Introduction

The way that paternity is experienced has under gone major changes over time^2-4. During most of the last century, as a result of both demographic and epidemiological transitions, families have evolved from being large, extended, and matri-or-patrilocal units, towards becoming smaller, nuclear and neolocal units⁵. In general, in western capitalist societies, fami lies were characterized by a clear definition of parental role, where the mother assumed the role of raising chil dren and maintaining the household, whilst the father had a clear role as financial provider^3,6. Progressively, fathers have assumed a more active role supporting the mother during pregnancy and childbirth⁷.

Evidence has shown that the inclusion of fathers in the childrearing process from pregnancy contributes to optimal child, maternal and family development; pro motes the establishment of secure attachment between the child and their main caregivers; and strengthens family bonds and the emotional satisfaction for the mother^7,8. The first year of life is key in establishing effective bonding between the father and his child; du ring this period there is a process of meaningful inte raction between the two, as the child gains autonomy in his or her development.

The aim of this Qualitative Systematic Review (QSR) was to explore the experience of first time fatherhood during the first year of their child’s life. Considering the importance of the father’s presence during a child’s growth and development as well as the importance of the first year of life for the development of secure attachment, this systematic review proposed to answer the following question: How do first time fathers experience fatherhood during their child’s first year of life?

Subjects and Method

Joanna Briggs Institute (JBI) Method for QSR was used to conduct this investigation⁹. This form of research involves analyzing the theory, methods and fin dings of qualitative research and synthesizing new ways of understanding a phenomena¹⁰. The steps followed in this QSR were: establishing the review question, de termining the type of studies to include, designing the search strategy, defining assessment criteria, extracting data, and performing data synthesis.

The criteria for inclusion in this review were as follows: heterosexual male study participants aged 18 years or older whom had experienced becoming a father and taking care of their child, with their cou ples, during his/her first year of life. This QSR was res tricted to healthy children; therefore studies with men who shared experiences of miscarriage, child malfor mation and prematurity were not included. The study included only biological fathers whom had lived with his child during the period. There was no restriction on the ethnicity or cultural background of the parti cipants, however only studies published in English, Spanish, French and Portuguese were included in the review.

This review considered research articles and ma nuscripts that assessed the following qualitative outcomes: lived experiences of being a first time father, and caring for their child during the first year of life.

This review considered qualitative primary re search studies including designs such as: ethnography, phenomenology, grounded theory, narrative analysis and action research.

The search strategy aimed to find published and unpublished studies. A three-phase search strategy was conducted between August and September of 2014. A secondary search was conducted April 2017 to identify any new research since the original search. Phase one, supported by a specialized librarian, consisted of two steps. The first step was to identify initial key words ba sed on the research question, and the second step was to perform an initial search through a logic grid of key words from titles and abstracts found in MEDLINE and CINAHL databases.

The second phase consisted of analyzing the words contained in the titles and abstracts, and indexing the terms used to describe articles, in order to be able to develop a comprehensive and specific search strate gy for each database. Thereafter a second search was performed using all identified keywords across all databases (CINAHAL, Medline and Pubmed, PsycINFO, Lilacs, Scielo, BVS, BVS-Psi, Scopus, Cochrane Li brary, Embase and Sociological Abstracts). The key words were: fathers, caregivers, family, lived experien ces, experiences, father care and fatherhood. Finally the references list of all identified reports and articles were searched for additional studies. Studies published from 2000 to 2016, were considered for inclusion in this review. Year 2000 was chosen because this was the year that child protection was formally incorporated as a Public Health Policy in Chile. This policy recom mends the presence of the father in childcare¹¹.

The search for unpublished studies included the Dissertation Abstracts International, the University of São Paulo Dissertations and Thesis bank, and the Pontificia Universidad Católica de Chile Dissertations and Thesis bank. The access to the grey literature was through exploration of relevant worldwide web pa ges to find technical reports from scientific research groups and working articles from research groups or committees. An initial search was performed to obtain appropriate keywords and subject listings, according to the databases to be explored. For each identified article, the references list was revised, and a manual search was performed for those references articles that do not appeared in databases.

Qualitative articles selected for retrieval were as sessed by two independent groups of reviewers for methodological validity prior to inclusion in the re view, using standardized critical appraisal instruments from JBI Qualitative Assessment and Review Instrument⁹. Any disagreements between the reviewers were resolved through discussion, or with a third reviewer. The flow of the articles selection is showed on (Figure 1).

Figure 1 Identification and selection of research articles. 

Qualitative data were extracted from articles using the JBI standardized data extraction tool⁹, that includes: identification of the article, description of the stu dy, author conclusions and reviewer’s comments.

The next step was to pool the textual phrases that corresponded to the qualitative research findings found in the full text articles. The analysis process in volved the synthesis of findings using the following steps: a set of statements were generated through as sembling the findings rated according to their quality, and categorizing these findings on the basis of simi larity of meanings. These categories were subjected to a meta-synthesis to produce a comprehensive set of synthesized findings that can be used as a basis for evidence-based practice.

