The national goal of public health in Sweden is to create societal conditions for good health on equal terms for the entire population . Swedish Child Health Care (CHC) services work to promote children’s health, to prevent illness and to initiate actions when problems are discovered in health, development or upbringing . Parental support is already well established in Sweden, and through local Child Health Care Centers (CHCC), CHC services essentially reach all families with children in Sweden .
There are substantial health inequalities within Stockholm County . The multicultural city district of Rinkeby-Kista, with more than 90 % of the population having a migrant background (born outside of Sweden or in Sweden with two foreign-born parents) , is one of the disadvantaged districts, displaying poorer health in several aspects; children’s health in the area is affected .
To improve prerequisites for better health development among children, early support was initiated for first-time parents in the Rinkeby-Kista district by CHC services and social services [6, 7]. The extended postnatal home visiting program in Rinkeby includes six home visits during the child’s first 15 months, where new parents are visited by two experts: one CHC nurse and one parental advisor. By contrast, the ordinary CHC program in Sweden only includes one home visit by one child health nurse. The CHC nurses provide health care support, while the parental advisors, who are trained social workers, provide psychosocial support, especially regarding family relations and interactions. The program was offered to all first-time families, who chose to register their child at Rinkeby CHCC from the 1st of September 2013 to the 31st of December 2014 [6, 7]. A first-time family is defined as the mothers’ first child. Both parents were encouraged to participate in the program by the CHC nurses and parental advisors during the whole home visiting program. Ninety-four percent of the included families wanted to participate in the home visiting program and signed a consent from before participating in the program evaluation [6, 7]. Around 79% of the fathers attended at least one extended home visit . There is some estimation from the literature that up to one-half of fathers participate in home visiting programs to some extent when fathers participation is a focus in the programs .
The extended home visiting program of this study follows the guidelines of the Swedish CHC program  and the visits are integrated in the universal CHC center-based services, including themes about development, safety, nutrition, interaction, parenthood, social network and support [6, 7]. Parents are supported in their parental roles, and their questions are discussed from a perspective emphasizing resilience, promoting health, and supporting and encouraging a positive parent-child relation [6, 7]. A manual has been created for the extended home visiting program by CHC nurses and parental advisors in a parallel process within the intervention .
The published study protocol of the extended postnatal home visiting program describes housing, as well as the financial situation of the participating families. Preliminary findings show parental insecurity after child birth, and that home visits seem to meet this need and are appreciated by the families, as well as by the professionals that are engaged in the program .
The final evaluation report of the home visiting program (in Swedish), based on questionnaire-based interviews and analyses of medical records, reports increased confidence in the new parental role, increased knowledge of the Swedish society and support for parenthood, as well as increased trust in the Swedish health care system through close relationships with home visitors. Increased coverage of MRR immunization is observed in the study site, as well as at least temporarily decreased utilization of emergency care .
The analysis of the content of the meetings between families and professionals during the home visits based on the CHC nurses’ documentations reveal that the home visits within the extended home visiting program covers three main categories of content related to i) the health, care and development of the child, ii) the strengthening of roles and relations within the new family unit, iii) and the influence and support located in the broader external context around the family .
Fathers’ experiences and their perspectives on home visiting are the focus of this study, as it is known that fathers play an important role in children’s social, emotional and cognitive development  and their lower attendance in other studied home visiting programs means that we know less about their experiences.
Migrant fathers’ descriptions of fatherhood in earlier studies include both stress, joy and pride, as well as a feeling of being overwhelmed . Entering fatherhood has been described further by migrant fathers as a life-changing experience that includes their responsibility to raise the child . In earlier research migrant fathers describe their strong desire to be family providers [13, 15,16,17,18,19], which may be challenging in the new country when the work does not always correspond to their level of education or skills [13, 16, 17], employment is insecure, jobs are low-paid [16, 17] and racism is present at the workplaces . Some migrant fathers express that unemployment can contribute to feelings of isolation; a lack of productivity, a negative effect on finances and hinder integration . Housing issues, together with other consequences and stressors of migration, can challenge migrant parents . Earlier studies have also determined that misleading information, language difficulties , cultural differences, lack of social resources and financial stress  may hinder migrants’ participation in society. Lacking a social network that provides practical help and knowledge can further challenge parenthood generally [22,23,24], as can relationship issues, health and finances .
In earlier studies, migrant fathers describe the time spent with their children as important [14, 16], although lack of time to do so was mainly caused by work [15, 16, 19]. Migration sometimes offers fathers more time with their family compared with life in their home countries . Activities at home and outside, and participating in their children’s everyday routines are mentioned among the activities of paternal involvement [13, 15, 16]. Communication with children can be important , and is also cited as a major factor for successful parenting by some migrant parents .
