BACKGROUND:Parental depressive symptoms are associated with adverse child outcomes, but evidence simultaneously considering maternal and paternal depressive symptoms across multiple child domains remains limited. AIM:To examine cross-sectional associations between parental depressive symptoms and child education delay, including statistical indirect associations involving child growth and morbidity. METHODS:We analysed Indonesia Family Life Survey wave 5 (2014-2015) data for 5898 children aged 7-14 years in two-parent households. Parental depressive symptoms were measured with the Centre for Epidemiologic Studies Depression scale (CES-D). Education delay was operationalized as the cumulative difference between expected grade-for-age and current grade level. Structural equation modelling used robust maximum likelihood (MLR) with full-information maximum likelihood (FIML). A targeted document analysis of national policies (2015-2025) was conducted to contextualize findings. RESULTS:Higher maternal and paternal depressive symptoms were associated with lower child height-for-age z-scores (HAZ), lower BMI-for-age z-scores (BAZ), and higher child acute morbidity count but not chronic morbidity. Indirect association estimates indicated a small but statistically significant association between maternal and paternal depressive symptoms and education delay involving lower HAZ. Total association of maternal depressive symptoms on education delay was statistically significant, whereas the total association of paternal depressive symptoms was not. The reviewed documents focused on nutrition and poverty-alleviation approaches, with less attention on parents' mental health within strategies for child growth or school-age wellbeing. CONCLUSIONS:Parental depressive symptoms were statistically indirectly associated with education delay primarily through lower child height-for-age. Integrating parental mental health screening and referral within child health and nutrition platforms may represent a scalable strategy to address educational disadvantage.

BackgroundHospital-at-home (HaH) care models are increasingly being adopted as a strategy to treat older adults with acute care needs and reduce strain on health care systems. Technological innovations, particularly digital communication platforms, have become essential in enabling care delivery beyond traditional hospital settings. Among these, asynchronous messaging tools have the potential to facilitate safe, timely, and coordinated interactions between health care providers, patients, and caregivers. Despite growing interest, little is known about how the content and relational dynamics of such exchanges influence care experiences in real-world HaH contexts. ObjectiveThis study aimed to examine the content of SMS text messaging exchanged between health care providers and patients or caregivers within a HaH program in Singapore during the COVID-19 pandemic. MethodsA descriptive qualitative design was used to analyze retrospective WhatsApp messages exchanged between health care providers and patients or caregivers from August 2022 to October 2022. An inductive qualitative content analysis approach was used to systematically identify and categorize emerging patterns in the data. ResultsThe analysis of 1218 WhatsApp messages from 354 HaH admissions identified three main categories: (1) clinical checks and advice; (2) administrative and transport arrangements; and (3) quality of interpersonal dynamics, supported by 13 subcategories, reflecting both task-oriented and relational dimensions of communication. The findings highlight how asynchronous messaging enables continuous care coordination while fostering trust and engagement between health care providers, patients, and caregivers. ConclusionsThis study underscores the multifaceted role of digital communication in HaH care, demonstrating its influence beyond clinical coordination to operational efficiency and the quality of interpersonal relationships. The findings provide insights into how digitally mediated interactions supported care delivery and patient engagement within a Singapore HaH program during the COVID-19 pandemic. While situated within a pandemic-specific context, these findings offer transferable considerations for the design of communication strategies and digital tools to enhance the responsiveness, coordination, and patient-centeredness of HaH programs.

BACKGROUND:Artificial intelligence (AI) is increasingly integrated into higher education. However, evidence on theory-informed AI interventions supporting nursing research training remains limited. PURPOSE:To evaluate an AI-facilitated teaching assistant (INSPIRE-AI) on final-year undergraduate nursing honors students' research self-efficacy, motivation, and research interest, and explore students' experiences of using INSPIRE-AI. METHODS:An embedded mixed-methods study comprising a one-group quasi-experimental pretest/posttest design with postintervention semistructured qualitative interviews. Nursing students received access to INSPIRE-AI throughout the honors year. Quantitative survey data (N = 146) were analyzed using paired t-tests and repeated-measures general linear models. RESULTS:Research self-efficacy improved significantly (P < .001). Students reported that INSPIRE-AI supported structured thinking and reduced uncertainty, though engagement varied due to trust concerns, perceived surveillance, and preference for familiar AI tools. CONCLUSIONS:Together, these findings suggest that INSPIRE-AI has the potential to support research self-efficacy through structured scaffolding; however, this interpretation should be considered alongside the broader educational support that students received throughout the honors program.

BACKGROUND:Mothers at high risk for developing depression due to psychosocial vulnerabilities that need to be supported in the perinatal period. A theory-based, user-centered mobile health application-based perinatal intervention can potentially improve at-risk mothers' maternal and infant outcomes. AIM:To describe the development of SMART, a mobile health application-based perinatal intervention designed to support at-risk mothers across the perinatal period. METHODS:The SMART intervention was developed using a combined information systems research framework and design thinking approach. The development process included identification of user needs, intervention design, prototype development, integration of theory, treatment fidelity planning, and user acceptance testing. User acceptance testing was conducted with 21 perinatal women using a SMART-specific questionnaire and the user version of the Mobile Application Rating Scale. RESULTS:The development process resulted in a mobile health intervention comprising educational content, an activity hub, peer support chat, discussion forum, gratitude journal, helplines, and useful links, push notifications, and personalisation features. User acceptance testing indicated favourable ratings for app quality, information quality, usability, and perceived impact. Participant feedback informed refinements to the intervention, including improvements to content presentation, search/filter functions, pregnancy-related resources, and the user-guide video. Interdisciplinary collaboration and treatment fidelity planning supported the systematic development of the intervention. CONCLUSION:This study described the key processes in developing a mobile health application-based perinatal intervention. Researchers can learn from the insights gained to plan future multidisciplinary, technology-based perinatal interventions. TRIAL REGISTRATION:The SMART study was registered on clinicaltrials.gov (Registration ID: NCT06363019) on 04 September 2024.

BACKGROUND:The mother-infant relationship is critical for child development, but may be compromised among mothers facing multiple vulnerabilities. In Singapore, family structures and caregiving norms are rapidly evolving, and at-risk mothers often experience heightened stress and limited social support. AIM:To understand how psychosocial and biological factors influence mother-infant emotional availability (EA) and bonding. METHODS:We conducted a cross-sectional study involving 68 at-risk mother-infant dyads drawn from the control arm of a randomized controlled trial in Singapore. Mothers completed validated questionnaires including the Mother-to-Infant Bonding Scale (MIBS), Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), and What Being the Parent of a Baby Is Like (WPBL). Mother-infant interactions were video-recorded and assessed using the EA Scales. Maternal salivary cortisol was collected as a stress biomarker during the six-month postpartum home visit. RESULTS:Higher continuous maternal salivary cortisol was significantly associated with poorer mother-infant bonding (β = 0.56, p = 0.045). Compared with the middle tertile, the lowest tertile had higher EA scores (B = 7.16, p = 0.007) and greater odds of emotional availability (OR = 5.28, p = 0.019). Greater parenting satisfaction was associated with stronger bonding (β = -1.31, p < 0.001). CONCLUSIONS:Biological and psychosocial factors may relate differently to distinct dimensions of the mother-infant relationship among at-risk mothers. Higher salivary cortisol was linked to greater bonding difficulties, whereas emotional availability showed a non-linear pattern across cortisol tertiles. Greater parenting satisfaction was linked to more favourable relational outcomes.

BackgroundAcquired brain injuries are injuries that occur after birth and are a leading cause of long-term disability and death in children and young adults. They may result from trauma, hypoxia, stroke, infection, or a variety of other causes. Fatigue is one of the most common and underrecognized consequences of pediatric acquired brain injury, often expressed behaviorally rather than verbally. Traditional rehabilitation programs are frequently static and cognitively demanding, limiting engagement and therapeutic outcomes. Extended reality (XR) technologies offer new opportunities to address these challenges by enabling interactive, adaptive, and motivating home therapy environments. However, few XR systems are co-developed with children and therapists, and there is limited knowledge about how to co-design engaging, gamified, XR-based motor rehabilitation solutions that take into account children’s fatigue. ObjectiveThis study explores why specific gamification and XR design elements facilitate or hinder engagement and effective fatigue response during rehabilitation for children with acquired brain injuries. MethodsA qualitative case study approach was employed with a total of 25 participants (22 provided consent), combining co-design workshops, interviews with health care professionals, observational data, and iterative user testing with children ages 8-16, their parents, and the clinical team. Participants who provided consent included 4 children with acquired brain injury (ages 8-16), 4 parents, 4 clinicians, and 10 healthy children involved in early ideation only. The XR prototype was developed using Unity, Cognitive3D, and the Meta Quest 3 headset. Engagement and fatigue related to prototype use were evaluated using subjective measures adapted from the User Engagement Scale and the Virtual and Mixed Reality Fatigue Scale, supplemented by thematic analysis of interview and workshop data. ResultsChildren demonstrated higher engagement with short, modular XR sessions (3-10 minutes) that included interactive game elements and preserved visibility of their surroundings. Fatigue was identified through behavioral cues such as gaze, posture, and responsiveness. Therapists emphasized the importance of adaptive difficulty, personalization, and simplified environments. A therapist-facing dashboard was developed to visualize behavioral fatigue-related cues, consistent with clinician observation. ConclusionsThis qualitative case study provides preliminary insights into how XR-based rehabilitation, when co-designed with children and clinicians, may support engagement and facilitate observation of fatigue-related behaviors in pediatric brain injury contexts. The findings provide design-oriented insights for creating engaging XR home-rehabilitation experiences while accounting for fatigue-related limitations (eg, short, modular sessions; visual grounding; adaptable challenge). The results of our study indicate a need for objective fatigue measurement within XR solutions to adjust content in ways that support both engagement and fatigue considerations. However, fatigue detection was not validated in this study and should be addressed in future research.

INTRODUCTION:Psychological resilience equips adolescents to manage distress and foster positive development. However, its multidimensional nature and dynamic relationships with stress and mental health make it difficult to identify specific intervention targets. This study used network analysis to examine the relationships between resilience, perceived stress, academic expectation stress, and depressive problems, identify key resilience processes, and explore developmental differences across adolescence. METHODS:An undirected network model was estimated in a sample of 3336 adolescents in Singapore (mean age of 13.6 years, 54.4% females). Cross-sectional surveys were conducted from 2019 to 2021 and the present study uses the: Singapore Youth Resilience Scale (resilience; 10 nodes), Youth Self-Report (depressive problems; two nodes), Perceived Stress Scale (stress; two nodes), and Academic Expectation Stress Inventory (academic expectation stress; two nodes). RESULTS:The network revealed clear clustering of protective and stress-distress nodes, with perceived helplessness emerging as the most central node. Four resilience domains-emotional regulation, relationships/social support, personal control, and positive self-image/optimism-served as key bridge nodes linking resilience and stress-distress clusters. Personal confidence is highly connected within its domain, suggesting a central role in reinforcing other resilience processes. Sensitivity analyses indicated that the overall network structure was largely consistent across adolescence, although differences in the strength of specific edges involving the key resilience domains were observed. CONCLUSION:Network modeling identified key resilience processes linking stress and depressive problems, highlighting potential intervention targets within the broader stress-distress system. Together, the findings provide insights into developmentally informed and ecologically grounded hypotheses to further develop resilience interventions.

This pilot study primarily aimed to evaluate the feasibility of conducting a cluster randomised controlled trial of the Integrated Network for Student Psychosocial Interventions, Resilience, and Education (INSPIRE) programme, including recruitment, retention, counsellor-led delivery, attendance, and completeness of outcome data. As a secondary aim, the study explored preliminary signals of change in adolescent mental health knowledge and related outcomes to inform the design of a future definitive trial. Two-centre, two-arm cluster randomised controlled pilot trial with pretest and posttest design. Adolescents aged 13–15 years and their parents were recruited from public junior high schools in West Java, Indonesia. Two schools were randomly assigned to intervention or control groups using a computer-generated sequence. The eight-week INSPIRE programme, delivered by a school counsellor, included three joint sessions with parents and two home-based activities. Feasibility outcomes included recruitment, retention, intervention fidelity, attendance, and outcome data completeness. Preliminary signals of change were described at baseline and 2‑month follow-up. Recruitment achieved 74

