Feasibility, Development and Dissemination of a Father Focused Parenting Intervention, DadPlay

Feasibility, Development and Dissemination of a Father Focused Parenting Intervention, DadPlay | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility, Development and Dissemination of a Father Focused Parenting Intervention, DadPlay Jennifer StGeorge, Emily Freeman, Linda Campbell This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6425121/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract We report the feasibility of an mHealth intervention for fathers of young children, tested in real-world community settings, with a focus on four aspects of feasibility: demand, acceptability, implementation and limited efficacy. DadPlay was an intended for fathers who were raising young children with challenging behaviours. While programs targeting parenting skills are effective at reducing behavioural problems in early childhood, many parenting programs unintentionally work against father inclusion and fail to engage, retain or measure men's participation. We evaluated feasibility according to four components of feasibility: Demand, Acceptability, Implementation and Limited Efficacy. Participants were eligible for the intervention if they were fathers of a pre-school aged child. A service network was established as a reference group, which included family and child-focused non-government charities and organisations and preschools located across regional, rural and remote localities in Australia. Results for Demand showed we reached out to approximately 340 organisations: 57% agreed to disseminate information. 325 parents submitted an EOI, 108 completed enrolments, and 96 completed the program. For Acceptability, findings indicated that the message content and program features were very acceptable. For Implementation, our reach was vast, however efficiency appeared low, with exceptions. A low response rate limits our Efficacy findings, however, summary statistics showed that fathers’ confidence and relationship quality had increased. We demonstrated that DadPlay was acceptable and has the potential to support fathers of young children. To upscale and sustain such initiatives, we need to better collaborate and co-create with fathers, professionals and organisations. Psychology Fathers mHealth intervention parenting feasibility service provision Figures Figure 1 Highlights DadPlay is a father-tailored intervention focused on positive father-child interaction Using the four components of feasibility facilitated an in-depth evaluation of program implementation. Service providers are keen to include father-focused initiatives. There remained a gap between perceived need and actual uptake of DadPlay. INTRODUCTION This paper reports a feasibility study of an intervention for fathers of young children. We report on an intervention tested in real-world community settings, with a focus on four aspects of feasibility: demand, acceptability, implementation and limited efficacy (Bowen et al., 2009). DadPlay was a free telephone messaging service for fathers raising a young child with challenging behaviours. Messages provided evidence-based information and practical advice to fathers on positive activities and relationships with their child, about their child’s social skills and behaviour, and on family relationships. DadPlay was disseminated through a large network of organisations across several states of Australia. Below we describe the rationale and context of the program. DadPlay was intended for fathers who were raising young children with challenging behaviours. Behavioural difficulties in early childhood are generally described as oppositional, aggressive or defiant (i.e., externalising problems), or as withdrawal or anxiety (i.e., internalising problems) (Cicchetti & Toth, 2014). Such problems are directly linked to trajectories of behavioural and emotional dysfunction, and poor academic outcomes (Broidy et al., 2003). The causes of behavioural difficulties lie in a complex interplay of biology and environment (Crone & Ridderinkhof, 2011) and the parenting environment can be both an enabler and a preventer of problems. Programs targeting parenting skills are effective at reducing behavioural problems in early childhood (Tarver et al., 2014). However, despite the robust evidence for fathers' positive effect on child development (Cabrera, 2016), many parenting programs unintentionally work against father inclusion and fail to engage, retain or measure men's participation and impact on child outcomes (Panter-Brick et al., 2014). Successfully engaging fathers involves direct targeting and invitation, evidence-based and contextually relevant content, convenience and tailoring to fathers' strengths and desires to be a good father (Bauer & Giles, 2019). Reviews of father engagement strategies have shown that fathers want more fathers’ groups and tailored resources (Maxwell et al., 2012), and they are more likely to participate in an intervention if their child's behaviour problems increase (Heinrichs et al., 2005; Tully et al., 2017). DadPlay was intended for fathers in two priority groups:children in rural and remote areas of Australia, and children in families with low income. Children and their families who live in rural and remote areas tend not to have timely access to adequate support for developmental behavioural issues (AIHW, 2019); here, a free telephone messaging service may assist. Likewise, parents living in poverty, which is linked to developmental problems and poor parenting, tend to not access support (Reiss, 2013), and a free telephone messaging service may offer an alternative pathway to support. mHealth or ‘digital’ interventions are increasingly adopted as a cost-effective method of disseminating healthcare information to a broad population (World Health Organization, 2018). mHealth encompasses the use of mobile wireless technologies such as smartphones, and software may include applications (‘apps’), short messages/texts (SMS), multimedia messaging, and social networking media. mHealth technologies are increasingly taken up by the community, and research shows high feasibility and positive outcomes in SMS programs targeting fathers (Fletcher et al., 2017). These types of alternative mHealth programs can provide services that fill gaps in waitlists and provide an adjunct father-focused program alongside mother-focused interventions . DadPlay was therefore positioned as a strategy to better engage families in the early years of child development by increasing opportunities to support fathers. The Theoretical Basis of DadPlay Theories of parenting suggest that fathering behaviour emerges from a constellation of individual, social and societal factors that interact to create fathering cognitions, attitudes and activities that then shape child outcomes (Cabrera et al., 2014). Reciprocal, dynamic interactions occur at each level, and social and political conditions also shape how men think and act in regard to parenting. In Australia, as in many Western, educated, industrial, rich, democratic countries, social demands for involved nurturant fathers are increasing (Churchill & Craig, 2022). However, this is a slow-burn change of gender-role and culture, and many men lack experience, knowledge and skills concerning child behaviour and development. Furthermore, information for fathers typically only indirectly addresses fathers’ role, thereby missing an opportunity to inform and upskill. DadPlay provides an additional targeted resource to increase fathers’ knowledge and capability. Theoretical elements that were relevant to the change intention of the program included the Reasoned Action Approach (RAA, Fishbein & Ajzen, 2010) and social cognitive theory (Bandura, 1977). In the RAA, behaviour change occurs by the intervention changing intentions and increasing skills and or reducing environmental constraints. DadPlay did this by providing high quality information, identity affirmation and prompts to action in messages, and demonstrations of skills through videos. Social cognitive theory underpinned the intervention’s intention to enhance self-efficacy, and was applied by providing modelling, verbal persuasion and opportunity for mastery experiences through the videos, messages and prompts. The Program The DadPlay messages were developed in a staged process. Content was first drafted for 54 messages based on research and clinical literature. Messages were formatted, following self-efficacy theory and information processing principles, as short, chunked pieces of information, with specific prompts, tailored to developmental events. Links to reputable non-commercial websites for further information were also provided. The messages were then reviewed by 30 clinicians and content experts for importance, clarity, and acceptability, rating on 4-point scales. Messages rated two or below on Importance were deleted, and all other messages were edited as per the review comments. The messages were set in chronological sequence and then sent for a second qualitative review by the same reviewers (N=8). Feedback comments concerned completeness of information, timing of the message and adequacy of the concept addressed. There were 48 messages in the final set that addressed child development, father role, co-parenting, games, and administration. Messages in the child development domain focused on two core areas of child development: emotion regulation and behavioural inhibition. These two skills are central to healthy developmental trajectories and are core school readiness skills. They are also the areas most open to shaping through parenting (Cabrera et al., 2017; Perry et al., 2018). Example message: “My brain lets information in from many of my senses all day Dad. Watch this video to see how different brains work to process all this input!” External URL example about behaviour. Messages on the father role focused on his role in child development, specifically about a warm responsive connection with his child, modelling of self-regulation, and the importance of self-care (Dishion et al., 2008; Fabiano, 2007; McWayne et al., 2013). Example message: “Spending time playing with your child will help them to develop and learn.” External URL example on self-care. Coparenting messages focused on trust with the parenting partner and on shared parenting tasks (Altenburger & Schoppe-Sullivan, 2021; Fagan & Cabrera, 2012). The messages were carefully worded to be inclusive of a range of parenting partnerships, such as separated, transgender, same-sex, or father-figure. Example message: “DP: Every adult working to raise your child brings their own skills, strengths and abilities. This is why they say, 'it takes a community to raise a child'. External URL example on parenting teamwork. Vigorous active play contributes to development of the brain, specifically the prefrontal cortex, where networks for emotion regulation and behavioural inhibition are located (Pellis et al., 2014; Tsujimoto, 2008). The games that were included in the program as activities (with message and accompanying video) were selected or adapted from extant programs or books (e.g., Healthy Dads, Healthy Kids (Carlson, 2011; DeBenedet & Cohen, 2011; Lubans et al., 2012). Each game was selected to embody the following characteristics, Interactive, physical, big body contact father and child Competition, “I’m the strongest” Fun, playful and somewhat novel Involve no more than everyday risk and safety or limit setting The selected games were first evaluated by a reference group (N=13) by ratings and comments on five questions: Do you think this game could be playful and fun for dads and children? Do you think this game helps push children’s limits? Do you think this game could inspire children to compete? Do you think this game could allow dads to keep kids on track/set limits? Do you think this game could be an opportunity for connectedness? Games were edited and scripted based on the feedback received. Then, volunteer fathers and their children played these games while a professional videographer recorded the sessions. The finished video of each game included the father-child game play and embedded information about safety and wind-down. The program protocol was designed as 3 months of messages, with each participant receiving 50 messages in a stochastic frequency averaging 4 messages weekly. Some messages were followed by a request for feedback. Messages were sent for three months once fathers enrolled any time between April and November 2021. Participants could opt out at any time by texting STOP. Research Questions In this study, we evaluated Bowen et al. (2009) four components of feasibility of DadPlay Demand. What is the perceived and actual demand for the program? Acceptability. To what extent is the program suitable and satisfactory for participants and for organisations? Implementation. What are the efficiency, resourcing and or barriers affecting implementation of the program? Limited efficacy. What