Jennifer StGeorge

BACKGROUND The demands associated with caring for a child begin prior to birth, as pregnancy itself requires substantial physical, psychological, and material resources. In previous generations, advice and support for new parents would come from trusted family members alongside health professionals. In the ‘digital age’, alternate sources of advice challenge parents to decide on a course of action. Fathers in particular are not sure who to trust for information and guidance on parenting and mental health. SMS4dads, a digital mental health service for fathers was designed to address new fathers’ use of parenting and mental health information and support. The service fosters a relational connection, and the Working Alliance Inventory Short Form (WAI-SF) was adapted to capture the unique factors of SMS4dads that are likely to contribute to alliance formation. OBJECTIVE (1) Examine whether SMS4dads fostered a therapeutic alliance between the service and participants. (2) Examine whether demographic factors, specifically education and location, were associated with the strength of this alliance. (3) Examine whether exposure to the service, measured by enrolment period, was associated with the strength of this alliance. METHODS Using a cross-sectional design, we linked data from a single-timepoint exit survey with programme enrolment records to derive demographic and exposure variables. RESULTS The SMS4dads-WAI-SR was completed by 599 fathers at the conclusion of their programme, in the period March to December 2025. Internal consistency of the total and subscales of SMS4dads-WAI-SR ranged from α.78 to .92. Mean scores ranged from Goal subscale M = 3.66 (SD 0.76) to Bond subscale M = 4.09 (SD 0.72). Fathers without tertiary education reported significantly higher Goal, Task, Bond, and Total Scale scores than fathers with tertiary education. No significant differences were observed between urban and rural fathers. Exposure was not associated with the total scale score. CONCLUSIONS The results support the existence of a working alliance between the SMS4dads text-based programme and men transitioning to fatherhood. The existence of an alliance did not depend on education level, rural/urban location or exposure. The SMS4dads-WAI-SR captures unique elements of the intervention and may serve as exemplar or template for father-specific parenting or mental health initiatives or for male parents in generic parenting initiatives. CLINICALTRIAL n/a

While programs targeting parenting skills are effective in early childhood, many parenting programs unintentionally work against father inclusion and fail to engage, retain or measure men’s participation. We developed DadPlay , an mHealth intervention, intended for fathers of young children with a focus on supporting positive behaviour and father-child relationships. In this paper, we report the feasibility of DadPlay , tested in real-world community settings, with a focus on four aspects of feasibility: Demand, Acceptability, Implementation and Perceived Impact. Participants were eligible for the intervention if they were fathers of a pre-school-aged child. A service network was established as a reference group, including family and child-focused non-government charities and organisations, as well as preschools located across Australia. Regarding Demand for DadPlay , of the approximately 340 organisations we approached, 57% agreed to disseminate information, and 325 parents submitted an Expression of Interest, of which 108 fathers completed enrolment, and 96 completed the programme. The message content and programme features of DadPlay were high in Acceptability. For Implementation, while Reach was vast, Efficiency of dissemination was low relative to the effort required, with some exceptions. A low post-programme response rate limits our Perceived Impact findings; however, summary statistics showed that responding fathers perceived improvements in their confidence and relationship quality. Overall, these findings suggest DadPlay was considered acceptable by fathers and has the potential to support fathers of young children. To scale up and sustain such initiatives, we need to better collaborate and co-create with fathers, professionals and organisations.

Parenting self-efficacy refers to the confidence that parents have in their ability to successfully promote children’s development and to overcome parenting challenges. Yet how parenting self-efficacy unfolds in men remains largely unknown. Developmental ecological models of fathering suggest that fathers’ parenting beliefs, such as parenting self-efficacy, develop through a complex interaction of factors. In the present study, we examine two important individual factors that may influence parenting self-efficacy: men’s recollection of affection received from their own father and men’s cultural values regarding traditional masculinity. Data were obtained from the Australian Longitudinal Study on Male Health (Ten to Men), Wave 1 and Wave 2 of the adult age group ( N = 7,901). After adjustment for covariates and prior depression, we found that higher levels of recalled paternal affection were significantly associated with greater parenting self-efficacy. Masculine norms relating to ‘winning’ and ‘risk taking’ were positively associated with greater parenting efficacy, while ‘emotional control,’ ‘violence,’ ‘playboy,’ and ‘power over women’ were associated with lower parenting self-efficacy. Our findings suggest that fathers’ affection has long-term consequences for their children’s future parenting self-efficacy. To enhance their parenting self-efficacy, some men may benefit from support that challenges the idealisation of masculine dominance while reinforcing evolving expectations of fathers.