The family’s well-being, health and access to health care are important for migrant fathers , and a good education for the children [13, 16, 17, 21], seen as guaranteeing a better life for the next generation, is sometimes the primary factor inspiring migration . Extended possibilities in the new country for the life of children and families, including parks and playgrounds as well as safety, security and peace are mentioned [13, 16, 21]. Migration can give financial benefits , and well-organized health care systems are appreciated [13, 14].
Migrant parents often note the lack of original social networks in their new countries [13, 16, 17, 20, 21]. Parental tasks and responsibility are described as being shared more collectively with relatives in home countries [13, 20, 21]. The lack of social networks may cause isolation, and parenthood may be perceived as a difficult task in the new country [13, 16, 20, 21]. Retained contacts with families in the home country can provide consultation and support . The paternal role in child care may expand due to a reduced network [17, 21], but adjustment to the new role can also be stressful .
As social networks may be lacking for migrant women, fathers are described as participating within maternity care and at childbirth in their new countries [14, 18]. Involvement within maternity and child care is mentioned by some migrant fathers to challenge traditional values and perceptions about masculinity . Middle Eastern women in Sweden note that men do not always succeed in replacing the support provided by female networks during the stressful postnatal period . Migrant men’s participation in household duties is sometimes expressed as a change compared with their corresponding role in the home country .
A previous study in Sweden report that migrant parents might feel vulnerable and concerned about being misjudged when visiting CHCC . Parents may feel confident, hesitant or unwilling to continue contact with CHCC, depending on how the interaction with the nurse develops . Practical, individual tailored advice within maternal or child health care is described as important and used in combination with advice from their own social networks .
Non-European migrant parents express gratitude when comparing Swedish CHCC with health care provisions in their home countries . Home visiting is appreciated, and parents are mainly content with the involvement, oral and written information and parental advice provided by CHC nurse and an easy access to CHCC .
Postnatal home visiting programs have historically focused on mothers [28, 29]. The outreach provided by parental prevention programs is argued for in order to increase fathers’ engagement with children [28, 30, 31]. Increased paternal involvement is reported to have positive child outcomes . Among the challenges in engaging low-income fathers in home visiting programs in the USA are recruitment into programs, keeping fathers engaged, schedule-related issues, staff resistance, maternal gate keeping, and fathers’ perceptions of home visiting and meeting the needs of particular populations, including those of nonresident, migrant, and teen fathers .
In looking at different national home visiting programs in the USA, research shows little evidence, that paternal involvement into home visiting programs may increase their involvement and improve children’s outcomes . Programs such as Early Head Start and Healthy Families America promote fathers’ involvement and engagement . Nurse-Family Partnership targets mainly mothers but also welcomes fathers’ participation .
One example of more recent studies promoting fathers’ participation in early home visiting services for vulnerable families is The National Healthy Start Association’s ‘Where Dads Matter’ initiative in Midwestern metropolitan areas in the USA. Findings from a pilot study including fathers with different ethnic backgrounds (n = 12) indicate positive trends associated with the quality of the mother-father relationship, perceived stress reported by both parents, fathers’ involvement with the child, maltreatment indicators, and fathers’ verbalizations toward the infant .
Results from an evidence-based home visiting program Healthy Families New York, (HFNY), which targets expectant and new parents in socioeconomically disadvantaged families at elevated risk for child maltreatment and other adverse outcomes, shows that when fathers participated in home visiting, families were more than four times as likely to be retained in the program. Families (n = 3341) had different ethnic backgrounds. Fathers who are engaged in the program are more likely to live at home with the child and to remain emotionally involved at 6 months follow –ups, supporting the need of policies and practices to encourage participation of fathers in high-risk families in home visiting services .
The Family Nurse Partnership’s (FNP) home visiting program in England, which focuses on young fathers, including those with different ethnic backgrounds, is another example of home visiting programs involving some migrant fathers . The FNP program focuses on strengths as well as on areas in need of development, and has showed results in improved parental skills and decreased anxiety about child care . Fathers’ involvement increases over time, and the program helps with relationship issues, and the development of practical skills, leading to increased parental self-confidence .
More examples of the successful use of targeted home visiting programs to risk families are found in the USA  and Finland , showing long-term effects including fewer psychiatric symptoms for children as young adults compared with control families  and improved academic adjustment to elementary school .
Taken together, there appears to be the will, but also challenges to involve fathers in postnatal home visiting programs, and there is limited knowledge about home visiting programs involving fathers, especially those with a migrant background.
This study focused on the experience of fathers participating in a home visiting program. Resilience was chosen as the theoretical perspective of this study. Resilience as a concept has different definitions in the literature but is defined in this study as “the ability to successfully adapt to stressors, maintaining psychological well-being in the face of adversity” . The extended postnatal home visiting program in Rinkeby has a resilience perspective, operationalized in terms of strengthening parental self-efficacy, trust, and access to local community and health care services .
The aim of the study was to gain in-depth knowledge of the parental experiences and needs of fathers, who took part in an extended home visiting program in a multicultural suburb in Stockholm, Sweden.