Instead of seeing it as a health care issue, you see it as you: Reasons for alcohol use, consequences of use, and barriers to help seeking among fathers in Kenya

IntroductionFather alcohol use negatively impacts family systems, yet research in this area is scarce in low- and middle-income countries like Kenya. An understanding of why fathers drink, consequences of alcohol use, and barriers to care is needed to refine and adapt clinical and implementation approaches to treating fathers. MethodsCommunity members, leaders, mental health providers, and fathers experiencing alcohol use problems in Eldoret, Kenya were recruited to participate in semi-structured qualitative interviews and focus groups. Participants were asked about why fathers engage in alcohol use, potential impacts of use, and barriers to accessing care. The frame method was employed to analyze the data. The study team read transcripts, iteratively memo-ed and discussed notes, developed a codebook, and coded transcripts. Broad codes were summarized and reviewed alongside transcripts. ResultsParticipants noted reasons for and consequences of fathers drinking at individual, family and interpersonal, and sociocultural levels. At the individual level, alcohol use facilitated an escape from mental distress and acted as a means to cope with "idleness" due to unemployment. Consequences included poor physical and mental health, such as depression. At the family/interpersonal level, fathers used alcohol to distract themselves from family conflicts. Consequences included violence and poor child outcomes. Gender and drinking norms were drivers at the sociocultural level. Consequences at this level included stigmatization and loss of social status, which can drive shame and isolation. Salient barriers to care included fathers lack of awareness of their alcohol use problem, limited-service access, and social stigma. ConclusionsFather motivations for drinking are influenced by multiple ecological levels, and drinking has a cascade of consequences on the family. These effects are worsened by barriers to care. Intervention and implementation strategies should consider masculinity norms, resources, and avoidant coping motivations in adaptation.