Fathers' Involvement in Child Feeding Practice and Its Associated Factors Among Fathers Having Children Aged 6–24 Months in Ambo Town, Ethiopia, 2024: A Mixed Method Design

ABSTRACT

Father involvement in child feeding refers to the support fathers provide such as financial, social and physical that influences child feeding habits. While previous research has focused predominantly on mothers, limited attention has been given to fathers' roles in this context. A community‐based cross‐sectional study employing a concurrent mixed‐methods approach was conducted from 1 January to 1 March 2024. A two‐stage sampling technique was used to recruit 634 fathers with children aged 6–24 months. Quantitative data were collected using a structured interviewer‐administered questionnaire, while qualitative data were obtained through in‐depth interviews using a semi‐structured guide. Quantitative data were analysed using SPSS version 27, and bivariable and multivariable binary logistic regression analyses were conducted to identify factors associated with father involvement in child feeding. Qualitative data were thematically analysed and triangulated with the quantitative findings. Overall, 54.1% of fathers were involved in child feeding practices (95% CI: 50.04%, 58.2%). Significant predictors of involvement included: fathers with diploma‐level education and above (AOR = 3.42, 95% CI: 1.19, 9.83); employment in government or private/nongovernment sectors (AOR = 3.75, 95% CI: 1.10, 12.76; AOR = 3.65, 95% CI: 1.01, 13.19, respectively); spouses with similar employment status (AOR = 3.48 and 2.61, respectively); positive attitudes (AOR = 3.87, 95% CI: 2.23, 6.73); good knowledge (AOR = 2.21, 95% CI: 1.30, 3.75); and positive perceptions of cultural norms (AOR = 2.31, 95% CI: 1.36, 3.94). Qualitative findings reinforced that negative attitudes, unfavourable cultural norms and occupational constraints hinder father involvement. Only about half of fathers were involved in their child's feeding. Key influencing factors included education, employment status, attitudes, knowledge and cultural perceptions. To improve paternal involvement, targeted interventions should be undertaken by stakeholders such as the Ministry of Health, community leaders and family welfare organizations, focusing on behavioural change communication and supportive workplace policies.

Summary

• Fathers' involvement in child feeding practice was suboptimal, with only 54.1% getting involved in the current study.

• Key factors, including educational status, employment, attitudes, knowledge and perceptions of cultural norms, were found to significantly affect fathers' involvement.

• Negative attitudes, long work hours and inflexible schedules, traditional gender roles and cultural expectations and lack of knowledge or confidence in child feeding were identified as barriers to fathers' involvement in child complementary feeding practices.

• Interventions such as targeted health education, efforts to transform cultural norms and promoting shared caregiving roles in households where both parents work should be done.

Abbreviations

CF

complementary feeding

HEWs

health extension workers

1. Background

Fathers' involvement in child feeding practices is explained when he supports the child and family by feeding the child, financially, providing necessary resources, offering social and physical support and sharing responsibility for the child's nutritional well‐being and overall health (Bogale et al. 2022).

Infant and young child feeding is critical for child health and survival (WHO/UNICEF 2008). World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) recommend that receiving adequate complementary foods in addition to continued breastfeeding until 2 years of age or beyond (WHO/UNICEF 2008). Child health is affected and influenced by several factors such as nutrition and feeding practices in the early months of life. These are also important determinants of children's health, growth and survival (Mithra et al. 2022). Complementary feeding is a universal practice, the methods and manners in which it is practised vary between cultures, individuals and socioeconomic classes (Arikpo et al. 2018).

The way parents feed their children has gained significant attention globally, regardless of income levels, to combat child malnutrition (Bilal et al. 2016). This issue is particularly critical in developing countries where child under‐nutrition is a pressing public health concern. It is important to recognize that child feeding extends beyond providing healthy food and also encompasses fulfilling the child's basic needs (Bilal et al. 2016; Stevens et al. 2012).

The common focus on women‐only in health and nutrition programmes fails to acknowledge the influential role fathers play in household decision‐making processes that directly impact the health and nutrition of the infant and young children. Some of these decisions involve financial choices, such as determining the types of nutrient‐rich foods to purchase and how much to allocate for food expenses. Fathers' involvement in child feeding practices refers to their active participation in caring for and nourishing their children (Saaka et al. 2023).

While recent endeavours to engage men in health have concentrated on maternal or reproductive health and addressing the underlying causes of gender‐based violence, there has been comparatively less emphasis on involving men in child health and child care. This includes areas such as nutrition and child feeding issues (Catholic Relief Services 2016).

Different studies conducted in coastal South India and the urban slums of Bangladesh found that the prevalence of fathers' involvement in infant and young child feeding is 59.1% and 63%, respectively (Mithra et al. 2022; Bhattacharyya et al. 2023). Additionally, the magnitude of fathers' involvement in child feeding from two studies conducted in Antsokiya Gemza district and Damot Woyde district, Ethiopia, showed only 43.1% and 50.9%, respectively (Bogale et al. 2022; Wolkanto et al. 2023). Studies have also reported that fathers' involvement in child feeding is influenced by factors such as socioeconomic status, family structure, cultural conditions, religion, fathers' knowledge and practices regarding child feeding and paternal occupation (Bogale et al. 2022; Wolkanto et al. 2023; WHO 2016; Allotey et al. 2022).

Despite the well‐established role of fathers in child‐feeding, research and policies related to child feeding have generally overlooked the importance of including fathers (Moyo and Schaay 2019). The role of fathers in child feeding has rarely been studied, particularly in Ethiopia, where the limited available research has predominantly focused on father‐ and child‐related factors, often overlooking the influence of maternal factors, which are also crucial. Therefore, this study aimed to assess the level of fathers' involvement in the complementary feeding of children and to identify factors associated with it in the study area. In this study, important variables such as the mother's educational level and the mother's occupation were incorporated.

2. Methods

2.1. Study Setting and Period

The study was conducted in Ambo town, Oromia Regional State, Ethiopia. Ambo town is located 114 km to the west of the capital city of Ethiopia, Addis Ababa, with an estimated population of 99,905, including 50,584 men and 49,321 women. The town of Ambo has six kebeles (The smallest administrative unit in Ethiopia). The town also has one referral teaching hospital running under Ambo University, one general hospital and two health centres. The study was carried out from 1 January 2024 to 1 March 2024 (West Shoa zone Health Office 2021).

2.2. Study Design and Population

A cross‐sectional study design with a concurrent mixed‐methods approach was employed among fathers with children aged 6–24 months living in the selected kebeles of Ambo town. Fathers who were critically ill or unable to communicate were excluded. Qualitative interviews were conducted with purposively selected mothers of children aged 6–24 months and health extension workers residing in the same kebeles during the study period. Mothers and health extension workers were included in the qualitative component to capture household and community perspectives on fathers' involvement in child feeding.

2.3. Participants' Recruitment

The sample size was calculated using the single population proportion formula: n = (Z² × p × (1 – p))/d², where n is the required sample size before adjustments, Z is the standard normal value at a 95% confidence level (1.96), p is the estimated proportion of fathers' involvement in child feeding from a study conducted in Damot Woyde District, South Ethiopia (50.9%) (Wolkanto et al. 2023), and d is the margin of error (5%). By applying a design effect of 1.5 to account for clustering and considering a 10% nonresponse rate, the final sample size was calculated to be 634.

This study employed a two‐stage cluster sampling approach. In the first stage, three kebeles were selected from the six available in Ambo town using simple random sampling. The selected kebeles were Hora Ayetu, Kisose Edo‐liban and Torban Kutaye. In this study, kebeles were treated as clusters, and a design effect was applied during the sample size calculation to account for clustering.

In the second stage, eligible participants (fathers with children between 6 and 24 months old) residing in the selected kebeles were identified in collaboration with Health Extension Workers (HEWs). After determining the total number of eligible fathers in each kebele, numeration was done. The calculated sample size was proportionally allocated to each kebele to ensure adequate representation. Finally, a systematic random sampling technique was used to select the study participants. The sampling interval (K) was calculated as K = 2131/634 = 3.34, which was rounded down to 3. The first participant was identified from among the first three using the lottery method, and the third participant was selected as the starting point. Subsequently, every third eligible participant was selected within each kebele. Although the sample was proportionally allocated to each kebele based on the number of eligible participants, the same sampling interval (K = 3) was applied across all kebeles for operational feasibility. We acknowledge that this approach may have introduced differential selection probabilities, and this limitation is addressed in the discussion section.

For the qualitative component, purposive sampling was used to recruit 17 key informants, including 11 mothers of children aged 6–24 months and 6 health extension workers, from the same three kebeles selected for the quantitative study. Participants were identified based on their experience and willingness to participate, and interviews continued until data saturation was reached.

2.4. Measurements

Involved Fathers in Child Feeding: To conclude fathers' involvement in child feeding a questionnaire consisting of 22 items was used and from these 22 questions directed to the fathers, variable scores of 12 and above were considered as involved fathers while variable scores of below 12 were considered as non‐involved fathers involvement in child feeding practices (Bogale et al. 2022; UNICEF 2010; Save the Childern 2019).

Knowledge: Knowledge of fathers towards fathers' involvement in child feeding was assessed by using 9 items that were directed to the fathers. Fathers who scored five and above among the listed nine items were considered to have knowledge of fathers' involvement in child‐feeding practices, and fathers who scored below five were considered to have poor knowledge of fathers' involvement in child‐feeding practices (Yonas et al. 2015).

Perceived Cultural Practices in the Community: A perceived cultural practice in the community of fathers towards fathers' involvement in child feeding was assessed by using 5 items that were directed to the fathers. Fathers who scored 3 and above among the listed 5 items were considered as having positively perceived cultural practices in the community towards fathers' involvement in child feeding practices, and fathers who scored below 3 were considered as having negatively perceived cultural practices in the community towards fathers' involvement in child feeding practices (Bogale et al. 2022).

