 All right, we're recording. And I am very happy to introduce Shafali Shori. Dr. Shori is an assistant professor at Alice Lee Center for Nursing Studies at the National University of Singapore. Her research focuses on family and women's health. She has designed psychosocial and educational interventions for varied populations and has conducted both systematic and integrative reviews. She has conducted both quantitative and qualitative studies involving national and international collaborations. And her research focus is on enhancing health outcomes, quality of care, and satisfaction with the quality of care received by participants. Dr. Shori has received various awards for her academic and research excellence and has been invited as a plenary speaker at various conferences presenting in national, regional, and international conferences just like this one. So without further ado, I'd like to turn it over to Dr. Shori, who's going to talk to us about first-time father's postnatal experiences and support needs in Singapore, a descriptive qualitative study. All right, Dr. Shori, you're on. Thank you very much, time for such a kind introduction. Good morning, everyone. I hope you can hear me all out and clear. Well, I can't see the responses. It seems to be all right. And before I begin, I would like to wish everyone, those who are midwives, or aspiring to be a midwife to a very happy international midwifery day. And as introduced by Sam, I'm Shafali, and I'll be presenting to you this topic entitled First-time Father's Postnatal Experiences and Supporting in Singapore a Qualitative Study. And before I begin, I just want to share with you, because it's a qualitative study, I will have a lot of verbatim from the participants, the fathers themselves. And because in Singapore, mostly we speak English, but with a bit of a Singapore accent, it's called English. So you will see some of the English in a bit different way, but I can, I'll do my best to explain to you what participants are trying to say. So without further ado, let's begin. And before I start, I would like to, hey, I'm moving up. Right, before I begin, I would like to introduce a bit of a highlights of Singapore, and these are some of our important monuments. And I really wish that one day you decide to come to Singapore, it's a warm city, and hosted by a lot of warm people, a lot of good food, and a lot of sights to see. So yes, before I begin, I'm almost reaching from Singapore. Very low voice, okay, I just heard somebody saying that the voice is very low, and I'm gonna do something about it. Just give me a minute. Let me know if that is all right. Okay, I've just turned on my mic and the volume, and just let me know if that is all right. Okay, thank you, yes, Singapore is beautiful, and let's begin with today's presentation. This is overview of my presentation, I'll be sharing with you the background of the studies, methodology, results, discussion, and I'll end my presentation with some implications for both research as well as for the clinical practice. So let's start with the presentation. Early postpartum period is a stressful transition period for both parents, especially for fathers. Reason being fathers face numerous interpersonal and interpersonal challenges like they feel frustrated, especially when they are not sure how they can support their partners, how they can look after their children, especially the newborn. They feel there's a lack of support from healthcare professionals, especially they feel that the nurses and midwives do not acknowledge them when they are in the hospitals with their partners, and they felt restrictive sense of freedom, especially in the early postpartum period, reason being because they feel after giving birth, they do not have the same amount of free time which they used to have with their partners or their wife. And that resulted in some of them feeling being depressed and also unprepared in newborn care tasks. So several international bodies as well as national bodies like WHO and NIH, they have especially recommended that family members need to be involved to provide support to the new mothers in the early postpartum period. And out of those family members, especially fathers being picked up, reason being because they spend a lot of time with the mothers and the newborns and that they need to be trained so that they can provide good support to their wives or their partners. And involving fathers not only may enhance their self-efficacy, which is in a very lay-mantle confidence, but it is not, maybe we can discuss more during the Q&A session if you have some queries regarding self-efficacy and satisfaction. And it also decreases their fear and increase their trust in themselves that they can provide support to their wives and the newborns. And it has also shown in the literature that supporting fathers in the early postpartum period does not just give benefit to the fathers, but it also provides support to their wives, especially it enhances their psycho-emotional benefit, not only for the mothers, but also it helps in their child's development. So moving on, fathers' perceptions have been already explored in the literature. However, the focus always remains either during pregnancy or childbirth. The postnatal period is definitely a period which is one of the most stressful period, like I mentioned for both parents, but not much studies or other very few studies have explored fathers' experiences during this period. And even those studies which are available, they are only focusing on fathers which are just within three days of postpartum or after six months or one year of their childbirth. And also they have been focusing on a special things like if they are depressed or not. But the generalized experiences of fathers have been unexplored in the literature to the best of my knowledge, and that's why it needs to be explored. And especially in Asian context, we have almost negligible studies which are exploring fathers' experiences. Especially when in Asia, the beliefs of fathers and values are influenced by our diverse culture, socioeconomic values as well as political structures, especially in Singapore with rapid urbanization, globalization and declining birth rates are not sure anyone is aware. After Singapore is one of the top countries where our