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Parental Engagement and Gendered Inclusion in Perinatal Support: A Qualitative Study of the Happiest Baby Method in Dutch Youth Healthcare 

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Ouderbetrokkenheid en gendergerelateerde perinatale ondersteuning: een kwalitatieve studie naar de 'Happiest Baby'-methode in de Nederlandse jeugdgezondheidszorg

Summary

Background:
The Happiest Baby Method (HBM) is a structured intervention designed to support new parents in managing infant crying and sleep through five practical soothing techniques. While increasingly offered within Dutch Youth Healthcare (Jeugdgezondheidszorg, JGZ), fathers are underrepresented despite research showing that father involvement in early parenting interventions improves family outcomes and caregiving confidence. This study examined factors shaping maternal and paternal involvement in HBM to inform equitable implementation strategies.

Methods:
This qualitative study used purposive sampling to recruit 18 families with infants under four months who had received HBM instruction through JGZ workshops or home visits. Semi-structured interviews and observations were conducted with 32 parents (16 couples and 2 mothers). Data were analyzed thematically following Braun and Clarke’s method using the Socio-Ecological Model framework. Interpretation was informed by Gender Role Theory and the Gender Analysis Framework to examine multilevel influences on parental engagement.

Results:
Parents generally reported positive experiences with HBM, though gendered patterns emerged in technique learning and application. Societal-level barriers included work-related scheduling conflicts, limited parental leave flexibility, and cultural role expectations, all of which disproportionately affected father participation. Organizational factors encompassed variable professional awareness of available interventions, inconsistent outreach to fathers, and rigid service delivery structures, though explicit invitation strategies showed promise for engaging both parents. Interpersonal dynamics showed that when only one parent attended workshops, knowledge transfer to partners was often incomplete or filtered, while maternal gatekeeping behaviors sometimes limited fathers’ opportunities to develop independent caregiving competence. Individual factors revealed that early differences in parental identity formation and preparation approaches, combined with internalized beliefs about gender roles in caregiving, led parents to default to traditional role distributions despite intentions for egalitarian task division.

Conclusions:
Gendered disparities in early parenting intervention access persist despite fathers’ expressed interest in participation. However, specific organizational practices show promise for increasing father engagement, including explicit professional invitations to both parents, flexible delivery formats combining workshops with follow-up home visits, and creating peer environments where fathers see other fathers participating. These findings demonstrate that systematic implementation changes can transform well-intentioned interventions from inadvertently reinforcing caregiving inequalities to truly supporting shared parenting.

Keywords: parental involvement, gender, Happiest Baby Method, early infancy, parenting interventions, Dutch Youth Healthcare, qualitative research

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