Birth weight is an important determinant of infant growth and development associated with neonatal morbidity (e.g., respiratory distress, hypoglycemia) and mortality, as well as long-term health risks such as developmental delays and chronic conditions (e.g., asthma, type 2 diabetes) in later life. These adverse health outcomes are particularly concerning when infants are born small or large for their gestational age. A potential strategy to improve optimal birth weight is preconception care, with consistent evidence demonstrating a relationship between maternal preconception health and infant birth weight. However, little attention has been given to the influence of paternal preconception health on pregnancy outcomes. This scoping review aimed to capture the existing literature and highlight evidence gaps regarding associations between paternal preconception health and infant birth weight. We followed the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. The review considered studies that included men in the preconception period who identified as the parent of a child for whom infant birth weight outcomes were reported. Medline, PsycINFO, Embase, Scopus and CINAHL databases were searched to June 30, 2024. Two independent reviewers screened the titles/abstracts and full-text articles. Data extraction was performed independently by two researchers using a standardized form in Covidence. The data were synthesized narratively according to the paternal preconception health factors identified within the included studies (e.g., physical well-being, health behaviors, substance use, environmental exposures, mental health, and treatment effects). From 7,690 citations, 57 published studies were included in the review. Most studies were conducted in China (n = 18, 31.6%) or the United States (US) (n = 17, 29.8%) and used a cohort design (n = 54, 94.7%). Our review identified growing evidence that specific paternal preconception factors, such as physical well-being (e.g., BMI, physical health), certain medications (e.g., recreational drugs, sulfonylureas, diazepam), and environmental chemical exposure, may adversely influence infant birth weight. There are mixed findings related to other paternal health factors, including some health behaviors (e.g., nutrition, sleep, physical activity), substance use, and mental health. Consideration should be given to expanding preconception counseling and public health initiatives to include fathers, to improve paternal health and potentially reduce risks to offspring (e.g., birth weight). We also identified key areas where further research is required to advance knowledge in this field.

While paternal environmental exposures and lifestyle factors can influence sperm epigenetic states and affect fetal development, this area of research remains relatively underexplored. This comprehensive scoping review aimed to identify, compile, and analyze the literature on paternal preconception health and its impact on fetal development, specifically related to congenital birth defects (CBDs) and head circumference. We conducted a scoping review following the Joanna Briggs Institute methodology and a published protocol. Five databases were searched for articles that included men in the preconception period and outcomes for CBDs and head circumference. Studies were published in English up to July 16, 2025. Two independent reviewers screened titles and abstracts and extracted data from eligible studies using Covidence. Forty-eight studies were included in the review. We identified several paternal factors associated with CBDs, including paternal physical health (metabolic syndrome, viral infections, cancer), smoking and alcohol use, and environmental exposures (solvents, metals, pesticides). Most medications were not associated with increased risks; however, metformin and diazepam were identified as potential risk factors for increased CBD risk. The limited studies on head circumference also suggest a potential relationship; however, the findings are not widely applicable due to the small number of included studies. We also identified important knowledge gaps and methodological limitations that require further research to advance this field. Our findings indicate that paternal preconception health and exposures-particularly paternal health, substance use, environmental factors, and certain medications-significantly influence offspring health outcomes, including congenital defects and infant head circumference. These findings highlight the need to expand preconception counselling and preventive strategies to explicitly include fathers, with targeted efforts to improve paternal health, eliminate tobacco and alcohol use, and reduce occupational and environmental exposures. Incorporating paternal health into preconception frameworks is essential to understanding mechanistic pathways, decreasing congenital risks, and developing precision strategies for improving reproductive and neonatal outcomes.

Parents of children with autism spectrum disorder (ASD) face unique mental health challenges. Systematic mental health screening could identify parents in need of timely support; however, parental perceptions toward this have not been adequately explored. This qualitative descriptive study aimed to explore parental knowledge and attitudes toward mental health screening among parents of children with ASD in Singapore. Adult parents, who were primary caregivers of children with ASD aged between 2 and 18 years, were invited to participate in semi-structured individual online interviews. A purposive sample of 14 mothers was recruited from a tertiary paediatric developmental clinic between July and November 2024. Data were analysed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist was used for reporting. Three themes identified as follows: (1) Understanding and Acceptance of Mental Health Screening, (2) Navigating Barriers to Mental Health Support, and (3) Shaping Effective Mental Health Services. Our findings indicate that while mothers recognise the benefits of mental health screening, stigma, lack of awareness and logistical challenges remain significant barriers. Effective implementation of mental health screening and follow-up support requires collaboration between healthcare, schools, government and community organisations to ensure a non-judgmental and accessible screening process.