are participants’ perceptions of the impact of the program? METHODS The feasibility study was designed as a prospective single arm, pre-test/post-test within-subjects design. Additional post-program feedback was sought regarding participants’ perceptions of change. This design was appropriate for the context of ‘virtual’ participation in the SMS intervention, as well as for assessing aspects of feasibility. Participants were eligible for the intervention if they were fathers (resident or non-resident, biological or non-biological father-figure) of a pre-school aged child (3 years to 5 years and 11 months; not in school). Families were not eligible for the study if the father or child had a physical, intellectual developmental delay or disability, or a history of head injury, or were not English speaking. A service network was established as a reference group, which included family and child-focused non-government charities and organisations and preschools located across regional, rural and remote localities in Australia. Organisations were offered a “Taster” of the program designed to support their understanding of DadPlay. Participants were recruited through the study’s ‘service network’, using community social and traditional media and by word of mouth. Participants gave consent to participate through their own efforts of either texting for more information to the study mobile phone number or clicking a 'more information' link on the web. A study information statement was provided, and participants enrolled by completing consent and the pre-test questionnaire. Recruitment and enrolment occurred on a rolling basis for 8 months throughout April and November 2021. We operationalised the four components of feasibility (demand, acceptability, implementation, limited efficacy) with a collection of measures including metrics on text messages and URL access, exit surveys, and interviews. We also used (Piotrowska et al., 2017) CAPE Model (Connection, Attendance, Participation and Engagement), to help organise the range of metrics into the four feasibility aspects. Analysis Descriptive statistics were used to summarise aspects of demand, acceptability and limited efficacy. Textual data was analysed as manifest content (Sandelowski & Barroso, 2003) and reduced to topics to summarise aspects of acceptability and limited efficacy. A descriptive review of processes summarised aspects of implementation. All statistical analyses were completed in Excel, and textual data was analysed manually. Table 1 provides a summary of the outcomes, measures and analytic methods for each of the feasibility concepts, which are elaborated below. Table 1 Summary of outcomes, measures and analytic methods for each of the feasibility concepts Feasibility Components Sub-component Measures/data Analysis Demand Organisational Buy-In Number of organisations agreeing to disseminate DadPlay ; count of seminars and invitations to team meetings. Descriptive statistics Connection EOIs from potential participants Descriptive statistics Attendance N enrolment N completion Duration of dropouts Descriptive statistics Acceptability Participation Clicks on linked information; responses to feedback requests, surveys; unsolicited reply texts Descriptive statistics Topic analysis Professional Acceptability Ratings & feedback of taster messages Descriptive statistics Topic analysis Implementation Efficiency Of Dissemination Description of process, change over time Descriptive review Resources Required Funding, technology Descriptive review Enablers & Barriers Troubleshooting issues Descriptive review Limited efficacy Enactment Ratings of Change in Parent-Child Bond and in Confidence. Descriptive statistics Topic analysis Demand (Buy-In, Connection & Attendance) To measure the extent to which the program was likely to be used, that is, what demand existed, we gathered data on organisational buy-in, and connection and attendance (from the CAPE model) of fathers in DadPlay . (1) Organisational buy-in was measured as number of organisations agreeing to disseminate DadPlay , as well as count of seminars and invitations to team meetings, and feedback . (2) Connection was measured as the number of fathers who attempted to engage with the program through expressions of interest submitted by text or through the website. (3) Attendance was measured throughmetrics of initial enrolment, continuation to completion and duration of enrolment for those who opted out. Acceptability (Participation, Acceptability Taster) To measure the extent to which DadPlay was ‘acceptable’ (satisfactory) for participants and for organisations, we gathered data on the participation of fathers and acceptability from service professionals. (1) Participation was represented by factors that indicated fathers’ actual engagement with the program such as 1) clicks on linked information and 2) responses to feedback requests and surveys, and their own unsolicited replies to us. Three messages in the corpus were followed up by a request for feedback on the message, “What do you think about the last message? Please reply 1=great, 2=not sure, 3=poor. Add any comments about the message if you want to”. Service professional acceptability (2) was gathered through ratings and comments following the “Taster”. Organisations were offered a “Taster” of the program designed to support their understanding of DadPlay . A sample of the text messages was provided in real time across one week. A final message invited the professional to rate the messages, 1=not as good as I thought, 2=just what I thought they'd be, 3=way better than I thought. Optional free text comments could be made. Implementation To measure the extent to which DadPlay could be successfully delivered to the participants, we summarised reflections on the following outcomes suggested by Bowen et al. (2009): Efficiency, speed, or quality of implementation – describe the ‘rollout’, dissemination Amount, type of resources needed to implement – Funding and expertise needed Factors affecting implementation ease or difficulty – any issues? Limited Efficacy To measure the extent to which DadPlay showed promise of being successful with the intended population, we gathered data on Enactment, represented by participant responses to a study-specific questionnaire about their perceptions of the impact of DadPlay messages. We counted frequencies and descriptively categorised freetext comments. RESULTS First, we report the recruitment, consent and enrolment of fathers into DadPlay , and then report on the four aspects of feasibility: demand, acceptability, implementation and limited efficacy (Bowen et al., 2009 ). Recruitment, consent and enrolment in DadPlay Demographics Of the 75 participants who reported their demographic information, 66 fully completed this section. Most identified themselves as the child’s biological father, one reported that they were the adoptive father, two indicated that they were a stepfather (3%), and three (4%) answered ‘other’. For those who selected ‘other’, two reported that they were a mother, and one did not provide an explanation. These three were excluded from the analysis, given the focus on male fathers in this version of the program. Therefore, the analytic sample was N = 63. Fathers ranged in age from 30 to 53 years ( M = 39.14, SD = 5.40). Most lived in the same home with their child. The three (5%) participants who indicated that they did not live with their child spent 30, 78, and 84 hours per week with their child. As shown in Table 2 , most fathers did not identify as either Aboriginal or Torres Strait Islander, most considered themselves to be at least comfortable financially, and had some form of tertiary education. Additionally, most were raising their child with a female parenting partner. Table 2 Demographic information of participants in DadPlay, N = 63 Demographic Variable Frequency (%) Aboriginal and Torres Strait Islander ( N = 63) Neither Aboriginal nor Torres Strait Islander 62 (98.4%) Prefer not to say 1 (1.6%) Highest level of educational achievement ( N = 63) Secondary to Year 10 3 (4.8%) Secondary to Year 12 5 (7.9%) Tertiary (Uni, TAFE, or college) 55 (87.3%) Perception of family prosperity ( N = 63) Very poor 1 (1.6%) Just getting along 9 (14.3%) Reasonably comfortable 31 (49.2%) Very comfortable 16 (25.4%) Prosperous 6 (9.5%) Description of how they are raising their child ( N = 63) Raising this child with a parenting partner 61 (96.8%) Raising this child alone 2 (3.2%) Primary parenting partner gender ( N = 61) Man 1 (1.6%) Woman 60 (95.2%) Child identified gender ( N = 63) Boy 31 (49.2%) Girl 32 (50.8%) Child attends childcare ( N = 63) Yes 59 (93.7%) No 4 (6.3%) Number of other children (0 to 15 years) in the household ( N = 60) 0 12 (19.0%) 1 20 (31.7%) 2 19 (30.2%) 3 7 (11.1%) 4 1 (1.6%) 5 1 (1.6%) There were about equal numbers of male and female children, and most households had one or two other children in addition to the child participating with their father in DadPlay . Most children also attended some form of early childhood learning centre (e.g., preschool or daycare), spending 7 to 50 hours per week there. Demographic information of participants in DadPlay, N = 63 Parenting Responsibilities. Sixty-one fathers responded to questions about how they share parenting responsibilities with their parenting partner. These questions focused on care-taking activities such as putting children to bed, bathing them, and preparing meals; play and leisure activities; and taking children to daycare, preschool, or health services. The majority of participants felt that they generally shared parenting responsibilities equally with their parenting partners. Service Seeking Sentiments. Sixty-three fathers answered questions about their feelings towards seeking services for their child. Most reported feeling confident to very confident about being able to find services (e.g., health or education) for their child, although 20% were unsure. Similarly, most reported that as fathers, they were likely to engage with services for their child, although 35% were unsure (Table 3 ). Table 3 Fathers’ service sentiments Service Seeking Not Confident/ Unlikely Neutral Confident/Likely Finding services? 6 (9.5%) 8 (12.7%) 49 (77.8%) Engage with services? 9 (14.3%) 13 (20.6%) 41 (65.1%) Fathers’ service sentiments Demand Organisational Buy-In Buy-in was defined as a phone or email conversation with an identified contact person, where the centre agreed to disseminate information about the program to their families/clients. By telephone and email, we reached out to approximately 170 family or child-focused organisations. We made connection with an identified contact with 138 of these organisations. We also reached out to 168 daycare and preschools in rural and remote areas. We connected with 53 of these centres. We held approximately 15 online team meetings, representing > 75 staff in different organisations, to outline implementation of DadPlay . Overall, 57% of the contacted organisations agreed to disseminate information. Connection Connection was represented by the number of participants who attempted to engage with the program through expressions of interest submitted by text or through the website. 325 parents submitted an expression of interest however the first 79 submitters were not asked to identify their parental role and an additional 53 did not provide the information. Of those who were asked and answered, 24 (12.90%) indicated that they were mothers and 162 said they were fathers (87.10%). Of the 166 parents who submitted an expression of interest and provided their child’s age, four (2.41%) children were too old, 25 (15.06%) were too young, and 137 (82.53%) were in the eligible age group. Attendance Attendance was measured by assessing metrics of 1) initial enrolment, 2) continuation to completion and 3) duration of enrolment for those who opted out. Of the 137 who expressed interest in participating in DadPlay and had a child of the correct age, 117 (85.40%) provided consent to the program and 108 people completed their enrolment in DadPlay . 96 continued through the 12 week program, and 12 requested a ‘stop’. Upon receipt of a stop request, fathers were asked to feedback a reason, ‘Do you want to tell us why you are stopping. 