Global Workforce Development in Father Engagement Competencies for Family-Based Interventions Using an Online Training Program: A Mixed-Method Feasibility Study

Research shows that fathers play an important role in their child’s development [1]. However, a significant gap exists between recognition of the importance of fathers in child development and representation of fathers in attendance and participation in child mental health treatments [2‐4]. This is especially problematic in family-based interventions for child behaviour problems where involving fathers in treatment could enhance child outcomes [5, 6]. Practitioner’s competencies to engage fathers have become a target of workforce development to improve father engagement in parenting programs [7]. Recent findings from an Australian study provided preliminarily support for online training as an effective method of increasing practitioners’ confidence and competence in relation to engaging fathers, and disseminating training on a large scale [8]. In line with this, the current study evaluated the feasibility of global workforce development in father engagement by examining training effectiveness and satisfaction when online training is provided to practitioners working in international contexts (Canada and UK).

A large and convincing evidence base exists for the effectiveness of family-based interventions in supporting children with a range of child problems such as disruptive behaviour and anxiety problems [5, 9‐12]. However, research shows that parents’ treatment engagement behaviours like attendance and quality of participation are important for effective treatment [13‐16]. Furthermore, findings from meta-analyses show improvements from a family-based intervention for child behaviour problems are greater for the child when both mothers and fathers participate in treatment compared to when mothers participate in treatment alone [6, 17]. And individual studies have also demonstrated the positive impact of father involvement for parent and child outcomes in family-based interventions targeting infant-parent relationships, eating disorders, and challenging behaviours in context of intellectual disability across different countries [18‐22].

Despite the importance of father participation in family-based interventions, international research examining parental engagement suggests fathers are less likely to participate and benefit from family-based interventions [23‐26]. Even when both parents are invited to participate, fathers’ rate of attendance and quality of participation tend to decline across the intervention [18, 27]. Preliminary results from qualitative research suggest barriers to treatment engagement may be experienced differently by fathers. For instance, research suggests that fathers’ attitudes around gender roles and help‐seeking, fathers’ low knowledge of family-based interventions, programs not meeting fathers’ individual needs (e.g., managing personal and parenting stress), and the perception that interventions are directed towards mothers, may be key barriers to engaging fathers in family-based interventions [28, 29]. These findings suggest a need to develop father-inclusive approaches to the design and delivery of family-based interventions to improve the effectiveness of treatment [2, 30].

Practitioners notably represent an important target for enhancing father engagement with specific attention to training clinical–interpersonal skills in engaging parents [2, 8, 31, 32]. Indeed, reviews of research findings from different countries suggest there are significant limitations in practitioner’s knowledge and confidence to engage fathers in family-based interventions [2, 33]. Surveys of mental health practitioners indicate that, while many endorse father participation in treatment as important, most of them report low levels of competence and use of strategies to engage fathers [7]. Practitioners also report limited knowledge of methods to engage fathers in family-based interventions [34]. Further adding to arguments for the need to target practitioners is international evidence that few receive specific training in engaging fathers within tertiary level courses in health, welfare, and education [34, 35]. Collectively, these findings suggest a need for developing and widespread dissemination of practitioner training programs in father engagement. Previous studies evaluating face-face training in father engagement competencies have shown positive results in potentially improving practitioners’ self-reported use of father engagement skills [36‐38].

While results related to face-face training are positive, online training represents a low-cost method to overcome barriers to training practitioners on a large scale. For instance, research suggests that a major barrier to training practitioners is the cost and resource burden to health professionals and services [2, 39]. Face-face training places significant demands on practitioners’ time which in turn may reduce uptake of training [8]. Practitioners’ participation in training can also disrupt service delivery due to reduced staff availability because of time allocated to training leading to lack of organisational support [40]. Direct costs in delivering training would be avoided via online training formats since training would not require employment or availability of trainers. Further, practitioners can access training at their convenience, thus limiting disruption to service delivery. Research supports online training methods to achieve similar effects as face-face delivery in training health professionals [41]. Further, the increased accessibility of training via the internet means that online training has the potential for widespread dissemination and reach into communities [8]. This includes increasing reach to practitioners in overseas health settings as there are no geographic boundaries associated with online training delivery.