BACKGROUND:Effective communication between healthcare providers and marginalized youth and adolescents is essential for promoting equitable care. However, existing models of care reinforce adult-centric and biomedical norms that overlook the diverse developmental and sociocultural realities faced by these youth. AIM:This review aimed to synthesize the perceptions and experiences of healthcare communication by marginalized youth and adolescents. METHODS:We used Noblit and Hare's meta-ethnographic approach. Six electronic databases were searched from their inception date till 31 December 2025. The included studies were assessed using the Critical Appraisal Skills Program tool. RESULTS:We synthesized findings from 42 included studies and identified four main findings: (1) Building trust in healthcare encounters is a relational process; (2) Shared agency in communication is key; (3) Marginalized youth construct a coherent sense of self through an iterative process; (4) Structural conditions shaping communication must not be overlooked. CONCLUSION:Drawing on the findings of this review, we developed a conceptual framework - the Culturally Safe and Relational Approach Tool (CARAT) - to support culturally safe, relational communication with marginalized youth. The framework positions marginalized youth as active agents and highlights the role of healthcare providers in either bridging bureaucratic health systems or functioning as gatekeepers to care. It underscores the importance of cultural safety, scaffolded autonomy, and relational continuity within healthcare systems. Reorienting communication practices to recognize youths' strengths and lived realities, alongside policy and practice reforms that center marginalized youths' voices, will strengthen trust and inclusivity across healthcare settings.

This paper proposes a framework for leveraging large language models (LLMs) to generate misconceptions as a tool for collaborative learning in health care education. While misconceptions—particularly those generated by AI—are often viewed as detrimental to learning, we present an alternative perspective: that LLM-generated misconceptions, when addressed through structured peer discussion, can promote conceptual change and critical thinking. The paper outlines use cases across health care disciplines, including both clinical and basic science contexts, and a practical 10-step guidance for educators to implement the framework. It also highlights the need for medium- to long-term research to evaluate the impact of LLM-supported learning on student outcomes. This framework may support health care educators globally in integrating emerging AI technologies into their teaching, regardless of the disciplinary focus.

BACKGROUND:At-risk mothers experience disproportionately higher rates of antenatal depression and anxiety, which can hinder mother-infant bonding and adversely affect infant socioemotional development. Despite growing evidence on postpartum mental health, antenatal risk factors among psychosocially vulnerable mothers remain underexplored, particularly in multi-ethnic Asian settings. AIM:To identify factors associated with antenatal depression, anxiety, and maternal-fetal bonding among at-risk mothers. METHODS:This cross-sectional observational study was nested within an ongoing randomised controlled trial. Two hundred at-risk mothers, defined as single, of low socioeconomic status, referred for psychosocial support, at risk of depression, with adverse childhood experiences, or with a fetus with a congenital malformation, were recruited from outpatient obstetric clinics between February and September 2024. Participants completed online self-administered questionnaires assessing antenatal depression, anxiety, perceived stress, social support, parenting self-efficacy, and maternal-fetal bonding. General Linear Models were used to analyse data and identify factors associated with depression, anxiety, and bonding. RESULTS:Higher perceived stress was associated with increased depression (β = 0.28, p < 0.001) and anxiety (β = 1.28, p < 0.001) and poorer bonding (β = 0.08, p = 0.02), while greater social support predicted lower anxiety (β = -0.31, p < 0.001). Higher parenting self-efficacy was linked to stronger bonding (β = -0.09, p = 0.06). Younger mothers (β = -2.68, p = 0.025) and Indian mothers (β = 7.46, p = 0.017) were particularly vulnerable to anxiety, whereas post-secondary education was protective against depression (β = -1.44, p = 0.02). Model fit ranged from 0.14 to 0.65. CONCLUSION:Perceived stress, social support, and parenting self-efficacy significantly influenced antenatal mental health and bonding in at-risk mothers. These findings underscore the need for culturally sensitive, nurse/midwife-led interventions that integrate early screening, stress reduction, and empowerment strategies within routine antenatal care to strengthen maternal mental health and early bonding outcomes. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: (1) Nurses and midwives play a critical role in screening for antenatal depression and anxiety in mothers with risk profiles highlighted in this study. (2) Culturally responsive nursing practice that demonstrates sensitivity towards sociocultural pressures is needed to provide individualised care. (3) Integration of digital and community-based antenatal education programs could provide more equitable access to care for at-risk mothers who may face barriers to in-person care. IMPACT:(1) Despite having a higher susceptibility for antenatal mental health conditions, risk factors for antenatal depression, anxiety, and maternal-infant bonding have been underexplored in at-risk mothers. (2) Antenatal stress and anxiety are universally associated with depression across risk groups, while maternal self-efficacy and perceived social support serve as key protective factors. (3) The findings from this study suggest the need for early screening and nurse-led interventions that support maternal parenting self-efficacy and stress management to improve maternal mental health outcomes among at-risk mothers. REPORTING METHOD:STROBE reporting checklist. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

