Mixed models incorporating intra-familial correlation through spatial autoregression

Parent-Reported Contribution of Family Variables to the Quality of Life in Children with Down Syndrome: Report from an International Study

PURPOSE

The intent of this study was to determine parents' views of the contribution of family variables to the quality of life (QoL) of children with Down Syndrome (DS). Based on prior research, we hypothesized that parents would report that family variables reflecting positive aspects of family functioning contributed to better QoL; and family variables reflecting the negative aspects of family functioning contributed to poorer QoL.

DESIGN AND METHODS

A cross-sectional study was carried out. Invitation letters were sent to DS support groups. Upon agreement, the parents of the children were sent a link to an online survey that included a consent form, demographic questionnaire, and child and family measures.

RESULTS

Results demonstrated the contribution of family demands to children's interpersonal relations. Family appraisals concerning the child and the family's ability predicted the children's physical and material well-being, personal development, self-determination, social inclusion, interpersonal relations, and rights. Family problem-solving served as a prominent predictor for children's physical and emotional well-being, personal development, interpersonal relations, and rights. Also, family resources predicted various aspects of children's QoL including physical, emotional, and material well-being, self-determination, social inclusion, interpersonal relations, and rights.

CONCLUSION

Results confirmed the significant relationship between family and children's QoL variables. Family appraisal and family problem-solving were especially identified as significant predictors of children's QoL that can be targeted for family interventions, since the family variables are modifiable aspects of family life.

PRACTICE IMPLICATIONS

Nurses can use current findings to develop interventions to enhance QoL of children with DS and families.

Measuring Family Members' Experiences of Integrating Chronic Illness Into Family Life: Preliminary Validity and Reliability of the Family Integration Experience Scale:Chronic Illness (FIES:CI)

Measures of family members' experiences of integrating chronic conditions (CC) or chronic illnesses (CI) into family life are needed to optimize family care. This article reports development and psychometric testing of the Family Integration Experience Scale: Chronic Illness (FIES:CI), a measure of family member perceptions of integrating CC or CI into evolving family life. Family Systems Nursing (FSN), the Reintegration Within Families in the Context of Chronic Illness Model, and measurement theory guided the study. Participants were those (N = 328) managing a CC or CI. Concurrent validity (r = +.629; p < .001) and discriminant validity, F(1, 155) = 7.09; p < .05, were demonstrated. Exploratory factor analysis revealed a two-dimensional model explaining 63.8% variance. Scale internal reliability was α = .70 and .785, and factor reliabilities were α = .798 (Factor 1) and α = .847 (Factor 2). Test-retest item and subscale correlations, while accounting for intra-family correlation, were acceptable. The FIES:CI contributes a valuable new measure of family integration in the context of CC or CI with preliminary validity and reliability as tested in these samples.

Tips for Developing a Successful Family Research Proposal

Based on the authors' experiences conducting family research using varied methodological and conceptual approaches, the intent of this article is to offer practical advice for developing a successful research proposal that builds on existing work and makes a compelling case for the investigator's family focus, study design, and analytic approach. The article highlights key challenges unique to family research and offers suggestions and strategies for addressing the challenges.

Discrepancies between couples' perceptions of family functioning in child-rearing Japanese families

This study examined discrepancies in couples' family functioning scores on the Japanese version of the Feetham Family Functioning Survey, which evaluates both internal and external family functioning, and the relationship of family demographic characteristics to such discrepancies. Participants were 313 husband and wife pairs with child(ren) attending nursery school. The discrepancies were significantly related to: the presence of a family member living with a disease/illness; the number of children; mean age of the children; and annual household income. A possible factor that may explain the discrepancies was question design, that is, use of "you" or "your," and the inclusion of questions concerning intrafamily issues. The findings indicated that family-related perceptions by each individual family member may differ. Nurses should therefore be aware that information from just one family member will not necessarily represent the family's actual situation.

A strategy for selecting among alternative models for continuous longitudinal data

Linear mixed models (LMMs) can be used to analyze continuous longitudinal response variables of research studies. Specific aims are then addressed through tests of fixed effects comparing means. However, generated fixed effects results can vary according to the choice of the covariance structure, and so strategies for selecting a model should be utilized first to identify an appropriate covariance structure. We describe alternative LMMs for analyzing continuous longitudinal data and discuss a strategy for using model selection criteria to choose among those models. This is accomplished through the analysis of an exemplar data set considering a wide variety of alternative models for the means, variances, and correlations.

