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Title: The New Dad Study (NEST) : a mixed methods feasibility study to improve first-time fathers' transition to fatherhood, their mental health and wellbeing
Author: Baldwin, Sharin
ISNI:       0000 0005 0287 530X
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2020
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Background: Men’s mental health and wellbeing during their transition to fatherhood is an important public health issue, that remains under-researched, especially from a qualitative perspective. Available evidence suggests that rates of mental health problems in new fathers and their impact on the family are significant, but not adequately addressed by UK policies for maternal and child health services. Many health visiting services in England use the Promotional Guide system with mothers and fathers, an intervention to support their transition to parenthood, but there is little known about its use and effectiveness, especially with fathers. Aims: The primary aim of this study was to explore first-time fathers’ needs and experiences during their transition to fatherhood, particularly focusing on their mental health and wellbeing. The secondary aim was to test the feasibility of health visitors’ use of the Promotional Guide system with first-time fathers and whether new fathers found this to be an acceptable intervention which met their needs. Methods: This thesis was designed around the Medical Research Council (MRC) framework for the developing and evaluating complex interventions and incorporates three separate study phases: 1) a qualitative systematic review; 2) an exploratory qualitative study; and 3) a feasibility study with a nested process evaluation, using a mixed-methods approach. Results: Phase I Qualitative systematic review: Twenty-two studies were included, from eight different countries, published between 1990 and 2017. The total number of first-time fathers included in the studies was 351. One hundred and forty-two extracted findings were aggregated into 23 categories and seven synthesized findings: 1) New fatherhood identity, 2) Competing challenges of new fatherhood, 3) Negative feelings and fears, 4) Stress and coping, 5) Lack of support, 6) What new fathers want, and 7) Positive aspects of fatherhood. Gaps identified in this review with respect to the type of support that fathers wanted, how it is provided, by whom, the optimal time for providing this; and whether new fathers would welcome routine mental health enquiry or screening by health professionals, informed the focus of the qualitative study in phase II. Phase II Qualitative exploratory study: Nine major categories were identified from 21 qualitative interviews with first-time fathers: 1) Preparation for fatherhood, 2) Rollercoaster of feelings, 3) New identity, 4) Challenges and impact, 5) Changed relationship: we’re in a different place, 6) Coping and support, 7) Health professionals and services: experience, provision and support, 8) Barriers to accessing support, and 9) Men’s perceived needs: what fathers want. A new finding of this study related to men’s own perceived needs and how they wanted to be supported during the perinatal period, contributing to the current evidence. Phase III Feasibility study with a nested process evaluation: Six major categories were identified from 45 questionnaires and ten interviews with a purposive sample of first-time fathers. They were: 1) Fathers’ experience of health visitor contact, 2) Fathers’ experience of Promotional Guides, 3) Fathers’ experience of health services in the perinatal period, 4) Fathers’ experience of fatherhood, 5) Fathers’ mental health and wellbeing, and 6) Fathers’ experience of the research process. The main themes identified from data collected from interviews with 11 health visitors and observations of eight health visitors using Promotional Guides were: 1) Enquiry into fathers’ mental health, 2) Promotional Guides in practice, 3) Health visitors’ perception of the Promotional Guides system, 4) Barriers to using Promotional Guides with fathers, and 5) Facilitators and recommendations for using Promotional Guides with fathers. While antenatal and postnatal outcomes were collected from 45 first-time fathers, none had received the intervention in its entirety. There is also some uncertainty that the fathers who did report receiving the intervention partially, actually did so. This study identified major gaps in the implementation of the Promotional Guide system. Conclusion: This study highlighted first-time fathers’ mental health and wellbeing needs during their transition to fatherhood, and how they wanted to be supported. It also identified barriers to implementation of the Promotional Guide system by health visitors, which need to be addressed prior to any future research into this intervention. These findings have a number of implications for researchers, health professionals, health service managers, commissioners, policy makers and parents.
Supervisor: Bick, Debra Elizabeth ; Sandall, Jane ; Malone, Mary Ellen Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available