About SMS4dads

It's a simple idea.
Dad's are really busy before and after
the birth - there is no way they'll come to lots of
parenting classes... but they do have mobile phones.

SMS4dads provides new fathers with information and connections to online services through their mobile phones. The text messages with tips, information and links to other services help fathers understand and connect with their baby and support their partner. The expected date of delivery or date of birth, which is entered at enrolment, ensure that the texts are linked to the developmental stage of the baby (from week 20 of the pregnancy until 24 weeks post birth). Many texts use the ‘voice’ of the baby, for example, ‘Talk to me about anything dad. Your words will help my brain development’ others suggest actions ‘Find ways to tell your partner she is doing an amazing job. This could be really important to her’.

Frequently asked questions

What do the text messages say?

- A father may receive a message saying...

Although it is noisy in here I will

be able to hear your voice from about

20 weeks. Try telling me about the things

we will do together

[Txt STOP to OptOut]-

Some messages will contain links to
other sources of information…

4dad: If you are both up for it then there is

usually no problem with having sex

during pregnancy. It will not harm the

baby, check here [Link]

Approximately every three weeks a ‘How’s it going?” interactive text is sent timed for common challenges such as baby crying or getting intimacy back. Dads can reply with a click and be directed to online help or information.

Are mothers supportive?

They certainly are. As one mother put it: “It helped my partner to feel part of the "baby process", and that his experiences were also important. This made for a more cohesive family unit. The messages gave us both confidence and helped to avoid fights when extreme fatigue set in”.

How do you sign up?

It couldn’t be simpler. Click on the Join up button and enter your name, phone number and demographics, say if you smoke or drink, complete a 10 question survey and you’re in. Any dad or partner of a mum who is pregnant, or any dad (or someone who is in the role of the dad) of a baby less than 24 weeks old can join up.

How many messages?

You will receive about 3 per week. The messages are timed to match the development of the foetus or baby. But you get the messages to suit your baby, if you sign up one week before the birth your messages are synced to that stage of pregnancy. If your baby is 2 months old, your messages will be for this age. The messages start from 16 weeks into the pregnancy and the last one is sent at 48 weeks after the birth.

What if I don’t want to keep getting the messages?

You simply text back ‘STOP’ to any message and we take you out of the program. There are no follow up offers or message asking you ‘Are you sure you want to leave?’ Just one text asking you to give a reason. It will say Thanks for being part of SMS4dads. Your messages have been stopped. 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. And that is all.

What is the Mood Checker?

About every three weeks you will receive an interactive text with a question about how you are going with one of the common challenges such as: getting ready for the birth, baby crying, regaining intimacy, or returning to work. The idea is to take a few moments to register how you are doing and maybe get some info or help. The Mood Checker has links to online resources.

Current projects:

SMS4Rural dads (Tresillian)

While more than 2,000 dads have completed the SMS4dads program nearly all of them came from urban areas. The SMS4Rural Dads project is seeking to enrol dads from regional areas of NSW. Tresillian Family Centre staff based in Wagga, Albury, Taree, Dubbo, Lismore and Queanbeyan have been actively promoting the SMS4dads program to other health workers and to parents.

Go to https://www.tresillian.org.au/advice-tips/parent/sms-4-dads/

Focus on New fathers (NSW Health)

In what will be the largest trial yet up to 30,000 dads-to-be and new dads will be able to enrol in SMS4dads over the 9 months from September 2020. The project is being conducted by NSW Health with funding from The Australian Government. Four Local Health Districts, Northern NSW, Northern and Western Sydney and Murrumbidgee will be involved. The project will test recruitment to SMS4dads and whether distressed dads will be identified through the Mood Checker and screening. The project will also try to increase awareness of fathers’ needs among health staff and make perinatal services more father-inclusive.

SMS4baba (Kenya) A pilot study is translating the texts from SMS4dads into Swahili for dads living in the settlements surrounding Nairobi and in Kilifi. Focus groups with these dads are ensurng cultural translation occurs. This project is a partnership between the University of Newcastle and Aga Khan University Kenya. Researchers involved include: Marleen Temmerman, Vibian Angwenyi, Stanley Luchters and Amina Abubakar; Aga Khan University, Nairobi, Kenya and Liz Comrie-Thomson, Burnett, Melbourne.

