Table 1 Specific Stakeholder Feedback in Relation to Initial “First Heroes” Intervention Protocol Design

Recruitment

Program branding

“First 1000 Days Fatherhood Intervention”; obesity prevention initiative

Suggested “HEROES” name to capture the important/ inclusive role of fathers

N/A

N/A

Eligibility Criteria

First time biological mother-father dyad, > 18 yo, English/Spanish speaking, intent to continue care at MGH obstetric and pediatric practice

Concern for excluding certain demographic groups (i.e. single/separated parents and same-sex couples)

N/A

N/A

Intervention Design

Staffing

Research nurse or Health Coach, supplemented by pediatrician and research assistant

-Staff team with sociodemographic diversity

-Adequate educational backgrounds

-Social skills/personality traits (non-judgmental, communicative, empathetic, flexible, trusting)

-Not necessary to be healthcare professional but adequate training/supervision

-Active role models (males and fathers)

-Train on cultural sensitivities and mandatory reporting

-Pair (1) research nurse with academic experience and (2) health coach with community and parenting experience to provide well-rounded intervention delivery experience

Fathers open to a variety of different messengers to receive information relating to:

-Their child’s health: trusted pediatrician (n = 6), their partner (n = 3), then family (n = 2)

-Being a father: trusted other fathers (n = 4), pediatrician (n = 2), their own parents (n = 2), then family (n = 1) and peers (n = 1)

-Their own health: trusted physician or another healthcare professional (n = 4), then peers (n = 2) and family (n = 2)

Content

-Responsive parenting

-Parent lifestyle behaviors

-Access to resources/Social Determinants of Health

-Growth and developmental milestones

-Specific supports for fathers to learn about infant temperament

-Importance of social connectedness and relationships

-Focus on post-partum mental health for both mothers and fathers

-Substance abuse information in relation to the emotional part of being a new parent

-Frame as the importance of ‘being present’ for their child

-Basic routines (i.e. changing diapers)

-Child sickness and medical emergencies

-Critical developmental milestones

-Early bonding with the baby

-Supporting mothers through pregnancy and the postnatal period

-Developing healthy and stress-reducing habits for parents

Visit timing/ associated critical time points

Prenatal: 30–34 weeks gestation/3^rd trimester

Program initiation during pregnancy, when the decision to be an active parent occurs

N/A

Some fathers preferred program initiation before birth and some preferred after birth

Postnatal 1: 3–4 weeks of age/establish feeding practices

N/A

N/A

-General support

-Concern that 3–4 weeks was too late for urgent needs with breastfeeding support during weeks 1–2

Postnatal 2: 3–4 months of age/introduction of solids

N/A

N/A

-General support (considered an “impactful time”)

-Some thought too early for introduction of solids

-Some suggested 3–4 months is too late because there is less uncertainty and fewer questions than during the first 1–2 months

Visit modality

Prenatal: virtual visit

Postnatal 1: home visit

Postnatal 2: home visit

Consider some parents in target population cannot be in same place at the same time due to work or other conflicts

-Home visits over virtual visits, particularly when first meeting dyads to establish rapport;

-Consider family preference

-Support for virtual prenatal visit

-Preferred in-person home visits for postnatal visits

Delivery mode

Print/web/text-based materials

N/A

-Package intervention content in ‘bite-sized’ pieces (videos, text messaging, and short summaries)

-Web-based materials

-Mobile-based materials and printed information (especially postnatal period)

-Advanced notice of topics and after-visit summaries

Engagement

Engaging champions

Job postings for Health Coach and Research Nurse positions distributed to CAB members, clinical champions with MGH (physician, nursing), local universities with graduate programs in public health, nursing, education, etc

N/A

-Use community health worker model for health coach position to address potential qualification barriers for applicants

-Connect with professional associations and community organizations (i.e. Fathers’ Uplift, Nurturing Fathers Program, Roca) to further advertise positions

N/A

Engaging innovation participants

Text messaging, videos, mobile applications, electronic groups

-Parent leaders from community partners to engage fathers

-Dads in images for outreach

-Focus group messages/images with men and women

-Use incentives/ material goods

N/A

-Practical and evidence-based content

-Low maintenance intervention

-Home visitor continuity

-Include peer and group support

-Gift for participation

-Adaptable/tailored to parental needs