Father involvement in infant care: two longitudinal studies

Development of the Paternal Involvement in Early Infancy Scale (PEACE) for fathers in Singapore

OBJECTIVES

To develop and validate a psychometrically sound self-reported Paternal involvement in Early InfAnCy ScalE (PEACE) for Asian fathers with infants aged 0-12 months old.

METHODS

This study comprised of three phases: (1) Pilot test among 100 fathers, (2) Exploring and confirming the PEACE's multidimensional structure using exploratory factor analysis (EFA) (n = 200 fathers) and confirmatory factor analysis (CFA) (n = 200 fathers), and (3) Assessing one-month test-retest reliability of PEACE among 30 fathers. Data was collected from August 2022 to August 2023. The EFA was conducted using principal axis factoring and varimax rotation. The CFA confirmed the factor structure via goodness-of-fit statistics. To assess the PEACE's concurrent validity, paternal involvement was measured using a previously validated paternal involvement scale. Convergent validity was established by examining correlations between PEACE and theoretically related measures of parenting self-efficacy, parent-child bonding, parenting satisfaction, and depression. Test-retest reliability was examined using the intra-class correlation coefficient.

RESULTS

The EFA and CFA results supported the five-factor 25-item PEACE. The five subscales were: i) Providing Tangible Support, ii) Meeting Basic Needs, iii) Bonding with Baby, iv) Decision-Making for Baby, and v) Sense of Responsibility and Accomplishment. All subscales reported good internal consistency and weak to moderate one-month test-retest reliability. Correlation coefficients between the PEACE and other scales supported the concurrent and convergent validity of the PEACE.

CONCLUSION

This study provided sufficient evidence to establish the initial reliability and validity of the five-factor 25-item PEACE.

IMPLICATIONS TO PRACTICE

The PEACE could be used to quantitatively assess paternal involvement in infant care.

A Qualitative Endline Evaluation Study of Male Engagement in Promoting Reproductive, Maternal, Newborn, and Child Health Services in Rural Kenya

Background: Globally, male involvement in reproductive, maternal, newborn, and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University implemented the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Toward the end of the project, we conducted a qualitative evaluation to explore how male engagement strategies influenced access to and utilization of RMNCH services. This paper presents the endline evaluative study findings on how male engagement influenced RMNCH in rural Kisii and Kilifi.

Methods: The study used complementing qualitative methods in the AQCESS intervention areas. We conducted 10 focus group discussions (FGDs) with 82 community members across four groups including adult women, adult men, adolescent girls, and adolescent boys. We also conducted 11 key informant interviews (KIIs) with facility health managers, and sub-county and county officials who were aware of the AQCESS project.

Results: Male engagement activities in Kisii and Kilifi counties were linked to improved knowledge and uptake of family planning (FP), spousal/partner accompaniment to facility care, and defeminization of social and gender roles.

Conclusion: This study supports the importance of male involvement in RMNCH in facilitating decisions on women and children's health as well as in improving spousal support for use of FP methods.

The Applicability and Performance of Tools Used to Assess the Father-Offspring Relationship in Relation to Parental Psychopathology and Offspring Outcomes

Introduction: Father-infant interactions are important for optimal offspring outcomes. Moreover, paternal perinatal psychopathology is associated with psychological and developmental disturbances in the offspring, and this risk may increase when both parents are unwell. While, the father-offspring relationship is a plausible mechanism of risk transmission, there is presently no "gold standard" tool for assessing the father-offspring relationship. Therefore, we systematically searched and reviewed the application and performance of tools used to assess the father-offspring relationship from pregnancy to 24-months postnatal. Methods: Four electronic databases (including MEDLINE, PsycINFO, Maternity and Infant Care Database, and CINAHL) were searched. Selected articles included evidence of father-offspring relationship assessment in relation to parental perinatal psychopathology and/or offspring outcomes. Data was extracted and synthesized according to the following: (i) evidence supporting the performance of tools in terms of their psychometric properties when applied in the context of fathers, (ii) tool specific characteristics, and (iii) study specific methodological aspects in which the tool was embedded. Results: Of the 30,500 records eligible for screening, 38 unique tools used to assess the father-offspring relationship were identified, from 61 studies. Ten tools were employed in the context of paternal psychopathology, three in the context of maternal psychopathology, and seven in the context of both maternal and paternal psychopathology, while nine tools were applied in the context of offspring outcomes only. The remaining nine tools were used in the context of both parental psychopathology (i.e., paternal, and/or maternal psychopathology) and offspring outcomes. Evidence supporting the psychometric robustness of the extracted observational, self-report and interview-based tools was generally limited. Most tools were originally developed in maternal samples-with few tools demonstrating evidence of content validation specific to fathers. Furthermore, various elements influencing tool performance were recognized-including variation in tool characteristics (e.g., relationship dimensions assessed, assessment mode, and scoring formats) and study specific methodological aspects, (e.g., setting and study design, sample characteristics, timing and nature of parental psychopathology, and offspring outcomes). Conclusion: Given the strengths and limitations of each mode of assessment, future studies may benefit from a multimethod approach to assessing the father-offspring relationship, which may provide a more accurate assessment than one method alone.