birth rate is very, very, very low. And we are doing all means to increase that birth rate. And that's why we have this pro-native policies in Singapore lately. One of the thing they have done is they have increased maternity leave which was used to be one, one and a half months to four months from others, only for those who are Singaporeans, not for the foreigners. And for the fathers, we used to have only two days of maternity leave. Now it has been increased to two weeks. So these are some of the ways our government is working towards enhancing the birth rate. However, long way to go. And previous local studies which has been conducted in Singapore has focused only on mothers and given the centrality of the cultural beliefs as well as which determine the fatherhood, it is important that we need to understand fathers' experiences from the local point of view. So that's the reason the aim of this study was to explore fathers' post-native experiences and support needs after their partner's hospital discharge to provide evidence support to the improvement of their post-native services in Singapore. So this study basically had two phases. I'm only presenting a part of phase one. Phase one was supposed to get experiences and support needs of fathers and mothers, explore that. And based on that in phase two, we are developing and testing our intervention. If you need to know more about during Q&A, I can share with you. In fact, the educational intervention is already ready and the data collection for phase two is ongoing now. But for today's presentation, my focus is only on phase one and I will be sharing only fathers' experiences and support needs. Right, so descriptive qualitative research design was used in this study and data was collected from November 2015 to January 2016. Just recently, we have completed the data collection and purposive sampling was used to recruit first-time fathers. Now, you'll be wondering why this purposive sampling was used. The reason being we wanted to actually represent the ethnic diversity in Singapore because in Singapore, we have Chinese as a major cultural group followed by Malay, Indian and some others. So we wanted to recruit it, represented it of all ethnicities and that's why we used the purposive sampling and participants were recruited from a public hospital in Singapore. Are you okay so far? Am I too fast? Okay, I hope everything is going fine. All right, so this is the inclusion and exclusion criteria of this study. Participants, those who were 21 years of age or above, first-time fathers, able to read and speak English and accompanying their partners who are admitting in the delivery room of a particular public hospital as well as those who decided to stay in Singapore for two weeks after their partner's date of delivery were recruited in this study. Let me give you a bit more details why we have this specific inclusion criteria. Now, you must be wondering why 21 and not 18 years old, just to let you know Singapore is unique and our legal consenting age is 21 years old. So that's the reason for that. Now, first-time fathers, because the research has shown that the first-time fathers have more support than the fathers who already have kids before. So that's why we wanted to focus on first-time fathers only and able to read and speak English because as a recruiter it's difficult to find a person who can speak lots of dialects. So that's why I know that's one of the limitations you only focus on each speaking father. And we wanted fathers to be recruited from the hospital. That's why they were recruited when they were within the hospital with their wife after their baby was born. And lastly, they stayed in Singapore at least two weeks. Now, why two weeks was used for data collection because research again, our literature has shown that the first two weeks postpartum is one of the most stressful period for the new parents and that's why we wanted to know their support needs and their experiences during this period. Exclusion criteria was parents or the father story with the physical or mental disorders or their partners who have given birth to newborns with some deformities, complications or their newborns have been admitted to ICU or lastly if the baby is not discharged home. Again, the reason being we wanted fathers to be able to give us the detailed information about the experiences and if the baby has not been discharged home with them or the baby is still in the ICU, they will not be able to experience that fatherhood with the baby at home and that's why they were excluded from this study. And we prepared an interview guide a semi-structured interview guide was prepared in order to get information or follow-up information on specific fathers needs as well as the experiences. And this interview guide was prepared based on our previous study which we have done on first-time mothers and also this guide was content validated by the nurses, clinical nurses because it's very important as an academic we need to be in close contact with the clinicians so that we know that the information we are soliciting it is relevant. And this particular semi-structured guide was actually piloted, tested on one of the father and there was no changes were made in the questions we've been asked and at the end when we analyzed this interview this particular pilot interview was also analyzed together and total we had 15 fathers who participated in these qualitative interviews and how we got this number was based on data saturation. Our data was saturated at 13 participants and then we recruited one more and total 14 and the 15th was from the pilot interview. So total we had 15 fathers who provided us great detail of information regarding their experiences and support. And we also not only just audio recorded these interviews but we also took field notes while these interviews were going on. This is actually to keep the objectivity of the data. And we took international review boards approval and we also had consent taken from the fathers and they were told that the participation of this in this study was based totally voluntary and if they wish at any time that they do not wish to participate they can actually do so without any harm or without any issues to them as well as to their wife. PIS it actually stands for patient information