Richard Fletcher, Chief Investigator; Chris May, Senior Project Officer; Jaime Wroe, Research Assistant
The University of Newcastle
beyondblue with donations from the Movember Foundation
Request for proposal
Project completion year
To develop SMS-based messages to be delivered to the phones of new fathers that link them to tailored information and resources, track their mood and respond to signs of significant distress, connect them to services when required, and connect them to other dads facing similar challenges.
Develop and test a smartphone based, SMS information and support system for new fathers at risk of depression and/or anxiety.
1. Utilise smartphone messaging software which will:
- Send regular text messages to fathers addressing the areas: fathers' mood and help-seeking; father infant care; and, support for mother.
- Include 'pull-notifications' - links within texts to internet sites containing information, self-assessment and treatment options.
- Include user-response texts to identify fathers at risk for depression and anxiety and connect them to phone call follow-up (telephone triage) and/or text-based guidance to internet and help-line support.
2. Engage key leaders from health, employment, community and welfare agencies, services and organizations from within the Hunter region to:
- Support the involvement and up skilling of relevant staff.
- Assist in identifying communication channels with expectant and new fathers.
- Explore additional procedures and collaborative arrangements to enhance existing information and support for expectant and new fathers.
3. Develop print and online materials, educational support and processes for recruiting fathers to SMS4dads:
- Materials will be tailored to the entry points such as pharmacies, industry sites, ultrasound clinics, general practice surgeries, antenatal clinics.
- Educational support will be directed at key groups such as midwives, Human Relations staff, sonographers, obstetricians, early intervention staff to upskill them on talking to fathers and mothers about the relevance of fathers' role in infancy and the usefulness of SMS4dads.
- Workplace and health services processes, including perceived costs and benefits, that enable fathers' enrolment in SMS4dads will be identified.
4. Track and quantify entry to SMS4dads, usage of SMS4dads texts and follow-on contact rates for fathers engaged in SMS4dads
Nine key insights emerged from the research:
- Both health professionals and media-generated attention are effective for recruiting new fathers to projects such as SMS4dads
The most effective strategy for recruiting new fathers to a project such as SMS4dads is via a combination of promotion by health professionals involved in antenatal education, delivery and postnatal care and media-generated attention through news and social media outlets. The effectiveness of recruitment is enhanced when friends, partners or other family members are familiar with and recommend joining up to the program.
- Normalising language is successful in recruiting distressed fathers
The normalising language used to promote SMS4dads emphasised dads need for ‘information’ or ‘tips’ rather than ‘counselling’ or ‘help’. Fathers did not need to declare any deficiency in joining.
- The ease and relevance of the messages keeps fathers engaged in the program
In post program interviews, fathers commented on both the ease of receiving messages (not having to go online) and the relevance of the infant development information. Eighty-five percent of fathers completed the entire set of messages.
- SMS4dads stimulates discussion between partners
A common theme in fathers’ comments was the role of the messages in promoting conversation between partners. If, as seems to be the case, the texts stimulate discussion and mutual support between the parents, SMS4dads could act as a support for the family unit.
- The messages developed for the program demonstrates evidence of a family-wide effect
The messages developed for the project were endorsed by the majority of participants and the areas nominated in the texts, resonated well with men making the transition to fatherhood. The focus on fathers’ connection to their infant (using baby voice messages) and to their parenting partner were endorsed by participants. Father-directed messages that facilitate discussions with their partners provides evidence of a family-wide effect.
- This type of support is effective for distressed fathers unlikely to seek help through health practitioners
The proportion of fathers who scored above the cut-off point for distress on the Kessler 6 measure, demonstrates the acceptability of this type of assistance even for those men who would be unlikely to seek help for their mental health through health practitioners. This group of fathers stayed enrolled until the final texts, which indicates the acceptability of this type of support for distressed fathers.
- The delivery of texts is an economical approach to maintaining contact with this ‘hard-to-reach’ group
Costs for sending 14 SMS texts per month to fathers from the second trimester in the pregnancy until the infant is 12 months of age is approximately $25.00. In this study costs for PANDA involvement were estimated at $2.30 per enrolled father. By comparison, costs related to primary care, psychiatrist and allied health services, medications, hospitals and community services for perinatal depression in Australia have been assessed at $4,509 per person (DA Economics).
- SMS4dads provides a virtual companion to men during this critical transition in their identity
Messages were one-way and fathers were only asked to reply if they wanted to opt out. However, more than 170 unsolicited text comments were sent back. In the interviews after completing the program a theme of “feeling like someone was with you”, and the sense of reassurance that they were not alone was noted in several of the comments by fathers. This suggests that SMS4dads was regarded as more than a set of messages and provided a virtual companion to fathers.
- Isolation, awareness of mood changes, help-seeking and self-efficacy can be altered in a positive direction through SMS4dads
SMS4dads appeared to reduce fathers’ isolation from health and parenting support (use of links), from their partner (conversations started), and from the wider society (texts make them feel they are being supported) while increasing awareness of mood and increasing their self-efficacy. Each of these factors: isolation, awareness of mood, access to services and self-efficacy are linked in the research to fathers’ mental health.
Interest in SMS4dads generated during the project has generated two randomised controlled trails to test the efficacy of SMS4dads in reducing paternal distress over the perinatal period.
With funding from the Movember Foundation and beyondblue a study to test the effect of sending texts to both mothers and fathers is underway.
The success of SMS4dads in reaching new fathers offers a strategic direction for policy makers and program designers aiming to promote the mental health of families.
Download the full research report