Stakeholder engagement in developing a father-inclusive early life obesity prevention intervention: First Heroes

We held an open CEM in September 2019 to guide the initial formative stages of intervention adaptation. In identifying meeting invitees, we leveraged existing community connections from the First 1,000 Days, as well as solicited requests from these connections to identify any other key stakeholders we may have overlooked. We systematically created an invite list, including MGH obstetric and pediatric clinicians providing care in the perinatal period, care providers from community home visiting programs, leaders of father advocacy groups, and local fathers. During this meeting, we provided an update on results from First 1,000 Days, explained our rationale in extending the program to include fathers, and described the current proposed intervention structure (Table 1). The initial intervention design was the product of an extensive literature review of effective obesity prevention and father-inclusive perinatal interventions targeting the first year of life [4, 38]. The research team collaboratively reviewed the current literature relation to existing First 1,000 Days intervention content to develop our proposed intervention structure.

We invited CEM attendees to provide ongoing feedback through participation in our CAB. We informed potential members that responsibilities would include (1) attending quarterly meetings and (2) providing feedback on intervention design and content. We asked members to identify other stakeholders within the fatherhood community for invitation. The first CAB meeting was held in January 2020. The meeting agenda addressed program modifications based on initial feedback, recruitment plans, and study educational materials. Board members received all study materials prior to the meeting for their review, with opportunities for feedback provided within the meeting as well as through follow-up phone conversations or written communication. The first meeting was held via video conference. To minimize the burden on our advisory board members during the COVID pandemic, we provided ongoing updates through email (Spring–Summer 2020), with resumption of the quarterly meeting schedule in Fall 2020.

We conducted 16 semi-structured qualitative interviews (November 2019-April 2020) with fathers of children under 1 year old to investigate the acceptability and feasibility of the proposed intervention. We identified fathers for participation through review of well-child visits with pediatric practices at MGH, including both hospital- and community-based locations. Fathers were eligible to participate if they were at least 18 years old, had a child receiving care at a MGH pediatric primary care site, were English proficient, were first time fathers, and had a child 0–12 months without significant medical comorbidities that would affect growth, development, and feeding. This study was approved by the MassGeneral Brigham Institutional Review Board.

Study staff mailed recruitment letters to eligible fathers describing the engagement study. One week after the letters were mailed, study staff contacted fathers by phone to explain the study, answer questions, and enroll fathers who chose to participate. Three phone call attempts were made to reach each eligible father who received a letter. We called 137 fathers; 83 did not answer the phone, 17 declined, 21 were ineligible (n = 8 due to language barriers, n = 2 due to medical comorbidities, n = 3 due to child age > 12 months, n = 2 due to moving out of state, and n = 6 due to not being a first-time father), and 16 consented to participation. Participants received a $25 gift card upon interview completion. After providing informed consent, fathers participated in semi-structured, in-depth interviews. The development of the interview guide was informed by a review of prior studies exploring early life obesity prevention strategies [4] and literature review of relevant methodological considerations regarding father engagement [25, 27, 38, 39] as well as CFIR constructs [37]. The interview guide included core and probing questions to elicit discussion of relevant topics, such as fathers’ information and resource needs, perceptions of their roles and experiences, and preferences for intervention content and modalities (see Supplemental File). Each semi-structured 30-min phone interview was audiotaped and transcribed by an independent company for analysis. We reached thematic saturation with a total of 16 interviews, as review of transcripts revealed reinforcement of previously identified themes and no new themes were generated.

At both the CEM and AB meeting, a research team member transcribed detailed notes of all feedback provided by meeting attendees. We reviewed findings in detail in group debrief meetings following both stakeholder meetings. We categorized transcribed notes into CFIR domains using a deductive approach.

We used an iterative immersion-crystallization inductive approach to conduct content analysis through repeated cycles of reading and discussing transcripts to identify predominant themes [40]. The full analysis team (HFM, RW, GK, MK, ET) individually read nine transcripts in-depth in sets of three before discussing as a group. Based on our initial list of themes, three team members (HFM, RW, GK) independently coded interview content line-by-line, collating codes into an Excel spreadsheet to generate a preliminary codebook. We reviewed independent coding for consensus between coders. We revised and reviewed the codebook after each set of three interviews.

After in-depth review of nine interviews with the full analysis team, we noted overall repetition of themes. We reviewed the codebook at this time, reorganizing all codes under relevant corresponding themes that had been identified through group discussion. Two coders (SS, RW) independently coded the next two interviews using the revised codebook, with agreement > 85%. The final five interviews were independently coded, with no new themes emerging from content review and discussion. We sorted codes within CFIR domains using a deductive approach.