sheet. It was provided with a detailed comment on what that study is all about. We give them all the information if they're gonna if there's any harm, if there's any issue who they can contact if they have any concerns regarding the study. So all that information is about a foresight speech sheet. I'm sure many of you those who are involved in this search we give such patient information sheets to the participants. And confidentiality was maintained in all time. And like I mentioned earlier the participation in this study was voluntary. We use thematic analysis to analyze the data. Now those who are involved in qualitative study I'm sure they will resonate with me they actually various ways we can analyze the qualitative data. And with my previous experiences I've been using thematic analysis and I'll give you a bit of glimpse how we do that. All interviews were conducted in English like I said and it was transcribed verbatim that means they were audio recorded and then we transcribed them in English to the written form. Interviewers and the PI read the interviews and the field notes several times in order to gain familiarity with the data. That's one of the first steps when we do thematic analysis that we need to analyze the data or rather get familiarized with the data very, very clearly. And when we do that we don't only just focus on the transcribed verbatim but we also take note of the field notes which we have taken. And especially we take note in those field notes we especially take note of special things. For example, if father is saying something he suddenly get emotional. So we will write down in the field notes especially mentioning this sentence the father was emotional so that we can analyze in light of a holistic view of a father when we analyze the data. And inductive analysis was used to identify interesting and relevant aspects. Okay, so how I'm gonna do the thematic analysis I'm gonna just give a bit of glimpse on that it's actually can be a two to three hours of a lecture how you do thematic analysis and some of them even do a proper qualitative module in our PhD curriculum here but I will just give you a glimpse of that in order for me to come up with the themes out of this particular data I had actually use a color coded theme I actually give a color to the similar meaning but I found in a particular transcript and then for example, if something our fathers are talking about their emotional wellbeing that will be given pink code throughout all the 15 interviews and then we will consolidate them and then come up with the major themes umbrella themes which covers those smaller codes. So common concepts were linked together to form broader themes like I mentioned and not only just one researcher but the two other core researchers underwent the same process until unanimous agreement was reached to ensure the credibility of the files that means when I came up with the themes with my research assistant and the two other independent researchers did the same thing and we come up with the major themes out of this data which I'll be sharing with you in my slides. Okay, this is another I'm sorry this is gonna be a bit it's an abstract information but I'm sure those who are in research they will appreciate that that whenever we do a qualitative study we need to maintain the rigour in the study for the qualitative studies like credibility, dependability, transferability, confirmability and authenticity what does it mean? Basically, credibility is that we the data we are collecting we have to it has to be ongoing when we are collecting the data and analysis should be done at the same time reason being when we are doing the analysis we need to make sure that if there's any new information is coming out and we need to change the semi-structured guide which we have already prepared we need to make some changes in those questions we are asking from the fathers we also have a self-critical stance on research and preconceptions especially for example, I'm a midwife if I'm collecting data I've already done a literature review and I'm collecting data I may have some preconceptions that fathers should say such things so please be note it helps us to remain objective of our personal feelings and actions, feelings and conflicts so that was one then comes dependability audit trail of relevant documents used over the course of data collection and analysis are kept including the interview guide field notes, audio recordings and everything and when we're going to publish this data these information will be provided in order for the data to be dependable and clear presentation of the findings comes under transferability for example, when I'm going to share with you in my finding section very soon you will see that I have actually given a verbatim exact verbatim without making any changes to them what fathers spoke during those interviews conformability means by maintaining research objectivity something very similar to credibility audit trail and authenticity is verbatim code like I said like transferability so with this we will be moving on to the findings now I'm not sure if anyone has any questions so far can I get some hints that if my speed is okay are we doing fine? okay so I think Sam is typing yes okay great thanks Sam so I'm moving on to the findings now right so these are a little fast I'm sorry Lorraine okay I'll slow down okay great right timing for me to slow down now because I'm going to share with you the findings which are very interesting alright so this is the demographic profile of my fathers the fathers we interviewed the mean age of the father was 31 31 years old and that is the mean age of first time fathers in Singapore according to Singapore's demographic profile again not surprisingly Chinese was the main ethnicity 40% of them were Chinese followed by Malay Indian and others which were 20% 100% of the participants they were married and the highest education level 56.7% of them had university degree and all of them were employed that means they were working at the time of interview and the monthly household income income Singapore dollars 73% fall in the range of 3000 to 10,000 and most of them 80% of them did not attend the international classes which may be shocked to many of you I'll share with you probably why and type of delivery