Fathers and the well-child visit Garfield, Craig F; Isacco, Anthony
Pediatrics (Evanston),
04/2006, Volume:
117, Issue:
4
Journal Article
Peer reviewed
Societal and economic shifts have expanded the roles that fathers play in their families. Father involvement is associated with positive cognitive, developmental, and sociobehavioral child outcomes ...such as improved weight gain in preterm infants, improved breastfeeding rates, higher receptive language skills, and higher academic achievement. However, father involvement in health care has been studied little, especially among nonmarried, minority fathers. Fathers are a significant part of the child's medical home, and comprehensive involvement of both parents is ideal for the child's well-being and health. Well-child visits (WCVs) represent opportunities for fathers to increase their involvement in their child's health care while learning valuable information about the health and development of their child. The objective of this study was to explore fathers' involvement in, experience and satisfaction with, and barriers to WCVs using qualitative methods.
In-depth, semistructured, qualitative interviews were conducted in 2 cities with a subsample of fathers who were participating in the national Fragile Families and Child Wellbeing Study. The 32 fathers who participated in our study come from a nested qualitative study called Time, Love, and Cash in Couples with Children. Fathers in our study reside in Chicago or Milwaukee and were interviewed about health care issues for 1.5 hours when the focal child was 3 years of age. Questions focused on the father's overall involvement in his child's health care, the father's attendance and experiences at the doctor, health care decision-making between mother and father, assessment of focal child's health, gender/normative roles, and the father's health. The open-ended questions were designed to allow detailed accounts and personal stories as told by the fathers. Coding and analysis were done using content analysis to identify themes. Particular themes that were used for this study focused on ideals of father involvement and dis/satisfaction, barriers to, and experiences in the health care system.
Of the 50 fathers from the Time, Love, and Cash in Couples with Children study in the 2 cities, 3 had moved out of the state, 6 were in jail, 7 had been lost in earlier follow-up, and 1 had died, leaving 33 eligible respondents. Of those, 1 refused to participate, resulting in a final sample of 32 fathers and an adjusted response rate of 97%. The mean age was 31 years, and the sample was 56% black, 28% Hispanic, and 15% white; 53% were nonmarried. Only 2 fathers had attained a college degree or higher, and 84% of the fathers were employed at the time of the interview. The majority (53%) had attended a WCV and 84% had been to see a doctor with their child in the past year. Reasons for attending a WCV included (1) to gather information about their child, (2) to support their child, (3) to ask questions and express concerns, and (4) to gain firsthand experience of the doctor and the WCV. Fathers reported positive and negative experiences in their encounters with the health care system. The 3 main contributors to fathers' satisfaction with health care professionals were (1) inclusive interactions with the physician, (2) the perception of receiving quality care, and (3) receiving clear explanations. The negative experiences were often specific instances and noted along with positive comments. The negative experiences that were mentioned by the fathers included feeling viewed suspiciously by health care staff, being perceived as having a lesser emotional bond with their child than the mother, and the perception that they were receiving a lower quality of service compared with the mother. Major barriers to attending WCVs include employment schedules as well as their relationship with the focal child's mother. For example, some fathers stated that they did not attend WCVs because that was a responsibility that the mother assumed within the family. Other fathers lacked confidence in their parenting skills, which resulted in lower involvement levels. Also mentioned were health care system barriers such as inconvenient office hours and a lack of access to their child's records. Despite the presence of several barriers that seem to prevent fathers from attending WCVs, many fathers (20 of 32;63%) mentioned "situational flexibility," which enables them to overcome the stated barriers and attend doctor visits. For example, some fathers viewed the seriousness of the visit such as "ear surgery" as a reason to rearrange their schedules and attend a doctor visit with their child.