1 = not helpful, 2 = I did not sign up for this, 3 = situation has changed, 4 = too busy, 5 = other reasons’. Of those 12 who opted out, N = 3 reported “not helpful”, and the others did not reply. Duration of enrolment for those who opted out ranged from 15 to 47 days. Acceptability Participation Participation was represented by factors that indicated actual engagement with the program; this included clicks on 1) linked information and 2) responses to feedback requests, surveys, and unsolicited reply texts. Linked Information . Clicks on linked information were measured by how many times each of the 10 links were accessed. There were 581 clinks on the 10 links, with the highest number of clicks on message #5, “DP: Behaviour is everything we say and do. It is driven by our needs and wants. Your child communicates through behaviour. For more info: (Link to Raising Children Network).” Information in Table 4 shows the approximate number of clicks on linked information, and the number of views of the YouTube game demonstration videos. Table 4 Number of clicks on linked information Item Number of clicks/responses Promotion video > 5000 Sock wrestle 816 Giant Tamer 92 Sumo Wrestler 98 Steam Roller 45 Pocket Roller 64 Number of clicks on extra information external link 581* *Note e.g., message # 5 Raising Children Network, bit.ly/30FpkBa, 102 clicks. Number of clicks on linked information Responses to Feedback Requests, Surveys, and Unsolicited Reply Texts. Three messages in the corpus were followed up by a request for feedback on the message. The number of responses ranged from 25 to 30 for each request, with 84–96% of responding fathers indicating “great”. 11 comments were offered, and another 10 unsolicited comments were texted to DadPlay . The topics with the replies ranged from answers to questions, to appreciation of a message. For example, These messages really help. Re: competitive play, would love some ideas about the right balance of letting my (almost 4yo) daughter win vs me winning/presenting a challenge for her. Experienced that moment last night, so great timings Participation in the Professional Taster Of 89 professional service providers taking the one-week taster, 31 provided a rating and 21 left a comment. The majority (93%) rated the messages as ‘just what I thought’ or ‘way better’. Of the 21 comments received, 16 offered positive appraisal, such as Terrific and accessible I think it's great! Simple and easy with informative easy to read and view websites || Great clip. Easy and simple to understand and looked like great fun. Five comments focused on ways to improve the program, for example: A better understanding of attachment in dads and why it's so critical to brain development and life outcomes would be really helpful. Implementation Efficiency To appraise the efficiency or quality of the implementation, we reflected on the reach, the efficiency of the contact method, resources and constraints. Reach. We reached out to 138 organisations who specifically target families (parents and children) in regional, rural and remote areas (NSW, QLD, VIC, SA, WA), as well as organisations with nation-wide coverage that included these localities. We also reached out to 168 daycare and preschools, connecting with 53. We used the Modified Monash Model (MMM), and maps of Local Government Area and the Index of Relative Socio-Economic Disadvantage to identify relevant localities. We refer to these organisations who agreed to disseminate as the “network”. The network promoted DadPlay to relevant clients across their service footprint (Fig. 1 ). While the reach of the network was relatively wide and we anticipated recruiting participants through these networks, most EOI participants who provided their postcodes were from metropolitan areas. Efficiency of Contact Method. We broadcast the program through phone calls, direct email, and social media. Many contacts were followed up by team meetings, and or further dissemination of materials to team members through email or post. The network thus consisted of those who agreed to disseminate the program to their teams and clients. Updates of progress were sent to the organisation contact person approximately each quarter. Establishing and maintaining the network was an administrative task requiring high input of hours at the beginning of the project, decreasing as the project progressed. Email and phone call cold calling resulted in a 31% ‘success rate’. Each successful contact required at least two phone calls and two emails. Many although not all were followed up the next week to encourage uptake of the materials. We cannot assess the ensuing action of any of these organisations; the main indicator may be where there is parity between MMM location of the service and location of the EOI. The promotional video for DadPlay was viewed by the public over 5000 times, which may give some indication of contact efficiency. Resources. An integral part of resourcing a program such as DadPlay is the expertise required. The investigator team consisted of academics with expertise in best practice father engagement, assessing children’s developmental functioning, and conducting and evaluating observational or clinical studies. The methodology included drawing on the expert knowledge of practitioners in the field. While we did not calculate a cost-consequence analysis, a range of items including technology consultant and platform, video production and website development and maintenance, required monetary support in developing the program resources and platform. Constraints. The DadPlay program was delivered as intended. The enrolment process was streamlined after 2 months to reduce initial participant burden upon enrolment. The delivery of the program was automated, but flexible enough to enable replies and stops. There was only one instance of text receipt failure due to out-of-range issues. Whilst telecom carrier outages were a risk, these appeared not to occur during this period. Limited Efficacy We operationalised limited efficacy by a study-specific questionnaire about perceived impact of the messages. Thirteen fathers completed the 6-item questionnaire. Answers were recorded on a 5-point scale, ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (5). Responses are shown in Table 5 . Table 5 Participant perceptions of DadPlay, N = 13 The messages have… M SD Disagree & strongly disagree Undecided Agree & strongly agree Helped me feel more supported as the father 4.31 .48 0 (0%) 0 (0%) 13(100%) Helped in my relationship with child 4.15 .38 0 (0%) 0 (0%) 13(100%) Increased my knowledge about parenting 4.08 .64 0 (0%) 2 (15.4%) 11(84.6%) Influenced my thinking about parenting 4.08 .64 0 (0%) 2 (15.4%) 11(84.6%) Changed the way I do some things with child 3.85 .56 0 (0%) 3 (23.1%) 10(76.9%) Increased my knowledge about child 3.77 .83 1 (7.7%) 3 (23.1%) 9(69.2%) All fathers agreed that DadPlay helped them feel more supported as fathers and helped in their relationship with their child. Almost all felt that DadPlay increased their knowledge about parenting and influencing their thinking about parenting. Most fathers felt that DadPlay changed the way they do some things with their child, while three were undecided on this. Nine fathers felt that DadPlay increased their knowledge about their child, while three were unsure and one disagreed (Table 5 ). Participant perceptions of DadPlay, N = 13 Change in Parent-Child Bond Participants answered the item “my bond with [child name] is…” by placing a mark on a line labelled at each end and the middle: ‘much worse’, ‘much better’ and ‘no change’. These marks were converted into numbers between 0 to 100. Ratings ranged between 48 to 86 ( M = 65, SD = 9.80), with 10 fathers indicating that their bond with their child had improved after completing DadPlay . Three fathers indicated no change. Change in Confidence Being with Child. Using the same scale construction, ratings on the scale “my confidence in being with [child name] is ‘much worse’, ‘much better’ and ‘no change’” ranged between 50 to 83 ( M = 65.46, SD = 10.17), with 10 fathers indicating that their confidence with their child had improved after DadPlay . Three fathers indicated no change. Evaluative comments on DadPlay There were 21 comments from 11 participants in response to the question “what was the best thing about getting these messages?” and “any final comment?” Categorisation of the comments revealed most were positive (18/21), and three suggested DadPlay needed improvement. The substantive meaning of the comments revealed that DadPlay was a helpful reminder to play, and that it provided reassurance and encouragement. Information on ideas for play, child thinking, and ‘anger issues’ were identified as useful, although games need to be more aptly mapped to child capabilities. DISCUSSION AND CONCLUSION The DadPlay program was devised to provide evidence-based information and practical advice for fathers in rural and remote areas who were raising a child aged 3–5 years with challenging behaviours. A service network served as a reference group as well as a recruitment pathway. Demand The organisational buy-in was strong and many professionals and leaders in organisations were enthusiastic about the potential of the program to meet their organisation goals and their clients’ needs, as shown by their attendance at meetings and commentary. A handful of professionals remained engaged throughout the rollout of the program. While the number of expressions of interest was a 170% increase on the number of organisations, the conversion of EOI to program completers was 30%. Put another way, the completion rate was 50% of the contacts we made with organisations. There seemed to be a contrast between the perceived demand from the system of family services, and the actual interest and take up by fathers themselves. Seemingly there was an imbalance between what we think people need and what people themselves feel they need and have the capacity to undertake (Bornstein et al., 2022 ; Lansford et al., 2022 ). Future programming may need to find more effective ways of connecting with fathers who self-identify as ‘needing to know’. While we targeted organisations working with families who may be experiencing hardship through problematic child behaviour or access to services, this brush may be too broad. A more targeted approach, where an organisation uses the program as their ‘curriculum’ for working with dads, may be a more specific route. In this way, the organisations would embed the resource in their practice, rather than it existing as a shelf resource that is underutilised due to time and awareness constraints of individual staff. Acceptability Acceptability is often measured in implementation studies, but it is not always well defined (Pinto et al., 2024 ). Our operationalisation specifically included participation through measurable clicks and feedback received from participants and service providers. The notable engagement link click-rate and highly positive feedback from participants and service providers indicated that the message content and program features were very acceptable. The high apparent acceptability begs the question as to why snowballing or increasing enrolments did not follow. As an online program, it avoids the stigma that can accompany intentions to attend parenting programs (Buchanan et al., 2023 ; Lanier et al., 2017 ). Possibly, attributes such as self-reliance may also influence men’s (lack of) uptake of parenting programs, much as it does in health care help-seeking (Gough & Novikova, 2020 ). Perhaps men feel they can figure it out themselves. To better understand the disjunction between service provider enthusiasm and father uptake, it could also help to understand if any aspects of professionals’ work circumscribed options available to fathers (Collyer et al., 2017 ). Implementation We operationalised implementation as reach and efficiency. The reach was vast as it was matched to program goals and KPIs; the efficiency however appeared to be less impressive. Multiple (cold) phone calls and emails were unanswered. We believe the intensity of program dissemination by any one centre was likely weak. It appeared to be stronger in the larger organisations as evidenced by seminars, workshops and participation in the Professional Taster. There were also exceptions where enthusiastic staff or organisations had a more systemic (but limited) adaption of the program. Strong partnerships between program developers and family organisations are most likely an effective strategy. Partnership for translational research is increasingly seen as the most viable approach to implementation. The change agents most likely to drive new program or evidence implementation are often those deeply embedded in the systems (Porritt et al., 2023 ). We attempted this with the network, however, the partnerships clearly needed to be stronger. Limited Efficacy We operationalised limited efficacy as participants’ rating of change in their parenting confidence, change in their father-child relationship and through their evaluative comments. The response rate was very low, however, the summary statistics showed that fathers perceived that both their confidence and relationship quality had increased. This demonstrates, albeit it at an individual level, that the program goals were achieved. Corollaries to this may be positive child outcomes (Connor & Stolz, 2022 ), and or improvement in maternal parenting (Havighurst et al., 2019 ). Limitations We had planned for the study to be a pre-test post-test design, however, the low response rate meant that there was not enough statistical power to support within-subject change in factors such as caregiver strain or child strengths and difficulties. The low response rate to the final surveys suggests that either fathers could not be bothered completing a small battery of questionnaires, or, only 13 fathers remained engaged in the messages until the end of the program. Conclusion For every $ 1 spent on parenting interventions, up to $ 30 is saved in other social service delivery costs by preventing adverse child outcomes (Havighurst et al., 2022 ). Through DadPlay , we have shown an increase fathers’ parenting knowledge, their relationship with their child, as well as supported fathers’ overall role as a responsible parent. We therefore have contributed to prevention of adverse outcomes for children, although we do not have any power to calculate this. Demand for the program is out of our control, yet implementation strategies are the tool by which we can sharpen our approach. This will include a better understanding of ways of reaching fathers, as well as understanding how to collaborate, or better, co-create, with professionals and organisations, working on the ground with families. Declarations Funding: The implementation of DadPlay was funded by the Australian Commonwealth Department of Health GO2648. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University of Newcastle (Date 16/12/2020/No H-2020-0384). Conflicts of interest/Competing interests: The authors have no competing interests to declare that are relevant to the content of this article. Consent to participate: Informed consent was obtained from all individual participants included in the study. References Altenburger LE, Schoppe-Sullivan SJ (2021) Contributions of parenting quality and coparenting relationship quality to the development of child executive functioning. 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BMC Public Health 17(1):953. https://doi.org/10.1186/s12889-017-4978-0 Gough B, Novikova I (2020) Mental health, men and culture: How do sociocultural constructions of masculinities relate to men’s mental health help-seeking behaviour in the who european region? (9289055138). (Health Evidence Network (HEN) Synthesis Issue Havighurst SS, Chainey C, Doyle FL, Higgins DJ, Mathews B, Mazzucchelli TG, Zimmer-Gembeck M, Andriessen K, Cobham VE, Cross D, Dadds MR, Dawe S, Gray KM, Guastella AJ, Harnett P, Haslam DM, Middeldorp CM, Morawska A, Ohan JL, Sanders MR, Nicholson JM (2022) A review of Australian government funding of parenting intervention research. Aust N Z J Public Health 46(3):262–268. https://doi.org/https://doi.org/10.1111/1753-6405.13235 Havighurst SS, Wilson KR, Harley AE, Kehoe CE (2019) Dads tuning in to kids: A randomized controlled trial of an emotion socialization parenting program for fathers. Soc Dev 28(4):979–997. https://doi.org/https://doi.org/10.1111/sode.12375 Heinrichs N, Bertram H, Kuschel A, Hahlweg K (2005) Parent recruitment and retention in a universal prevention program for child behavior and emotional problems: Barriers to research and program participation. Prev Sci 6(4):275–286. https://doi.org/10.1007/s11121-005-0006-1 Lanier P, Frey J, Smith Q, Lambert M (2017) Measuring stigma for seeking parenting help among head start fathers. J Soc Social Work Res 8(2):189–210. https://doi.org/10.1086/691997 Lansford JE, Betancourt TS, Boller K, Popp J, Pisani Altafim ER, Attanasio O, Raghavan C (2022) The future of parenting programs: Ii implementation. Parenting 22(3):235–257. https://doi.org/10.1080/15295192.2022.2086807 Lubans DR, Morgan PJ, Collins CE, Okely AD, Burrows T, Callister R (2012) Mediators of weight loss in the 'healthy dads, healthy kids' pilot study for overweight fathers. Int J Behav Nutr Phys Activity 9:45. https://doi.org/10.1186/1479-5868-9-45 Maxwell N, Scourfield J, Holland S, Featherstone B, Lee J (2012) The benefits and challenges of training child protection social workers in father engagement. Child Abuse Rev 21(4):299–310. https://doi.org/10.1002/car.2218 McWayne C, Downer JT, Campos R, Harris RD (2013) Father involvement during early childhood and its association with children's early learning: A meta-analysis. Early Educ Dev 24(6):898–922. https://doi.org/10.1080/10409289.2013.746932 Panter-Brick C, Burgess A, Eggerman M, McAllister F, Pruett K, Leckman JF (2014) Practitioner review: Engaging fathers – recommendations for a game change in parenting interventions based on a systematic review of the global evidence. J Child Psychol Psychiatry 55(11):1187–1212. https://doi.org/10.1111/jcpp.12280 Pellis SM, Pellis VC, Himmler BT (2014) How play makes for a more adaptable brain. Am J Play 7(1):73–98 Perry NB, Calkins SD, Dollar JM, Keane SP, Shanahan L (2018) Self-regulation as a predictor of patterns of change in externalizing behaviors from infancy to adolescence. Dev Psychopathol 30(2):497–510. https://doi.org/10.1017/S0954579417000992 Pinto R, Canário C, Leijten P, Rodrigo MJ, Cruz O (2024) Implementation of parenting programs in real-world community settings: A scoping review. Clin Child Fam Psychol Rev 27(1):74–90. https://doi.org/10.1007/s10567-023-00465-0 Piotrowska PJ, Tully L, Lenroot R, Kimonis E, Hawes D, Moul C, Frick P, Anderson V, Dadds M (2017) Mothers, fathers, and parental systems: A conceptual model of parental engagement in programmes for child mental health—connect, attend, participate, enact (cape). Clin Child Fam Psychol Rev 20(2):146–161 Porritt K, McArthur A, Lockwood C, Munn Z (2023) Jbi's approach to evidence implementation: A 7-phase process model to support and guide getting evidence into practice. JBI Evid Implement, 21 (1) Reiss F (2013) Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Soc Sci Med 90:24–31. https://doi.org/https://doi.org/10.1016/j.socscimed.2013.04.026 Sandelowski M, Barroso J (2003) Classifying the findings in qualitative studies. Qual Health Res 13(7):905–923 Tarver J, Daley D, Lockwood J, Sayal K (2014) Are self-directed parenting interventions sufficient for externalising behaviour problems in childhood? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 23(12):1123–1137. https://doi.org/10.1007/s00787-014-0556-5 Tsujimoto S (2008) The prefrontal cortex: Functional neural development during early childhood. Neuroscientist 14(4):345–358. https://doi.org/10.1177/1073858408316002 Tully LA, Piotrowska PJ, Collins DAJ, Mairet KS, Black N, Kimonis ER, Hawes DJ, Moul C, Lenroot RK, Frick PJ, Anderson V, Dadds MR (2017) Optimising child outcomes from parenting interventions: Fathers’ experiences, preferences and barriers to participation. BMC Public Health 17(1):550. https://doi.org/10.1186/s12889-017-4426-1 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6425121","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":441489753,"identity":"09d893fe-768e-4e1d-ba2c-37050550a38e","order_by":0,"name":"Jennifer StGeorge","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-4979-2267","institution":"University of Newcastle","correspondingAuthor":true,"prefix":"","firstName":"Jennifer","middleName":"","lastName":"StGeorge","suffix":""},{"id":441489754,"identity":"f1352c58-2e0e-4deb-b5fa-02ebefa3156a","order_by":1,"name":"Emily Freeman","email":"","orcid":"https://orcid.org/0000-0002-1594-5213","institution":"University of Newcastle","correspondingAuthor":false,"prefix":"","firstName":"Emily","middleName":"","lastName":"Freeman","suffix":""},{"id":441489755,"identity":"817edeb3-fc70-4147-a7e9-1803b013ae4d","order_by":2,"name":"Linda Campbell","email":"","orcid":"https://orcid.org/0000-0002-8872-9626","institution":"University of Newcastle","correspondingAuthor":false,"prefix":"","firstName":"Linda","middleName":"","lastName":"Campbell","suffix":""}],"badges":[],"createdAt":"2025-04-11 05:56:29","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6425121/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6425121/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80713158,"identity":"a02304b8-e6f0-4b58-8e8b-ce20a84af90b","added_by":"auto","created_at":"2025-04-16 09:22:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38693,"visible":true,"origin":"","legend":"\u003cp\u003eGeographical spread of network members and EOI entries\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6425121/v1/215d502533427b4719cc4ac3.png"},{"id":80714477,"identity":"2ad5a030-60c2-430e-9247-87a019ffbb7f","added_by":"auto","created_at":"2025-04-16 09:38:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1219502,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6425121/v1/05bed126-a99a-4e89-b629-c6d0484a0b27.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eFeasibility, Development and Dissemination of a Father Focused Parenting Intervention, DadPlay\u003c/p\u003e","fulltext":[{"header":"Highlights","content":"\u003cul\u003e\n \u003cli\u003eDadPlay is a father-tailored intervention focused on positive father-child interaction\u003c/li\u003e\n \u003cli\u003eUsing the four components of feasibility facilitated an in-depth evaluation of program implementation.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eService providers are keen to include father-focused initiatives.\u003c/li\u003e\n \u003cli\u003eThere remained a gap between perceived need and actual uptake of DadPlay.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eThis paper reports a feasibility study of an intervention for fathers of young children. We report on an intervention tested in real-world community settings, with a focus on four aspects of feasibility: demand, acceptability, implementation and limited efficacy (Bowen et al., 2009). \u003cem\u003eDadPlay\u003c/em\u003e was a free telephone messaging service for fathers raising a young child with challenging behaviours. Messages provided evidence-based information and practical advice to fathers on positive activities and relationships with their child, about their child\u0026rsquo;s social skills and behaviour, and on family relationships. \u003cem\u003eDadPlay\u003c/em\u003e was disseminated through a large network of organisations across several states of Australia. Below we describe the rationale and context of the program.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDadPlay\u0026nbsp;\u003c/em\u003ewas intended for fathers who were raising young children with challenging behaviours. Behavioural difficulties in early childhood are generally described as oppositional, aggressive or defiant (i.e., externalising problems), or as withdrawal or anxiety (i.e., internalising problems) (Cicchetti \u0026amp; Toth, 2014). Such problems are directly linked to trajectories of behavioural and emotional dysfunction, and poor academic outcomes (Broidy et al., 2003). The causes of behavioural difficulties lie in a complex interplay of biology and environment (Crone \u0026amp; Ridderinkhof, 2011) and the parenting environment can be both an enabler and a preventer of problems.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrograms targeting parenting skills are effective at reducing behavioural problems in early childhood (Tarver et al., 2014). However, despite the robust evidence for fathers\u0026apos; positive effect on child development (Cabrera, 2016), many parenting programs unintentionally work against father inclusion and fail to engage, retain or measure men\u0026apos;s participation and impact on child outcomes (Panter-Brick et al., 2014). Successfully engaging fathers involves direct targeting and invitation, evidence-based and contextually relevant content, convenience and tailoring to fathers\u0026apos; strengths and desires to be a good father (Bauer \u0026amp; Giles, 2019). Reviews of father engagement strategies have shown that fathers want more fathers\u0026rsquo; groups and tailored resources (Maxwell et al., 2012), and they are more likely to participate in an intervention if their child\u0026apos;s behaviour problems increase (Heinrichs et al., 2005; Tully et al., 2017).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDadPlay\u003c/em\u003e was intended for fathers in two priority groups:children in rural and remote areas of Australia, and children in families with low income. Children and their families who live in rural and remote areas tend not to have timely access to adequate support for developmental behavioural issues (AIHW, 2019); here, a free telephone messaging service may assist. Likewise, parents living in poverty, which is linked to developmental problems and poor parenting, tend to not access support (Reiss, 2013), and a free telephone messaging service may offer an alternative pathway to support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003emHealth or \u0026lsquo;digital\u0026rsquo; interventions are increasingly adopted as a cost-effective method of disseminating healthcare information to a broad population (World Health Organization, 2018). mHealth encompasses the use of mobile wireless technologies such as smartphones, and software may include applications (\u0026lsquo;apps\u0026rsquo;), short messages/texts (SMS), multimedia messaging, and social networking media. mHealth technologies are increasingly taken up by the community, and research shows high feasibility and positive outcomes in SMS programs targeting fathers (Fletcher et al., 2017). These types of alternative mHealth programs can provide services that fill gaps in waitlists and provide an adjunct father-focused program alongside mother-focused interventions\u003cem\u003e.