Previous research evaluating online practitioner training in father engagement competencies showed promise in improving practitioners’ use of father engagement skills in local contexts. Drawing from social cognitive theory, Burn et al. [8] evaluated a training program delivered in either face-face or online formats. This training targeted practitioners’ confidence and competence in using strategies to engage fathers, as well as organisational practices to engage fathers, and was tested in a diverse sample of mental health professionals in Australia. Both training formats were associated with improvements in practitioner competencies, organizational practices, and self-reported rates of father engagement over time. Practitioners reported high levels of satisfaction with both program formats. While some deterioration in self-reported competencies was noted from post-training to three-month follow-up for practitioners in the online format, the follow-up scores were still significantly improved compared with pre-training. This research demonstrates the potential for online training programs targeting practitioners’ self-efficacy in engaging fathers to improve rates of father attendance in family-based interventions. The preliminary evidence also shows promise in overcoming putative barriers for practitioners to access training. No research exists evaluating training programs disseminated internationally to address low father engagement in family-based interventions on a global scale.

Following Kirkpatrick and Kirkpatrick’s [42] training evaluation framework, the current study examined the feasibility of disseminating the Australian-based online training program [8] internationally by examining training effectiveness and satisfaction, as well as qualitative feedback among child and family practitioners in the United Kingdom (UK) and Canada. Based on Burn et al. [8], it was hypothesised that the training would be effective, and practitioners’ confidence and competence would improve following participation in the online training program (Hypothesis 1). Benchmarking analysis was used to compare previous training outcomes from Australia [8] to those in the UK to evaluate equivalency in training effectiveness. It was expected that training effectiveness would be equivalent between practitioners in the UK and Australia (Hypothesis 2). We also examined practitioners’ self-reported satisfaction with the training program. Finally, thematic analysis was used to analyse practitioners’ feedback about the training program. The aim of the qualitative analysis was to evaluate practitioners’ reports of the quality of, and satisfaction with, the training program, as well as identify future directions for ensuring the program is appropriate for different countries.

The current study examined whether it was feasible to educate health practitioners in father engagement competencies on a global scale using online training. Samples of health practitioners from the UK and Canada were used as case examples. Feasibility was assessed by training effectiveness, satisfaction, and qualitative feedback regarding practitioners’ experience of the training program. Providing support for hypothesis 1, the results indicated significantly large improvements in self-reported confidence and competence in engaging fathers following participation in the online training program among practitioners from the UK and Canada. Providing support for hypothesis 2, rates of improvements in self-reported confidence and competence among UK and Canadian practitioners were similar to that observed in a previous Australian study [8]. Self-reported ratings of training satisfaction were high overall. Qualitative feedback also indicated high satisfaction with the training program, while providing directions of future development in relation to training content. Overall, the findings indicate that it is possible to disseminate an online training program in father engagement into overseas health settings.

Significantly large improvements in practitioners’ self-reported confidence and competency in engaging fathers suggests that, the online training program is effective in increasing practitioners’ self-efficacy in the use of skills to engage fathers in family-based interventions. The results extend and replicate research findings showing that training in father engagement competencies improves domains of self-efficacy considered important to application of engagement skills when training is delivered in online formats, at least when self-efficacy was measured immediately after participation in online training [8, 36‐38]. Importantly, the current study showed training effectiveness in samples of practitioners working in different countries from which the original program was developed with similar levels of training effectiveness. The findings also provided further support that this training program was effective for a range of professionals working in different countries and settings. Overall, the results suggest that the online training program can be effective in improving father engagement competencies when disseminated into different countries.

Practitioners self-reported high levels of satisfaction with the online training program, in relation to their satisfaction, utility, and knowledge, converges with previous evaluation studies of father engagement competency training [8, 36, 38]. Practitioners in the current study also reported high levels of intent to use the knowledge in their everyday work suggesting translatability of training knowledge into practice, although the current study did not measure whether training participation led to measurable change in practitioners’ use of engagement skills. Qualitative analysis provided further support for training satisfaction among health practitioners in the UK and Canada. The findings suggested that the online training program was well-received by health practitioners in the UK and Canada in relation to delivery and format of training, as well as training content and implications for practice. However, minimal adaption might be required to make the program relevant to local contexts. It is noted that, while findings for satisfaction and qualitative themes were consistent, the Canadian site had higher rates of incomplete post-training measures, thus finding are somewhat tentative.

Taken together, the results preliminarily support the feasibility of using online training as part of global workforce development improving father engagement competencies. However, practitioners’ feedback may be useful in refining approaches to dissemination. Practitioners’ suggestions to localise resources and increase social diversity in training content to represent local populations are well taken to improve training relevance to local contexts. Previous studies have shown the value of adapting content to improve outcomes for healthcare professionals [49]. However, these suggestions should be considered in context of practitioners’ reports that the standard online program improved self-efficacy in engaging fathers, was suitable for their context, and high satisfaction with the program. Furthermore, consideration should be given to costs in adapting content as the online format was intended to provide low-cost methods of training [8]. Rather than adapting content therefore, it might be helpful to consider how best to implement online training. Blended learning models whereby online training is delivered alongside other learning modules is a well-established method of integrating online learning for healthcare workforce development [50]. To this end, we propose that access to follow-up support such as reflective practice workshops or cultural competence training be provided to consider cultural variation [51].