Promoting Father Involvement for Child and Family Health

Paternal involvement in children's lives is associated with a variety of child outcomes, including improved cognition, improved mental health, reduced obesity rates, and asthma exacerbation. Given this evidence, the American Academy of Pediatrics has promoted actions by pediatricians to engage fathers in pediatric care. Despite these recommendations, the mother-child dyad, rather than the mother-father-child triad, remains a frequent focus of care. Furthermore, pediatric care is often leveraged to improve maternal health, such as screening for maternal depression, but paternal health is infrequently addressed even as men tend to exhibit riskier behaviors, poorer primary care utilization, and lower life expectancy. Therefore, increasing efforts by pediatric clinicians to engage fathers may affect the health of both father and child. These efforts to engage fathers are informed by currently used definitions and measures of father involvement, which are discussed here. Factors described in the literature that affect father involvement are also summarized, including culture and context; interpersonal factors; logistics; knowledge and self-efficacy; and attitudes, beliefs, and incentives. Innovative ways to reach fathers both in the clinic and in other settings are currently under investigation, including use of behavior change models, motivational interviewing, mobile technologies, peer support groups, and policy advocacy efforts. These modalities show promise in effectively engaging fathers and improving family health.

Fathers' engagement in pregnancy and childbirth: evidence from a national survey

Background

Early involvement of fathers with their children has increased in recent times and this is associated with improved cognitive and socio-emotional development of children. Research in the area of father’s engagement with pregnancy and childbirth has mainly focused on white middle-class men and has been mostly qualitative in design. Thus, the aim of this study was to understand who was engaged during pregnancy and childbirth, in what way, and how paternal engagement may influence a woman’s uptake of services, her perceptions of care, and maternal outcomes.

Methods

This study involved secondary analysis of data on 4616 women collected in a 2010 national maternity survey of England asking about their experiences of maternity care, health and well-being up to three months after childbirth, and their partners’ engagement in pregnancy, labour and postnatally. Data were analysed using descriptive statistics, chi-square, binary logistic regression and generalised linear modelling.

Results

Over 80% of fathers were ‘pleased or ‘overjoyed’ in response to their partner’s pregnancy, over half were present for the pregnancy test, for one or more antenatal checks, and almost all were present for ultrasound examinations and for labour. Three-quarters of fathers took paternity leave and, during the postnatal period, most fathers helped with infant care. Paternal engagement was highest in partners of primiparous white women, those living in less deprived areas, and in those whose pregnancy was planned. Greater paternal engagement was positively associated with first contact with health professionals before 12 weeks gestation, having a dating scan, number of antenatal checks, offer and attendance at antenatal classes, and breastfeeding. Paternity leave was also strongly associated with maternal well-being at three months postpartum.

Conclusions

This study demonstrates the considerable sociodemographic variation in partner support and engagement. It is important that health professionals recognise that women in some sociodemographic groups may be less supported by their partner and more reliant on staff and that this may have implications for how women access care.