\u0026nbsp;\u003c/em\u003e\u003cem\u003eDadPlay\u003c/em\u003e was therefore positioned as a strategy to better engage families in the early years of child development by increasing opportunities to support fathers.\u003c/p\u003e\n\u003ch2\u003eThe Theoretical Basis of \u003cem\u003eDadPlay\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eTheories of parenting suggest that fathering behaviour emerges from a constellation of individual, social and societal factors that interact to create fathering cognitions, attitudes and activities that then shape child outcomes (Cabrera et al., 2014). Reciprocal, dynamic interactions occur at each level, and social and political conditions also shape how men think and act in regard to parenting. In Australia, as in many Western, educated, industrial, rich, democratic countries, social demands for involved nurturant fathers are increasing (Churchill \u0026amp; Craig, 2022). However, this is a slow-burn change of gender-role and culture, and many men lack experience, knowledge and skills concerning child behaviour and development. Furthermore, information for fathers typically only indirectly addresses fathers\u0026rsquo; role, thereby missing an opportunity to inform and upskill. \u003cem\u003eDadPlay\u003c/em\u003e provides an additional targeted resource to increase fathers\u0026rsquo; knowledge and capability. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTheoretical elements that were relevant to the change intention of the program included the Reasoned Action Approach (RAA, Fishbein \u0026amp; Ajzen, 2010) and social cognitive theory (Bandura, 1977). In the RAA, behaviour change occurs by the intervention changing intentions and increasing skills and or reducing environmental constraints. \u003cem\u003eDadPlay\u003c/em\u003e did this by providing high quality information, identity affirmation and prompts to action in messages, and demonstrations of skills through videos. Social cognitive theory underpinned the intervention\u0026rsquo;s intention to enhance self-efficacy, and was applied by providing modelling, verbal persuasion and opportunity for mastery experiences through the videos, messages and prompts.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eThe Program\u003c/h2\u003e\n\u003cp\u003eThe \u003cem\u003eDadPlay\u003c/em\u003e messages were developed in a staged process. Content was first drafted for 54 messages based on research and clinical literature. Messages were formatted, following self-efficacy theory and information processing principles, as short, chunked pieces of information, with specific prompts, tailored to developmental events. Links to reputable non-commercial websites for further information were also provided. The messages were then reviewed by 30 clinicians and content experts for importance, clarity, and acceptability, rating on 4-point scales. Messages rated two or below on Importance were deleted, and all other messages were edited as per the review comments. The messages were set in chronological sequence and then sent for a second qualitative review by the same reviewers (N=8). Feedback comments concerned completeness of information, timing of the message and adequacy of the concept addressed. There were 48 messages in the final set that addressed child development, father role, co-parenting, games, and administration.\u003c/p\u003e\n\u003cp\u003eMessages in the child development domain focused on two core areas of child development: emotion regulation and behavioural inhibition. These two skills are central to healthy developmental trajectories and are core school readiness skills. They are also the areas most open to shaping through parenting (Cabrera et al., 2017; Perry et al., 2018). Example message: \u0026ldquo;My brain lets information in from many of my senses all day Dad. Watch this video to see how different brains work to process all this input!\u0026rdquo; External URL example about behaviour.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMessages on the father role focused on his role in child development, specifically about a warm responsive connection with his child, modelling of self-regulation, and the importance of self-care (Dishion et al., 2008; Fabiano, 2007; McWayne et al., 2013). Example message: \u0026ldquo;Spending time playing with your child will help them to develop and learn.\u0026rdquo; External URL example on self-care.\u003c/p\u003e\n\u003cp\u003eCoparenting messages focused on trust with the parenting partner and on shared parenting tasks (Altenburger \u0026amp; Schoppe-Sullivan, 2021; Fagan \u0026amp; Cabrera, 2012). \u0026nbsp;The messages were carefully worded to be inclusive of a range of parenting partnerships, such as separated, transgender, same-sex, or father-figure. Example message: \u0026ldquo;DP: Every adult working to raise your child brings their own skills, strengths and \u0026nbsp;abilities. This is why they say, \u0026apos;it takes a community to raise a child\u0026apos;. External URL example on parenting teamwork.\u003c/p\u003e\n\u003cp\u003eVigorous active play contributes to development of the brain, specifically the prefrontal cortex, where networks for emotion regulation and behavioural inhibition are located (Pellis et al., 2014; Tsujimoto, 2008). The games that were included in the program as activities (with message and accompanying video) were selected or adapted from extant programs or books (e.g., Healthy Dads, Healthy Kids (Carlson, 2011; DeBenedet \u0026amp; Cohen, 2011; Lubans et al., 2012). Each game was selected to embody the following characteristics,\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eInteractive, physical, big body contact father and child\u003c/li\u003e\n \u003cli\u003eCompetition, \u0026ldquo;I\u0026rsquo;m the strongest\u0026rdquo;\u003c/li\u003e\n \u003cli\u003eFun, playful and somewhat novel\u003c/li\u003e\n \u003cli\u003eInvolve no more than everyday risk and safety or limit setting\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe selected games were first evaluated by a reference group (N=13) by ratings and comments on five questions:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eDo you think this game could be playful and fun for dads and children?\u003c/li\u003e\n \u003cli\u003eDo you think this game helps push children\u0026rsquo;s limits?\u003c/li\u003e\n \u003cli\u003eDo you think this game could inspire children to compete?\u003c/li\u003e\n \u003cli\u003eDo you think this game could allow dads to keep kids on track/set limits?\u003c/li\u003e\n \u003cli\u003eDo you think this game could be an opportunity for connectedness?\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eGames were edited and scripted based on the feedback received. Then, volunteer fathers and their children played these games while a professional videographer recorded the sessions. The finished video of each game included the father-child game play and embedded information about safety and wind-down.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe program protocol was designed as 3 months of messages, with each participant receiving 50 messages in a stochastic frequency averaging 4 messages weekly. Some messages were followed by a request for feedback. Messages were sent for three months once fathers enrolled any time between April and November 2021. Participants could opt out at any time by texting STOP.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eResearch Questions\u003c/h2\u003e\n\u003cp\u003eIn this study, we evaluated Bowen et al. (2009) four components of feasibility of \u003cem\u003eDadPlay\u003c/em\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eDemand. What is the perceived and actual demand for the program?\u003c/li\u003e\n \u003cli\u003eAcceptability. To what extent is the program suitable and satisfactory for participants and for organisations?\u003c/li\u003e\n \u003cli\u003eImplementation. What are the efficiency, resourcing and or barriers affecting implementation of the program?\u003c/li\u003e\n \u003cli\u003eLimited efficacy. What are participants\u0026rsquo; perceptions of the impact of the program?\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"METHODS","content":"\u003cp\u003eThe feasibility study was designed as a prospective single arm, pre-test/post-test within-subjects design. Additional post-program feedback was sought regarding participants’ perceptions of change. This design was appropriate for the context of ‘virtual’ participation in the SMS intervention, as well as for assessing aspects of feasibility.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants were eligible for the intervention if they were fathers (resident or non-resident, biological or non-biological father-figure) of a pre-school aged child (3 years to 5 years and 11 months; not in school). Families were not eligible for the study if the father or child had a physical, intellectual developmental delay or disability, or a history of head injury, or were not English speaking.\u003c/p\u003e\n\u003cp\u003eA service network was established as a reference group, which included family and child-focused non-government charities and organisations and preschools located across regional, rural and remote localities in Australia. Organisations were offered a “Taster” of the program designed to support their understanding of DadPlay. Participants were recruited through the study’s ‘service network’, using community social and traditional media and by word of mouth. Participants gave consent to participate through their own efforts of either texting for more information to the study mobile phone number or clicking a 'more information' link on the web. A study information statement was provided, and participants enrolled by completing consent and the pre-test questionnaire. Recruitment and enrolment occurred on a rolling basis for 8 months throughout April and November 2021.\u003c/p\u003e\n\u003cp\u003eWe operationalised the four components of feasibility (demand, acceptability, implementation, limited efficacy) with a collection of measures including metrics on text messages and URL access, exit surveys, and interviews. We also used (Piotrowska et al., 2017) CAPE Model (Connection, Attendance, Participation and Engagement), to help organise the range of metrics into the four feasibility aspects.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAnalysis\u003c/h2\u003e\n\u003cp\u003eDescriptive statistics were used to summarise aspects of demand, acceptability and limited efficacy. Textual data was analysed as manifest content (Sandelowski \u0026amp; Barroso, 2003) and reduced to topics to summarise aspects of acceptability and limited efficacy. A descriptive review of processes summarised aspects of implementation. All statistical analyses were completed in Excel, and textual data was analysed manually. Table 1 provides a summary of the outcomes, measures and analytic methods for each of the feasibility concepts, which are elaborated below.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSummary of outcomes, measures and analytic methods for each of the feasibility concepts\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeasibility Components\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-component\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasures/data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003col\u003e\n \u003cli\u003eDemand\u0026nbsp;\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eOrganisational Buy-In\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eNumber of organisations agreeing to disseminate \u003cem\u003eDadPlay\u003c/em\u003e;\u003c/p\u003e\n \u003cp\u003ecount of seminars and invitations to team meetings.