'Being on Top of It:' A Qualitative Examination of the Processes and Contexts Shaping Pediatric Caregiving among Low-Income, Young, African-American Fathers.

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Several studies have noted the positive relationship between father involvement and children's health outcomes (Stewart & Menning, 2009; Bronke-Tinkew, Horowitz, Scott, 2009; Yogman, Kidlon, & Earls, 1995; Lamb, 1997; Dubowitz, Black, & Cox, 2001; Chenning 2008). Recent years have also seen a growing interest in the impact of adolescent fathers' characteristics and involvement on children's outcomes (Black, Dubowitz, & Starr, 1999; Fletcher & Wolfe, 2011). Few studies of public health or pediatric outcomes, however, have examined how fathers provide and shape healthcare for their children.

Through semi-structured interviews (n = 29), this study explored how low-income, minority young men care for their children's health. Participants were recruited from two programs that provide integrative medical care, mental health services, and case management support for adolescent and young adult parents in the Washington, DC metropolitan area. Interviews were digitally recorded, transcribed, and entered into Atlas.ti (Friese, 2014). Informed by grounded theory, data were analyzed over three phases of coding.

This study explored how the contexts in which young men fathered facilitated and complicated fathers' involvement in pediatric caregiving. These contexts included young men's relationships with the mothers of their children, family and kin-relationships, socioeconomic circumstances, community contexts, as well as proximity and distance from their children. This study found that young men developed their approaches to pediatric caregiving from their general health knowledge, prior caregiving experiences, personal health histories as well as their intimate familiarity with their children.

Taken together, the findings suggested a tripartite framework for describing fathers' involvement in pediatric caregiving. This framework also highlights common processes--constructing self as caregiver and a father, navigating coparent relationships, and engaging in medical visits--that young men used to engage in preventative, acute, and chronic caregiving. These common processes helped men negotiate contexts that often challenged their involvement in pediatric caregiving.