Attitude: A five‐point Likert scale was used to assess attitudes. The questionnaire included five positive statements (scored from ‘strongly disagree = 1’ to ‘strongly agree = 5’) and three negative statements (reverse‐scored, with ‘strongly disagree = 5’ to ‘strongly agree = 1’). For each respondent, the scores for all eight items were adjusted so that higher values consistently reflected a more positive attitude. The adjusted item scores were then summed to obtain a total attitude score. Finally, the mean score across all respondents was calculated and used as a cutoff to dichotomize attitudes into ‘positive’ (scores ≥ mean) and ‘negative’ (scores < mean).

Positive Attitude: The respondents scored greater than or equal to the mean value of the attitude‐related questions.

Negative Attitude: For fathers' answers lower than the mean value to the attitude‐related questions (Yonas et al. 2015).

2.5. Variables of the Study

Fathers' involvement in child feeding

Independent Variables

1. Father‐related factors:

• Socio‐demographic characteristics: age, educational status, household income and occupational status.

• Psychosocial factors: knowledge, attitude and perceived cultural practices in the community knowledge, attitude and perceived cultural practices in the community

2. Mother‐related factors: education level and occupational status.

3. Children‐related factors: number of children, sex of the child and birth order of the youngest child.

Dependent Variable: Father involvement in child feeding (Involved/not involved).

2.6. Data Collection Procedures and Instruments

For the quantitative study, structured questionnaires were prepared in English, translated into Afan Oromo (the local language), and then back‐translated into English to ensure consistency and accuracy. The questionnaire was adapted from previously validated tools and related literature (Bogale et al. 2022; Wolkanto et al. 2023; Save the Children 2019; Monguilhott et al. 2018). It consisted of five sections: socio‐demographic characteristics, father‐related factors (knowledge, attitudes, perceived cultural practices), mother‐related factors and child‐related factors (Supporting information S1). To protect confidentiality, no names or identifying information were included. Data were collected through face‐to‐face interviews conducted in private settings in participants' homes to ensure comfort and privacy. Six trained nurses with bachelor's degrees collected the data, supervised by two master's level supervisors.

For the qualitative component, in‐depth interviews were carried out with mothers and health extension workers from the same kebeles selected for the quantitative survey. Data collectors with experience and master's level qualifications conducted the interviews in quiet, convenient locations chosen by the participants, often in their homes or health posts. The purpose and procedures of the study were explained in detail before each interview. Probing questions were used to explore perceptions, cultural norms and contextual factors influencing fathers' involvement in child feeding practices. The qualitative findings were used to complement and enrich quantitative results by providing deeper insights into household and community perspectives. Interviews were audio‐recorded with consent and transcribed verbatim. All recordings and notes were securely stored and kept confidential until the transcripts were verified for accuracy.

2.7. Data Quality Control

Before data collection, a pre‐test was performed on 5% of the participants in Ambo, a town of nonadjacent kebeles, which are not incorporated into the study area by simple random sampling. Coefficient of reliability, Cronbach's alpha was 0.791. Training was given to data collectors and supervisors on the objective, the benefit of the study, individual rights and informed consent for a common understanding of the study. To get informed consent and reliable data, a clear explanation of the purpose and procedure of the study was given to the study participants. Each questionnaire was checked for completeness, missed values and unlikely responses. The data was checked daily for completeness and consistency throughout the data collection period, then, each completed questionnaire was given a unique code.

2.8. Data Analysis

The quantitative data were entered into the computer with the Epi‐data 3.1 software and exported to SPSS version 27.1 for analysis. Descriptive statistics were computed to determine frequencies and summary statistics were used to describe the study population's socio‐demographic and other relevant variables. The assumption of multi‐collinearity was met (VIF was less than 1.6 for all predictors).

Binary logistic regression analysis was employed to determine factors associated with the dependent variable. Variables with p < 0.2 in bivariable logistic regression were included in the multivariable logistic regression model. In the multivariable logistic regression model, a variable with a p‐value < 0.05 was considered significantly associated variables with the outcome variable. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated to measure the association's strength between the overall involved fathers' involvement and independent variables. Furthermore, even though a design effect was applied during sample size calculation to account for clustering at the kebele level, the final analysis did not adjust for clustering due to resource and software constraints.

The qualitative data were transcribed verbatim and translated into English. The transcripts were read and re‐read to achieve familiarity with the content. Data were analysed manually without the use of qualitative data analysis software. An inductive thematic analysis approach was employed. Two researchers independently conducted open coding of the transcripts to identify meaningful segments of text. The codes were then reviewed collaboratively, grouped into categories and combined into overarching themes through discussion and consensus. The main themes that emerged included fathers' attitudes towards involvement in child feeding, the occupations of fathers and their spouses, and perceived cultural practices influencing fathers' participation. To enhance the trustworthiness and rigour of the analysis, strategies such as peer debriefing, member checking and maintaining an audit trail were utilized. The qualitative findings were triangulated with the quantitative results to enrich interpretation and ensure credibility.

