Title: Testing the feasibility and acceptability of an intervention to improve first time fathers’ transition to fatherhood focusing on the role of mental health and wellbeing.
Funder: Health Education England

Abstract: Background: CHAR(13) + CHAR(10)Promotion of mental health and wellbeing, and prevention of mental illness is a priority for the UK (DH, 2011a) and European government (European Commission, 2008). Poor mental health impacts on individuals, their families, and is a major burden for society, accounting for 23% of all ill health in the UK (WHO, 2004). While the estimated cost of treating mental health problems is likely to double over the next 20 years, there are also wider societal impacts; loss of productivity, reduced levels of education and increased crime (DH, 2011a). This therefore is a major public health issue. A meta-analysis reported postnatal depression in about 10% of fathers after birth (Paulson and Bazemore, 2010). There is a lack of preventative interventions focusing on fathers' mental health and wellbeing, highlighting the need for research to establish efficacious and cost-effective mental health interventions for men in the postnatal period (Wee et al, 2013). The proposed intervention is the Promotional Guide system, which is the most established and evidence-based parenting intervention used by many health visiting services in England and is underpinned by the Family Partnership Model. CHAR(13) + CHAR(10)Research Questions: What is already known about men's mental health and wellbeing during their transition to fatherhood? How do first-time fathers perceive their mental health and wellbeing needs during this transition? What is the feasibility and acceptability of the Promotional Guide system on first-time fathers' mental health and wellbeing? Plan of Investigation: CHAR(13) + CHAR(10)This study is designed around the Medical Research Council (2008) framework for developing and evaluating complex interventions. CHAR(13) + CHAR(10)Theoretical phase (April 2016 - November 2016) The first research question will be addressed in this phase through a systematic qualitative synthesis review of the literature, using meta-ethnography, which will then inform the qualitative interviews in the modelling phase of the study and allow exploration of the unknown aspects relating to men's transition to fatherhood. CHAR(13) + CHAR(10)Modelling Phase (December 2016 - September 2017) CHAR(13) + CHAR(10)The second research question will be answered in this phase through qualitative interviews with 15-20 first time fathers, 3-6 months after birth of their child, which will be analysed using framework analysis. This will create wider understanding of first-time fathers' mental health and wellbeing needs, by clarifying the findings and exploring the unknown aspects of the first phase. Findings from these qualitative interviews will inform the process evaluation in the third phase of the study.CHAR(13) + CHAR(10)Exploratory Evaluation Phase (October 2017 December 2018) The third research question will be addressed through a feasibility evaluation study, incorporating quantitative and qualitative data collection. This will determine whether the intervention achieved the changes in mental health and wellbeing outcomes anticipated, and enable a process evaluation of every aspect of acceptability, feasibility and fidelity of program delivery. Fathers receiving the intervention from two London sites will be asked to complete a questionnaire containing a range of outcome measures and baseline information during the antenatal Promotional Guide contact and again after the delivery of the postnatal Promotional Guide. Data will be collected over six months and analysed using statistical methods suitable for paired data. In-depth qualitative interviews will also be conducted with 15-20 of these fathers and 15-20 health visitors delivering the intervention. Potential benefits This study will increase the understanding and knowledge of fathers' mental health and wellbeing needs during their transition to fatherhood and test the feasibility and acceptability of the Promotional Guides. It has the potential to inform healthcare practice to: ensure the best start in life for every child, improve understanding of fathers' mental health & wellbeing, improve public health, and drive quality improvement in relation to this parenting intervention (Promotional Guides) and the related process.

Lay abstract: The transition to fatherhood is a vulnerable time in men's lives. Up to 10% of fathers are reported to be depressed after birth, which impacts negatively on fathers, mothers and their children, and increases the cost to society. Ensuring the best start in life for every child is a priority for the UK government (DH, 2013, 2015) and father's mental wellbeing is crucial to healthy couple relationships and effective parenting. While the transition to parenthood has recently been identified as one of six high impact areas by the government, where health visitors can really make a difference (DH, 2014), very little is known about effective interventions to support fathers' during this period. This study will explore an intervention to improve first time fathers' transition to fatherhood focusing on mental health and wellbeing. There are three phases to the study, through which the following three research questions will be answered: What is already known about men's mental health and wellbeing during their transition to fatherhood and what needs further exploration? How do first-time fathers perceive their mental health and wellbeing needs during this transition? What is the feasibility and acceptability of the Promotional Guide system on first-time fathers' mental health and wellbeing? In the first phase a systematic review of literature will be undertaken to create a wider, deeper knowledge of fathers' experiences during their transition to fatherhood, including: how fathers express mental distress, their experience of help seeking, where they seek help, how they manage masculinity, and differences between experiences of fathers from different classes or ethnic backgrounds. This will then inform the qualitative interviews in the next phase of the study and allow exploration of the unknown aspects relating to men's transition to fatherhood. In the second phase, in-depth interviews will be carried out with 15-20 first time fathers in order to explore the unknown aspects relating to men's transition to fatherhood and ascertain how they perceive their mental health and wellbeing needs during this period. This will create wider understanding of first-time fathers' mental health and wellbeing needs during their transition to fatherhood by clarifying the findings and exploring the unknown aspects of the first phase. Findings from these qualitative interviews will inform the process evaluation in the third phase of the study.In the third phase, an intervention known as the 'Promotional Guides System' will be tested. The Promotional Guide system is the most established and evidence-based parenting intervention used by health visiting services in England. It involves the use of a structured guide in the antenatal period around 4-6 weeks prior to the birth of the baby and again in the postnatal period around 4 weeks after the birth of the baby. The guides cover 5 different areas: Health, wellbeing and development of baby, mother and father Couple relationship Family and social support Parent-infant care and interaction Developmental tasks of early parenthood and infancy During this phase, fathers receiving the intervention from two London sites will be asked to complete a questionnaire during the antenatal Promotional Guide contact and again after the delivery of the postnatal Promotional Guide. The questionnaires will include two outcome measures based on commonly used tools in the area of perinatal mental health and wellbeing. It is envisaged that data will be collected over six months and at least 40-50 fathers will be recruited. In addition, in-depth qualitative interviews will be carried out with 15-20 of these fathers, and 15-20 health visitors delivering the intervention. Each phase of the study will inform the subsequent phase, and provide answers to the three research questions. This study will increase understanding and knowledge of fathers' mental health and wellbeing needs during their transition to fatherhood, while testing how acceptable the Promotional Guide System is to both fathers and health visitors. It has the potential to provide vital information that could help develop the Promotional Guides further, and inform more effective mode and timely delivery of this intervention to address fathers' mental health and wellbeing needs during their transition to fatherhood. This study may also highlight current gaps in fathers' needs being met and ways in which they could be addressed. As outlined by DH (2013), this study has the potential to inform healthcare practice to: ensure the best start in life for every child, improve understanding of fathers' mental health & wellbeing, improve public health, and drive quality improvement in relation to this parenting intervention (Promotional Guides) and the related process.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH