Healthy Dads Healthy Kids in prisons: a feasibility study and pilot for an intervention to improve father 'Äì child relationships

People who have been imprisoned (95% of whom are men) are at high risk of increased mortality and poor health. Children of imprisoned parents have poorer health, education and offending outcomes compared to other children. Around half of people in custody lose contact with their families while imprisoned. Delivering effective relationship-promoting interventions to fathers in custody can improve the mental health, wellbeing and self-esteem of fathers and their children, break possible inter-generational cycles of disadvantage, and reduce recidivism and inequalities. A program known as Healthy Dads, Healthy Kids (HDHK) has shown significantly improved health outcomes and behaviors in fathers and children when delivered in community settings. For the first time internationally, we have adapted the program for delivery in prisons (HDHK-P). HDHK-P is designed to facilitate children'Äôs contact with their fathers and uses enjoyable joint physical activity and healthy eating sessions to improve their physical and mental health, and father-child relationships. Completed development work means a first version of HDHK-P is available, which requires some further adaptation following changes in prison regimes during COVID-19. Physical Education Instructors (PEIs) in two prisons will then be trained to deliver the program. Work package 1 (WP1) will adapt the current version of HDHK-P to reflect the 'ÄòCOVID prison context', before testing the feasibility of delivering the program to groups of fathers and their children in two prisons. It will then further refine the program content and delivery process for the WP2 pilot. Meetings with key stakeholders in the two prisons and with those supporting men'Äôs families within the community will inform COVID-related adaptations, identify any recruitment and implementation issues for wider delivery, and will allow us to explore the acceptability and feasibility of the proposed research methods. WP2 will pilot the optimized HDHK-P over two deliveries (A and B) in the same two prisons (four deliveries in total) and will assess the research procedures for a future full-scale evaluation. We will conduct: observations of program sessions; in-depth interviews with the prison Physical Education Instructors facilitating program delivery, the participating fathers and the adults accompanying the children to participate in the sessions; and focus groups with the participating children. Baseline and follow-up measures (at 9 weeks and 6 months for both A and B deliveries, and 9 months for A deliveries only) will collect data on fathers' mental health or wellbeing (likely future full-scale evaluation primary outcome), and a selection of the following (to be finalized in WP1): father and child self-esteem, father discretionary food and drink canteen purchases, father and child self-reported dietary intake, father and child physical activity, father and child weight, child screen time, quality of father-child relationship from both perspectives, and child socio-emotional health and self-worth (potential future full-scale evaluation secondary outcomes). We will also conduct a wider prison consultation with regard to a future full-scale evaluation and/or roll-out (WP3). An optimized HDHK-P program will be a key output of the study. Progression to a full-scale evaluation will make use of a red-green-amber system designed to assess positivity about the program among stakeholders, and aspects of delivery and sustainability that are pertinent to such an evaluation being possible. If there is considerable support for HDHK-P, but a future full-scale evaluation looks to be unfeasible, the possibility of embedding the program in the Scottish'Äôs Prison Service'Äôs Family Strategy will be explored.