Supporting fathering through infant massage

Fathers may feel dissatisfied with their ability to form a close attachment with their infants in the early postpartum period, which, in turn, may increase their parent-related stress. Our study sought to determine if an infant massage intervention assisted fathers with decreasing stress and increasing bonding with their infants during this time. To address the complex father-infant relationship, we conducted a pilot study using a mixed methodology approach. Twelve infant-father dyads participated in the intervention, and 12 infant-father dyads populated a wait-list control group. Paternal stress was measured using the Parenting Stress Index at baseline and at postintervention. We found infant massage instruction significantly decreased paternal stress. Our findings were also supported by the qualitative data and suggest fathers may benefit from applied postnatal education.

Envolvimento paterno aos três meses de vida do bebê

O presente estudo investigou o envolvimento paterno aos três meses de vida do bebê. Foram entrevistados 38 pais primíparos, com idades entre 20 e 40 anos. Realizou-se uma análise de conteúdo baseada nas dimensões do conceito de envolvimento paterno: interação, acessibilidade e responsabilidade. Os pais revelaram envolverem-se nas atividades de cuidado, embora nem sempre de maneira rotineira. Também relataram preocupações e envolvimento nas decisões relativas aos cuidados, educação e saúde do bebê. Contudo, consideravam que sua participação estava aquém da ideal em função das restrições impostas pelo trabalho. Os resultados apontam para um aumento no envolvimento paterno nos primeiros meses do bebê e para a necessidade de apoio aos pais neste momento de transição familiar.

A transição para a paternidade: da gestação ao segundo mês de vida do bebê

O presente estudo longitudinal teve como objetivo compreender a transição para a paternidade, investigando as expectativas e sentimentos dos pais, durante a gestação, e a experiência da paternidade após o nascimento do bebê. Participaram do estudo 20 homens casados, primíparos, com idade entre 20 e 40 anos, entrevistados no final da gestação de sua esposa e dois meses após o nascimento do filho. A análise de conteúdo qualitativa das entrevistas revelou que a gestação foi vivida como emocionalmente intensa, marcada por alegria, ansiedade e conflitos. Preocupações com a saúde da esposa e do bebê e sentimentos de exclusão mostraram-se presentes. No segundo mês de vida do bebê, os pais relataram sentimentos positivos e satisfação, confirmando as expectativas construídas durante a gestação, embora o sentimento de exclusão persistisse. Já a participação nos cuidados do bebê não se mostrou tão efetiva quanto planejado, embora houvesse grande proximidade e afeto na relação pai-bebê.

Facial experience during the first year

Parents of 2-, 5-, 8-, and 11-month-olds used two scales we developed to provide information about their infants' facial experience with familiar and unfamiliar individuals during one week. Results showed large discrepancies in the race, sex, and age of faces that infants experience during their first year with the majority of their facial experience being with their primary caregiver, females, and other individuals of the same-race and age as their primary caregiver. The infant's age and an unfamiliar individual's sex were predictive of their time spent interacting with one another. Moreover, an unfamiliar individual's sex was predictive of the attention infants allocated during social interactions. Differences in frequency and length of interactions with certain types of faces, as well as in infant attention toward certain individuals, all likely contribute to the development of expertise in processing commonly experienced face types and deficiencies in processing less commonly experienced face types.

Fathers of Girls, Fathers of Boys: Influence of Child’s Gender on Fathers’ Experience of, Engagement in, and Representations of Paternity

The aim of this study was to examine the influence of child’s gender on several dimensions of paternity: the fathers’ personal experience of paternity, their involvement in child rearing, and their representations. A total of 147 Swiss fathers of 18-month-old children (65 girls and 82 boys) completed questionnaires. The child’s gender had little influence on paternal experience, relationship to the child or relationship with the child’s mother. Globally, the fathers took on few responsibilities which were largely devolved to mothers. Fathers of boys were more involved in child care than fathers of girls. Finally, a discrepancy was found between the fathers’ representations of paternal roles in rearing girls and boys and the actual level of responsibility that fathers adopted in their relationship with their child.

Fathers' support to mothers of medically fragile infants

OBJECTIVE

To examine mothers' perceptions of support from fathers over the 1st year after birth of a medically fragile infant.

DESIGN

A descriptive, correlation design based on an ecologic systems view of the family. It was hypothesized that the levels of paternal support would be influenced by factors within the two subsystems: the mother-father system (marital status) and the child subsystem (health and gender).