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescriptive statistics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConnection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eEOIs from potential participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescriptive statistics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAttendance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eN enrolment\u003c/p\u003e\n \u003cp\u003eN completion\u003c/p\u003e\n \u003cp\u003eDuration of dropouts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescriptive statistics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003col start=\"2\"\u003e\n \u003cli\u003eAcceptability\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eParticipation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eClicks on linked information; responses to feedback requests, surveys; unsolicited reply texts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescriptive statistics\u003c/p\u003e\n \u003cp\u003eTopic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eProfessional Acceptability\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eRatings \u0026amp; feedback of taster messages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescriptive statistics\u003c/p\u003e\n \u003cp\u003eTopic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003col start=\"3\"\u003e\n \u003cli\u003eImplementation\u0026nbsp;\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eEfficiency Of Dissemination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescription of process, change over time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescriptive review\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eResources Required\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eFunding, technology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescriptive review\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eEnablers \u0026amp; Barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eTroubleshooting issues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescriptive review\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003col start=\"4\"\u003e\n \u003cli\u003eLimited efficacy\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnactment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eRatings of Change in Parent-Child Bond and in Confidence.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eDescriptive statistics\u003c/p\u003e\n \u003cp\u003eTopic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eDemand (Buy-In, Connection \u0026amp; Attendance)\u003c/h3\u003e\n\u003cp\u003eTo measure the extent to which the program was likely to be used, that is, what demand existed, we gathered data on organisational buy-in, and connection and attendance (from the CAPE model) of fathers in \u003cem\u003eDadPlay\u003c/em\u003e. (1)\u003cstrong\u003e\u0026nbsp;Organisational buy-in\u003c/strong\u003e was measured as number of organisations agreeing to disseminate \u003cem\u003eDadPlay\u003c/em\u003e, as well as count of seminars and invitations to team meetings, and feedback\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e(2)\u003cstrong\u003e\u0026nbsp;Connection\u003c/strong\u003e was measured as the number of fathers who attempted to engage with the program through expressions of interest submitted by text or through the website. \u0026nbsp;(3) \u003cstrong\u003eAttendance\u003c/strong\u003e was measured throughmetrics of initial enrolment, continuation to completion and duration of enrolment for those who opted out. \u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eAcceptability (Participation, Acceptability Taster)\u003c/h3\u003e\n\u003cp\u003eTo measure the extent to which \u003cem\u003eDadPlay\u003c/em\u003e was ‘acceptable’ (satisfactory) for participants and for organisations, we gathered data on the participation of fathers and acceptability from service professionals. (1)\u0026nbsp;\u003cstrong\u003eParticipation\u003c/strong\u003e was represented by factors that indicated fathers’ actual engagement with the program such as 1) clicks on linked information and 2) responses to feedback requests and surveys, and their own unsolicited replies to us. Three messages in the corpus were followed up by a request for feedback on the message, “What do you think about the last message? Please reply 1=great, 2=not sure, 3=poor. Add any comments about the message if you want to”.\u003c/p\u003e\n\u003cp\u003eService professional \u003cstrong\u003eacceptability\u003c/strong\u003e (2) was gathered through ratings and comments following the “Taster”. Organisations were offered a “Taster” of the program designed to support their understanding of \u003cem\u003eDadPlay\u003c/em\u003e. A sample of the text messages was provided in real time across one week. A final message invited the professional to rate the messages, 1=not as good as I thought, 2=just what I thought they'd be, 3=way better than I thought. Optional free text comments could be made.\u003c/p\u003e\n\u003ch3\u003eImplementation\u003c/h3\u003e\n\u003cp\u003eTo measure the extent to which \u003cem\u003eDadPlay\u003c/em\u003e could be successfully delivered to the participants, we summarised reflections on the following outcomes suggested by Bowen et al. (2009):\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eEfficiency, speed, or quality of implementation – describe the ‘rollout’, dissemination\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAmount, type of resources needed to implement – Funding and expertise needed\u003c/li\u003e\n \u003cli\u003eFactors affecting implementation ease or difficulty – any issues?\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch3\u003eLimited Efficacy\u003c/h3\u003e\n\u003cp\u003eTo measure the extent to which \u003cem\u003eDadPlay\u003c/em\u003e showed promise of being successful with the intended population, we gathered data on \u003cstrong\u003eEnactment,\u0026nbsp;\u003c/strong\u003erepresented by participant responses to a study-specific questionnaire about their perceptions of the impact of \u003cem\u003eDadPlay\u003c/em\u003e messages. We counted frequencies and descriptively categorised freetext comments.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFirst, we report the recruitment, consent and enrolment of fathers into \u003cem\u003eDadPlay\u003c/em\u003e, and then report on the four aspects of feasibility: demand, acceptability, implementation and limited efficacy (Bowen et al., \u003cspan class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecruitment, consent and enrolment in\u003c/strong\u003e \u003cstrong\u003eDadPlay\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eDemographics\u003c/h3\u003e\n\u003cp\u003eOf the 75 participants who reported their demographic information, 66 fully completed this section. Most identified themselves as the child’s biological father, one reported that they were the adoptive father, two indicated that they were a stepfather (3%), and three (4%) answered ‘other’. For those who selected ‘other’, two reported that they were a mother, and one did not provide an explanation. These three were excluded from the analysis, given the focus on male fathers in this version of the program. Therefore, the analytic sample was N = 63.\u003c/p\u003e\n\u003cp\u003eFathers ranged in age from 30 to 53 years (\u003cem\u003eM\u003c/em\u003e = 39.14, \u003cem\u003eSD\u003c/em\u003e = 5.40). Most lived in the same home with their child. The three (5%) participants who indicated that they did not live with their child spent 30, 78, and 84 hours per week with their child. As shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, most fathers did not identify as either Aboriginal or Torres Strait Islander, most considered themselves to be at least comfortable financially, and had some form of tertiary education. Additionally, most were raising their child with a female parenting partner.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eDemographic information of participants in DadPlay, N = 63\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eDemographic Variable\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency (%)\u003c/p\u003e\n \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eAboriginal and Torres Strait Islander (\u003cem\u003eN\u003c/em\u003e = 63)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eNeither Aboriginal nor Torres Strait Islander\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e62 (98.4%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eHighest level of educational achievement (\u003cem\u003eN\u003c/em\u003e = 63)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary to Year 10\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary to Year 12\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eTertiary (Uni, TAFE, or college)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e55 (87.3%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003ePerception of family prosperity (\u003cem\u003eN\u003c/em\u003e = 63)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eVery poor\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eJust getting along\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eReasonably comfortable\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e31 (49.2%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eVery comfortable\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (25.4%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eProsperous\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eDescription of how they are raising their child (\u003cem\u003eN\u003c/em\u003e = 63)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eRaising this child with a parenting partner\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e61 (96.8%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eRaising this child alone\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e2 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary parenting partner gender (\u003cem\u003eN\u003c/em\u003e = 61)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e60 (95.2%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eChild identified gender (\u003cem\u003eN\u003c/em\u003e = 63)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eBoy\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e31 (49.2%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eGirl\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e32 (50.8%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eChild attends childcare (\u003cem\u003eN\u003c/em\u003e = 63)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e59 (93.7%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of other children (0 to 15 years) in the household (\u003cem\u003eN\u003c/em\u003e = 60)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (19.0%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e20 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e19 (30.2%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e1 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eThere were about equal numbers of male and female children, and most households had one or two other children in addition to the child participating with their father in \u003cem\u003eDadPlay\u003c/em\u003e. Most children also attended some form of early childhood learning centre (e.g., preschool or daycare), spending 7 to 50 hours per week there.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e\u003cem\u003eDemographic information of participants in DadPlay, N = 63\u003c/em\u003e\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eParenting Responsibilities.\u003c/strong\u003e Sixty-one fathers responded to questions about how they share parenting responsibilities with their parenting partner. These questions focused on care-taking activities such as putting children to bed, bathing them, and preparing meals; play and leisure activities; and taking children to daycare, preschool, or health services. The majority of participants felt that they generally shared parenting responsibilities equally with their parenting partners.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eService Seeking Sentiments.\u003c/strong\u003e Sixty-three fathers answered questions about their feelings towards seeking services for their child. Most reported feeling confident to very confident about being able to find services (e.g., health or education) for their child, although 20% were unsure. Similarly, most reported that as fathers, they were likely to engage with services for their child, although 35% were unsure (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eFathers’ service sentiments\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eService Seeking\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eNot Confident/ Unlikely\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eConfident/Likely\u003c/p\u003e\n \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eFinding services?\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e8 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e49 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eEngage with services?\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e9 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e13 (20.6%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e41 (65.1%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eFathers’ service sentiments\u003c/h2\u003e\n \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n \u003ch2\u003eDemand\u003c/h2\u003e\n \u003cdiv id=\"Sec14\" class=\"Section4\"\u003e\n \u003ch2\u003eOrganisational Buy-In\u003c/h2\u003e\n \u003cp\u003eBuy-in was defined as a phone or email conversation with an identified contact person, where the centre agreed to disseminate information about the program to their families/clients. By telephone and email, we reached out to approximately 170 family or child-focused organisations. We made connection with an identified contact with 138 of these organisations. We also reached out to 168 daycare and preschools in rural and remote areas. We connected with 53 of these centres. We held approximately 15 online team meetings, representing \u0026gt; 75 staff in different organisations, to outline implementation of \u003cem\u003eDadPlay\u003c/em\u003e. Overall, 57% of the contacted organisations agreed to disseminate information.