Results

The eight reports included in the QSR were from: Sweden (2), United States (2), United Kingdom (1), Japan (1), Australia (1), and Brazil (1). Three studies were conducted using a phenomenological approach; two using a grounded theory approach; and the other three studies were conducted using a descriptive qua litative approach. A summary of the characteristics of each studies can be found in (Table 1).

Table 1 Studies included for analysis. 

This research revealed three meta-syntheses: (a)the process of adjusting to fatherhood, (b)developing the paternal role, and (c)being an active father. To repre sent the path towards fatherhood, a diagram is propo sed (Figure 2). The path that allows a man to become an active father is mediated through processes that are consolidated consecutively. It starts with the process of adjusting to fatherhood, moving towards developing the role of father, and finally a single figure arises, represented by becoming an active father.

Figure 2 Meta-syntheses Diagram. 

Discussion

Men who become fathers for the first time are pro tagonists in a process that leads them to experience different emotions. The process of first time fatherhood produces a radical change in their lives. As they face the challenges imposed by their new role, they see the need to change and learn. Through this process they live the experience of integration of their new role until they eventually become actives fathers^19-24.

In the literature review men express the need to be part of the process of parenting, playing an active role and not remaining as a mere spectator. It is neces sary to find ways to support their needs and recognize them as an important part of parenting¹. One possible orientation to find ways to support the needs of fathers and recognize them as key actors in the process is to analyze these results from a gender perspective. This perspective shows that the exercise of child rearing in western societies still assigned to the female role as something that is born and found in the collective cons ciousness of mothers and fathers^(8>25).

International studies have described ways men ex perience becoming a father for the first-time, and this allowed for the identification of three meta-syntheses on the experience and meaning of this phenome non, based on eight studies of similar quality and rigor^{1,12-15,17,18,26}. No other QSR of first time fatherhood was found during this review.

Conclusion

The results of this QSR may lay the groundwork for considering men in the reproductive stage from an inclusive perspective, making an impact on the welfare and self efficacy of new fathers and as well an improved development and welfare of his children and partner. The health system needs to demonstrate the capacity to involve fathers as active participants in the childrea ring process, by developing spaces to facilitate their active participation in childcare, including fathers in the childbirth process across both public and private health sectors. The health system should consider the importance of both parents and their complementary roles in promoting their child's development.

Men becoming fathers for the first time have multi ple life roles to reconcile such as their family life, work life and their social life. However, often public policies and working conditions do not recognize this process. Therefore there is a need for strengthening public po licies directed towards family wellbeing. Based on the notion that parenthood is a social process that equates men and women with the same degree of responsibility, currently there seems to be a lack of programs and policies designed to facilitate and protect family life, including policies to promote paternal participation during childbirth, paternal postnatal leave, and per mission for fathers to leave work to be at home with their sick child or attend child health checkups. This QSR confirms that becoming a father is a process that should be considered in all its dimensions.

The results of this review has important implica tions for families who are at the parenting stage of fa mily life cycle, since they contributes to highlight each one of its members (father, mother and child) as part of a complex system. This also has implications for fa mily nursing and other health professionals’ practice, since it contributes to the visibility of a fundamental participant, the father, in the process of raising chil dren. Health care professionals and nurses could in clude fathers in different activities that allow him to be part of the process e.g. ask fathers to prepare his child for physical exams, involve the father in health care decisions, and ask father information about the child temper behavior.

A limitation of this study is the lack of available qualitative studies about first-time fatherhood. Specifically many of the studies that focus on this topic did not report the key elements necessary to meet the inclusion criteria for this current study. Another limi tation was the language restriction for the selections of the articles, something that affected the breadth of cultural backgrounds of the fathers whom participated in the studies reported in this review.

This QSR demonstrate that there is little qualitative research about first time fatherhood, however the sig nificance of their lived experiences are relevant for the implementation of childrearing programs including both mothers and fathers. Although the articles inclu ded in this SR do not refer to sociohistorical contexts, in which the participants developed their experience of parenting, it is necessary to incorporate these aspects into future paternity studies. Thus, the importance of additional research studying fatherhood in different settings is recommended.

Ethical responsibilities

Human Beings and animals protection: Disclosure the authors state that the procedures were followed according to the Declaration of Helsinki and the World Me dical Association regarding human experimentation developed for the medical community.

Data confidentiality: The authors state that they have followed the protocols of their Center and Local regulations on the publication of patient data.

Conflicts of Interest: Authors declare no conflict of interest regarding the present study.

Acknowledgement:

The authors would like to thank Melissa A. Suther land (U.S. Fulbright Scholar-Chile) Associate Profes sor at the William F. Connell School of Nursing Boston College, for her assistance with manuscript edits and publishing suggestions.

The authors would like to thank Gloria Rojas, Librarian of San Joaquín Campus Library, Pontifi cia Universidad Católica de Chile. For developed the search strategy.