mainly was vaginal delivery and the support they received though we were having an interview but even in the demographic profile we tried to get some solicit some information regarding the support they received from and 46.7% of them received support from others sources like internet and friends and books and mobile apps and 33% received support from in-laws that may be another interesting thing some of you which I'll be sharing with you soon and paternity leave which I like I said it was just recently been introduced two weeks we just wanted to know how many of you are the of them already was using this paternity leave it was only actually 6.7% who was taking more than two weeks and 46% was taking two weeks from paternity leave they were still quite a number or proportionate of fathers who do not have maternity leave all they had maternity leave less than two weeks so that's something I think a long way for us to go on this side of why the paternity leave is not being well utilised though it is being utilised by government okay maybe I can share with you a bit of a detail here on why antinatal classes not been used surprisingly I also did a research on first time mothers a while ago and the same things came out the same findings we found that they do not attend antinatal classes so after further probing we found out that in Singapore for parents to attend antinatal classes they have to pay money for that it is not free so that's the reason it is something that it is not well liked by parents or well utilised by parents because it's not cheap when they have to pay for that antinatal class so again I'm repeating it's not free I know I had a chance to go to another country I went to Australia and that's not the case there but here we have to pay for that antinatal classes that's one and secondly like I said support these parent-in-laws if you see this here in Singapore being an Asian country I will share with you more in my findings that these fathers they are supporting their wives and in-laws I'm talking about is fathers I mean the mother's wife's parents and all that so that's something very very unique thing which we see because when we saw interview mothers they were saying that they are getting more help from their father's parents so this is something very surprisingly I think it depends upon the on the on the buildup of a family in some families father's side is more dominating than the wife's side so yeah that's something to take note of okay apologies for the small font size here I'm sharing with you and introducing to you the four main themes which we found out from our interviews the four themes are no sense of reality to the sense of responsibility that's how fathers felt and they felt unprepared and challenged they had some support needs they also mentioned to us the sources they get that support from experiences with the support and the attitude they had towards providing support to their wives and lastly future health for fathers so these four themes each theme has further sub themes so total we had 17 sub themes so first theme had four first theme which is no sense of reality to sense of responsibility had four sub themes then the number two theme unprepared and challenged had other four sub themes followed by support and future health for fathers which had five sub themes I know it's a bit confusing don't worry I'm going to share with you one by one from each theme to the sub theme with the patient verbatim or the participant verbatim in my next slide so let's begin first theme no sense of reality to the sense of responsibility fathers felt that till the baby was born they did not have this sense that they are going to be a father most of them did not attend antenatal classes like I mentioned earlier could be the reason they didn't really share with us the main reason though some of them said that they were not even aware of that those antenatal classes were being introduced by the particular hospital and those who attended the antenatal classes they verbalized the need of teaching on real babies so that's something very unique we found out with our fathers in this study they feel that during the antenatal classes the very few who attended or even during the post-natal period when they were being taught in the hospital they felt that nurses are using dolls or dummy babies and they felt that that doesn't give them realism that they have a or they had a baby or they're going to have a baby especially during pregnancy when they're let me share with you one of the father a Malay father I just give a number in order to prevent confidentiality it would be better if there is an actual baby I would prefer the training to be realistic like their real life scenarios I would not attend any classes where it is just a theory based I can't relate to it so fathers were looking for something they can relate to first and foremost they wanted a baby a real baby they wanted to hear the cries of the baby so that they feel that something we are going into it and that something was shared by the mother though they didn't mention in the study about real babies and all that but they did say that sometimes when baby cries that give them a realism that they may feel the same thing so yes so that's one and also fathers also felt that they should have more practical information rather than giving a carry basis so that was first something which is no sense of reality moving on to feeling of joy versus frustration fathers felt overwhelming emotions from joy to anger worry fear misery and frustration they seldom shared their feelings with anyone so like one father Chinese father mentioned I had a sense of achievement as I felt when the baby start crying and I managed to calm the baby down it becomes very comfortable and when the baby start sleeping and that's where I see the sense of joy to it and some achievement so I think that was something when fathers were able to be helpful or when babies were responding or reciprocating to their health they were providing to their baby without a sense of joy and another father not so happy he said like when she's breastfeeding a lot of time I'm just sitting next to my wife he's mentioning about his partner then just looking at the baby but still I can't do the housework instead it will be nice if I can provide more support mentally