Service-level barriers and facilitators to father engagement in child and family services: A systematic review and thematic synthesis of qualitative studies

Background and objectives
Service-level factors that influence father engagement within child and family services are not well understood due to diversity in research studies and evidence from different contexts. Accordingly, the aim of this systematic review was to identify and synthesise available qualitative evidence across contexts to identify the common service-level barriers and facilitators of father engagement in child and family services.

Methods
The following six databases were systematically searched from database inception in February 2022: Medline, EMBASE, AMED, PsycINFO, CAB Abstracts, and Global Health. Studies were considered eligible if they described service-level factors impacting father engagement in healthcare services and interventions aimed at improving child and family well-being. The screening and selection processes were conducted by two independent reviewers to reduce the risk of bias. Selected studies were quality assessed using the CASP appraisal tool. Results from the included studies were synthesised thematically.

Results
Twenty-three eligible qualitative studies were included in the analysis. All studies were published between 2005-2022 Thematic synthesis identified seven main themes encompassing service-level barriers and facilitators to father engagement: practitioners; environment; marketing; resources; staff education; policy and practice guidelines; and evaluation.

Conclusions
The findings show that improving father engagement is dependent on a combination of individual practitioner competence, and service environment that provides the necessary structure, processes, and resources to enable effective work with fathers. Addressing the barriers and prioritizing facilitators therefore requires strengthening of both the organizational and practitioner capacity for father-inclusive practice.