Early parenthood is shaped by evolving parental behaviors, attitudes, beliefs, and well-being embedded within biopsychosocial contexts. In this nationwide longitudinal study, we used latent growth curve modeling to examine how biopsychosocial vulnerability is associated with trajectories of parental experiences among new mothers and fathers during the first 2 years postpartum. Coresiding mothers (N = 2,994) and fathers (N = 2,787) across Canada self-reported various biopsychosocial vulnerabilities (e.g., lower couple relationship quality, lower perceived social support) at a single time point, with most factors collected at 3 weeks postpartum and others at 3 months postpartum. Parents further reported on parental outcomes (e.g., involvement, distress, overreactivity) starting at 3 months postpartum for up to five time points across the first 2 years postpartum. Results showed that vulnerability factors had the strongest and most frequent associations with initial status in parental outcomes, with lower relationship quality and lower perceived social support having the largest effect sizes. These patterns were similar for both mothers and fathers. In contrast, the number and strength of associations with change in parental outcomes over time was smaller. While lower relationship quality and perceived social support were linked to improvements in some parental outcomes over time, high childhood adversity, immigrant background, lower household income, and lower education were associated with less favorable changes in outcomes. These patterns varied between mothers and fathers. Overall, the findings underscore the contribution of biopsychosocial vulnerability in the functioning and well-being of first-time parents, with shared and unique risks for mothers and fathers. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Respectful Maternity Care (RMC) emphasises dignity, autonomy, and compassion as universal rights, yet its practical enactment within highly medicalised, standardised, and multicultural systems remains complex. This study aimed to explore how RMC is enacted by women and obstetricians, nurses, and midwives in hospital-based maternity care in Singapore. A qualitative exploratory study involving in-depth semi-structured interviews with mothers and healthcare providers was conducted. Mothers with maternity experience within the last 48 months were included regardless of parity (number of previous pregnancies). Healthcare providers were included if they had worked within the maternity setting within the last 4 years. Braun and Clarke's reflexive thematic analysis approach was used to develop themes and subthemes. We found that concepts of RMC, particularly autonomy, were interpreted differently by mothers and providers. Though nurse-midwives were intermediaries for respectful care, providers were operating within the constraints of protocol-driven efficiency within a technocratic society with norms of deference to authority. Mothers demonstrated situated agency by drawing on informal networks and using payment tiers to secure more relational care. However, this market-based differentiation risks commodifying dignity and deepening inequities in RMC based on the ability to pay. Systems need to integrate relational autonomy and informed choice to improve respectful maternity care practices.