The majority of fathers from our sample have attended a WCV, and most have been to their child's doctor in the past year; WCVs and doctor appointments are ways in which fathers are involved in their child's health care. Fathers detailed specific reasons for why they attend WCVs, such as to support their child, ask questions, express concerns, and gather information firsthand. The fathers reported more positive than negative experiences with the health care staff, and, overall, they are satisfied with their experiences with the health care system. Reasons for satisfaction include feeling as though their questions had been dealt with seriously and answered appropriately. However, the fathers in our study did report a variety of barriers to health care involvement, including conflicting work schedules, a lack of confidence in their parental role, and health care system barriers. Professionals who care for children and families need to explore creative ways to engage fathers in the structured health care of their children. For example, pediatricians can stress the benefits of both parents being involved in their child's health care while reframing the importance of WCVs. Understanding that many fathers have situational flexibility when it comes to health care encounters may encourage physicians to suggest more actively that fathers attend WCVs. Pediatricians can also support existing public policies such as the national 2003 Responsible Fatherhood Act that provides grants and programs that promote the father's role in the family and advocate for additional policies that would foster quality father involvement. Continued collaboration among families, physicians, and other health care professionals is essential to support father involvement and ensure positive health outcomes for children.
Despite the known positive child outcomes associated with father involvement, how fathers are involved in the health and healthcare of their children is largely unexplored. This qualitative study ...conducted interviews with a subsample of fathers from the national Fragile Families and Child Well-being Study to explore fathers' perceptions of their involvement in their child's health and healthcare. Using an integration of Grounded Theory and Consensual Qualitative Research qualitative methodologies, results indicated that fathers reported being involved in their child's health through encouraging healthy eating and exercise, monitoring their child's well-being and development, and understanding their child so they know how to respond when their child becomes sick. Some fathers also expressed "messing up", not adhering to medical advice, and lacking confidence in the healthcare setting. This study concluded that fathers are involved in their child's health in ways that promote child health and well-being as well as respond to acute care situations. Findings were applied to models of father involvement and led to an expanded conceptualization of father involvement. Health professionals are encouraged to educate and support fathers regarding proper medical care of children and to increase fathers' self-efficacy in this involvement domain through parenting education and active support.
Roman Catholic diocesan priests are a subgroup of men with unique religious and spiritual roles, beliefs, and practices. This qualitative study of 15 priests from the mid-Atlantic area of the United ...States focused on how priests’ relationship with God and promises of celibacy and obedience influenced their psychological health. Using a consensual qualitative research (CQR) design, the analysis revealed that participants described their relationship with God as central to their health and contributing to positive outcomes (e.g., sense of connection and support). The influence of their promises of celibacy and obedience were linked to both positive outcomes (e.g., decreased stress, improved relationships) and negative outcomes (e.g., internal conflict, depression/loneliness). This study highlighted the central role that priests’ relationship with God has on positive psychological health. Future research is necessary to understand how to maximize the positive effects and minimize the negative effects of priests’ promises of celibacy and obedience, which would benefit programs aimed at supporting priests’ psychological health.
Measuring masculinity ideologies is an important scientific effort for the psychology of men and masculinity. This commentary responds to the article by Thompson and Bennett (2015) by discussing the ...need (a) to consider the developmental contexts when measuring masculinity ideologies, (b) to continue empirical pursuits that identify and measure masculinity ideologies that are pathways to men's health, and (c) to use qualitative inquiry to further the theoretical and empirical development of masculinity ideologies of diverse as well as marginalized groups of men.
Fathers’ mental health help seeking is an understudied area. Using participants (N = 1,989) from the Fragile Families and Child Wellbeing Study, this study hypothesized that few fathers would seek ...mental health services; and increases in anxiety, depression, and parental stress would predict less mental health help seeking. Only 3.2% of the participants reported seeking mental health counseling. Among the three independent variables, only depression emerged as a significant factor that predicted less mental health help-seeking behaviors in fathers. Future research and clinical efforts need to better understand the low rates of help seeking and to identify pathways that facilitate positive mental health help seeking among fathers.
