Fatherhood intervention development in collaboration with African American non-resident fathers

Recruitment, Retention, and Intervention Outcomes from the Dedicated African American Dad (DAAD) Study

A significant proportion of African American (AA) fathers live in households apart from their young children. This living arrangement can have detrimental effects for children, families, and fathers. One hundred seventy-eight (n = 178) AA fathers, not residing with their 2-6-year-old children, were enrolled in a randomized trial to test the Building Bridges to Fatherhood (BBTF) program against a financial literacy comparison condition. BBTF is an intervention that was developed collaboratively with a fathers' advisory council of AA fathers who oversaw all aspects of program development. Based upon advisory council feedback, short video scenes captured fathers interacting with their children, their children's mothers, and other fathers. These video scenes were used to jump start the discussion around fatherhood, parenting, communication, and problem solving during the intervention group meetings. The actors in the video scenes were recruited from the community. Two trained group leaders, using a standardized group leader manual, delivered the intervention. The Money Smart Financial Literacy Program (MSFLP), which served as the comparator, was also delivered by AA men. Program satisfaction was high in both conditions. Even so recruitment and retention challenges influenced the ability to detect father and child outcomes. This study informs the participation of vulnerable urban AA fathers in community-based fatherhood intervention research and provides insight into bolstering engagement in studies focused on this population.

Overcoming Historical Barriers: Enhancing Positive Perceptions of Medical Research Among African Americans Through a Conference-Based Workshop

BACKGROUND

African Americans (AAs) and other racial/ethnic minority groups continue to be underrepresented in medical research and clinical trials. Failure to create more racially diverse research cohorts can exacerbate existing health disparities among these groups.

OBJECTIVE

To investigate best practices and strategies for enhancing participation of AAs in medical research among attendees of a preconference Institute at a faith-based public health conference.

DESIGN

Qualitative study using semi-structured interviews.

PARTICIPANTS

A total of 21 out of 29 attendees (90% AA) of the Institute (72% response rate).

APPROACH

A culturally tailored preconference Institute was held at the 2017 Healthy Churches 2020 National Conference. The Institute was led by AA researchers focused on underrepresentation of AAs in medical research. Semi-structured interviews were conducted 1-year post-Institute (n=21) and were audio-recorded, transcribed verbatim, and reviewed using thematic analysis.

KEY RESULTS

The majority of attendees reported that they were more likely to participate in medical research after attending the Institute (75%). Salient learning points reported by attendees demonstrated attainment of the Institute objectives. Key themes emerged describing barriers preventing AAs from participating in medical research including fear/lack of trust, lack of information on research projects, and not being approached to participate. Key themes regarding facilitators for participation in medical research by AAs were clear communication of study objectives and research benefits along with trust in researchers.

CONCLUSIONS

Attendees' perceptions of participation in medical research were largely positive following their attendance at a conference-based Institute aimed to address the underrepresentation of AAs in medical research. Our culturally tailored approach to disseminating knowledge of the research process could extend to other national conferences prioritizing AAs and other racial/ethnic minority populations to improve research participation.

Parenting and child-caretaking among black men who have sex with men and associated sexual and reproductive health factors: A brief report

The purpose of this exploratory study was to examine the prevalence of parenting and child-caretaking among a sample of black men who have sex with men (MSM), as well as associations between parenting roles and sexual and reproductive health (SRH) factors. Parenting and SRH data were derived from a survey of 199 black MSM. Nearly half of the sample reported being a father or father-figure (44.4%), almost a third indicated serving as caretaker of a child (29.1%), and one in five have a biological child (20.1%). Over half of the sample reported at least one of these three parenting/child-caretaking roles (52.5%). Two significant differences were observed for sexual health variables: men with biological children were significantly more likely to report using condoms inconsistently (55.0% vs. 35.7%, p=.026) and engaging in transactional sex work (36.8% vs. 21.0%, p=.041). Given the observed prevalence, parenting and child-caretaking among black MSM warrant further inquiry as factors that may influence SRH outcomes and care utilization. Services and interventions tailored to black MSM should consider these men's potential roles and responsibilities as parents and caretakers of children.