2.9. Ethics Statement

Ethical clearance for the study was obtained from Ambo University, College of Health Sciences and Referral Hospital Ethical Review Board. All procedures in the study were conducted in accordance with the Declaration of Helsinki. Then, supportive letters were distributed for all selected kebeles. The selected participants were informed by the data facilitators as they are selected to participate in the study. To obtain the written informed consent, the study title, purpose, procedure and duration, possible risks and benefits of the study were clearly explained to the participants using the regional language. The confidentiality of the respondents was assured by excluding their name and any other identifying information during the period of data collection, and they were informed well that they have full right to refuse to participate and/or withdraw from the study at any time if they have any difficulty. The information collected was kept in a private till data insertion and then kept for a reasonable time to be discarded so that it does not fall into the hands of other researchers who might misappropriate it.

3. Results

3.1. Socio‐Demographic and Individual‐Related Characteristics of the Respondents

In this study, 593 fathers participated, giving a 93.5% response rate. Half of study participants, 303 (51.1%) were above or equal to 40 years of age, with a mean age of 38.13 years and a standard deviation of (SD ± 5.76). About three‐fifth 350 (59%) of them had a diploma and above educational status and 269 (45.4%) of their spouses had a diploma and above educations. About two‐fifth of fathers 234 (39.5%) were government employees. Nearly two‐fifth of participants 232 (39.1%) had a household income between 2500 and 4800 birr, with a mean of 4830.69 and a standard deviation of ±2165.09 (Table 1).

Table 1.

Socio‐demographic characteristics of father involvement in child feeding among fathers who had children aged from 6 to 24 months Ambo town, Ethiopia, 2024 (n = 593).

Variables	Category	Frequency	Percent
Age of participant	24–29	77	13
	30–39	213	35.9
	≥ 40	303	51.1
Age of participants spouse	19–24	72	12.1
	25–29	208	35.1
	≥ 30	313	52.8
Religion	Protestant	244	41.33
	Orthodox	254	42.83
	Muslim	65	10.93
	Others	30	5.05
Educational Status	No formal education	62	10.5
	Primary School	93	15.7
	Secondary school	88	14.8
	Diploma and above	350	59.0
Education status of spouse	No formal education	96	16.2
	Primary school	122	20.6
	Secondary school	106	17.8
	Diploma and above	269	45.4
Household monthly income	≤ 2500	108	18.2
	2500–4800	232	39.1
	4801–6999	170	28.7
	≥ 7000	83	14
Occupation of participant	Daily labourer	29	4.9
	Merchant	135	22.8
	Government employer	234	39.5
	NGO/Private	123	20.7
	Farmer	72	12.1
Occupation of Spouse	Merchant	79	13.3
	Government employer	123	20.7
	NGO/private	76	12.8
	Daily labourer	72	12.0
	House wife	243	41.0
Number of children	≥ 3	201	33.9
	< 3	392	66.1
Sex of the youngest child	Female	249	42.0
	Male	344	58.0
Birth order of the youngest child	Not the first child	378	63.7
	First child	215	36.3

3.2. Knowledge About Father Involvement in Child Feeding

The majority, 462 (77.9%) of participants had knowledge of when should an infant start complementary feeding. Less than half 260 (43.8%) of respondents identified that fathers have a role in cooking meals for their child. Overall, about 333 (55.6%) of fathers had good knowledge about father involvement in child feeding (Figure 1).

Figure 1.

Knowledge of fathers about fathers' involvement in child feeding in Ambo town, Ethiopia, 2024 (n = 593).

3.3. The Attitude Towards Fathers Involvement in Child Feeding

About 189 (31.9%) of respondents strongly agreed, and 64 (10.8%) agreed that they are confident in preparing food for their child. One hundred sixty‐one (27.2%) of respondents strongly agreed, and 92 (15.5%) agreed that they feel confident in supporting their wife with child feeding and care. Overall, 266 (44.9%) of participants had positive attitudes towards fathers' involvement in child feeding (Table 2).

Table 2.

Attitude of fathers about fathers' involvement in child feeding in Ambo town, Ethiopia, 2024 (n = 593).

