Improving fathers' mental health, parenting, and familial engagement through an mHealth intervention in Kenya

Fathers play a pivotal role in early child health and development with impact on mental, social, and financial wellbeing throughout a child’s lifespan. One in ten fathers experience severe mental health challenges due to the stressors of parenting. Fathers’ poor mental health adversely impacts their relationships with partners, parenting behaviors and families’ health and safety, yet mental health services for fathers are scarce. The adverse effects of low paternal involvement disproportionately affects low- and middle-income countries (LMICs) of Africa where a quarter of ≤5 year-olds are developmentally delayed. WHO’s “Nurturing Care Framework” prioritizes fathers’ parenting role and calls for strategies to improve dyadic father-child mental health. Parenting interventions that support effective parenting knowledge, skills, and behaviors improve parent-child mental health outcomes, including in LMICs. Involving fathers strengthens and extends positive outcomes. Yet, most parenting programs solely engage mothers and prioritize mothers’ roles. Improving fathers’ mental health and parenting skills requires interventions tailored to fathers’ unique roles, needs, and preferences. Stigma and logistical challenges are reported by men in LMICs as barriers to in-person counseling. Mobile health (mHealth) interventions increase confidentiality and convenience to address these barriers. mHealth parenting interventions are acceptable and feasible in LMICs with benefits similar to in-person programs. To date, no mHealth tools tailored to fathers’ mental health are developed for LMICs. We propose using the IDEAS framework to develop “BABAText”—a father-facing mHealth parenting intervention to improve father-child mental health tailored to the needs and preferences of Kenyan fathers. The proposed project leverages our team’s ongoing study (R01HD100201, PrIMA-X) and extends novel data collection to adapt an existing mHealth platform (Mobile WACh) which sends automated theory-based SMS messages and enables 2-way communication with a remote nurse-counselor. In Aim 1, we will identify mental health needs, parenting challenges, and preferences for mHealth approaches among Kenyan fathers in a mixed methods needs assessment. In Aim 2, we will collaboratively develop “BABAText”, an mHealth parenting intervention for fathers, using a user-centered approach by incorporating fathers’ needs and preferences, feedback from iterative codesign workshops, and effective elements from evidence-based parenting and mental health interventions. In Aim 3, we will evaluate the acceptability, preliminary efficacy, and implementation barriers and facilitators of BABAText. This program of research will be conducted in partnership with fathers in Kenya to maximize impact. Overall, I anticipate a mHealth parenting intervention co-developed with fathers will improve father-child mental health and family wellbeing. This proposal addresses the high mental health burden among men in settings of Africa and is designed to provide an acceptable, effective mHealth parenting support intervention for fathers.