Mood Checker

We want to check if dads who are getting the text messages are doing OK. The time around the birth and afterwards is really busy and dads sometimes don’t notice how stressed they are. The Mood Checker is a nudge to stop and ask “How am I going?”

A father enrolled in SMS4dads commented when I get that text message… I know it’s probably being a little bit dramatic  but it felt like somebody just walked into my office, put their hand on my shoulder and said, “Are you okay?”  And that’s golden, because guys struggle with all that kind of stuff.

Purpose and Rationale

The Mood Checker has three aims: to normalise the difficulties that a new father may face over the perinatal period; to raise fathers’ awareness of their physical and emotional state; and, to link fathers to resources and assistance.

Normalisation

Normalisation processes have been used in public health campaigns to reduce smoking and alcohol use and reduce mental health stigma ^1,2,3. Mood Checker texts in SMS4dads are timed to coincide with typical parenting issues that a partner to a pregnant woman or a father with a new baby may face.  The expected date of delivery or date of birth that is entered by the father during registration allows the texts to be keyed to typical baby development. Texts begin with a statement such as Some dads find the lead up to the birth really stressful “How are you going as you head for the big day?” to normalise the experience of stress or worry that a father might have.

Raise awareness off mental and physical state

Scaling is a commonly used technique in counselling to bring to awareness clients’ felt experiences ^4,5. Mood Checker texts ask fathers to rate their experience for each issue on a scale from 0 (worst case) to 10 (best case). A response of 8 to 3 triggers further options to clarify the seriousness of any distress and offer support through online or phone resources.

Link to resources and assistance

Responses indicating wellbeing or mild distress trigger responses offering links to father-specific parenting resources. Fathers who indicate significant distress or concern are urged to contact online and telephone support services such as Mensline, Perinatal Anxiety and Depression Australia or beyond blue. Although telephone assistance is available through these services phone numbers are not provided as there would be no way to automatically record if a father rang the phone number. When links (URLs) embedded in the texts are activated by the father clicking on the link this action is recorded against the fathers’ phone number to provide a record of use. As fathers enrol at different points in the perinatal journey their exposure to the Mood Checker will vary.

REFERENCES

1. Jones, S. et al. (2019). What helped and hindered implementation of an intervention package to reduce smoking in pregnancy: process evaluation guided by normalization process theory. BMC health services research, 19(1), 297
2. France, K.,et al. (2010). Health professionals addressing alcohol use with pregnant women in Western Australia: barriers and strategies for communication. Substance Use & Misuse, 45(10), 1474-1490.
3. Taggart, D., & Speed, E. (2019). Stigma and Mental Health: Exploring Potential Models to Enhance Opportunities for a Parity of Participation. Journal of Ethics in Mental Health, 10(VI).
4. Yu, F. (2019). Scaling Questions in Couple and Family Therapy. Encyclopedia of Couple and Family Therapy, 2560-2562.
5. Strong, T., Pyle, N. R., & Sutherland, O. (2009). Scaling questions: Asking and answering them in counselling. Counselling Psychology Quarterly, 22(2), 171-185. Yu, F. (2019). Scaling Questions in Couple and Family Therapy. Encyclopedia of Couple and Family Therapy, 2560-2562.

Mood Tracker (Mood Checker) development 2014 to 2020

The initial grant from beyondblue specified a Mood Tracker interactive text as part of SMS4dads that would be sent at approximately 3 weekly intervals to include distress-tracking questions linked to an exacerbation protocol triggering telephone support from Perinatal Anxiety and Depression  Australia (PANDA).  The initial Mood Tracker texts consisted of questions such as “How are you travelling today? Inviting participants to indicate their level on five levels from ‘awesome’ to ‘bad’. A ‘bad’ response triggered a telephone contact from PANDA.

Advisers for the development of the initial SMS4dads project which enrolled 520 fathers included Professor Jan Nicholson, Professor John Attia, Doctor Geoffrey Skinner, Professor Brian Kelly, Doctor Frances Kay-Lambkin, Professor Louise Newman, Professor Alan Hayes, Conjoint Associate Professor Adrian Dunlop, Doctor Chris May.

The Mood Tracker, renamed Checker was further developed in the smsm4dadsSA study which enrolled 244 fathers. The topics for the Mood Checker were linked to the issues likely to be faced by parents at that stage in their infant’s development, for example sleep and settling, intimacy and exercise. These changes were developed with the assistance of Dr Ros Powrie, Stephen Sheehy, Professor Ian Symonds and Fiona Margrie. As in the initial Mood Tracker, fathers indicating significant distress were escalated to PANDA for telephone contact.

Following the sms4dadsSA study the functionality of the Mood Checker was reviewed by a group of researchers and clinicians with experience in perinatal mental health for the Queensland Health pilot study (n= 60) sending text messages to fathers whose partners had severe mental illness: Prof Louise Newman, Dr Nick Kowalenko, Dr Anne Sved-Williams, Dr Elizabeth Hoehn, Catherine Rawlinson, Sarah Moakes, Janette Garvey and Julianne Everson. These changes involved fine tuning the message response set and introduced a mid-level response where fathers indicating a ‘parenting’ problem as opposed to a mental health issue were referred to a ‘father worker’ for assistance. However, there were no escalations at this level when the Mood Checker was introduced and this feature was not retained.

The Mood Checker message set detailed above for the Focus on New Fathers (FONF) program replaces the escalation to PANDA with a direction to Mensline for assistance. The FONF program includes the K10 to identify distressed fathers. These are escalated to PANDA for telephone contact. The Research Reference Group for this program includes: Prof Louise Newman, Dr Nick Kowalenko, A/Prof Rebecca Giallo, Professor Frances Kay-Lambkin, Prof John Attia, Dr Geoff Skinner, Dr Jacqui Macdonald and Dr Jennifer StGeorge.

MC no		For Week
1	Introduction	-19
2	Antenatal Stress	-15
3	Exercise	-11
4	Emotion	-8
5	Will I be a good father?	-5
6	Connection	+2
7	Crying	+6
8	Attachment	+10
9	Responsibility	+13
10	Sleep	+16
11	Intimacy	+19
12	Work Life balance	+22
13	Emotion 2	+26
14	Social connection	+29
15	Sleep 2	+32
16	Negotiating	+40

In each Mood Checker the dad initially selects 0-10.

The text introducing the Mood Checker varies to fit the parenting challenge at the time. The coding for all Mood Checkers follows this convention: Buttons 10,9 = 1 (no worries) Buttons 8-3 = 2 (OK) Buttons 2,1 & 0 = 3 (Worried). Clicking on any link (URL) within the Mood Checker is automatically recorded (although no information is available as to what happens when the participant arrives at the nominated web page).