Designing a Fatherhood Intervention to Improve Family Caregiving Relationships and Early Child Development in Tanzania

• In Event: Using Qualitative Research to Optimize the Design of Parenting Interventions in the Global South

Abstract

Most caregiving interventions to support early child development (ECD) have been designed for, delivered to, and evaluated among mothers. Fathers, in addition to mothers, can influence ECD through their own parenting behaviors, relationships with their partners, and psychosocial wellbeing. However, little is known about how to jointly address these distinct components of fatherhood and engage men as part of community-based interventions in low-income countries. We conducted formative qualitative research to guide the development of a multicomponent gender-transformative caregiving intervention that aims to target fathers’ parenting behaviors, relationship dynamics with their partners, and mental health to improve ECD in Mwanza, Tanzania. We completed in-depth interviews with 40 fathers and 40 mothers of children younger than aged 3 years as well as five village leaders and five community health workers stratified across four villages. We also completed 10 total focus group discussions: four with fathers, two with mothers, and four that combined some fathers and mothers. Semi-structured interview questions investigated fathers’ daily routines and caregiving responsibilities, the relationship quality between fathers and their children and partners, and common mental health problems affecting fathers. We conducted thematic content analysis and further applied theoretical frameworks (e.g., COM-B model of behavior change) to the analysis process. We found that fathers’ caregiving behaviors for young children were primarily described in terms of financial provisions. Although many parents also noted fathers’ direct engagement in play, this was limited by fathers’ employment and time largely spent out of home. Harsh discipline was another common paternal behavior that was deemed generally acceptable per social norms. Fathers rarely engaged in other childcare (e.g., feeding, bathing) or household activities (e.g., cleaning, cooking) also due to time barriers and gender norms. Respondents contextualized various aspects of couples’ relationships dynamics, ranging from couple’s decision-making processes and support received and provided between partners to issues that caused contention and how couples resolved such conflicts. We found that these dynamics and the degree of fathers’ cooperation and synchrony with their partners were linked with fatherhood identities and men’s engagement with young children. Respondents also shared various mental health concerns affecting fathers – including parenting stress, depressive symptoms, and excessive alcohol use – that were discussed as underlying determinants of men’s suboptimal caregiving behaviors. Overall, we identified a set of priority behaviors encompassing parenting, couple’s relationships, and mental health that are relevant and have potential for enhancing the role of fathers within family systems and ultimately improving ECD in the local Tanzanian context. Through mapping the interconnections across these thematic messages and determining the respective barriers and facilitators for each cluster of behavioral messages, we developed a theory of change to inform the design, structure, and approach of a new intervention curriculum for fathers. By drawing directly from the lived experience of fathers and through a subsequent process that will include iterative pretesting and additional qualitative consultations with community stakeholders, we will produce an intervention package that is theory-informed, culturally-relevant, and gender-based and has potential for engaging and supporting fathers and achieving efficacy in an eventual pilot trial.

Authors

• Joshua Jeong, Harvard University
  Presenting Author

• Juliet McCann

• Marilyn N Ahun, Harvard University

• Alya Al-Sager

• Alina Bhojani, Harvard T.H. Chan School of Public Health

• Damas Joachim