with health issues in preterm infants, primary caregivers—particularly those with limited coping capacity [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref007)], psychological adjustment difficulties, or delayed role acceptance [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref008)]—exhibit strong and diverse care needs. Research indicates that within six months after discharge, parents have multifaceted information needs aimed at improving their mental health and sleep quality, and they expect tailored resources and informational support [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref009)]. The uncertainties and responsibilities inherent in caregiving often cause anxiety, underscoring the urgent need for informational and peer support to help caregivers navigate this transitional period [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref010),[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref011)]. Although caregivers acquire some basic skills through discharge education (such as bathing, dressing, and diaper changing), they frequently feel inadequately prepared for specialized care tasks, including home oxygen therapy, electrocardiogram monitoring, or nasogastric feeding. As infants progress through developmental stages, care demands continue to evolve, demonstrating both dynamism and complexity [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref012)]. Accurate identification of caregivers’ needs is a prerequisite for providing effective support. At present, hospital and community nurses often struggle to prioritize these needs, resulting in generalized rather than targeted interventions. This mismatch between services and needs can reduce resource efficiency. Previous studies have shown that providing scientific feeding guidance alleviates feeding difficulties in preterm infants, while information on behavior, growth, and development enhances caregivers’ skills and confidence, reduces anxiety, and promotes parent-infant interaction [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref013)]. However, the specific attributes and priorities of various needs remain unclear, limiting the precision of support. In addition, most existing research has focused on parental caregivers, with insufficient attention to the individualized needs of grandparents—who also serve as primary caregivers for some preterm infants [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref014)]. The absence of population-specific analysis hinders the delivery of precisely matched services. Since its introduction into nursing research, the Kano model has been widely applied to identify user needs, optimize service strategies, and promote innovation in nursing models and management practices [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref015)]. Through a cross-sectional survey and Kano analysis, this study aims to clarify the attributes and priorities of care needs among primary caregivers of discharged preterm infants, thereby providing a foundation for developing targeted nursing interventions. ## Methods ### Study design and participants A cross-sectional survey was conducted between November 1,2024 and January 31,2025 using convenience sampling. Primary caregivers of preterm infants discharged within the previous six months from a Grade A tertiary hospital in Hubei Province were recruited. The NICU of this hospital admits all preterm infants, mostly moderate-to-late preterm, and provides postoperative care for surgical conditions. The NICU operates a closed management system. During hospitalization, primary caregivers are not involved in daily care (e.g., feeding, bathing, diaper changing). At discharge, caregivers receive standardized health education on basic home care skills. This system is standard in most NICUs in China. The entire research design and reporting process followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Inclusion criteria for preterm infants were: (1) gestational age < 37 weeks; and (2) discharge within the past 6 months. Exclusion criteria for preterm infants were: (1) severe complications including moderate-to-severe anemia, severe retinopathy of prematurity requiring treatment, severe intraventricular hemorrhage, necrotizing enterocolitis requiring surgery, and moderate-to-severe bronchopulmonary dysplasia; (2) genetic disorders or congenital malformations; (3) transfer to another hospital due to medical needs; and (4) discharge against medical advice at the family’s request. Inclusion criteria for primary caregivers were: (1) adult primary caregivers, female ≥20 years old, male ≥22 years old [[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360393#pone.0360393.ref016)]; (2) a family member (parent or grandparent) serving as the main caregiver with ≥ 6 h of daily caregiving; (3) normal cognitive function and communication ability; and (4) voluntary participation in the survey. Exclusion criteria for primary caregivers were: (1) caregivers whose caregiving ability was impaired by severe cardiac, cerebral, pulmonary, or renal diseases; and (2) withdrawal during the study. Note on participant age: All primary caregiver participants met the inclusion criterion of being adults (female ≥20 years, male ≥22 years). Therefore, no minors were included as direct participants in this survey, and the requirement for parental or guardian consent was not applicable. ### Questionnaire survey #### Demographic questionnaire. A self-designed form was used to collect demographic information, including infants’ gestational age, birth weight, singleton status, and caregivers’ age, gender, relationship to the infant, education level, caregiving experience, and place of residence. #### Home care needs questionnaire for primary caregivers of preterm infants. The care needs questionnaire was developed through a systematic process: First, keywords such as “preterm infant”, “post-discharge”, “home care”, “primary caregiver”, and “needs” were used to search Chinese and English databases (PubMed, Web of Science, Embase, Cochrane, CINAHL, CNKI, Wanfang, VIP, CBM). High-frequency care needs were extracted and categorized based on the ERG(Existence, Relatedness, and Growth) needs theory, and an initial draft was prepared through research team discussions. Next, qualitative interviews were conducted with 25 eligible primary caregivers to identify practical service needs during home care. Finally, 21 clinical nursing experts with over 10 years of experience, at least a bachelor’s degree, and intermediate or senior professional titles(nurse-in-charge or above, including associate chief nurse and chief nurse) were invited to review and revise the questionnaire, resulting in a preliminary version. Following the principles of the Kano model, each item was phrased in both positive and negative for
## Related Clinical Research

- [Cross-national validation of the DASS-Y in Lebanese and Chinese adolescents](https://medichelpline.com/clinical-feed/plos-one-20-cross-national-validation-of-the-depression-anxiety-and-stress-scale-for-youth.md)
- [Longitudinal links between pain and anxiety/depression in young people: systematic review and meta](https://medichelpline.com/clinical-feed/medrxiv-10-temporal-associations-between-pain-and-anxiety-depression-in-young-people-a.md)
- [Serum ferritin and ADHD in children: systematic review and meta-analysis findings](https://medichelpline.com/clinical-feed/plos-one-11-serum-ferritin-in-children-with-attention-deficit-hyperactivity-disorder-adhd-a.md)
- [Bipartisan Concerns Over Kids' Online Safety Drive Legislative Action](https://medichelpline.com/clinical-feed/kff-health-news-0-fears-about-kids-online-safety-unite-democrats-and-republicans.md)
- [Suicidal ideation in school-going adolescents in northern Bangladesh: prevalence and associated fa](https://medichelpline.com/clinical-feed/medrxiv-0-prevalence-of-suicidal-ideation-and-its-associated-factors-among-school-going.md)

## Navigation
- [← Back to Pediatrics Feed](https://medichelpline.com/clinical-feed/pediatrics.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.