The Catholic priesthood in the United States faces challenges such as increased ministry demands and identity confusion. To address such challenges, this article contends that priests and those ...studying to be priests would benefit from embracing and exhibiting spiritual fatherhood. Spiritual fatherhood is rooted in Catholic Church history and theology but has not been well defined or integrated with psychology. The purpose of this article is to provide an integrative conceptualization of spiritual fatherhood that draws upon theology and psychology. In addition, the article develops several avenues of practical implications for the learning of spiritual fatherhood over time. Future directions of research and professional practice are offered.
Fathers’ mental health help seeking is an understudied area. Using participants (N = 1,989) from the Fragile Families and Child Wellbeing Study, this study hypothesized that few fathers would seek ...mental health services; and increases in anxiety, depression, and parental stress would predict less mental health help seeking. Only 3.2% of the participants reported seeking mental health counseling. Among the three independent variables, only depression emerged as a significant factor that predicted less mental health help-seeking behaviors in fathers. Future research and clinical efforts need to better understand the low rates of help seeking and to identify pathways that facilitate positive mental health help seeking among fathers.
Psychological evaluations of clergy applicants to the Catholic Church are an important gatekeeping mechanism during the admission process. However, limited research exists on the validity of ...assessments for this evaluative purpose and none have examined the predictive utility of the MMPI-2-RF to determine if an applicant will be accepted to formation, or if they ultimately ordained. This study fills that gap in the literature by investigating the predictive validity of MMPI-2-RF scales in 147 male applicants evaluated as part of their application for seminary or diaconate formation programs in a mid-sized Catholic diocese in the United States. Group analyses (e.g., Kruskal-Wallis tests) with admission status as the independent variable and MMPI-2-RF scales as the dependent variables yielded significant differences, most notably, those participants not admitted had higher mean scores on F-r, Fp-r, EID, RC7, THD, RC8, RC1, MLS, NUC, and JCP than the other three groups. Relative risk ratios were estimated for all MMPI-2-RF scales, indicating that higher scores are generally associated with a lower likelihood of admission and, ultimately, ordination. Limitations and future directions of research are also discussed.
Public Significance Statement
This study evaluates the predictive utility of the MMPI-2-RF for use in clergy evaluations and supports its use in this capacity.
Trends in higher education indicate that more women are earning advanced degrees than men and that male students in female-concentrated programs experience barriers to their academic success. This ...study investigated male graduate students' experience at a female-concentrated university. Four focus groups with 30 participants were conducted at a Mid-Atlantic university in the United States. Data was analyzed using grounded theory methodology. Participants identified with a wide range of masculinity norms, but focused on how their academic pursuits are tied to fulfilling traditional gender roles of worker, provider, and breadwinner and traditional gender norms of pursuit of status and being achievement-oriented. Participants experienced academic support from faculty and peers, which was tied into their sense of connection with their specific academic program. The perceived academic support and programmatic connection contributed to their desire to stay at the university and complete their degree. Practical considerations, such as being close to graduation and the high cost of transferring, were also reported as factors to their retention. The current research suggests that aspects of traditional masculinity and high academic motivation may be linked for male graduate students. Suggestions for future research and potential programmatic implications for male students at a female-concentrated university are considered.
The measurement of paternal involvement as a multidimensional construct has evolved with current societal trends of fathering and corresponding advanced theories. As a result, research must keep pace ...by continuing to examine predictors of the dynamic ways that fathers are involved with their children, particularly with infants. The current study built upon Belsky’s theoretical model of determinants of parenting to posit that paternal involvement with their infants (dependent variable) will be influenced by a combination of father, child, and contextual factors (independent variables). A total of 456 participants were recruited within the United States. Paternal involvement was categorized into five subfactors from the Paternal Involvement with their Infants Scale (PIWIS). Five separate linear regressions were conducted using each of the PIWIS subscale domains as the dependent variable. Results provide support for examining paternal involvement with a multidimensional approach. Characteristics of the child, and psychosocial and relational and contextual variables of the father were uniquely related to the five domains of involvement measured by the PIWIS. Clinical and programmatic implications as well as future directions for research are discussed.
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