Parenting self-efficacy, individual beliefs regarding parenting skills, has far-reaching consequences for family well-being and child development. Yet how parenting self-efficacy unfolds in men remains largely unknown. Here, we focus on two important social factors that may influence parenting self-efficacy: men’s recollection of affection received from their own father, and men’s values regarding traditional masculinity. Using nationally representative data from Australian men (N = 7,901), we found that recalled paternal affection was significantly associated with greater parenting self-efficacy. Masculine norms relating to ‘winning’ and ‘risk taking’ were positively associated with greater parenting efficacy, while ‘emotional control’, ‘violence’, ‘playboy’, and ‘power over women’ were associated with lower parenting self-efficacy. To enhance their parenting self-efficacy, men may require additional support to normalise and reinforce changing expectations of fathers and which provides a foundation for their own children’s parenting.

While active engagement of both parents in neonatal intensive care is considered best practice, fathers are less involved than mothers. This study describes the co-development of text messages targeting fathers whose infants were admitted to NICU, supporting Family Centred Care aims. Parents whose infants were admitted to NICU completed a survey of fathers' needs (Stage 1). Qualitative descriptive analysis (Stage 2) created topics for text messages (Stage 3). These were reviewed for importance and understanding by fathers and for clinical relevance by clinicians (Stage 4). Messages were revised and screened again (Stages 5-6) to produce a final set (Stage 7). Mothers (n = 36) and fathers (n = 15) responded to the survey, with analysis producing 12 themes and 21 subthemes. The 57 draft messages generated from themes were highly rated by 64 fathers and 41 clinicians (median rating 4.85/5). Twenty-three messages were accepted unchanged whilst 32 required editing and two were discarded, resulting in 55 messages. Final evaluation by 13 fathers and 11 clinicians led to 49 messages. Messages for fathers whose infants are admitted to NICU, developed and evaluated collaboratively with lived-experience parents and clinicians, can address identified needs and may better engage fathers whilst meeting Family Centered Care goals.

We report the feasibility of an mHealth intervention for fathers of young children, tested in real-world community settings, with a focus on four aspects of feasibility: demand, acceptability, implementation and limited efficacy. DadPlay was an intended for fathers who were raising young children with challenging behaviours. While programs targeting parenting skills are effective at reducing behavioural problems in early childhood, many parenting programs unintentionally work against father inclusion and fail to engage, retain or measure men's participation. We evaluated feasibility according to four components of feasibility: Demand, Acceptability, Implementation and Limited Efficacy. Participants were eligible for the intervention if they were fathers of a pre-school aged child. A service network was established as a reference group, which included family and child-focused non-government charities and organisations and preschools located across regional, rural and remote localities in Australia. Results for Demand showed we reached out to approximately 340 organisations: 57% agreed to disseminate information. 325 parents submitted an EOI, 108 completed enrolments, and 96 completed the program. For Acceptability, findings indicated that the message content and program features were very acceptable. For Implementation, our reach was vast, however efficiency appeared low, with exceptions. A low response rate limits our Efficacy findings, however, summary statistics showed that fathers’ confidence and relationship quality had increased. We demonstrated that DadPlay was acceptable and has the potential to support fathers of young children. To upscale and sustain such initiatives, we need to better collaborate and co-create with fathers, professionals and organisations.

MHealth interventions can efficiently distribute healthcare information to broad populations. However, take-up, adherence or engagement can be hard to assess. Building on previous efforts to create mHealth engagement indices, we developed an engagement metric to measure men's participation in SMS4dads, a message service for men in transition to fatherhood. Data were collected from 3261 fathers in NSW Australia in 2020-2021. An engagement metric was computed as a proportion of interactions across links and texts. Hazard ratios of dropping out were applied as external validity. To further understand men's engagement, we explored characteristics related to engagement in the program. Engagement scores did not significantly differ for rural or urban fathers. Engagement scores differed for Indigenous status, education level, first child status, antenatal enrollment, smoking status, alcohol use, and psychological distress score. The range of Engagement scores suggests that some men respond to few prompts, while others respond to almost all prompts. Understanding characteristics associated with mHealth engagement can improve precision when tailoring interventions to individual needs and vulnerable groups.

