The transition to fatherhood – evaluation of an online intervention for new fathers

ABSTRACT This mixed-methods study explores an innovative online group intervention for new fathers. The specific aims were to investigate attendance rates, fathers’ participation experiences, and the effects on their psychological well-being and marital quality. The research design included a randomized controlled trial with 122 participants split into intervention (n = 62) and comparison groups (n = 60). The study measured post-partum depression symptoms (PPD) using the Edinburgh Post-Natal Depression Scale (EPDS) and spousal relationship quality using the Israeli Marital Quality Scale (IMQS). Qualitative data were collected through session transcripts and feedback questionnaires that were completed two years post- intervention. Results reveal an 86.47% average attendance rate in the intervention groups and positive outcomes at both individual and spousal levels. Participants reported feeling a sense of normalcy, decreased loneliness, increased awareness of fatherhood transition, and becoming active co-parents. Marital quality also showed better results for the intervention group. Further research is recommended to explore online group interventions among additional groups of post-partum fathers.

The transition to parenthood involves changes in marital roles, relationships with family of origin, social support, and coping mechanisms (Giallo et al., 2013;Habib, 2012).Like mothers, fathers need to build parental competence and parenting self-efficacy to develop a positive relationship with their new infant (Giallo et al., 2013).Until the late twentieth century, research on father's roles in child development was limited (Cabrera et al., 2018;Lamb, 1975).Most studies on the transition to parenthood focused on mothers, with only a few dedicated to fatherhood e.g (Fägerskiöld, 2008;Singley & Edwards, 2015).Studies on men's experiences during the transition to fatherhood indicate that many new fathers feel unprepared and unsure about their role (Chin et al., 2011;Fägerskiöld, 2008;Habib, 2012).They may also feel left out as the mother takes charge of baby care, alongside the pressure of increased financial responsibility (Kaitz & Katzir, 2004).These changes can lead to feelings of despair and even depression, affecting their well-being and relationships (Rao et al., 2020).
The transition to parenthood can strain relationships, leading to approximately 50% of divorces occurring within the first seven years of marriage when parenthood typically starts (Lawrence et al., 2008;Shapiro & Gottman, 2005).Enhancing coping strategies during this period is vital to reduce marital strain (Petch et al., 2012;Shapiro & Gottman, 2005).While support programs exist for parents, they mostly target women and focus on infant care and couple relationship strengthening, making it challenging and costly to implement intervention programs specifically for fathers (Petch et al., 2012).Unique intervention programs are needed for fathers during this transition (Deave & Johnson, 2008;StGeorge & Fletcher, 2011), but their reluctance to seek help during stressful times and difficulties with conventional face-to-face meetings pose barriers to access (Addis & Mahalik, 2003;Doherty et al., 2006;Fägerskiöld, 2008;Fletcher et al., 2008;Kivari et al., 2018;Seidler et al., 2018;StGeorge & Fletcher, 2011).
Recognizing male reluctance to access help in stressful transitions, a tendency linked with masculine gender-role socialization (Addis & Mahalik, 2003), this study introduces a novel online group intervention, accessible from home, for new fathers.The group was led by a male group leader, to create a safe space to share personal experiences.The study aims to evaluate this intervention, which incorporates positive psychology principles (Seligman et al., 2005), emphasizing strengths and positive aspects to aid fathers in coping with challenges.The internet-based approach allows for diverse forms of support, information sharing, and assistance (Barak & Grohol, 2011).

The current study
The present mixed-methods study sought to broaden knowledge on new fathers' coping by examining: (1) the attendance rates in the intervention groups; (2) the effect of this intervention on the psychological well-being, as expressed in post-partum depression symptoms (PPD), and the quality of their spousal relationship, compared to new fathers who did not participate in the intervention program; and (3) the participation experience of fathers in the program.