Fatherhood Matters: An Integrative Review of Fatherhood Intervention Research

Positive father involvement is critical to the healthy social, emotional, and academic outcomes of children at all stages of development. The purpose of this integrative review was to identify, categorize, and evaluate the potential impact of fatherhood interventions on father and child outcomes. A systematic search of four major research databases yielded 44 studies published between 1988 and 2018 that met study inclusion criteria. The most effective interventions were delivered in the community, with fathers convened in groups. Content focused on promoting positive parenting, co-parenting, and father/child relationships. Consequently, father involvement and child cognitive and socioemotional development were improved. Academic settings were underutilized in the fatherhood interventions in this review. We conclude that in order to optimize healthy child development, school officials must adopt a more inclusive stance toward the involvement of fathers in their children's education. Future randomized trials of fatherhood interventions delivered within school-based settings are warranted.

Group-based transmission of fatherhood among intergenerational African American fathers: A case study

PROBLEM

Nonresidential fatherhood contributes to the fact that over 70% of African American (AA) children grow up in homes without their biological fathers. In the absence of gender-specific parental guidance, AA young men who become fathers may lack paternal-parenting preparation.

METHODS

This secondary data analysis describes the verbal exchange of fatherhood perspectives among four experienced fathers and one adolescent father who participated in a pilot of group-based fatherhood intervention. Qualitative descriptive case study methodology guided by Social Learning Theory was used to explore the transmission of fathering perspectives between fathers.

FINDINGS

Qualitative thematic analysis affirmed that adverse emotional and psychological distress may be avoided with positive parenting preparedness. Culturally-specific group-based bidirectional learning can transmit fatherhood knowledge and skills to adolescent nonresidential fathers and this new perspective can contribute to adolescent wellbeing.

CONCLUSIONS

There is a need to investigate channels for AA adolescent boys, young men and fathers to engage in cultural-congruent paternal modeling in the event that their biological father or other social father role models are absent from their lives.

Father 2 Son: The Impact of African American Father-Son Sexual Communication on African American Adolescent Sons' Sexual Behaviors

Parent-child sexual communication has been associated with reducing adolescent sexual risk behaviors. Limited research on parent-child sexual communication has been conducted on African American (AA) adolescent males who are at increased risk of sexually transmitted infections (STIs) including HIV/AIDS. The purpose of this research was to examine AA father-son sexual communication and the effect of contextual factors on the sexual risk behaviors. The final sample consisted of 96 AA adolescent males, ages 16-21 years. Structural equation modeling was used to examine the variables of interest (neighborhood characteristics, father-son closeness and connectedness, father-son communication, sexual permissiveness, condom attitudes, sexual risk behaviors). A path model was developed and tested. Results demonstrated that AA father-son closeness and connectedness were related to father-son communication. AA father-son communication was negatively related to sons' permissiveness and positively related to condom attitudes. Sons' permissiveness positively predicted their sexual risk behaviors. AA sons' condom attitudes did not negatively or positively predict their sexual risk behaviors. The findings from this study demonstrate that AA father-son communication is an important factor in decreasing AA adolescent males' sexual risk behaviors and HIV risk.

Recruiting and engaging African-American men in health research

BACKGROUND

Improving the health of black and minority ethnic (BME) men in the US continues to be a public health priority. Compared with men of other races and ethnicities, African-American men have higher rates of mortality and morbidity from chronic illness and diseases including cancer, heart disease, prostate cancer, diabetes and HIV/AIDS. One way to address these disparities is to include African-American men in health research, to elicit their perspectives on health risks and protective factors. These can then inform interventions aimed at reducing health disparities. However, challenges remain in recruiting and engaging African-American men in health research.

AIM

To provide strategies for recruiting African-American men in health research, using as an exemplar a qualitative study of fathers' perspectives of sexual health promotion with young African-American males.

DISCUSSION

Efforts are needed to increase the representation of African-American men in health research. Ensuring that researchers are aware of the cultural, social and environmental factors related to decisions to participate in research can lead to effective methods to recruit and engage them.

CONCLUSION

There are several essential strategies for increasing African-American men's participation in health research: ensuring the research team is culturally and gender-sensitive; recruiting in trusted environments; using respected gatekeepers; developing trust with participants; and being transparent.

IMPLICATIONS FOR PRACTICE

Implementing strategies to include African-American men in health research has the potential to improve health disparities in the US.