Family functioning of child-rearing Japanese families on family-accompanied work assignments in Hong Kong

Although the number of employees on overseas assignments accompanied by their families has increased steadily, little is known about the effects of this experience on family functioning. Japanese families on family-accompanied assignments living in Hong Kong were compared with families living in Japan (consisting of 135 and 248 paired partners, respectively). Applying an ecological framework, family functioning was examined using the Feetham Family Functioning Survey-Japanese (FFFS-J). Japanese wives living in Hong Kong rated family functioning lower, particularly in the area of "relationship between family and family members." Between paired marital partners living in Hong Kong, the level of satisfaction in the area of "relationship between family and society" was significantly lower for wives than for husbands. This study provides application of the family ecological framework in families in a multicultural environment and identifies potential areas for family assessment and intervention that may of interest to health care professionals who care for families living away from their home countries.

Application of a hierarchical model incorporating intrafamily correlation and cluster effects

BACKGROUND

Research interventions at the family level often include individual- and group-level data that can present an analytic challenge. The study that motivated this article was an intervention study conducted with elementary school children and their parents. Randomization occurred at the school level, with families nested within schools. Repeated measurements collected from children and parents at different time points presented modeling challenges, including how to specify the covariance structure correctly among all measurements.

OBJECTIVES

The aim of this study was to introduce a mixed model with random effects to model the correlations among family members, repeated measures, and the grouping effect.

METHODS

A hierarchical random-effect model was used that included both fixed and random effects; time and intervention-by-time variables were included as fixed effects, the school-specific variable was included as random effect, and the intrafamily correlation was modeled through a spatial autoregression covariance matrix. Comparisons were made between the performance of the proposed modeling method and that of other parsimony models using Akaike's Information Criterion (AIC).

RESULTS

The proposed modeling method produced a 3% and 9% reduction in AIC values, respectively, compared with the two other models. The likelihood ratio test further confirmed that the full model was better than the other two models (p < .0001 for both models).

DISCUSSION

The data suggest that using the proposed mixed model technique will produce a significantly better model fit for intrafamily correlation with a nested study design.

The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes

Current evidence indicates that individuals and families who engage in self-management (SM) behaviors improve their health outcomes. While the results of these studies are promising, there is little agreement as to the critical components of SM or directions for future study. This article offers an organized perspective of similar and divergent ideas related to SM. Unique contributions of prior work are highlighted and findings from studies are summarized. A new descriptive mid-range theory, Individual and Family Self-management Theory, is presented; assumptions are identified, concepts defined, and proposed relationships are outlined. This theory adds to the literature on SM by focusing on individuals, dyads within the family, or the family unit as a whole; explicating process components of SM; and proposing use of proximal and distal outcomes.

Analysis of cross-sectional univariate measurements for family dyads using linear mixed modeling

Outcome measurements from members of the same family are likely correlated. Such intrafamilial correlation (IFC) is an important dimension of the family as a unit but is not always accounted for in analyses of family data. This article demonstrates the use of linear mixed modeling to account for IFC in the important special case of univariate measurements for family dyads collected at a single point in time. Example analyses of data from partnered parents having a child with a chronic condition on their child's adaptation to the condition and on the family's general functioning and management of the condition are provided. Analyses of this kind are reasonably straightforward to generate with popular statistical tools. Thus, it is recommended that IFC be reported as standard practice reflecting the fact that a family dyad is more than just the aggregate of two individuals. Moreover, not accounting for IFC can affect the conclusions.

The enduring and contextual effects of physical health and depression on care-dyad mutuality

Mutuality is a protective factor in family care situations, but little is known about changes in care-dyad mutuality. In this study, we examined mutuality in 103 care dyads over 20 months, and the enduring and contextual impact of older adult and family caregiver health on changes in mutuality. Care dyads consisted of frail older adults and their family caregiver. Older adults reported higher levels of mutuality than family caregivers, but their mutuality declined significantly faster over time. Although changes in physical health were more important than mean health for both older adults and family caregivers, mean depression was more important than changes in depression for older adults. This study shows the importance of examining time-varying covariates in the care dyad.