The online intervention
The program was designed based on the assumption that an online intervention may increase men's willingness to participate, as the internet is a tool used extensively by young people today.Furthermore, men will feel more comfortable when joining a men-only discussion group, allowing the interaction with male peers to alleviate and 'normalize' their feelings as they become aware of the experiences of other new fathers in similar situations.The program comprised six weekly, hour and a quarter long, semi-structured sessions.Each session centered around a specific topic, followed by open discussions where new fathers shared their experiences.After each meeting, fathers were given 'homework' to discuss in the next session, encouraging group reflection and fostering insights for the next gathering.Prior to each meeting, participants received emails containing relevant background materials and thought-provoking questions for discussion.

Group Topics
Session 1: The meaning of being a father -forging a new identity Session 2: The feelings the baby arouses in me Session 3: Changes and adjustment to new life circumstances Session 4: Expectations from the couple relationship versus reality Session 5: Involvement, responsibility and collaboration as parents and partners Session 6: Summary of group experiences and feedback on the intervention Topics were based on the literature on the transition to fatherhood, and homework was adapted from the 'Marriage Moments' intervention program (Gilliland, 2003).'Marriage Moments' was designed for delivery within the health care system to provide marriage education in a low-intensity, self-administered format in contrast with the leader-led, group intervention conducted in the present study.The intervention included 13 online groups, led by the first author, each comprising five fathers.

Sample and procedure
Fathers were recruited through snow-ball sampling and social media invitations for an online discussion group to support new fathers during the transition to fatherhood.Inclusion criteria required partnered fathers with an infant under one year of age and access to a home computer.Participants were aware that the intervention was not a therapy group, and the facilitator was experienced in leading discussions and mediating couples with marital tension but not a therapist.The sample included 122 new fathers, with 62 in the intervention program and 60 in the comparison group.where no intervention was administered.Random assignment placed participants into either the group intervention or the comparison group.The research protocol received approval from the Departmental Ethics Committee at Ben Gurion University of the Negev, and all participants provided informed consent, including permission to record the group sessions.
All the participants in both groups were secular, Jewish Israelis and working.T-tests on the demographic features did not find any significant differences between the intervention and comparison groups as shown in Table 1.

Quantitative
(1) The 10-item EPDS (Edinburgh Postnatal Depression Scale) was originally developed for identifying postpartum depression in women and has been validated for use with fathers (Edmondson et al., 2010;O'Brien et al., 2016;Ramchandani et al., 2011).
Participants rated each statement on a four-level Likert scale, ranging from 0 (not at all) to 3 (most of the time), resulting in a range of 0-30.The study used the Hebrew version of the questionnaire (Glasser & Barel, 1999), previously employed in a study involving fathers (Kaitz & Katzir, 2004), with symptom ranges categorized as follows: 0-7 (no symptoms), 8-10 (mild symptoms), and 11 and above (symptoms of clinical significance).The reliability in the present study was good, α = .81. (2) Marital Quality was assessed using the IMQS (Israeli Marital Quality Scale) (Lavie, 1995), an adaptation of the American 'Enrich' (Fowers & Olson, 1993).This 10item scale measures partner satisfaction, agreement, and compatibility on a fivelevel Likert scale ranging from 1 (very dissatisfied) to 5 (very satisfied).The IMQS showed good reliability in the present study, α = .75. (3) Demographic variables included father's age, place of birth, degree of religious observance, years of education, age of spouse, years of marriage and child's age.

Qualitative
(1) Transcripts of the closing session in each group, whereby participants were asked to describe their participation experience and its contribution on the individual and spousal level.(2) Two years after the completion of the intervention, the fathers were sent by email a brief feedback questionnaire asking them to retrospectively describe their participation experience.

Data analysis
The quantitative analysis used conventional bivariate analyses, t-tests, one-way Anova and 2 × 2Manova (groups by times).The qualitative data were analyzed using Braun and Clarke's thematic analysis method (Braun & Clarke, 2006).

Quantitative results
Attendance rates in the program: Out of the 65 fathers who participated in the intervention, 3 were excluded from the sample during data analysis due to work-related absences in more than two group sessions.The average attendance rate for all intervention groups was 86.47%.

