The neonatal period considers as the most critical and essential period in terms of growth and development , because newborns experience unstable conditions in the first hours and days of birth which puts them in the challenge of adapting themselves to extra uterine life. Meanwhile, preterm infants show less ability to adapt to the world around them [1, 2]. Consequently, many preterm infants may admit to the neonatal intensive care unit because of respiratory problems, temperature instability, blood pressure, heart rate, respiratory and heart problems, and neurological diseases at the very beginning days of their life . Epidemiological studies reveal that annually 9.6 to 12.9 million preterm babies are born, which accounts for 5 to 15% of live births in the world . In this regard, one million and six hundred thousand births occur annually in Iran, of which 160,000 newborns are born 8 to 12 percent preterm, who require specialized care in neonatal intensive care units [3, 4].
Moreover, preterm babies' mothers face a premature and disabled baby who needs special equipment and care to survive. Subsequently, they experience a severe emotional shock after a difficult birth-giving process. As a result of this shock, they don't have enough capability and strength to take care of the baby  because dealing with a preterm baby or a patient admitted to the neonatal intensive care unit is one of the most sensitive and stressful stages in the life of parents, especially mothers. This confrontation, which considers as a major emotional crisis, can have adverse and long-term effects on mothers' lives .
The adverse effects of preterm birth on mothers are feelings of inability and intolerance, incompatibility, sadness, anxiety, fear, worry, guilt, anorexia, inability to breastfeed, depression, and sleep disorders [7, 8]. These mothers also experience significant changes in family relationships, work, social activities and family responsibilities, and even their parenting roles . As they say, seeing a preterm baby inside an incubator or warmer under a ventilator or oxygen therapy, with multiple serums and lines attached to them, cause these mothers to doubt their ability to care for their babies. Many have become unable to adapt to the baby's condition and needs and subsequently have reported intolerance and intolerance in caring for their baby . Therefore, mothers are less active in the pediatric section and they are not capable enough to participate in caring for their babies and playing their mother role .
Besides, one of the most fundamental roles and signs of attachment between mother and baby is breastfeeding . Accordingly, the development of a sense of self-efficacy in breastfeeding in mothers of preterm infants improves their ability to care about their infants to reach them to a stable condition. In other words, breastfeeding self-efficacy means believing in one's ability to breastfeed a baby . Breastfeeding self-efficacy is influenced by four essential factors, including past breastfeeding experiences, surrogate experiences (watching mothers who have been successful in breastfeeding), verbal encouragement by influential people in the mother's life (spouse, friends, family, and treatment team, especially nurses) and physical and mental illnesses (postpartum depression, anxiety, and fear) [12, 13].
Medical personnel, particularly nurses in the neonatal intensive care unit, can promote mother-infant interaction, attachment, and strengthen resilience and self-efficacy in breastfeeding. Furthermore, they can encourage and support them to stay in bed with their baby and engage in care procedures [14, 15]. By advising and helping the mothers of these babies, nurses can promote a sense of self-efficacy in breastfeeding. Subsequently, mothers can experience a sense of empowerment, self-efficacy, and more peace in life .
According to what has been mentioned in previous studies, kangaroo care is one of the most influential participatory care in promoting the health of infants and improving mothers' sense of empowerment. Kangaroo care takes the form of skin-to-skin contact between mother and infant and concerns the three dimensions of infant health, mother-infant relationship, and maternal satisfaction and empowerment . Concerning this, studies have examined the effect of kangaroo care on preterm infants and their mothers in recent years. Particularly, recent investigations have shown that kangaroo care enhances the physical health indicators of preterm infants [11, 17]. However, kangaroo care is a pattern of two-way interaction between mother and baby, so in addition to infants, it can also affect mothers' physical and mental health indicators [10, 11, 17]. That's why Kangaroo care stimulates the secretion of oxytocin and decreases cortisol. Following these chemical happenings, the body can increase the mother's sense of calm, vitality, and pain tolerance, and reduces the mother's stress, anxiety, and worry . Although there are many studies in these areas, few studies have examined the effects of kangaroo care on mothers of infants, especially mothers of preterm infants admitted to the neonatal intensive care unit [7, 16, 19]. In this regard, Macedo et al. (2007), Bigelow et al. (2012), and Faramarzi et al. (2013) have shown that kangaroo care calms, makes mothers feel better, empowers, and more tolerant, and can reinforce these feelings [8, 15, 20]. In addition, researchers such as Svensson et al. (2019), Yilmaz et al. (2019), and Zhang et al. (2019) have reported that kangaroo care increases mothers' confidence in caring for their babies [21–23]. These studies also revealed that mothers needed less help with breastfeeding and reported more breastfeeding self-efficacy . Consequently, most of these investigations assessed the impact of kangaroo care on resilience, breastfeeding self-efficacy of infants using pamphlets and educational videos, and reported its benefits. Hence, it seems that examining the influence of kangaroo care by role-playing due to performance and role-playing before the actual performance can be practical and useful on the physical and mental health of mothers of preterm newborns. Wherefore, since a specific study has not evaluated the effect of kangaroo care by role-playing method on resilience and breastfeeding self-efficacy, we decided to study the influence of kangaroo care by role-playing method on resilience. Design and implement breastfeeding self-efficacy for mothers of infants admitted to the neonatal intensive care unit.