Strengthening First-time Fathers' Engagement in Early Parenthood When Having a Preterm Infant - The SUPPORTED Study.

Project description The overall aim of this research study is to identify, develop and evaluate whether supportive strategies for first-time fathers (FTF) of preterm infants will improve parental confidence, mood and anxiety as well as increasing paternal reflective function, and improve infants social-emotional competencies during admission in the Neonatal Intensive Care Unit (NICU), or Maternity Unit (MU) and follow up at home by health visitors in the municipalities in all five regions in Denmark. Thus, improve paternal confidence in the father role by involving, knowledge sharing, and guiding them in their infants' emotional, nutritional, and developmental needs.

Background Developing paternal confidence and engaging in the paternal role is pivotal to men's transition into fatherhood (1). The change in fatherhood culture from breadwinner to being involved in the care of the infant is challenging (2-4). Among first-time parents, fathers express more insecurity than mothers (5). Fathers of preterm infants experience even more insecurity as it is more difficult to read the infant's cues (6). Fathers have unique support needs that are frequently unmet (5,7), which may result in decreased mental health, father-infant interaction, and parenting confidence (7). In the health care system, they often feel like bystanders (4) even though they want a participating role to attach to the infant (8).

In Denmark, about 4.200 of 60.000 infants (7%) are born preterm (9). Preterm infants are admitted to the hospital for weeks or months due to immaturity of the organs. Information, emotional and practical support from healthcare professionals (HCP) are needed to enhance parents' experiences, well-being, caring, and confidence during admission and at home (10). Studies on fathers' involvement in early interventions of their preterm infant are limited (11). Generally, interventions that extend over a long period of time and include both primary and secondary sectors are the most effective (12). Studies have addressed parental relationships and insecurity and sought interventions to improve parents' opportunities to actively participate in care, showing positive effects, e.g., skin-to-skin helps fathers gain confidence in the paternal role (13). Across sections nurses, midwives, and health visitors provide early parenting support to all new families. There is a need to change the culture among HCP to increase the engagement of the father in a family-focused approach, and this requires the identification of changeable factors among HCPs in primary and secondary sectors like knowledge, attitudes, and behavior (14). Perceptions of fathers as important as the mother in early parenting are associated with favorable attitudes toward including them in family interventions; this association is mediated by the professionals' perception of their confidence (15).

Health- and socio-economic arguments exist for improving early paternal engagement, and fathers want to be engaged, attentive, and caring (16). Their involvement in fatherhood can benefit the health and well-being of both himself, the mother, and the infant (17). Fathers' engagement has been shown to improve social and relational functioning in childhood, decrease behavioral problems in adolescence, and increase educational outcomes (18,19).

Even though the Nordic countries have been at the forefront of involving fathers in pregnancy and delivery, evidence shows that fathers are still not included and approached by HCP equally to mothers. This project which works at and within all levels in the healthcare sector and across the country, has the potential to take the next step to a partnership with FTF of preterm infants by changing practice and culture to benefit the fathers, preterm infants, and families.