Support from fathers to their partners is important to reduce distress in mothers during the perinatal period when conditions such as depression and anxiety can be common. The SMS4dads digital platform delivers text messages to fathers but has not previously addressed specific messages to fathers with partners who are experiencing perinatal depression and/or anxiety (PNDA). To develop messages, in collaboration with experienced parents and clinicians, that are suitable for fathers whose partner is experiencing PNDA. Messages designed to enhance the quality of partner support for mothers experiencing PNDA were drafted by the SMS4dads team based on suggestions from mothers with lived experience of PNDA. Mothers and fathers with lived experience and expert clinicians rated the messages for importance and understanding. Clinicians additionally rated clinical relevance. Open response comments from parents and clinicians were collated for each message. Re-drafted messages were screened again and checked for literacy level. Forty-one draft messages received a total of 170 ratings from 24 parents and 164 ratings from 32 clinicians. Over three quarters of parents and clinicians agreed or strongly agreed that messages were understandable (parents 85.6%; clinicians 77.4%), important (parents 86.3%; clinicians 86.6%), and 85.5% of clinicians rated the messages as clinically relevant. Comments from clinicians (n = 99) and parents (n = 46) were reviewed and guided message development. Thirty re-drafted messages were screened and 16 edited based on a second round of ratings and comments from parents and clinicians. Messages for fathers whose partners are experiencing depression and anxiety can be developed and evaluated in collaboration with lived experience of parents and clinicians.

Issue AddressedMale partners are key supports for women in birth preparation and postnatally. Text-messaging can deliver timely information to expectant and new fathers to increase their support of the mother. However, technological innovations in healthcare often fail to be adopted. This study aims to assess the impact of disseminating a 'taster' set of SMS messages to increase clinicians' engagement with the intervention. MethodsExample messages from SMS4dads were delivered to clinicians over a 3-week period and a link provided to an evaluation survey. Agreement to two closed questions was rated on a five-point Likert scale; the frequency of specific recalled messages was calculated for the first open-ended question. Responses to the remaining open-ended questions were analysed with a descriptive thematic approach. ResultsA total of 418 participants (female 61.5%) working in health organisations (80.4%), mostly in nursing (33.9%) or midwifery (19.6%) enrolled. Of the 77 (18.4%) participants who provided an evaluation, 96% agreed or strongly agreed that the Professional Taster gave them a better understanding of how to explain the program, and 88% agreed or strongly agreed that they are now more likely to tell parents about the program. Analysis of the remaining two open-ended questions revealed clinicians' concerns for fathers alongside their primary focus on maternal wellbeing. ConclusionProviding 'how to' knowledge through receiving a sample of the intervention may increase clinicians' acceptance of technological innovation. So What?Health-promoting digital interventions using text are increasing. Novel tested strategies for gaining buy-in from healthcare staff will be needed.

Issue Addressed: Up to one in five new mothers experience depression or anxiety, and their partners are often the first line of social and practical support. However, many fathers are unprepared for their role as support person. The SMS4dads program (www.sms4dads.com) provides text‐based support to new fathers but lacks specific messages addressing maternal mental distress.Methods: A mixed methods process engaged mothers with lived experience of perinatal mental distress to identify message content for co‐designing texts in SMS4dads. Participants completed surveys derived from research literature and parenting websites using the theoretical framework of support domains: emotional or affectionate support, informational support, tangible support and positive social interaction. Mothers also indicated the most appropriate timing of support: at the point of identifying the distress (emerging), with ongoing symptoms (persistent) or during recovery (easing). Free text comments from mothers were linked to survey topics to provide examples of wording suitable for text messages to fathers.Results: Fifty‐five mothers with lived experience completed the surveys. All support items were more often endorsed as helpful rather than not helpful by mothers. Emotional support was thought helpful in the early stages, tangible support was valued with ongoing symptoms and social interaction appreciated as symptoms eased.Conclusions: Mothers experiencing perinatal depression and anxiety require a range of supportive actions by their partners, including household tasks and baby‐care, encouragement, listening and managing relationships with family and friends.So What?: Information provided by distressed mothers can provide guidance to professionals when designing information for fathers/partners. Digital delivery of this co‐designed information to fathers across urban and rural areas may enhance the competence of fathers working to support mothers experiencing mental distress in the perinatal period.