Variables	Strongly disagree		Disagree		Neutral		Agree		Strongly agree
	Freq.	Percent	Freq.	Percent	Freq.	Percent	Freq.	Percent	Freq.	Percent
I am confident in preparing food for my child	214	36.1	111	18.7	15	2.5	64	10.8	189	31.9
I feel difficult in giving the right kind of food for my child	100	16.9	199	33.6	17	2.9	103	17.4	174	29.3
I feel less important for a father to spend much time with my children	57	9.6	179	30.2	55	9.3	154	26	148	25
I feel difficult that support my wife for child feeding and care	55	9.3	298	49.4	0	0	98	16.5	147	24.8
I feel confident that support my wife for child feeding and care	54	9.1	270	45.5	16	2.7	92	15.5	161	27.2
I feel right that mother should be as heavily involved in the child feeding	77	13	189	31.9	74	12.5	141	23.8	112	18.9
I feel happy, if my wife asked me to help her by feeding the child	33	5.6	180	30.4	116	19.6	108	18.2	156	26.3
Overall attitude	Positive attitude								266	44.9
	Negative attitude								327	55.1

3.4. Perceived Cultural Practices in the Community About Fathers Involvement in Child Feeding

Among participants 523 (88.2%) of respondents replied that traditionally there was gender‐specific role in the community. Most of the community, 494 respondents (83.3%), believed that child feeding is primarily the mother's responsibility. Only 82 respondents (13.8%) reported that the community mocks or disapproves when fathers participate in child feeding. Overall, fewer than half of the respondents, 276 (46.5%), demonstrated supportive cultural practices towards father involvement in child feeding (Table 3).

Table 3.

Perceived cultural practices in the community of fathers about fathers' involvement in child feeding in Ambo town, Ethiopia, 2024 (n = 593).

Variables	Categories	Frequency	Percent
Community discourage father to take an active role	Yes	181	30.5
	No	412	69.5
Your wife did not want father involvement in child feeding	Yes	244	41.1
	No	349	58.9
Community laughed, sanctioned in your involvement in child feeding	Yes	82	13.8
	No	511	86.2
Traditionally gender gender‐specific role in your community	Yes	523	88.2
	No	69	11.6
Community think, CF is the only responsibility of mother	Yes	494	83.3
	No	99	16.7
Overall cultural practices	Good	276	46.54
	Poor	317	53.46

3.5. The Level of Father Involvement in Child Feeding

More than half, 321 (54.1%), with 95% C.I: 50.04%, 58.2%, of participants, had involvement in child feeding, while 272 (45.9%) of them had poor involvement in child feeding (Table 4).

Table 4.

Level of fathers' involvement in child feeding in Ambo town, Ethiopia, 2024 (n = 593).

Fathers involvement	Categories	Frequency	Percent
Discuss with wife in CF before making decision	Yes	351	59.2
	No	242	40.8
Fathers have equal decision making power as mother at home	Yes	382	64.4
	No	211	35.6
Participate in final decision on CF	Yes	308	51.9
	No	285	48.1
Final decision on when to start CF	Yes	285	48.1
	No	308	51.9
Final decision on what food to start during complementary feeding	Yes	249	42.0
	No	344	58.0
Final decision on the order of serving food during meal times	Yes	258	43.5
	No	335	56.5
Participate in child feeding during meal time	Yes	292	49.2
	No	301	50.8
Assist mother with household chores	Yes	415	70.0
	No	178	30.0
Assist mother with farming activities to get nutritious food for your child	Yes	124	20.9
	No	469	79.1
Accompany the mother for child health clinic	Yes	413	69.6
	No	180	30.4
Allow other family members/relatives to support the mother after deliver	Yes	442	74.5
	No	151	25.5
Community encourage you to take an active role in CF	Yes	254	42.8
	No	339	57.2
Encourage your children to take food while the mothers were in CF	Yes	448	75.5
	No	145	24.5
Motivate your spouse to get involved in the CF	Yes	390	65.8
	No	203	34.2
Buy food for the child	Yes	405	68.3
	No	188	31.7
Buy clothing, child care items and d/t child food for your child	Yes	410	69.1
	No	183	30.9
Transport your child to health clinics	Yes	344	58.0
	No	249	42.0
Gave money to the mother to purchase the necessary food for the children	Yes	537	90.6
	No	56	9.4
Usually feed the child at home	Yes	213	35.9
	No	380	64.1
Cook a meal for a child food at home, when a mother is in breastfeeding	Yes	188	31.7
	No	405	68.3
Look after your child when mother were not around	Yes	397	66.9
	No	196	33.1
Overall fathers involvement	Involved	321	54.1
	Not involved	272	45.9

3.6. Factors Associated With Fathers Involvement in Child Feeding

Binary logistic regression was performed to explore associations between fathers' involvement in child feeding and potential explanatory variables. In the bivariate analysis, factors including the educational status of the father and spouse, number of children, sex and birth order of the youngest child, occupational status of the father and spouse, knowledge, attitude and cultural practices were significantly associated (p < 0.2) with fathers' involvement. In the multivariable logistic regression model, educational status of the father, occupational status of both parents, knowledge, attitude and cultural practices remained statistically significant (p < 0.05). Fathers with a diploma or higher education were 3.42 times more likely to be involved in child feeding compared to fathers with no formal education (AOR = 3.42, 95% CI: 1.19–9.83). Those employed in government and nongovernment/private sectors were 3.75 (AOR = 3.75, 95% CI: 1.10–12.76) and 3.65 times (AOR = 3.65, 95% CI: 1.01–13.19) more likely, respectively, to be engaged compared to farmers. Similarly, fathers whose spouses worked in government or nongovernment/private sectors were 3.48 (AOR = 3.48, 95% CI: 1.60–7.59) and 2.61 times (AOR = 2.61, 95% CI: 1.11–6.15) more likely to be involved. Fathers with positive attitudes towards child feeding were 3.87 times more likely to be involved (AOR = 3.87, 95% CI: 2.23–6.73), while those with favourable cultural practices and good knowledge were 2.31 (AOR = 2.31, 95% CI: 1.36–3.94) and 3.84 times (AOR = 3.84, 95% CI: 1.32–3.75) more likely, respectively, to be involved in child feeding (Table 5).