SETTING

A tertiary care children's hospital.

PARTICIPANTS

Sixty-four mothers of medically fragile term and preterm infants, who were married or living with the father.

MAIN OUTCOME MEASURES

The Stress Support Scale assessed maternal perceptions of helpfulness and satisfaction with paternal support at enrollment, after discharge, and around 1 year of age.

RESULTS

Mothers reported high levels of help from fathers at enrollment. Married mothers did not differ from unmarried mothers in their perceptions of helpfulness of support but were more satisfied with support. Mothers of female infants received more help from fathers than mothers of male infants, and this difference increased over time. However, mothers of female infants were not more satisfied with paternal support. Neither number of technologies nor birthweight related the maternal perceptions of paternal support.

CONCLUSIONS

Family systems factors were more significant in maternal perceptions of paternal support than the health status of the infant.

Father-child teaching interactions: the relationship to father involvement in caregiving

This study examined whether the amount of caregiving is related to the behavior of a father and his child during a structured teaching interaction. Healthy infants and toddlers (51 girls and 59 boys) and their fathers were observed in their homes. Fathers reported the frequency of involvement in caregiving during the previous week. Although fathers in higher and lower involvement groups were equally sensitive to the child's cues and responsive to the child's distress, fathers who were more involved in caregiving had higher scores in cognitive growth fostering as measured by the Nursing Child Assessment Teaching Scale.

Parental involvement in pediatric cardiology outpatient visits

There is a lack of information regarding parental involvement in subspecialty care of their offspring. We evaluated trends in 3,118 parental visits, accompanied by their children to a pediatric cardiology office during a 5-year period. Offspring accompanied both parents 29%, mothers alone 64%, and fathers alone 5% of the total visits. The rates were similar for first-time visits and this trend was similar across all 5 years. Children were significantly younger when accompanied by both parents than by individual parents. Mothers play a major role in a child's subspecialty care. Our findings have important educational, social, research, and marketing implications.

Gender differences in adapting to a child's chronic illness: a causal model

This study investigated (1) the differential impact of the child's chronic illness (CI) on 80 fathers and 80 mothers and the psychosocial variables contributing to their adaptation and (2) the suitability of the causal model based on the Double ABCX Model to predict parents' adaptation to the child's illness. Eight questionnaires relating to the variables were used. Path analysis revealed similarities and differences between fathers and mothers. Social support and coping behaviors were the main variables influencing both parents' adaptation. Differences between fathers and mothers are discussed in this article. The Double ABCX Model is fairly effective in conceptualizing the process of parents' adaptation to the child's CI.

The experiences of new fatherhood: a socio-cultural analysis

For most men, first-time fatherhood involves significant changes in self-identity and their relationship with their female partner. This paper presents some findings from a longitudinal, qualitative study into the first 6 months of new fatherhood for a group of 15 Australian men. The discussion draws on a series of semistructured interviews undertaken on a minimum of four occasions from a few days before the child was born until 5-6 months after birth. We found that first-time fathering in contemporary western society requires men to be simultaneously provider, guide, household help and nurturer. The demands of these roles, and the tensions they sometimes produce, challenge men's relationships with their female partners, the meaning and place of work in their lives and their sense of self as competent adults. Almost all the men we interviewed found the early weeks and months of fatherhood more uncomfortable than rewarding, despite looking forward to fatherhood very positively. Their experience appeared more closely aligned to their difficulties with meeting social expectations and roles rather than individual deficits.

From fun and excitement to joy and trouble--an explorative study of three Danish fathers' experiences around birth

The role of the father has undergone considerable change in the West. Fathers of today are expected to take a more active part in birth preparation, birth and childcare than their predecessors were. The purpose of the present study is to describe some Danish fathers' experiences around birth. Three first-time fathers were interviewed at three different times: in the last month of pregnancy, two weeks after the birth of their child, and again three months later. Data were analyzed in several steps using a hermeneutical approach. The fathers' experiences were identified as fun and excitement at the end of the pregnancy, love at first sight at the birth, at which they all attended and took an active part, awakening when the new family was united at home and when they came to realize how much effort is needed in caring for an infant, and joy and trouble three months later. It is suggested that health personnel might benefit from the study in both a direct and indirect way.