PPD results
Of the fathers, 23% showed some symptoms of PPD (13.2% mild and 9.8% with clinical symptoms), while the majority (77%) did not have any indications of PPD.
A one-way ANOVA of the distribution of the EPDS results before the intervention found no differences between the groups (F(2, 119) = .39,p > .05).No significant interaction was found in the 2 × 2MANOVA analysis (Groups x Time) F(2, 119) = .41,p > .05.

Qualitative results
Four specific themes emerged from the analysis: developing a feeling of normalcy, escaping loneliness; increased awareness of their new role as fathers; and enhanced relationship with their spouses.

Developing a feeling of normalcy
The feeling of normalcy emerged as a central theme among the participants.The discussions within the group meetings enabled the fathers to realize they were going through shared experiences, leading to the normalization of their feelings.

Escaping loneliness
The term 'loneliness' frequently emerged in group sessions; participants remarked on the unique space to cope with the loneliness they felt in this significant life transition.
. ..It's good to hear that people who are supposedly strangers to me have similar experiences. ..it's a kind of a support. . . to know that I'm not alone here, and everyone is going through the same thing, enjoying/suffering . . .(Alon) The participants' accounts reveal their strong need for a new perspective on their current situation afforded through the group interaction.
'The uniqueness of this group is in the possibility to step out of your own worldview. . .It exposes you to other worlds and different perspectives that allow you to explore and experience a subjective world different from your own. . .We came to the group with a clear intention to escape. . .from our own situation'.(Adam)

Increased awareness of their new role as fathers
A major contribution from the intervention noted by the fathers, was their enhanced awareness of their new role, which led them to initiate activities.They described a process of self-realization and transitioning from being a mere 'helper' to their spouse to being proactive in parenting.
'Today, I feel like I'm in a different place, I'm more involved. . .The truth is that even the discussions here made me understand that I'm in a different stage, in a stage where I can fully participate in my child's growth. . .I'm not just assisting. . .I am fully involved'.(Barak) The fathers emphasized that the program created a space for them to pause, reflect, and internalize: 'For me personally, it raised many thoughts about things I wouldn't have thought about on my own, and it made me sit down and talk about them with my wife and dedicate time instead of just lounging in front of the television and dozing off'.(Golan)

Enhanced relationship with their spouses
Another significant experience noted by the fathers, related to the changes in the couple relationship.Many fathers stated that that group discussions helped them express their feelings more accurately to their partners: . . .The significant advantage of this [program] is learning to talk with my partner, who always wants to hear your feelings, and you don't always manage to express what you feel in the right way (sic).The ability to express these feelings first in a group that understands and accepts the male perspective was very helpful in personal conversations with her.For me, it was the most significant advantage. ..(Michael).
In conclusion, the findings show that the group intervention was significant for fathers in coping with loneliness.By sharing similar experiences with other fathers, they recognized these experiences as common phases in the transition to fatherhood.This realization empowered them to initiate actions in their roles as parents and partners.

Discussion
Our findings indicate that close to 25% of the fathers in the study had some symptoms of PPD.This corroborates previous findings indicating that postpartum depression in fathers is a relatively common phenomenon (Rao et al., 2020), stressing the need for interventions easing the transition of men into fatherhood.
The online intervention had significant positive effects on fathers, fostering a sense of normalcy, reducing loneliness, and increasing awareness of the fatherhood transition.This led to more meaningful parental involvement and active coparenting.The intervention also prevented a decline in marital quality, which is typical during the first year of parenthood according to previous research (Baldwin et al., 2018;Edhborg et al., 2016) and which was evident among the comparison group in this study.The high participation and low drop-out rate further underscore the intervention's value.
A major limitation of this study was its relatively homogeneous sample comprising secular, Jewish and educated fathers.Further research is needed to investigate the effects of the online intervention in a more heterogeneous sample of new fathers.We recommend replicating this study with other groups of postpartum fathers.
'. . .The meetings made me more conscious about things that I might not think of daily and just do automatically. . .It encouraged discussions with my partner. . .It was a very positive experience for me, and I really enjoyed it. ..'.(Yaron)

Table 1 .
Demographic features, means and standard deviations.