Hadi Pranoto, Dwi Sri Rahayu, Nila Zaimatus Septiana, Santy Andrianie
This letter responds to Varela Pulido et al.’s study on kangaroo care and paternal self-efficacy after preterm birth. We argue that the study's key finding is not simply that kangaroo care benefits fathers, but that the ratio of paternal to maternal kangaroo care frequency, rather than paternal frequency alone, was associated with paternal self-efficacy. To interpret this pattern, we propose relational legitimacy, defined as the extent to which fathers perceive their caregiving role in the NICU as expected, endorsed, and meaningful within the clinical care system. We distinguish this concept from parental inclusion, engagement, and role recognition by emphasizing its focus on whether fathers are positioned as bona fide caregivers within shared caregiving routines. This perspective has clinical relevance because it may be reflected in staff invitations, communication patterns, and the visibility of paternal participation in practice. Overall, paternal self-efficacy may depend not only on doing kangaroo care, but also on how fatherhood is legitimized in NICU care. © 2026 Neonatal Nurses Association.
Department of Guidance and Counseling, Faculty of Teacher Training and Education, Universitas Muhammadiyah Metro, Jl. Ki Hajar Dewantara 110, Iringmulyo, Metro Timur, Lampung, Kota Metro, Indonesia; Department Guidance and Counseling, Universitas Katolik Widya Mandala Surabaya, Jln. Manggis No. 15-17, Kota Madiun, Indonesia; Islamic Education Department, IAIN Kediri, Jl. Sunan Ampel No.7, Ngronggo, Kec. Kota, Jawa Timur, Kota Kediri, 64127, Indonesia; Department Guidance and Counseling, Universitas Sebelas Maret Surakarta, Jalan Ir. Sutami 36 Kentingan, Jebres, Jawa Tengah, Surakarta, 57126, Indonesia