Engaging Fathers in Pregnancy and Infancy: A Scoping Narrative Review, 2015–2020

Full Description:

Background: Fathers play important roles in shaping the future of maternal and infant health. Two U.S. reviews summarized interventions that engaged fathers to promote their participation during the perinatal period. Neither examined whether interventions addressed barriers to father engagement (e.g. unemployment, transportation) or other social determinants of health (SDoH). One assessed the quality of interventions.

Objectives: To (1) identify interventions to increase father engagement, (2) assess whether they addressed SDoH and (3) evaluate their quality.

Methods: Articles for potential review were found in PubMed/MEDLINE, ScienceDirect, CENTRAL, and GoogleScholar and in reference lists of review studies using search terms related to father engagement, interventions, pregnancy, and infancy. The inclusion criteria were these search terms and primary U.S.-based peer-reviewed publications in English from January 1, 2015 through December 31, 2020. Father engagement was defined as: physical presence; participation in prenatal care; participation in educational activities about pregnancy and infancy; positive support for a pregnant woman; or interaction with an unborn child or infant. Two standardized quality assessment tools for quantitative and qualitive studies were used to characterize studies as “strong,” “moderate,” or “weak,” based on several elements including selection bias, study design, and adjustment for confounders. We assessed impact by direction of association and statistical significance (p < 0.05).

Results: Of 2,068 articles found, 2,042 records were unique. Screening titles and abstracts for the inclusion criteria yielded 89 articles. These articles underwent a full-text review where 68 were excluded: 20 non-U.S.-based, 6 with children ages >1 year, 13 with missing intervention/outcome details, 12 with a different outcome (e.g. paternal postnatal mental health), 9 had father engagement as an exposure, 4 were non-peer reviewed or non-primary studies, 3 were study protocols, and 1 was a duplicate. Of the 21 included articles, 4 were randomized controlled trials, 5 were longitudinal cohort, 4 were other cohort, 2 were cross-sectional, and 6 were other studies. Fifteen different interventions were identified: 12 were educational, 2 policy, and 1 environmental. One environmental and 2 policy interventions were methodologically strong and increased engagement (p < 0.05). All educational interventions were methodologically moderate or weak and two increased engagement (p < 0.05). One policy and 2 educational interventions addressed SDoH. Of these, all but one educational intervention increased engagement.

Conclusion: Multiple interventions to increase father engagement exist. Published studies of policy and environmental interventions had the strongest quality and impact. Some policy and educational interventions reviewed addressed SDoH which may be a strategy to overcome barriers for father engagement.

Abbreviated Description: The study identifies and summarizes recent policies and interventions available for father engagement in pregnancy and infancy in the United States. It further assesses the quality of evidence behind each intervention and explores whether interventions address barriers to father engagement.