Table 5.

Binary and multivariable logistic regression analysis for factors associated with fathers' involvement among fathers having children aged 6–24 months in Ambo town, 2024 (n = 593).

		Father involvement
		Involved	Not involved
Variables	Categories	N (%)	N (%)	COR (95% CI)	AOR (95% CI)	p
Educational status of father	No formal education	9 (1.5)	45 (7.6)	1	1
	Primary school	9 (1.5)	81 (13.7)	0.556 (0.21, 1.5)	0.656 (0.18, 2.34)	0.517
	Secondary school	33 (5.6)	58 (9.8)	2.85 (1.24, 6.55)	2.97 (0.95, 9.3)	0.062
	Diploma and above	270 (45.5)	88 (14.8)	15.34 (7.21, 32.64)	3.42 (1.19, 9.8)*	0.023
Educational status of Spouse	No formal education	13 (2.2)	82 (13.8)	1	1
	Primary school	45 (7.6)	77 (13)	3.69 (1.85, 7.36)	2.17 (0.87, 5.38)	0.095
	Secondary school	60 (10.1)	47 (7.9)	8.05 (4.00, 16.19)	2.14 (0.82, 5.56)	0.119
	Diploma and above	203 (34.2)	66 (11.1)	19.40 (10.15, 37.07)	2.40 (0.98, 5.87)	0.054
Occupation of father	Farmer	24 (4)	5 (0.8)	1	1
	Merchant	84 (14.2)	51 (8.6)	2.91 (1.05, 8.12)	2.095 (0.608, 7.214)	0.241
	Government	54 (9.1)	180 (30.4)	16.00 (5.82, 43.95)	3.75 (1.102, 12.76)*	0.034
	NGO/private	43 (7.3)	80 (13.5)	8.93 (3.18, 25.07)	3.650 (1.010, 13.194)*	0.048
	Daily labourer	67 (11.3)	5 (0.8)	0.36 (0.09, 1,35)	0.381 (0.075, 1.930)	0.244
Occupation of spouse	Merchant	42 (7.1)	37 (6.2)	1.83 (1.10, 3.06)	1.31 (0.65, 2.62)	0.450
	Government	108 (18.2)	15 (2.5)	11.61 (6.38, 21.13)	3.48 (1.60, 7.59)*	0.002
	NGO/private	63 (10.6)	13 (2.2)	7.82 (4.08, 14.98)	2.61 (1.11, 6.15)*	0.028
	Daily labourer	15 (2.5)	57 (9.6)	0.42 (0.23, 0.79)	0.95 (0.41, 2.19)	0.899
	House wife	93 (15.7)	150 (25.3)	1	1
Number of children	≥ 3	51 (8.6)	150 (25.3)	1	1
	< 3	270 (45.5)	122 (20.6)	0.15 (0.11, 0.23)	1.64 (0.93, 2.89)	0.085
Sex of the youngest child	Female	96 (16.2)	153 (25.8)	1	1
	Male	225 (37.9)	119 (20.1)	0.33 (0.24, 0.47)	1.15 (0.89, 2.47)	0.698
Birth order of the child	First Child	158 (26.6)	57 (9.6)	3.66 (2.54, 5.27)	1.12 (0.64, 1.93)	0.698
	Not first child	163 (27.5)	215 (36.3)	1	1
Fathers attitude	Positive	216 (36.4)	50 (8.4)	9.13 (6.21, 13.43)	3.88 (2.23, 6.73)*	0.001
	Negative	105 (17.7)	222 (37.4)	1	1
Fathers culture	Positive	220 (37.1)	56 (9.4)	8.40 (5.77, 12.24)	2.31 (1.36, 3.9)*	0.002
	Negative	101 (17)	216 (36.4)	1	1
Fathers knowledge	Good	242 (40.8)	88 (14.8)	6.40 (4.47, 9.17)	2.21 (1.30, 3.75)*	0.003
	Poor	79 (13.3)	184 (31)	1	1

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio.

^*Significant at p‐value < 0.05; 1 – Reference.

3.7. Findings From Qualitative Data

Seventeen key informants, including six health extension workers and eleven mothers of children aged 6–24 months, were interviewed. They were asked about their perceptions of fathers' involvement in child feeding, how fathers support their wives in feeding their children, perceived barriers to fathers' involvement and recommendations for overcoming these challenges.