and physically to my wife because it doesn't affect me both like once I realize the sense of helplessness it's frustrating so again if this study shows that fathers were willing to help however they were not sure how they can do that so moving on to the next up thing need to bond with the baby fathers felt that it is important to establish strong family bond they also tried to divide their attention between equally between their wife and the baby and they also testified the need to understand their baby's cues as a means of bonding like Chinese father mentioned that I know it's quite a heavy and in the essence of time I will just read the snippets of it trying to catch the different cues of what my baby is using like sometimes when she cries then you can know that she's hungry or even trying to know the feeling cues I guess for a whole relationship it is important to bond with your baby so fathers felt the need of bonding is important with their baby sense of responsibility if you see from the beginning they were frustrated they were a bit lost and now slowly as the time passed by some fathers even felt the sense of responsibility they though felt helpless but as they were going into a relationship like I said they had this sense of responsibility as shared by one Indian father he said given that my wife will still have to wake up so in a sense it helps that I can empathize that's where she is going to I mean that's what she's going through because actually at the first few days she has difficulty coping the need of having to wake up every hour yes so I woke up with her accompanying her and handle the baby so this father felt the sense of responsibility that it's not just my wife's job he felt sorry for the wife actually I've read the whole verbatim where he was mentioning that he felt that the wife is having sleepless nights while he was sleeping soundly so he felt that it is equally his responsibility to provide support to the wife so he will wake up with the wife at night and now moving on to theme 2 which is unprepared and challenged we have just finished first theme with the four sub-teams today now I'm going to discuss with you unprepared and challenged the main theme and the first sub-team is unaware of any educational support available though from the first time mothers we felt that money could be an issue that they did not attend and middle classes but with this study it is more clear now that more than half of the fathers were not prepared and educated about the support they could provide they were disappointed on unawareness about the educational programs offered by the hospital one Malay father is mentioning actually I was not aware of such classes there is no awareness for me if there was maybe I can consider attending depending on the price depending upon the type of content or even the scope of the program so again though yes money is always important that could be one of the factor but even unawareness about the classes there was something this father mentioned in this study moving on to second sub-team sleep deprived I'm sure this one most of us will relate to and a lot of literature has been done on that that almost all the fathers reported some degree of sleep deprivation they felt bad or devised as the mothers needed to be up for the feeding at night especially those who were breastfeeding and Filipino fathers he's mentioning that yeah the sleeping pattern is no longer the same he's been very tiring baby's up around 10 a.m. no 10 p.m. and then he's wake up until maybe 7 that's why sleeping pattern is not the same so that's what these fathers are saying which like I said many literatures have shown before that sleep deprived is one major issue which parents are feeling after having their newborn baby especially in the first two weeks postpartum another sub-team which is confused almost all the fathers felt confused about the amount of support they could provide to their wives their confusion was further aggravated when they received varying advice from the family members and healthcare professionals and that is something a big issue here in Singapore I'll share with you more physician nurses this Malay father is mentioning physician nurses and midwives can teach you different things because when we went to clinic okay this person is trying to say that when he went to clinic this doctors say it's okay to feed your baby formula but when this couple went to the nurse then the nurse actually scolded them and said that no it should be always breastfeeding no formula so they were very confused they were not sure which or who to follow that's one that's from the healthcare professionals even with the family members they have a lot of confusion I didn't put the quote here the examples are like the family members many of the older generations feel that breastfeeding is not important baby when cries the baby will get dehydrated and that's why formula is the way to go so that's why many young parents are having this tug of war with their older parents who feel that breastfeeding is the way to go so yeah sorry the formula feeding is the way to go and that's why that is a challenge many new couples face lacking confidence fathers perceive lack of confidence in looking after their newborns they felt clueless to answer their wife so especially this father is saying Chinese father meant he difficult when your wife asks questions I cannot answer so this father was you know he was even saying that sometime wife will say why she's having pain despite of giving expressing out the milk or giving milk to the baby and so he said that because he cannot answer he felt so helpless that he will change the topic I try to talk about something not so serious I talk about baby and things like that so so that she can forget what she's asking but just imagine you know how frustrating it is for these fathers and they felt that they do not have even confidence they have not been prepared what they can actually answer to their wife and then comes to support me which is our team three in this I will be mentioning basically about social support their needs sources experiences and attitudes so support me formula a formal informational support on topics such as baby bathing diaper change and carrying the baby and how to support the vice these fathers specially mentioned