Redesigning and delivering inclusive parenting interventions for fathers
Authors: Joshua Jeong
Journal: The Lancet Global Health (2021)

In this study, Jill Luoto and colleagues1Luoto JE Lopez Garcia I Aboud FE et al.Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trial.Lancet Glob Health. 2020; 9: e309-e319Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar attempted to determine whether there are additive effects of inviting fathers alongside mothers in a parenting intervention to improve early child development (ECD) in Kenya. This study was well designed and encompassed a robust process and impact evaluation on various theory-informed parent and child outcomes, which included a direct assessment measure of ECD. However, they found null results of inviting fathers across parental and ECD outcomes. Nevertheless, the experimental invitation of fathers is novel and provides important new information to the existing literature that has principally focused on mothers exclusively. For this reason, I believe that a more nuanced assessment of the father involvement component of this trial is warranted to better contextualise findings and highlight potential future directions for advancing paternal engagement in parenting interventions. Luoto and colleagues suggested low paternal attendance as the primary interpretation of their null results. Despite efforts to incorporate multiple recruitment strategies, nearly half of the invited fathers did not attend a session; median attendance was one out of 16 sessions; and among those who attended one session, three-quarters discontinued entirely before their fourth session. Paternal attendance is dramatically lower in this study than the few previous parenting interventions with fathers in sub-Saharan Africa that have had greater success with fathers attending more than the majority of sessions.2Doyle K Levtov RG Barker G et al.Gender-transformative Bandebereho couples' intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: findings from a randomized controlled trial.PLoS One. 2018; 13e0192756Crossref PubMed Scopus (64) Google Scholar, 3Lachman J Wamoyi J Spreckelsen T Wight D Maganga J Gardner F Combining parenting and economic strengthening programmes to reduce violence against children: a cluster randomised controlled trial with predominantly male caregivers in rural Tanzania.BMJ Glob Health. 2020; 5e002349Crossref PubMed Scopus (7) Google Scholar However, the markedly low attendance rates raise concerns about the curriculum content and programme implementation model that were likely inadequate for engaging fathers in the local context. Specifically, a curriculum originally developed for mothers was applied nearly identically with fathers in the joint and gender-separated groups, despite evidence delineating unique parenting roles, expectations, and identities of fathers compared with mothers in low-income and middle-income countries.4Jeong J McCoy DC Yousafzai AK Salhi C Fink G Paternal stimulation and early child development in low- and middle-income countries.Pediatrics. 2016; 138e20161357Crossref PubMed Scopus (58) Google Scholar For most sessions, fathers were invited to accompany mother-child dyads in mixed groups, with only the four remaining sessions targeting fathers alone. Previous programmes for fathers have used more men-only sessions to promote belonging and facilitate discussion among men themselves with respect to local gender dynamics and norms, thereby achieving benefits on paternal and maternal caregiving outcomes.2Doyle K Levtov RG Barker G et al.Gender-transformative Bandebereho couples' intervention to promote male engagement in reproductive and maternal health and violence prevention in Rwanda: findings from a randomized controlled trial.PLoS One. 2018; 13e0192756Crossref PubMed Scopus (64) Google Scholar Furthermore, fathers were only invited to the community group meetings and ignored during home visits in the mixed programme delivery intervention. Home visits leverage unique family-strengthening opportunities for accommodating and gaining buy-in among fathers through reducing logistical and normative barriers to father engagement that often challenge community, group-based parenting programmes.5Panter-Brick C Burgess A Eggerman M McAllister F Pruett K Leckman JF Practitioner review: engaging fathers—recommendations for a game change in parenting interventions based on a systematic review of the global evidence.J Child Psychol Psychiatry. 2014; 55: 1187-1212Crossref PubMed Scopus (292) Google Scholar The important work of Luoto and colleagues offers insights to increase the possibilities and potential of engaging fathers. There is now an urgent need to move beyond merely inviting fathers as plus-ones of mothers to investing in the design of father-inclusive parenting interventions that, from the outset, aim to support fathers as programme co-beneficiaries. Gender-responsive adaptations of intervention content, delivery, and engagement strategies to incorporate the lived experiences of both parents will probably increase mothers' and fathers' interest, attendance, and sustain their programme engagement; thus maximising the potential for improving maternal and paternal parenting and ECD outcomes. I declare no competing interests. Group-based parenting interventions to promote child development in rural Kenya: a multi-arm, cluster-randomised community effectiveness trialParenting interventions delivered by trained community health volunteers in mother–child groups can effectively promote child development in low-resource settings and have great potential for scalability. Full-Text PDF Open Access