Adapting text4FATHER to directly link to first-time expectant fathers using social media to improve infant and family health

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ABSTRACT Father engagement in the prenatal and infant periods is associated with improved infant outcomes (e.g., physical, social and emotional health and development), and mother and father well-being. However, this key window of opportunity has been insufficiently leveraged to promote father engagement, especially, first-time expectant fathers. While engaging fathers is widely advocated, expectant fathers have limited clinical and public health touchpoints that engage them perinatally to learn about infant care. Not engaging fathers compromises the health of mothers and children and fails fathers. Past research, including our own, indicates fathers feel left out of maternity care and have gaps in their infant care skills and support. We developed text4FATHER, a multi-modal texting mobile health (mHealth) intervention, to increase infant care self-efficacy and behavioral engagement among expectant fathers with lower education in metro Baltimore with feedback from the target population, expert consensus-building, and an evidence-based review. text4FATHER sends texts twice-weekly to fathers with threaded content to support infant, partner, and father well-being including resource weblinks to support behavior change from mid-pregnancy through 2 months postnatally. Texts, written at a 5th grade reading level, are programmed to push/receive tailored based on: gestational age/infant age after birth and father’s resident status. Our pilot trial demonstrated significant improvements in first-time fathers’ infant care self-efficacy and behavioral engagement as well as reduced conflict between fathers and their partners’ mothers from baseline to 7-month follow-up (2 months postnatally) in the intervention than usual care (R21HD097453). Due to the pandemic and limits placed on fathers’ ability to accompany partners to maternity care, we piloted using social media in metro Baltimore to directly reach expectant fathers; more interested expectant fathers in metro Baltimore directly reached out than met our prior study’s inclusion criteria. Use of social media to directly recruit first-time expectant fathers has never been examined on a national scale for the benefit of all fathers where no similar strategy currently exists. In this R21 proposal, we propose adapting text4FATHER for use with a national audience of first-time expectant fathers recruited using social media. We will evaluate its efficacy with fathers enrolled in one of three arms: text4FATHER, attention control, or usual care control; assess its acceptability and satisfaction in the intervention arm, and its reach by father characteristics; we will also recruit expectant mothers to triangulate outcome data and fathers’ interactions with mothers and other caregivers. The current proposal would be the first to examine the efficacy of an mHealth intervention designed to engage first-time expectant fathers across the U.S. using social media. Results will help determine if using a national texting approach with social media can serve as a bridge to recruit a diverse sample of first-time expectant fathers in greater need and inform a larger randomized trial.