Regarding fathers' involvement in feeding children aged 6–24 months, key informants noted that fathers are rarely directly involved.

One health extension worker shared: ‘We have observed that fathers rarely get directly involved in feeding their children. During our house‐to‐house visits to provide community health services, we notice that fathers' involvement in child feeding is very poor’ (Age 32, female, HEW).

Similarly, a mother remarked: ‘There are very few fathers who get directly involved in feeding their children or cooking food for them’ (Age 29, Mother of a child aged 6–24 months).

The key informants described how fathers support child feeding indirectly, rather than through direct involvement. They highlighted that fathers tend to provide support by purchasing food, clothing and other necessities rather than participating in actual feeding.

For example, a health extension worker observed: ‘…Even though they are not involved in direct feeding, we observed that there are fathers who support child feeding by buying food, clothes, and other necessary items for their child’ (Age 34, female, HEW).

Another mother shared a similar perspective: ‘Some fathers support child feeding by buying food and childcare items like diapers, baby clothes, and wipes. Some also give money to the mothers rather than purchasing items themselves’ (Age 29, Mother of a child aged 6–24 months).

3.8. Barriers/Challenges Regarding Fathers' Involvement in Child Feeding

Interviews with the key informants (health extension workers and mothers of children's aged 6–24 months) revealed a number of factors that affected the involvement of fathers' involvement in child feeding. Accordingly, the main themes emerged as the key barriers the fathers' involvement in child feeding, include occupation of fathers, occupation of mother, cultural practices and attitude.

3.9. Attitude of Fathers Towards Fathers' Involvement in Child Feeding

Participants reported that most fathers do not take part in child feeding because of their negative attitude towards fathers' involvement in child feeding. The community has defined distinct roles for fathers and mothers in child feeding, and many fathers believe that involving in child feeding is not their role.

…some fathers have an uncaring or uninterested attitude towards feeding their child. This is influenced by traditional gender roles. They believe that feeding the child is the mother's responsibility and they don't see a need to be actively involved.

(Age 30, female, HEW)

My husbands preferred to stick to the traditional ways he was raised, even though I knew it wasn't the best approach for our child, my husband didn't see the need to be involved in our child's feeding. He thought it was my responsibility as the mother.

(Age 29, Mother of child aged 6‐24months)

3.10. Occupation of Father

In this study area mostly outside workers were fathers and because of long hour working time they have no time to participate in child feeding properly.

Fathers who have demanding or inflexible work schedules, often find it challenging to be involved in child feeding. They may have limited time and energy to participate in the process.

(Age 29, female, HEW)

My husband works long hours as daily laborer, so he's rarely at home during mealtimes. It's difficult for him to be actively involved in our child's feeding routine.

(Age 29, Mother of child aged 6–24 months)

…My husband's job as a construction worker keeps him away from home for most of the day, making it hard for him to be involved in our child's feeding.

(Age 29, Mother of child aged 6–24 months)

3.11. Occupation of Mother

In this study area mostly outside workers were fathers but there were also some mothers who work outside in such situation fathers' involvement were great.

In households where the mother works outside the home, we've observed that fathers tend to take on a more active role in child feeding. When the mother is away at work, the father has to step up and make sure the child is fed properly. This allows him to become more knowledgeable and hands‐on with feeding the child even if more of them have maid servant.

(Age 34, female, HEW)

Since I work long hours outside the home, my husband has had to get more involved in feeding our child. My husband has learned a lot about feeding our child because he's had to do it more often while I'm at work. He's become much more engaged in making sure our child eats well.

(Age 31, Mother of child aged 6–24 months)

As a full‐time homemaker, I'm expected to handle all the childcare responsibilities, including feeding, according to traditional norms. It's hard for me to find the time to actively engage my husband in our child's feeding.

(Age 28, Mother of child aged 6–24 months)

3.12. Perceived Cultural Practice in the Community

According to cultural norms of the society, it is not widely accepted or expected for fathers to be involved in child feeding activities, such as cooking food and directly feeding the child. Both HEW and mothers said.

….Traditional cultural beliefs and practices can significantly influence fathers' involvement in child feeding. Some communities may view it as the mother's exclusive responsibility, discouraging fathers from participating. ‘In our community, it's considered unacceptable for fathers to be actively involved in child feeding especially involving by cooking food and feeding child directly. They are expected to be the breadwinners, while mothers handle all the childcare duties.’

(Age 29, female, HEW)

…In our community, it's considered unacceptable for fathers to be actively involved in child feeding. Our traditional cultural norms dictate that child feeding is the mother's responsibility. My husband feels it's not his place to be involved, especially in cooking and feeding child directly, even though I know it would benefit our child.

