Testing a nursing intervention to enhance paternal-infant interaction and promote paternal role assumption

The purpose of this study was to determine if a nursing intervention designed to help fathers in interacting with their newborn infants could increase the father's understanding about the importance of his role and his confidence and competence in interacting with his infant, thus positively influencing paternal role assumption. King’s Dynamic Interacting Systems Model and Theory of Goal Attainment served as the theoretical framework for this study, and a middle range theory. The Theory of Interaction Enhancement derived from King’s work was proposed.

To test the theory and the effectiveness of the nursing intervention, 52 first-time families were randomly assigned to either an experimental or a control group. Forty-six families completed the study. The intervention. Demonstration and Development of Skills (DADS) was offered during the first 48 hours after delivery to the fathers in the experimental group, while fathers in the control group received only the customary information provided by the nursing staff at the time of discharge. Information about socioeconomic status, previous experiences surrounding childcare, attitude about pregnancy, and birth experience was also gathered to determine if these factors had any additional influence on paternal role assumption.

It was hypothesized that first-time fathers receiving the DADS nursing intervention in the immediate postpartum period 1) would perceive greater confidence and competence in the paternal role, 2) would demonstrate higher levels of paternal role assumption at 6 to 8 weeks postpartum compared to a control group, and 3) would be perceived by the mother as confident and competent in giving care to the infant compared to fathers who did not receive the intervention. The following subsidiary questions were also posed: 1) Are observed paternal behaviors consistent with the reported feelings of competence and confidence among first-time fathers?, 2) Does the amount of reported previous learning by first-time fathers correlate with paternal role assumption?, 3) Do first-time father's who perceive a positive birth experience demonstrate higher levels of paternal role assumption?, and 4) How does socioeconomic status correlate with paternal role assumption?

Data collection took place between 6 to 8 weeks postpartum. Gibaud-Wallston and Wandersman's (1978) Parenting Sense of Competency Scale (PSOCS) was used to determine the father’s competence and confidence in his role. The mother was asked to rate the father’s skills in infant care, and videotaping of paternal infant interaction over a six-minute period was done for later analysis and scoring.

Research assistants who were blind to group assignment were trained in the use of an observational tool developed by the researcher to analyze the quality of paternal infant interaction.

Statistical analysis was accomplished using Pearson’s correlation coefficient to determine the correlation between the three dependent variables as described in the hypothesis. Finding no significant positive or negative relationship, the researcher used a multiple regression selection process. R square and Mallows C(p) statistic were used to identify the most significant predictor variables for use in a linear regression model for each of the dependent variables. A model for PSOCS was identified through a backward elimination procedure.

Previous learning was found to be a significant predictor of the father’s perception of competence and confidence in his role as measured by the PSOCS (R square= 0.32 p= 0.003) Previous learning was also included in the linear regression models for mother’s rating of father’s infant care skills and on the video tape scores. The most significant variables in the model for mother’s rating were previous learning, and birth experience of the father which could influence his attitude about the infant (R square = 0.35, p = .0038). There was no group effect for either mother’s rating or the PSOCS, leading to a rejection of parts 1 and 3 of the hypothesis.

Fathers in the treatment group did demonstrate a higher quality of interaction with their infants than fathers in the control group, however. Predictors for video included group, previous learning, and infant state. Model R square was 0.54, p = 0.0001. All variables were significant at 0.049 or less. An interaction between group and previous learning and infant state was noted. Fathers in the control group displayed a positive relationship between previous learning and video scores, while fathers in the treatment group displayed a negative relationship. Mean scores from the videos higher in the treatment group. Infant state (whether awake or asleep) had a strong effect on video scores in both groups.

Results of this study suggests that previous learning does impact all aspects of paternal role assumption and that the DADS nursing intervention provided for the treatment group did influence paternal-infant interaction. This finding lends support for the Theory of Interaction Enhancement, suggesting that nurses can be influential in helping new fathers as they become acquainted with their newborn infant.