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eConnection\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eConnection\u003c/em\u003e was represented by the number of participants who attempted to engage with the program through expressions of interest submitted by text or through the website. 325 parents submitted an expression of interest however the first 79 submitters were not asked to identify their parental role and an additional 53 did not provide the information. Of those who were asked and answered, 24 (12.90%) indicated that they were mothers and 162 said they were fathers (87.10%). Of the 166 parents who submitted an expression of interest and provided their child’s age, four (2.41%) children were too old, 25 (15.06%) were too young, and 137 (82.53%) were in the eligible age group.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eAttendance\u003c/h2\u003e\n \u003cp\u003eAttendance was measured by assessing metrics of 1) initial enrolment, 2) continuation to completion and 3) duration of enrolment for those who opted out. Of the 137 who expressed interest in participating in \u003cem\u003eDadPlay\u003c/em\u003e and had a child of the correct age, 117 (85.40%) provided consent to the program and 108 people completed their enrolment in \u003cem\u003eDadPlay\u003c/em\u003e. 96 continued through the 12 week program, and 12 requested a ‘stop’. Upon receipt of a stop request, fathers were asked to feedback a reason, ‘Do you want to tell us why you are stopping. 1 = not helpful, 2 = I did not sign up for this, 3 = situation has changed, 4 = too busy, 5 = other reasons’. Of those 12 who opted out, N = 3 reported “not helpful”, and the others did not reply. Duration of enrolment for those who opted out ranged from 15 to 47 days.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eAcceptability\u003c/h2\u003e\n \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\n \u003ch2\u003eParticipation\u003c/h2\u003e\n \u003cp\u003eParticipation was represented by factors that indicated actual engagement with the program; this included clicks on 1) linked information and 2) responses to feedback requests, surveys, and unsolicited reply texts.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLinked Information\u003c/strong\u003e. Clicks on linked information were measured by how many times each of the 10 links were accessed. There were 581 clinks on the 10 links, with the highest number of clicks on message #5, “DP: Behaviour is everything we say and do. It is driven by our needs and wants. Your child communicates through behaviour. For more info: (Link to Raising Children Network).” Information in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows the approximate number of clicks on linked information, and the number of views of the YouTube game demonstration videos. \u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eNumber of clicks on linked information\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of clicks/responses\u003c/p\u003e\n \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003ePromotion video\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 5000\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eSock wrestle\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e816\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eGiant Tamer\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eSumo Wrestler\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eSteam Roller\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003ePocket Roller\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of clicks on extra information external link\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e581*\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e*Note e.g., message # 5 Raising Children Network, bit.ly/30FpkBa, 102 clicks.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eNumber of clicks on linked information\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eResponses to Feedback Requests, Surveys, and Unsolicited Reply Texts.\u003c/strong\u003e Three messages in the corpus were followed up by a request for feedback on the message. The number of responses ranged from 25 to 30 for each request, with 84–96% of responding fathers indicating “great”. 11 comments were offered, and another 10 unsolicited comments were texted to \u003cem\u003eDadPlay\u003c/em\u003e. The topics with the replies ranged from answers to questions, to appreciation of a message. For example,\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThese messages really help. Re: competitive play, would love some ideas about the right balance of letting my (almost 4yo) daughter win vs me winning/presenting a challenge for her.\u003c/p\u003e\n \u003cp\u003eExperienced that moment last night, so great timings\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipation in the Professional Taster\u003c/h2\u003e\n \u003cp\u003eOf 89 professional service providers taking the one-week taster, 31 provided a rating and 21 left a comment. The majority (93%) rated the messages as ‘just what I thought’ or ‘way better’. Of the 21 comments received, 16 offered positive appraisal, such as\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eTerrific and accessible I think it's great!\u003c/p\u003e\n \u003cp\u003eSimple and easy with informative easy to read and view websites || Great clip.\u003c/p\u003e\n \u003cp\u003eEasy and simple to understand and looked like great fun.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eFive comments focused on ways to improve the program, for example:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eA better understanding of attachment in dads and why it's so critical to brain development and life outcomes would be really helpful.\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003eImplementation\u003c/h2\u003e\n \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\n \u003ch2\u003eEfficiency\u003c/h2\u003e\n \u003cp\u003eTo appraise the efficiency or quality of the implementation, we reflected on the reach, the efficiency of the contact method, resources and constraints.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eReach.\u003c/strong\u003e We reached out to 138 organisations who specifically target families (parents and children) in regional, rural and remote areas (NSW, QLD, VIC, SA, WA), as well as organisations with nation-wide coverage that included these localities. We also reached out to 168 daycare and preschools, connecting with 53. We used the Modified Monash Model (MMM), and maps of Local Government Area and the Index of Relative Socio-Economic Disadvantage to identify relevant localities. We refer to these organisations who agreed to disseminate as the “network”. The network promoted \u003cem\u003eDadPlay\u003c/em\u003e to relevant clients across their service footprint (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). While the reach of the network was relatively wide and we anticipated recruiting participants through these networks, most EOI participants who provided their postcodes were from metropolitan areas.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEfficiency of Contact Method.\u003c/strong\u003e We broadcast the program through phone calls, direct email, and social media. Many contacts were followed up by team meetings, and or further dissemination of materials to team members through email or post. The network thus consisted of those who agreed to disseminate the program to their teams and clients. Updates of progress were sent to the organisation contact person approximately each quarter.\u003c/p\u003e\n \u003cp\u003eEstablishing and maintaining the network was an administrative task requiring high input of hours at the beginning of the project, decreasing as the project progressed. Email and phone call cold calling resulted in a 31% ‘success rate’. Each successful contact required at least two phone calls and two emails. Many although not all were followed up the next week to encourage uptake of the materials. We cannot assess the ensuing action of any of these organisations; the main indicator may be where there is parity between MMM location of the service and location of the EOI. The promotional video for \u003cem\u003eDadPlay\u003c/em\u003e was viewed by the public over 5000 times, which may give some indication of contact efficiency.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eResources.\u003c/strong\u003e An integral part of resourcing a program such as \u003cem\u003eDadPlay\u003c/em\u003e is the expertise required. The investigator team consisted of academics with expertise in best practice father engagement, assessing children’s developmental functioning, and conducting and evaluating observational or clinical studies. The methodology included drawing on the expert knowledge of practitioners in the field. While we did not calculate a cost-consequence analysis, a range of items including technology consultant and platform, video production and website development and maintenance, required monetary support in developing the program resources and platform.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eConstraints.\u003c/strong\u003e The \u003cem\u003eDadPlay\u003c/em\u003e program was delivered as intended. The enrolment process was streamlined after 2 months to reduce initial participant burden upon enrolment. The delivery of the program was automated, but flexible enough to enable replies and stops. There was only one instance of text receipt failure due to out-of-range issues. Whilst telecom carrier outages were a risk, these appeared not to occur during this period.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n \u003ch2\u003eLimited Efficacy\u003c/h2\u003e\n \u003cp\u003eWe operationalised limited efficacy by a study-specific questionnaire about perceived impact of the messages. Thirteen fathers completed the 6-item questionnaire. Answers were recorded on a 5-point scale, ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (5). Responses are shown in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003e\u003cem\u003eParticipant perceptions of DadPlay, N = 13\u003c/em\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eThe messages have…\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eDisagree \u0026amp; strongly disagree\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eUndecided\u003c/p\u003e\n \u003c/th\u003e\u003cth align=\"left\"\u003e\n \u003cp\u003eAgree \u0026amp; strongly agree\u003c/p\u003e\n \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eHelped me feel more supported as the father\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e4.31\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e.48\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e13(100%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eHelped in my relationship with child\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e4.15\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e.38\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e13(100%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eIncreased my knowledge about parenting\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e4.08\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e.64\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e11(84.6%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eInfluenced my thinking about parenting\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e4.08\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e.64\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e11(84.6%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eChanged the way I do some things with child\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e3.85\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e.56\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e10(76.9%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003eIncreased my knowledge about child\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"char\"\u003e\n \u003cp\u003e3.77\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e.83\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd align=\"left\"\u003e\n \u003cp\u003e9(69.2%)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eAll fathers agreed that \u003cem\u003eDadPlay\u003c/em\u003e helped them feel more supported as fathers and helped in their relationship with their child. Almost all felt that \u003cem\u003eDadPlay\u003c/em\u003e increased their knowledge about parenting and influencing their thinking about parenting. Most fathers felt that \u003cem\u003eDadPlay\u003c/em\u003e changed the way they do some things with their child, while three were undecided on this. Nine fathers felt that \u003cem\u003eDadPlay\u003c/em\u003e increased their knowledge about their child, while three were unsure and one disagreed (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipant perceptions of DadPlay, N = 13\u003c/h2\u003e\n \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\n \u003ch2\u003eChange in Parent-Child Bond\u003c/h2\u003e\n \u003cp\u003eParticipants answered the item “my bond with [child name] is…” by placing a mark on a line labelled at each end and the middle: ‘much worse’, ‘much better’ and ‘no change’. These marks were converted into numbers between 0 to 100. Ratings ranged between 48 to 86 (\u003cem\u003eM\u003c/em\u003e = 65, \u003cem\u003eSD\u003c/em\u003e = 9.80), with 10 fathers indicating that their bond with their child had improved after completing \u003cem\u003eDadPlay\u003c/em\u003e. Three fathers indicated no change.