SMSPAPA (Colombia) A pilot study is translating the texts from SMS4dads into Spanish for dads living in Bogota, Colombia. Focus groups with these dads are ensurng cultural translation occurs. This project is a partnership between the University of Newcastle and Pontifica Universidad Javeriana Bogota, Colombia. Researchers involved include:Dr Laura Ospina Pinillos, Maria Angelica Botero and Santiago Barrera.

Contributors to the development of SMS4dads

The original idea was one developed by Richard Fletcher but the SMS4dads program has had contributions from many researchers and clinicians from all areas of Australia and overseas. As well the thousands of dads who have engaged with SMS4dads there have been Individual who have helped to develop the content and delivery: Chris May, Jennifer StGeorge, Peter Gordon, Geoff Skinner, Frances Kay-Lambkin, Jacqui Macdonald. Jamie Wroe, Olive Auman, Rebecca Giallo, Rebecca Liackman, Jeanette Milgrom, Louie Hahn, Brett Sales, Alan Hayes, Brian Kelly, John Attia, Helen Skouteris, Craig Garfield, Paul Ramchandani, Louise Newman, Kim Hudson, Jenny Chaves Miranda Cashin, Jenni Richardson, Luke Martin, Dawson Cook, Nick Kowalenko, Nicole Highet, Bryanne Barnett, David Ellwood, Jane Warland, Ian Symonds, Michael Stark, Eileen Dowse, Alka Kothari, Jackie Mead, Cate Rawlinson, Elisabeth Hoehn, Libby Morton, Andrea Baldwin, Graham Stark, Jennifer Waterson, Janette Garvey, Sarah Moakes, Nick Kowalenko, Louise Newman.

What is the research behind SMS4dads?

There have been a number of studies. Here are the abstracts from some key papers

Fletcher R, Kay-Lambkin F, May C, Oldmeadow J, Attia J, Leigh L. (2017) Supporting men through their transition to fatherhood with messages delivered to their smartphones: a feasibility study of SMS4dads BMC Public Health DOI: 10.1186/s12889-017-4978-0

ABSTRACT Objective: The project aimed to test of the quality and acceptability of researcher- developed Short Message Service (SMS) messages designed to support fathers of infants aged 12 months or less. Background: The findings of previous studies suggest antenatal and postnatal depression among fathers’ impacts negatively on the health of family members. Method: Draft messages were first modified based on expert review. In a second phase, parents (mothers n = 56; fathers n = 46; unknown n = 4) were recruited through two early childhood parenting services to rate the clarity, usefulness and relevance of the 70 SMS messages using a paper-based survey. In a third phase, 15 fathers were recruited to receive texts at different times over three weeks. Results: Findings suggest that SMS items were easily understood by the majority of parents, with only 3% of responses indicating an item was ‘not easily understood’. Feedback from parents indicated that negatively rated SMS messages were considered as either poorly phrased, lacking enough information or as not offering sufficient support. The majority (88%) of the SMS items were also rated as ‘useful’ by the parents. Conclusion: Fathers’ responses indicated that receiving the texts at different times was acceptable and that message content was relevant to their fathering. The study has produced a set of brief text messages suitable and acceptable to new fathers and their partners.

May, C. D., & Fletcher, R. (2019). The development and application of a protocol for the writing, assessing, and validating of a corpus of relationship-focused text messages for new and expecting fathers. Health informatics journal, 25(2), 240-246.. DOI: 10.1177/1460458217704249

Abstract: In developed countries, antenatal education aims to reduce difficulties that mothers and fathers experience during transition to parenthood. However, fathers are often distracted from preparing themselves by the attention given to preparing and supporting mothers. Developments in digital communication present alternative means of supporting fathers at this time. Studies, across a range of health concerns, have reported successful outcomes from text-based interventions. Text messaging, focusing on the issues that cause paternal distress at this time, could provide timely, targeted, and effective support to fathers in their transition to parenthood. This study aimed to develop a corpus of messages that could be sent to new fathers during pregnancy and in the months after birth. Messages were intended to support new dads in caring for their own physical and mental health, nurturing strong relationships with their child, and developing strong parenting partnerships. The process employed in message development was similar to that previously employed in developing messages for people who had experienced a cardiac event. A corpus of messages and linked information focusing on fathers’ relationships with their children, partners, and themselves were initially developed by a core group. The corpus was then culled, refined, and expanded by a larger, more diverse, group of experts (n=46), including parents, academics, and practitioners. The iterative, consultative process used in this study proved to be a functional way of developing and refining a large corpus of timed messages, and linked information, which could be sent to new fathers during their transition to fatherhood.