that these topics must need to be educated to them when they are in the hospital before they go home or during even in the antinatal process they felt that even they were able to provide some help there was this father who was mentioning that he actually get together some information when a nurse was teaching his wife and despite of that he felt that when he did some some support or provide some support to their wife he had lack of feedback on the care he's providing he was not sure whether he's doing things correctly or not and emotional support they felt he was lacking and they was finding their own way of getting themselves supported by talk in by engaging in self talks or by talking to their friends or their fathers or uncles or especially the male figures in their life this father Chinese father is mentioning I won't get myself too stressed because I get if I get stressed my wife will get stressed because I don't want my wife to get postnatal depression so I will be talking to myself and sometimes to even talk to the baby so that shows that you know we we often feel especially in our Asian society that males are very stoic figure and they do not really need any support especially emotional but look at fathers they are trying out loud there that they need the support they want someone to listen to them to write them feedback on how they can provide support to their wife sources of support formerly they were getting from nurses and advice when they were in the hospital in former they got it from their in-laws especially mother-in-law and friends and social medias and youtube were their hot favorites non-singaporean fathers they had their family feud down from their from their native countries and very few non-singaporean fathers decided to bring the baby back as it was very difficult for them to get their family back here because of the visa issues and then they felt that in order to provide a good care to the baby they decided to bring the baby back to the their hometown like this filipino father it's really hard not having anyone around so we want to go home but we have to wait because of the document and eventually they will be bringing the baby back home to get more support for mother as well as baby experiences of the receipts of support this is very sad because the father starts left out by the nurses and which nurses can acknowledge their support means they felt happy for the added support received from their parents and in-laws Chinese father especially those who were local with overseas in north they felt that sometimes they had this unique pressure because they were asked to follow certain practices especially confinement practices I'm not sure this word confinement is how familiar it is with audience here just to let you know I know commonly in literature they use the word called doing the month stemming first 40 days after giving birth the person who treated the woman is confined in the house literally and they are not allowed to do go out of the house and also according to the cultural ethnicity being the Indian Malay or Chinese they follow certain rituals and some of the rituals I can share with you quickly is for example they can't take shower they have to take warm food they can't take cold water and they can't take ginger they have to take certain herbs and so forth it's a long list actually there's some publications that are in local context yeah and like this father said the nurses are focusing on my wife and I do not have much impression about nursing approach nurses approaching me so yeah that's that attitude towards support provided unique to the cultural ethnicity fathers had different attitude in providing support that's something very unique we found in this study Malay fathers they believe that child care is primarily mothers and female relatives role and mother should sought help from female relatives he felt that fathers are the breadwinners and they should they should not be any role confusion between fathers and fathers and most of the times I just Malay father said things are done by my wife and mother-in-law I don't think I need to support the wife needs to be a mother husband needs to be the support for the mother and the child and they should not be any role confusion moving on to educational programs specially focused on fathers almost all the fathers stated there is a need of involving them in educational program and they specially wanted the special programs for themselves they recommended to plan the programs within first two weeks for father as they feel more stress and they also requested to use real babies as we mentioned earlier not the cows this Chinese father is sharing one thing is we want to know do we get more involved and we want to know tell us exactly what we have to do involve us more so that we will feel more important and he had a laugh on that that we really want to be involved in supporting our wife after she has given birth future health for fathers this is my theme for continuity of care from sorry I just wanted to I didn't highlight this this is my I started my theme for now the first one was educational programs that is first sub team now is continuity of care from healthcare professionals as fathers trusted their advice from the nurses and doctors they requested that the continuity of care there should be some source of information still be provided to them by nurses and doctors again this could be something strange for the audience here just to share with you all number one is that in Singapore we do not have continuity of care in the form of home visit by any community nurses or midwives and nurses provided to the mothers and fathers or other babies after they have given birth so that's why these fathers are asking if they can or they receive some information from these healthcare professionals they will feel more trustworthy and they will feel more assured it was also highlighted that fathers should not be seen separate from their wives in providing informational support by their professionals like this Chinese father says that it will be good that I could connect to the professionals after my wife has discharged information is provided by the professionals from the real like doctors and nurses so at least this information is reliable I can trust this information so yeah that was