(Age 29, mother of child aged 6–24 months)

4. Discussion

This study assessed fathers' involvement in child feeding and associated factors among fathers of children aged 6–24 months in Ambo town, Ethiopia. Slightly more than half (54.1%) of fathers reported get involved in complementary feeding, which is lower than findings from Northern Ghana (63.5%) (Saaka et al. 2023), and rural Southwestern Uganda (63%) (Kansiime et al. 2017). This variation may reflect socio‐cultural differences, varying norms around fatherhood, and exposure to health promotion interventions. However, the proportion observed here was comparable to Damot Woyde district in Ethiopia (50.9%) (Wolkanto et al. 2023) and higher than that reported in Antsokiya Gemza district (43.1%) (Bogale et al. 2022). This difference might partly result from this study's urban focus, while other studies included rural areas where traditional gender roles may be more strongly enforced.

The study highlights the critical role of fathers' education in influencing their engagement. Fathers with at least a diploma were over three times more likely to be involved compared to those without formal education, consistent with studies in Nepal (WHO 2016) and the Antsokiya Gemza district, Ethiopia (Bogale et al. 2022; WHO 2016). Higher education likely increases awareness of child nutrition and reinforces the perceived importance of shared caregiving responsibilities (Bhattacharyya et al. 2023). Their educational attainment likely provides them with the knowledge and awareness to recognize the importance of their active participation in this crucial aspect of childcare. This might be explained by the fact that fathers who had better education could have better information and a better understanding of the importance of father involvement in child feeding (Bhattacharyya et al. 2023). This underscores the potential of educational attainment to positively shape parenting practices.

Occupational status also emerged as an important determinant of involvement. Fathers employed in government and nongovernment sectors demonstrated significantly higher engagement than daily labourers. This finding aligns with research from India (Kumari et al. 2015) and Bangladesh (Bhattacharyya et al. 2023). Where formal employment provided fathers with better access to information, financial stability and supportive work environments (Manikam et al. 2017; The Relationship between Maternal Gatekeeping, Paternal Competence, Mothers' Attitudes about the Father Role and Father Involvement). The qualitative data further illustrated that long working hours and inflexible schedules often limited direct participation in child feeding. However, fathers in stable employment were more likely to supplement caregiving through financial and material support, demonstrating how work circumstances shape the nature of fathers' contributions.

Interestingly, fathers whose spouses were employed outside the home reported greater involvement in feeding. This may reflect a redistribution of childcare responsibilities out of necessity when mothers are working. As some participants described, fathers acquired more knowledge and confidence in feeding when they assumed these duties during their spouses' absence. This finding suggests that promoting shared caregiving roles in households where both parents work could enhance fathers' engagement.

Cultural expectations also significantly influenced involvement. Fathers who perceived supportive cultural practices were more likely to be engaged, aligning with prior studies (Bogale et al. 2022; Alive and Thrive 2012). This underscores that interventions must consider local norms and work to transform entrenched stereotypes that discourage fathers' participation in domestic and childcare activities.

Finally, good knowledge of child feeding was associated with higher involvement, echoing findings from studies in Rwanda and Ethiopia (Bogale et al. 2022; Catholic Relief Services 2016; Wolkanto et al. 2023). Knowledge not only provides fathers with the information necessary for appropriate feeding practices but may also reinforce confidence and positive attitudes (Han et al. 2019). Integrated community nutrition programmes that combine knowledge dissemination with attitude change could be especially effective.

Overall, this study demonstrates that paternal involvement in child feeding is shaped by a complex interplay of educational, occupational, cultural and attitudinal factors. Integrating targeted health education with broader social norm change could be key to promoting fathers' engagement and improving child nutrition outcomes.

This study has several limitations. First, although a two‐stage cluster sampling design was applied, clustering was not accounted for during regression analysis, which may have led to underestimation of standard errors and narrower confidence intervals. Additionally, applying a uniform sampling interval across kebeles of different sizes may have introduced sampling bias and affected equal selection probabilities. The cross‐sectional design limits the ability to draw causal inferences about the observed associations. Self‐reported measures of fathers' involvement could be subject to social desirability bias, potentially leading to overestimation of actual practices. Finally, while the questionnaire demonstrated acceptable internal consistency overall, separate reliability estimates for each subscale were not calculated, which may affect measurement precision for specific constructs.

5. Conclusion

More than half of fathers were involved in complementary feeding of their children, though engagement remains suboptimal. Fathers' educational level, occupational status, knowledge, attitudes and cultural practices were significantly associated with involvement. Interventions aiming to improve fathers' participation should address these determinants through community‐based education and strategies to transform traditional norms that limit shared caregiving.

Author Contributions

Wakuma Amsalu Gemede, Gizachew Abdissa Bulto and Tufa Kolola Huluka conceptualized and designed the study, developed the methodology, supervised the data collection, analysed and interpreted the data, and participated in the write‐up and revisions of the manuscript. Mitsiwat Abebe Gebremichael, Kefyalew Taye Belete, Yonas Sagni Dob and Iranfachisa Gurmu Amana participated in the methodology, analysed and interpreted the data, and participated in the write‐up and revisions of the manuscript. All authors have read and approved the final manuscript.

Consent

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

S1: Additional file– Questionnaire.

Data Availability Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.