Fletcher, R., Hammond, C., Faulkner, D., Turner, N., Shipley, L., Read, D., & Gwynn, J. (2017). Stayin’on Track: the feasibility of developing Internet and mobile phone-based resources to support young Aboriginal fathers. Australian journal of primary health, 23(4), 329-334.

Abstract: Young Aboriginal fathers face social and emotional challenges in the transition to fatherhood, yet culturally appropriate support mechanisms are lacking. Peer mentoring to develop online- and mobile phone-based resources and support may be a viable approach to successfully engage these young men. This feasibility study engaged two trusted Aboriginal mentors and researchers to partner with one regional and two rural Aboriginal communities in New South Wales, Australia. Early in the research process, 20 young Aboriginal fathers were recruited as co- investigators. These fathers were integral in the development of web-based resources and testing of mobile phone-based text messaging and mood-tracking programs tailored to provide fathering and mental health support. Overwhelmingly positive feedback from evaluations reinforced community pride in and ownership of the outcomes. The young men’s involvement was instrumental in not only developing culturally appropriate support, but also in building their capacity as role models for other fathers in the community. The positive results from this feasibility study support the adoption of participatory approaches to the development of resources for Aboriginal communities

Fletcher, R., StGeorge, J., Rawlinson, C., Baldwin, A., Lanning, P., & Hoehn, E. (2020). Supporting partners of mothers with severe mental illness through text–a feasibility study. Australasian Psychiatry, 1039856220917073.

Abstract Objective: During the perinatal period, partners of mothers with severe mental illness (SMI) play an important role in managing the new baby and supporting the mothers’ wellbeing. Providing information via mobile phone on infant care, partner support and self-care may assist partners in their support role. Method: Partners (n = 23) of mothers with SMI were enrolled in a partner- focused SMS service sending brief texts 14 times per month for a maximum of 10 months. Partners (n = 16) were interviewed on exit and their responses analysed for acceptability and perceived usefulness of the texts. Results: Partners remained with the programme and expressed high acceptability of the texts. Participants identified effects such as increased knowledge of and interaction with their baby; effective support for their partner; and reassurance that ‘things were normal’. Few partners sought support for their own mental health. Conclusions: Texts supplied to mobile phones of partners of new mothers with SMI may increase partners’ support. The texts in this study were acceptable to partners and were reported to enhance a partner’s focus on the mother’s needs, raise the partner’s awareness of the infant’s needs, and support the partner’s confidence and competence in infant care.

Fletcher, R., Knight, T., Macdonald, J. A., & StGeorge, J. (2019). Process evaluation of text-based support for fathers during the transition to fatherhood (SMS4dads): mechanisms of impact. BMC Psychology, 7(1), 1-11.

Abstract Background: There is growing evidence for the value of technology-based programs to support fathers to make positive transitions across the perinatal period. However, past research has focused on program outcomes with little attention to the mechanisms of impact. Knowledge of why a program works increases potential for replication across contexts. Methods: Participants were 40 Australian fathers enrolled in the SMS4dads text-based perinatal support program (Mean age 35.11 (5.87). From a starting point between 16 weeks gestation and 12 weeks postpartum, they were sent a maximum of 184 text messages. An inductive approach was used to analyse post-program semi- structured interviews. The aim was to identify mechanisms of impact aligned to previously identified program outcomes, which were that SMS4dads: 1) is helpful/useful; 2) lessens a sense of isolation;

3) promotes the father-infant relationship; and 4) supports the father-partner relationship. Results: We identified two types of mechanisms: four were structural within the program messages and five were psychological within the participant. The structural mechanisms included: syncing information to needs; normalisation; prompts to interact; and, the provision of a safety net. The psychological mechanisms were: increase in knowledge; feelings of confidence; ability to cope; role orientation; and, the feeling of being connected. These mechanisms interacted with each other to produce the pre-identified program outcomes. Conclusions: If the current findings are generalisable then, future mobile health program design and evaluation would benefit from explicit consideration to how both program components and individual cognitive and behavioural processes combine to elicit targeted outcomes. Keywords: Process evaluation, Fathers, Mechanisms, Text-based, Qualitative