A tripartite model for recruiting African-Americans into fatherhood intervention research

Many studies have examined factors influencing African-American (AA) participation in research studies. But none inform the recruitment of AA men into fatherhood intervention research. Our purpose is to describe the recruitment and enrollment framework of the Dedicated African American Dad (DAAD) Study, a randomized controlled trial (RCT) designed to test a fatherhood intervention against a financial literacy comparison condition. AA nonresident (AANR) fathers are fathers who do not reside with their child on a full-time basis. Fathers attended 10 group-based sessions; and father and mother informants completed research interviews at baseline, postintervention, and 12 weeks postintervention. The DAAD Study tripartite model is a system of strategies that address three factors that individually and cooperatively affect recruitment of AANR fathers into research: community partnerships; study infrastructure; and recruitment personnel. The intersection of these three components forms a recruitment nexus that can be used to guide community-based research. The DAAD study serves as an exemplar of recruitment challenges, strategies, and lessons learned.

From Innovation to Impact at Scale: Lessons Learned From a Cluster of Research-Community Partnerships

This article presents a description of how an interdisciplinary network of academic researchers, community-based programs, parents, and state agencies have joined together to design, test, and scale a suite of innovative intervention strategies rooted in new knowledge about the biology of adversity. Through a process of cocreation, collective pilot testing, and the support of a measurement and evaluation hub, the Washington Innovation Cluster is using rapid cycle iterative learning to elucidate differential impacts of interventions designed to build child and caregiver capacities and address the developmental consequences of socioeconomic disadvantage. Key characteristics of the Innovation Cluster model are described and an example is presented of a video-coaching intervention that has been implemented, adapted, and evaluated through this distinctive collaborative process.

Study protocol for a randomized clinical trial of a fatherhood intervention for African American non-resident fathers: Can we improve father and child outcomes?

PURPOSE

African American (AA) fathers who live apart from their children face multiple obstacles to consistent and positive involvement with their children. Consequently, significant numbers of children are bereft of their father's positive involvement. Intervention research that is explicitly focused on promoting the positive involvement of non-resident AA fathers with their young children is limited. The purpose of this article is to describe the study protocol of a randomized trial (RCT) designed to test the Building Bridges to Fatherhood program against a financial literacy comparison condition; and discuss early implementation challenges.

METHODS

Fathers (n=180) are recruited to attend 10 group meetings, reimbursed for transportation, given dinner and activity vouchers for spending time with their child, and incentivized with a $40 gift card at each data collection time point. Mothers are incentivized ($40 gift card) at data collection and must be amenable to father child interaction. Intervention targets include father psychological well-being, parenting competence, communication, problem-solving ability; father-mother relationship quality; and child behavioral and emotional/social development.

RESULTS

To date, 57 fathers have been randomized to study condition. Recruitment has been influenced by father and mother hesitancy and the logistics of reaching and maintaining contact with participants. Strategies to surmount challenges to father and mother recruitment and engagement have been developed.

CONCLUSIONS

The prospective benefits of positive father involvement to children, fathers and families outweigh the challenges associated with community-based intervention research. The findings from this RCT can inform the body of knowledge on engaging AA non-resident fathers in culturally relevant fatherhood programming.

Unheard Voices: African American Fathers Speak about their Parenting Practices

Researchers have called for qualitative investigations into African American fathers' parenting practices that consider their social context and identify specific practices. Such investigations can inform the way we conceptualize African American fathers' parenting practices, which can in turn contribute to prevention interventions with at-risk youth. We conducted semi-structured, qualitative interviews about parenting with 30 self-identified, African American, biological fathers of pre-adolescent sons at-risk for developing aggressive behaviors, depressive symptoms, or both. Fathers provided descriptions of their parenting practices, which were at times influenced by their environmental context, fathers' residential status, and masculine ideologies. Our systematic analysis revealed four related themes that emerged from the data: managing emotions, encouragement, discipline, and monitoring. Of particular note, fathers in the current sample emphasized the importance of teaching their sons to manage difficult emotions, largely utilized language consistent with male ideologies (i.e., encouragement rather than love or nurturance), and engaged in high levels of monitoring and discipline in response to perceived environmental challenges and the developmental needs of their sons. The findings provide deeper insight into the parenting practices of African American fathers who are largely understudied, and often misunderstood. Further, these findings highlight considerations that may have important implications for father-focused prevention interventions that support African American fathers, youth, and families.