TOP 3 - Making Sense of Stress: A Qualitative Study of Fathers' Experiences in the NICU

Publication Number: 3758.TOP 3

Millie S.. Kothari, UMass Memorial Children's Medical Center, Natick, MA, United States; Lindsey Simoncini, Frank H. Netter MD School of Medicine at Quinnipiac University, Worcester, MA, United States; Xiao J.. Tong, University of Massachusetts Medical School, 3355 La Selva St Apt. C, CA, United States; Nikita Kalluri, UMass Medical School, Worcester, MA, United States; Margaret Parker, UMass Memorial Children's Medical Center, Brookline, MA, United States

Background: The neonatal intensive care unit (NICU) is a highly stressful environment where families face uncertainty, loss of parental control, and disrupted bonding. Fathers of NICU infants experience substantial emotional, logistical, and relational stress. Despite the recent literature showing the importance of family-centered care to the mother-infant dyad, paternal perspectives remain underexplored. Lazarus and Folkman's Transactional Model of Stress and Coping provides a useful framework for understanding how individuals appraise and respond to stressors based on perceived demands and available coping resources. Exploring fathers' experiences through this lens can inform interventions that enhance coping resources and promote inclusive support for fathers as integral members of the family care team.

Objective: Our objective is to use the Lazarus and Folkman's Transactional Model of Stress and Coping to explore the lived experiences of NICU fathers to understand how they appraise stress and employ coping strategies during their infant's hospitalization. We aim to identify common stressors, coping patterns, and areas for improved support within the NICU context.

Design/Methods: This qualitative study employed semi-structured interviews with fathers of infants hospitalized for at least seven days in a Massachusetts Level III NICU. The interview guide consisted of open-ended questions designed to elicit fathers' perspectives on their NICU experiences, with particular attention to the evolution of stress and coping strategies over time, informed by Lazarus and Folkman's model. To ensure questions were patient-centered and relevant, the study team collaborated with the father of a former NICU patient in the development phase. Purposive sampling was used to include a broad range of paternal perspectives, including Spanish-speaking fathers and fathers with varied ability to spend time in the NICU. Interviews were conducted in English or Spanish via Zoom, audio-recorded, and professionally transcribed. Three researchers independently coded transcripts using Dedoose qualitative analysis software, guided by the appraisal and coping constructs of the Lazarus and Folkman model. Codes were refined through consensus and will be grouped into themes through iterative analysis. Preliminary signals from initial interviews indicate that fathers experience stress as multidimensional, often coping through action-oriented strategies such as caregiving and information seeking. This study was approved by the Institutional Review Board of the UMass Chan Medical School.

Table 1
Demographic and clinical characteristics of father-infant dyads in a qualitative study exploring paternal stress and coping during neonatal intensive care unit hospitalization.