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eChange in Confidence Being with Child.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eUsing the same scale construction, ratings on the scale “my confidence in being with [child name] is ‘much worse’, ‘much better’ and ‘no change’” ranged between 50 to 83 (\u003cem\u003eM\u003c/em\u003e = 65.46, \u003cem\u003eSD\u003c/em\u003e = 10.17), with 10 fathers indicating that their confidence with their child had improved after \u003cem\u003eDadPlay\u003c/em\u003e. Three fathers indicated no change.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\n \u003ch2\u003eEvaluative comments on DadPlay\u003c/h2\u003e\n \u003cp\u003eThere were 21 comments from 11 participants in response to the question “what was the best thing about getting these messages?” and “any final comment?” Categorisation of the comments revealed most were positive (18/21), and three suggested \u003cem\u003eDadPlay\u003c/em\u003e needed improvement. The substantive meaning of the comments revealed that \u003cem\u003eDadPlay\u003c/em\u003e was a helpful reminder to play, and that it provided reassurance and encouragement. Information on ideas for play, child thinking, and ‘anger issues’ were identified as useful, although games need to be more aptly mapped to child capabilities.\u003c/p\u003e\n \u003c/div\u003e\n "},{"header":"DISCUSSION AND CONCLUSION","content":"\u003cp\u003eThe \u003cem\u003eDadPlay\u003c/em\u003e program was devised to provide evidence-based information and practical advice for fathers in rural and remote areas who were raising a child aged 3–5 years with challenging behaviours. A service network served as a reference group as well as a recruitment pathway.\u003c/p\u003e\u003ch2\u003eDemand\u003c/h2\u003e\u003cp\u003eThe organisational buy-in was strong and many professionals and leaders in organisations were enthusiastic about the potential of the program to meet their organisation goals and their clients’ needs, as shown by their attendance at meetings and commentary. A handful of professionals remained engaged throughout the rollout of the program. While the number of expressions of interest was a 170% increase on the number of organisations, the conversion of EOI to program completers was 30%. Put another way, the completion rate was 50% of the contacts we made with organisations. There seemed to be a contrast between the perceived demand from the system of family services, and the actual interest and take up by fathers themselves. Seemingly there was an imbalance between what we think people need and what people themselves feel they need and have the capacity to undertake (Bornstein et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e; Lansford et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e). Future programming may need to find more effective ways of connecting with fathers who self-identify as ‘needing to know’.\u003c/p\u003e\u003cp\u003eWhile we targeted organisations working with families who may be experiencing hardship through problematic child behaviour or access to services, this brush may be too broad. A more targeted approach, where an organisation uses the program as their ‘curriculum’ for working with dads, may be a more specific route. In this way, the organisations would embed the resource in their practice, rather than it existing as a shelf resource that is underutilised due to time and awareness constraints of individual staff.\u003c/p\u003e\u003ch2\u003eAcceptability\u003c/h2\u003e\u003cp\u003eAcceptability is often measured in implementation studies, but it is not always well defined (Pinto et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e). Our operationalisation specifically included participation through measurable clicks and feedback received from participants and service providers. The notable engagement link click-rate and highly positive feedback from participants and service providers indicated that the message content and program features were very acceptable. The high apparent acceptability begs the question as to why snowballing or increasing enrolments did not follow. As an online program, it avoids the stigma that can accompany intentions to attend parenting programs (Buchanan et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e; Lanier et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Possibly, attributes such as self-reliance may also influence men’s (lack of) uptake of parenting programs, much as it does in health care help-seeking (Gough \u0026amp; Novikova, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). Perhaps men feel they can figure it out themselves. To better understand the disjunction between service provider enthusiasm and father uptake, it could also help to understand if any aspects of professionals’ work circumscribed options available to fathers (Collyer et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e\u003ch3\u003eImplementation\u003c/h3\u003e\u003cp\u003eWe operationalised implementation as reach and efficiency. The reach was vast as it was matched to program goals and KPIs; the efficiency however appeared to be less impressive. Multiple (cold) phone calls and emails were unanswered. We believe the intensity of program dissemination by any one centre was likely weak. It appeared to be stronger in the larger organisations as evidenced by seminars, workshops and participation in the Professional Taster. There were also exceptions where enthusiastic staff or organisations had a more systemic (but limited) adaption of the program. Strong partnerships between program developers and family organisations are most likely an effective strategy. Partnership for translational research is increasingly seen as the most viable approach to implementation. The change agents most likely to drive new program or evidence implementation are often those deeply embedded in the systems (Porritt et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e). We attempted this with the network, however, the partnerships clearly needed to be stronger.\u003c/p\u003e\u003ch2\u003eLimited Efficacy\u003c/h2\u003e\u003cp\u003eWe operationalised limited efficacy as participants’ rating of change in their parenting confidence, change in their father-child relationship and through their evaluative comments. The response rate was very low, however, the summary statistics showed that fathers perceived that both their confidence and relationship quality had increased. This demonstrates, albeit it at an individual level, that the program goals were achieved. Corollaries to this may be positive child outcomes (Connor \u0026amp; Stolz, \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e), and or improvement in maternal parenting (Havighurst et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eWe had planned for the study to be a pre-test post-test design, however, the low response rate meant that there was not enough statistical power to support within-subject change in factors such as caregiver strain or child strengths and difficulties. The low response rate to the final surveys suggests that either fathers could not be bothered completing a small battery of questionnaires, or, only 13 fathers remained engaged in the messages until the end of the program.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFor every \u003cspan\u003e$\u003c/span\u003e1 spent on parenting interventions, up to \u003cspan\u003e$\u003c/span\u003e30 is saved in other social service delivery costs by preventing adverse child outcomes (Havighurst et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Through \u003cem\u003eDadPlay\u003c/em\u003e, we have shown an increase fathers\u0026rsquo; parenting knowledge, their relationship with their child, as well as supported fathers\u0026rsquo; overall role as a responsible parent. We therefore have contributed to prevention of adverse outcomes for children, although we do not have any power to calculate this. Demand for the program is out of our control, yet implementation strategies are the tool by which we can sharpen our approach. This will include a better understanding of ways of reaching fathers, as well as understanding how to collaborate, or better, co-create, with professionals and organisations, working on the ground with families.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding: The implementation of DadPlay was funded by the Australian Commonwealth Department of Health GO2648.\u003c/p\u003e\n\u003cp\u003eEthics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of University of Newcastle (Date 16/12/2020/No H-2020-0384).\u003c/p\u003e\n\u003cp\u003eConflicts of interest/Competing interests: The authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003eConsent to participate: Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAltenburger LE, Schoppe-Sullivan SJ (2021) Contributions of parenting quality and coparenting relationship quality to the development of child executive functioning. 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BMC Public Health 17(1):550. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-017-4426-1\u003c/span\u003e\u003cspan address=\"10.1186/s12889-017-4426-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Newcastle Australia","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Fathers, mHealth intervention, parenting, feasibility, service provision","lastPublishedDoi":"10.21203/rs.3.rs-6425121/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6425121/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe report the feasibility of an mHealth intervention for fathers of young children, tested in real-world community settings, with a focus on four aspects of feasibility: demand, acceptability, implementation and limited efficacy.\u003cem\u003e DadPlay\u003c/em\u003e was an intended for fathers who were raising young children with challenging behaviours. While programs targeting parenting skills are effective at reducing behavioural problems in early childhood, many parenting programs unintentionally work against father inclusion and fail to engage, retain or measure men's participation. We evaluated feasibility according to four components of feasibility: Demand, Acceptability, Implementation and Limited Efficacy. Participants were eligible for the intervention if they were fathers of a pre-school aged child. A service network was established as a reference group, which included family and child-focused non-government charities and organisations and preschools located across regional, rural and remote localities in Australia. Results for Demand showed we reached out to approximately 340 organisations: 57% agreed to disseminate information. 325 parents submitted an EOI, 108 completed enrolments, and 96 completed the program. For Acceptability, findings indicated that the message content and program features were very acceptable. For Implementation, our reach was vast, however efficiency appeared low, with exceptions. A low response rate limits our Efficacy findings, however, summary statistics showed that fathers’ confidence and relationship quality had increased. We demonstrated that\u003cem\u003e DadPlay\u003c/em\u003e was acceptable and has the potential to support fathers of young children. To upscale and sustain such initiatives, we need to better collaborate and co-create with fathers, professionals and organisations.\u003c/p\u003e","manuscriptTitle":"Feasibility, Development and Dissemination of a Father Focused Parenting Intervention, DadPlay","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-16 09:22:15","doi":"10.21203/rs.3.rs-6425121/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"11b3d85e-637e-4261-99d7-78fb99e9dc29","owner":[],"postedDate":"April 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47117351,"name":"Psychology"}],"tags":[],"updatedAt":"2025-04-16T09:22:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-16 09:22:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6425121","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6425121","identity":"rs-6425121","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}