AIMS:To explore how children, caregivers and healthcare providers experience shared decision-making in real time within an interdisciplinary paediatric feeding clinic in multicultural Singapore. DESIGN:A qualitative ethnographic approach was used. METHODS:Data collection involved one-time participant observations of interdisciplinary feeding clinic consultations, observations of healthcare providers-only debrief and follow-up interviews with caregivers. Data were collected from July 2024 to November 2024. Participants included caregivers, healthcare providers and otherwise well children presenting with feeding difficulties. Fieldnotes, including observational matrices, reflexive journals and interview transcripts, were analysed thematically using Braun and Clarke's six-step process for thematic analysis. RESULTS:Twenty observations and 11 interviews were conducted. Four themes were identified: (1) Centring the child: building trust and respect; (2) Tensions and teamwork: negotiating expertise and expectations; (3) Feeding across cultures; and (4) Parenting under pressure: the social context of feeding choices. CONCLUSION:In an interdisciplinary feeding clinic, shared decision-making extends beyond the clinical encounter, reflecting relational, cultural and structural realities. The feeding clinic modelled effective shared decision-making through child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. However, divergent perceptions of what problematic feeding entails, caregivers' hesitancy in taking on an active role in consultations, and the external pressures caregivers contended with constrained this process. These findings highlight the need for inclusive, culturally responsive care models and more caregiver support interventions that acknowledge the full complexity of feeding care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Nurses, with their central role in relational and communicative care, are uniquely positioned to bridge tensions between medical paternalism and collaborative, family-centred approaches. By facilitating trust, clarifying goals and supporting caregiver participation in feeding decisions, they play a critical role in advancing child health outcomes while strengthening caregiver agency within multicultural healthcare systems. IMPACT:This study revealed how cultural, familial and systemic pressures shape caregiving practices, often constraining caregiver participation and shared decision-making in clinical encounters. Shared decision making in an interdisciplinary feeding clinic comprised of child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. This study expounds on the potentially critical role nurses could play within the multidisciplinary team to negotiate expectations, foster caregiver agency and contribute to culturally responsive, family-centred feeding care. REPORTING METHOD:The reporting of this study is guided by the Standards for Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC INVOLVEMENT:This study did not include patient or public involvement in its design, conduct or reporting.

AIM:To explore how fathers in Singapore experience, interpret, and cope with the emotional and mental health demands of raising an autistic child, and how stigma and support contexts influence coping and help-seeking. DESIGN:Qualitative. METHODS:Interpretative phenomenological analysis guided this qualitative study. Purposive sampling recruited 17 fathers (aged 31-55 years) of autistic children under 18 years living in Singapore, with confirmed DSM-5 diagnoses by trained developmental behavioural paediatricians. The sample was multi-ethnic (Chinese n = 9; Malay n = 5; Indian n = 1; Other n = 2), broadly reflecting the national distribution. Most fathers held university-level education and were in full-time employment. Fathers completed one-to-one in-depth semi-structured interviews from September to October 2025. RESULTS:Three themes were identified: (1) Fatherhood disrupted: Grief and the spectre of an unscripted future; (2) Holding it together: functioning as a moral metric and the quiet toll of self-reliance; (3) Guarded disclosure: navigating stigma, masculinity and the search for safe spaces. CONCLUSIONS:These findings highlight that fathers' mental health experiences and help-seeking are shaped by identity-level processes that current services have not adequately addressed. Cultural stigma surrounding autism and masculine role expectations influence how fathers interpret and respond to psychological distress by encouraging functional self-monitoring and discouraging emotional disclosure, thereby delaying help-seeking and under-recognition of clinically relevant distress in fathers. The study reveals a significant need to understand paternal experiences in greater depth before designing interventions, and points to the importance of father-inclusive support structures that recognise the intersection of disability-related stigma with culturally specific masculine identity standards. Further research is needed to examine the longer-term trajectories of paternal coping and the potential consequences of sustained reliance on functional self-monitoring as the primary indicator of wellbeing. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE:Nurses and allied health professionals should recognise fathers of autistic children as distinct, underserved recipients of mental health support whose experiences are shaped by identity-level processes rather than symptom recognition alone. Practice should explicitly invite fathers into psychoeducation, coaching and care-planning conversations rather than defaulting to mothers as the sole service interface. Engagement strategies should use functional, role-sustaining language that aligns with how fathers conceptualise their own wellbeing, while remaining alert to the risk that such framing may inadvertently reinforce avoidance of emotional processing. Service pathways should integrate autism-specific peer-based entry points with clearly signposted escalation routes to professional mental health care. Culturally attuned practice should acknowledge the compounded effects of courtesy stigma, affiliate stigma and Confucian-influenced masculine norms, so that help-seeking can be framed as an expression of paternal duty rather than an admission of failure. Nurses are often the first and most sustained professional contact for these families; they are well placed to lead a two-step engagement pathway: first using capability-oriented language to lower the threshold to contact, then, within a trusting relationship, introducing emotion- and identity-level reflection and clear escalation to specialist care. Embedding father-inclusive, gender-sensitive and culturally safe competencies in nurse education and advanced practice would help nurses detect paternal need that symptom-based screening alone is likely to miss. IMPACT:What problems did the study address? Fathers of autistic children are disproportionately vulnerable to mental health difficulties yet remain peripheral to autism caregiving research and services. This is particularly the case in Asian contexts, where culturally specific masculine norms and disability-related stigma shape paternal help-seeking in under-examined ways. This study addressed how fathers in Singapore experience, interpret and cope with the mental health demands of raising an autistic child, and how stigma and support contexts influence their coping and help-seeking. What were the main findings? Fathers described their child's autism diagnosis as a turning point that disrupted expected fatherhood trajectories and required them to reconstruct what it meant to be a competent and caring father. They conceptualised mental health through functional capacity and moral duty rather than through emotional distress language, and they navigated compounded help-seeking barriers arising from the intersection of courtesy stigma, affiliate stigma and Confucian-influenced masculine norms. Autism-specific, peer-based, activity-embedded support emerged as the most acceptable form of help, while professional mental health services were positioned as a last resort. Where and on whom will the research have an impact? The findings will inform nurses, mental health clinicians, paediatric and early intervention professionals and policymakers designing father-inclusive autism caregiving services in Singapore and comparable multi-ethnic Asian contexts. The study will also extend the global autism caregiving evidence base by contributing an underrepresented Southeast Asian paternal perspective that foregrounds identity, masculinity and cultural stigma as central to paternal mental health. REPORTING METHOD:COREQ guideline. PATIENT OR PUBLIC CONTRIBUTION:This study did not include patient or public involvement in its design, conduct or reporting.