Discrepancies in completion rates of post-training measures across the UK and Canadian samples may also be important in disseminating the online program. It important to first note that low completion of post-training measures may not apply to rates of completing the actual training. Nevertheless, investigations were conducted during the study to determine whether noncompletion in the Canadian sample was associated with differences in instructions or website design, but neither were found to explain noncompletion. We hypothesise that the difference was related to structural differences in how the two cohorts were engaged. While recruitment at both sites involved the use of emails lists distributed within child and family services, recruitment in the UK included email lists of practitioners in the local CYP IAPT program. The CYP IAPT program delivers post-graduate training to practitioners for improving service quality. The higher completion rates in the UK may therefore relate to the utilisation of a specialised network for practitioner training. A key implication for further analysis is whether effective dissemination could be maximised with the support of existing training networks in local settings.

Several limitations of the current study should also be noted as areas of further research in disseminating the online ‘Engaging Fathers in Parenting Program’ internationally. First, the current feasibility analysis only recruited a small number of child and family organisations from the UK and Canada. Non-completion of post-training questionnaires in Canada was also high, putatively leading to low power in examining outcomes; however, findings were notably consistent. Nonetheless, future research should particularly examine feasibility of disseminating the online training program in different organisations where factors such as culture, types of services/programs offered, demographic of clients considering equity, diversity, and inclusion principles may impact the generalisability of findings. This includes evaluating training effectiveness in low to middle income countries which have different systems of workforce training. Second, current evaluation of training effectiveness did not assess whether practitioners implemented engagement strategies in practice or whether actual rates of father engagement improved following training participation. Future research should examine the performance and impact dimensions of Kirkpatrick’s hierarchy of training evaluation [42] as part of implementation, including observations of practitioners’ behaviour to provide multiple-informant assessment of training effectiveness. Third, estimates of training effects may be biased by self-selection as participation was voluntary and practitioners willing to participate in research and training directed at father engagement may not be representative of the diversity in practitioners within organisations. Self-selection bias could be minimised by implementing online training across an organisation allowing service-level evaluation of changes in father attendance and participation from training.

Finally, future research should extend beyond immediate pre- to post-training evaluations to examine the longer-term effects of training. The previous study in Australia identified minor deterioration in self-reported competency and confidence in engaging fathers from post-training to 3-month follow-up assessment, which was not observed in face-face training [8]. Future research should evaluate longer term outcomes such as 3-month and 1-year follow-up assessments to determine whether deterioration in effectiveness is observed among other practitioners as well as whether online training may require additional support (e.g. booster sessions) to ensure the training effects are maintained over the longer term. This could include evaluating any additional gains of additional support beyond the standard online training program to determine whether incurring costs of support is justified.

Meanwhile, the results of the current study provide preliminary evidence that online training in father engagement competencies can contribute to global workforce development in improving practitioners’ skills in engaging fathers in family-based interventions to optimise treatment outcomes. Training effectiveness associated with the online training program was similar across countries and participants reported high levels of satisfaction with the training program. Qualitative feedback suggests adaption may be required to increase fit of the training program in different local contexts. However, individual difference in contexts may alternatively be addressed via effective implementation in standard training pathways in workforce development. Notwithstanding these considerations, the online ‘Engaging Fathers in Parenting Programs’ training represents a promising direction to overcome significant barriers in workforce development in father engagement competencies in the community.

Knowledge and skills regarding the clinical engagement of fathers are core competencies for practitioners delivering family-based interventions, yet access to training in these competencies is often limited. Results from the current study which examined the feasibility of educating practitioners internationally in father engagement using an online training program indicated that participation could improve practitioner confidence and competence in engaging fathers in countries different from the one the original program was developed. Practitioners also reported high levels of training satisfaction. Notable recommendations to enhance relevance in local contexts were to provide local resources and increase representation of diversity in the training. However, further analysis is required to determine how to optimally deliver learning modules that target local cultural variations. Meanwhile, the findings provide preliminary evidence that online training in father engagement competencies can contribute to global workforce development in improving practitioners’ skills in engaging fathers in family-based interventions.