Early Service Experiences As a Barrier or Facilitator of Subsequent Service Engagement: An Examination of Father Engagement in Prenatal and Pediatric Care

Background and purpose: Studies have found that some fathers feel welcome and others feel marginalized in prenatal care settings. Engagement in prenatal care can lead some fathers to feel more attached. Whereas positive experiences in prenatal care may strengthen attachment and contribute to fathers’ commitment to continued participation in their child’s healthcare, negative experiences may create a barrier of discomfort or mistrust that must be overcome. We examined the impact of fathers’ experiences in prenatal care on subsequent participation in pediatric healthcare, and explored the components of fathers’ experiences attending a prenatal ultrasound.

Methods: We conducted a cross-sectional survey of a nationally representative sample of men aged 18–35 using the KnowledgePanel (GfK Custom Research North America). Applying the inclusion criterion of being father to a child age 0-3 yielded an analysis sample of N = 248. We asked participants if they had attended a prenatal ultrasound for their youngest child, and if so, they answered a 13-item index about their experience of the ultrasound, addressing comfort in the setting, feelings of inclusion by technician, and feelings of connection to baby and partner. We also asked about their frequency of attendance at their child’s pediatric visits. Using Stata 14, we calculated descriptive statistics. For each measure we created nationally representative estimates by applying survey weights that accounted for the sampling design and nonresponse. Factor analysis of the 13-item ultrasound experience index revealed two factors: 1) engagement with the setting (example item: “I felt that my questions were answered”); and 2) connection with the baby and partner (example items: “I felt more connected / attached to the baby” and “I felt more connected to my partner”). We conducted linear regression to assess the association of attending an ultrasound and experience at the ultrasound with later attendance at pediatric visits.

Results: 88% of fathers attended at least one prenatal ultrasound. Just 19% of fathers reported "never" or "rarely" attending a pediatric visit with their child. Attending an ultrasound was positively but not significantly associated with later attending pediatrician visits.  Linear regression using the two factors demonstrated that “connection with baby and partner,” and not “engagement with the setting,” has a significant positive relationship to attendance at later pediatrician visits.

Conclusions and Implications: To our knowledge, this study is the first nationally representative study of fathers to examine responses to ultrasound and its association with subsequent paternal involvement. Parent engagement is an important component of healthcare providers’ efforts to promote children’s healthy development. The majority of fathers in this nationally representative sample reported some degree of attendance at both prenatal and pediatric healthcare appointments. A positive experience attending a prenatal ultrasound was predictive of later attending pediatric visits. Most of the effect lay in a father’s feelings of enhanced connection to his baby and partner. Efforts by prenatal care providers to encourage fathers’ participation and offer support for fathers as parents and partners may facilitate fathers’ continued participation in children’s healthcare and prevent a barrier to father engagement in pediatric care.