Critical Realist Perspective About Pakistani Men Becoming a Father for the First Time: A Multi-Method Study

Abstract

Background: In Pakistan, and globally, first-time fathers may experience psychological distress during their wives' perinatal period. Causal mechanisms for this distress may be enmeshed in their roles within socio-ecological layers where they live. Research Purpose: This study explored the experiences of men in Pakistan becoming fathers for the first time and identified causal mechanisms behind their perinatal experiences in Pakistani society. Methods: A biphasic multi-method research approach was used to explore three research questions: (1) What evidence is available about factors contributing to paternal perinatal psychological distress (PPPD) in first-time fathers? (2) What are the experiences of men becoming first-time fathers in Pakistan? (3) What are the causal mechanisms behind these experiences? Phase 1 was a scoping review of instruments to measure men's psychological distress during the perinatal period. Phase 2, a qualitative descriptive study, was guided by Critical Realism (CR) philosophy and the Socio-Ecological Model (SEM), offering a roadmap for mitigating risk factors for developing PPPD in first-time fathers. Qualitative face-to-face individual interview data was analyzed by integrating Inductive Content Analysis (ICA) technique with CR philosophy and the SEM. Results: The scoping review included 16 studies and identified 56 instruments that measure aspects of men's experiences with PPPD. Causal mechanisms behind perinatal experiences of first-time fathers (n = 8; 4 prenatal, 4 postnatal) in SEM layers in Pakistan include personal values (individual layer), affection for wives (relationship layer), teachings at religious settings (community layer), and norms and policies of hospitals and Pakistani society (societal layer). Conclusions: This study provides evidence of the need to assess, and when appropriate treat, first-time fathers for PPPD during their wives' perinatal period. Mobilizing healthcare professionals, researchers, and policymakers across SEM layers may offer the best hope for recognizing and managing PPPD among first-time fathers, improving health for them, their families, and communities.