something is also shared by the mothers in our previous study use of technology especially mobile health applications surprisingly was mentioned by all the fathers they state that mobile health will be very useful but information in the app has to come from the professionals they were very very careful that the information they should receive it should come from professionals especially many fathers mentioned that they were looking at videos from YouTube however their main issue they had was that whether those videos are reliable or not so that's why they will spend a lot of time looking through the comments to see whether they can trust that video or not so that's why they state that technology should be there to support them but the information still should come from the professionals Holly this is Sam I'm sorry father I'm so sorry to cut in but we're almost running up to the end of our time and want to leave some time for questions do you think you could kind of sum up things so that people could ask the questions that they have in the next couple of minutes sure I can finish another five minutes okay all right because of the time I need to I know I had a lot of verbatim I will be finishing my study very well my presentation very soon another five minutes so that you can ask me questions focus group discussions with fathers they were asking that it will be nice that they can have some support from the fellow fathers who can share their experiences so lastly advertising the educational program they feel that if the programs can be advertised by the hospital so that they are aware there are such programs available so with this I'll just share with you that as found in the previous literature this study also shows that fathers undergo changes from feelings of joy to frustration they also feel that all in the educational program distance them from the reality of having baby like in previous studies and similar to fathers from many other parts of the world fathers felt described fathers also felt unaware of a valuable educational program and they also received different advices on confusing advices from nurses and that has been mentioned in previous literature the nurses need to be very mindful when they provide support in the care and education to the parents unique to Asian context in this study feelal piety was seen among the Chinese fathers especially when even though they were receiving different advices from their elders they were still very thankful to them this was in contrast to the study in Hong Kong where mothers felt actually depressed receiving such different advices from their in-laws this could be because in Singapore or rather in Asia these fathers they received a lot of respect from their in-laws and that could be the reason they were able to negotiate some sort of you know the practices they were negotiating with them if they could not it's okay for them not to follow those practices fathers liked informational support like in previous study and also unique to the Malay fathers they believed the newborn talks should be focused by only female this could be because of our cultural beliefs and also religious belief because in Singapore there's a Confucian Indian and Confucius Indian and Islamic belief so very popular so that could have give this certain beliefs which some fathers had in contrast to study among local mothers fathers prefer the continuity of support in form of informational technology we had it's a single center study and sampling was based only on English speaking people and that's why it's one of the limitation and interviews were conducted only once within two weeks we feel that in future study we should have longitudinal study with more information soliciting at different time periods postpartum and clinically we feel nurses and midwives need to target on ethnic diversity when they're providing information new fathers need to be addressed by their needs and they should be personally invited in the educational program listening to fathers are very important so that we can understand their unique needs and can plan educational programs according to their needs constructed feedback on fathers performance on the various tasks is equally important and the family based continuity of care is very important and it should be a routine care in every hospital in our local context use of informational technology in providing information can be used in clinical settings and that's what we are doing in my case too now we are actually coming off with a mobile health app educational program for these parents for research like I mentioned earlier future research should examine the needs and experiences both first time and experienced fathers to see any comparisons longitudinal cohort study should be done and effectiveness of targeted holistic support through antenatal and post-natal parental education should be tested and lastly research involved with technology which we are already doing it so in summary like I mentioned the fatherhood can be very challenging for sitting however we can make it joyful and happy for both for father mother and as well as for their family by providing them adequate support by listening to them and then soliciting information from them and then coming up with the tailor-made educational program which is specific and unique to them as well as to their families thank you very much and that's this is a publication it's under review from this particular study and this study has been given a grant from national university of singapore startup grant and let's have some Q&A all right unfortunately we don't have too much time for questions because we want to give everyone a few minutes to take a break before the next session but if we have if anybody has a really burning question that they want to ask now is the time we'd be happy to take it thank you Gemma Gemma thank you very much all right it doesn't look like we have any questions but I want to thank Shafali for that wonderful presentation about fathers I think sometimes the fathers get forgotten in all of this and that was a really really important presentation so thank you very much and everyone happy international day of the midwife and enjoy the rest of the conference thank you so much take care Sam thank you very much everyone I really appreciate it thank you