Paternal reports of healthcare decisionmaking: A qualitative study

1
Paternal reports of healthcare decision-making A
qualitative study Anthony Isacco, M.A.¹, Timothy
E. Rogers, M.A.², Craig F. Garfield, M.D.,
MAPP¹ ³
1Evanston Northwestern Healthcare, Evanston, IL
2Akron University, Akron, OH, ³Feinberg School of
Medicine, Northwestern University, Chicago, IL
Methods
Background
Discussion
Results

• As a result of cultural shifts, increased women
  in the workplace, and changing familial
  compositions fatherhood ideals have evolved from
  distant breadwinners to involved fathers to
  coparents.
• Decision-making represents a key aspect of the
  responsibility component of Lambs model of
  father involvement (see Figure 1).
• Investigation into how fathers participate in
  child healthcare decisions has largely focused on
  severe and atypical child health situations
  (i.e., prenatal abnormalities, premature
  delivery, and severe brain damage).
• Examining normative paternal decision-making in
  the healthcare domain is an important aspect of
  paternal involvement and is missing from the
  literature.

• Procedures
• Fathers in our sample are a sub-sample of the
  national Fragile Families and Child Wellbeing
  Study of 3,600 randomly sampled hospital births
  in large U.S. cities and participants in the
  nested qualitative study Time Love and Cash in
  Couples with Children (TLC3).
• We interviewed fathers in Milwaukee and Chicago
  for 1.5 hours when their child was approximately
  3 years old using in-depth, semi-structured
  interviews focusing on father involvement in the
  childs health and healthcare and healthcare
  decision-making.
• Interview questions focused on five normative
  healthcare decisions, identified by American
  Academy of Pediatrics (AAP) as common and
  important healthcare decisions that parents
  confront.
• Data Analysis
• Open coding The process of breaking down data
  into distinct concepts and comparing new
  statements to previously coded statements. If
  new statements do not fit with an established
  concept, a new code is developed. The process
  ends when the codes can account for all
  statements. Open coding was specifically used to
  identify the most common themes that were found
  in each particular five healthcare decisions.
  Table 2 has the results.
• Axial coding Explored and compared patterns of
  coding within and across the five individual
  healthcare decisions.
• Selective coding Combined specific patterns into
  core categories and linked related narratives
  with the core categories.
• Axial and selective coding were used to further
  analyze the themes identified in each specific
  five healthcare decision (Table 2) and Table 3
  presents the core categories that were found
  across the five healthcare decisions.

• Overall, fathers are involved in healthcare
  decision-making and their involvement is
  highlighted by shared responsibility with the
  mother, trusting the mothers judgment to make
  sound decisions for their childs health and
  healthcare, and a willingness to consult doctors,
  nurses, family, and friends before making a
  decision. These findings suggest that fathers
  are collaborative and coparental and will base
  their decision-making on what is best for their
  childs health.
• Participants in this study represent a unique
  sample of predominately non-married,
  racial/ethnic minority fathers of low-income
  status living in urban areas, who are
  traditionally underrepresented in research.
• Paternal involvement varies considerably based on
  those characteristics and social contexts. For
  example, being employed has been found to be a
  significant correlate of higher father
  involvement among low-income and minority
  fathers, in part, because employment allows
  fathers to make financial contributions to the
  childs care, which in turn, increases mothers
  cooperation with the father (Coley Hernandez,
  2006). The vast majority of fathers in this
  sample were employed (84) and reported styles of
  involvement in healthcare decision-making that
  included the mother.
• Implications
• Quality father involvement and positive
  coparenting are both associated with positive
  outcomes for child development and the parental
  relationship. Therefore, community programs and
  family/couples counseling may be important to
  educate and encourage fathers (and mothers) about
  collaborative decision-making.
• Working with fathers to promote collaborative
  decision-making likely will require an
  understanding of their social context, employment
  status, as well as exploring a fathers adherence
  to gender norms and their willingness to adopt a
  non-traditional (i.e., egalitarian) role as a
  coparent.
• Future Research
• Additional studies should examine the possible
  mediation or moderation of paternal involvement
  in normative healthcare decisions as a result of
  their perceived self-efficacy, adherence to
  gender role norms, degree of gender role
  conflict, and overall nature of the relationship
  with the child.
• Involvement in healthcare decision-making for
  fathers may be influenced by the relationship
  quality with the childs mother as well as
  specific familial norms. Additional studies
  would benefit from accounting for individual
  differences among families, which impact paternal
  involvement and how parents work together in
  their childs health and healthcare.

Objective
To qualitatively examine a sample of urban
fathers and their narratives of decision-making
processes regarding five common healthcare
decisions that parents typically respond to in
their childs first three years of life.
.
Figure 1 Model of Father Involvement (Lamb, 2000)
Results

Of the 50 fathers from the TLC3 study in Chicago
and Milwaukee, 3 had moved out of the state, 6
were in jail, 7 had been lost in earlier
follow-up and 1 had died, leaving 33 eligible
respondents. Of those, 1 refused to participate
and 1 transcript was incomplete due to a damaged
tape recording, resulting in a final sample of 31
fathers and an adjusted response rate of 94.
Healthcare Decision-Making
References Coley, R.L. Hernandez, D.C. (2006).
Predictors of paternal involvement for resident
and nonresident low-income fathers.
Developmental Psychology, 42, 1041-1056. Lamb,
M.E. (2000). The history of research on father
involvement An overview. Marriage and Family
Review, 29, 23-42.