Background Nurses are at risk for poor psychological outcomes due to work-related burnout and stress. Since supportive interventions such as coaching have been found to improve nurses' overall well-being, an ontological coaching intervention was developed to improve nurses' well-being. Objective To investigate the effects of an Ontological Coaching among Nurses intervention on nurses' psychological well-being (primary outcome), occupational stressors, social support, goal-setting proficiency, intention to leave nursing, and job satisfaction (secondary outcomes). Design Multi-centre, two-group parallel-armed randomised controlled trial with baseline, intermediate, and post-intervention measurements. Setting(s) Data were collected from public tertiary hospitals and primary care public outpatient clinics (polyclinics) under the National University Health System Cluster in the Central and Western region of Singapore between December 2023 and October 2024. Participants Four hundred nurses, aged 21 and above, working in the NUHS, were recruited and randomly assigned to either an intervention group (n = 200) or a control group (n = 200). Methods The intervention group received the Ontological Coaching among Nurses intervention, comprising one group coaching session followed by four individual coaching sessions, in addition to the standard support available to nurses. The control group received only the standard support provided by their respective hospitals or organisations. At baseline, all participants completed a sociodemographic questionnaire. Outcome data were collected at three time points: baseline (during recruitment), intermediate intervention (after two individual coaching sessions), and post-intervention (after four individual coaching sessions). Between-group differences were analysed using general linear models. Results After adjusting for baseline, recruitment site and intervention, participants in the intervention group also reported higher psychological well-being (mean difference (MD) = 8.70, 95% CI: 5.38 to 12.02, p < 0.001), goal-setting proficiency (MD = 1.88, 95% CI: 0.28 to 3.49, p = 0.02), job satisfaction (MD = 11.22, 95% CI: 2.59 to 19.85, p = 0.01), and lower intention to leave nursing (MD = 1.05, 95% CI: 1.74 to 0.37, p = 0.003) at post-intervention. At the intermediate timepoint, nurses in the intervention group reported a statistically significantly higher psychological well-being (MD = 2.93, CI 95%: 0.17 to 5.68, p = 0.04) and job satisfaction (MD = 8.24, 95% CI: 0.82 to 15.66, p = 0.03), and lower intention to leave nursing (MD = 0.76, 95% CI: 1.39 to 0.13, p = 0.02). Conclusions The Ontological Coaching among Nurses is a feasible and promising intervention to enhance nurses' psychological well-being, goal-setting skills, job satisfaction, and retention intentions. It could be integrated into workplace well-being programmes, with refinement to address occupational stressors and social support. Future research should adopt cluster randomisation, use shorter validated tools to reduce survey fatigue, include objective retention measures, and assess long-term outcomes. Registration https://clinicaltrials.gov/ (NCT06878157).