Psychometric properties of the Family Resilience Assessment Scale: A Singaporean perspective

A reliability generalization meta-analysis of the family resilience assessment scale (FRAS)

PROBLEM

Practitioners and researchers frequently rely on the Family Resilience Assessment Scale (FRAS) to assess family resilience, and previous research reported varying reliability statistics for the measurements with the scale. The present study aims to generalize the reliability of the FRAS based on Cronbach's alpha coefficients reported in the selected studies.

ELIGIBILITY CRITERIA

We selected relevant research on various databases, including Web of Science, PubMed, ProQuest, Scopus, YÖK Thesis Center, DergiPark, and TR Index.

SAMPLE

Satisfying our inclusion criteria, fifty-five studies were included in the present study.

RESULTS

We calculated the reliability generalization coefficients for the FRAS total score to be 0.951 (95% CI [0.942, 0.958]) and 0.949 for Family Communication and Problem Solving, 0.792 for Utilizing Social and Economic Resources, 0.861 for Maintaining a Positive Outlook, 0.635 for Family Connectedness, 0.873 for Family Spirituality, and 0.702 for Ability to Make Meaning of Adversity.

CONCLUSIONS

In a nutshell, our findings secure substantial insights into the reliability of the FRAS and its subscales for prospective researchers and practitioners. In this study, generalized Cronbach's alpha values imply average, good, and acceptable reliability for the FRAS subscales and total score, except for Family Connectedness.

IMPLICATIONS

The distinct contribution of our research may be to reemphasize the significance of avoiding reliability induction and to raise awareness among prospective researchers of evaluating the reliability of any measurement they would obtain.

A psychometric study of the revised Chinese version of the family resilience assessment scale among children disadvantaged due to family migration

OBJECTIVE

The family system is important for children's development. Previous research has demonstrated that some families are able to maintain good adaptability or resilience in the face of stressors. This study aimed to develop the revised Chinese version of the Family Resilience Assessment Scale and examine the psychometric properties of the scale among children disadvantaged in adversity due to family migration.

METHODS

A total of 1487 children (47.6 % girls) from disadvantaged families participated in this study, whom completed the revised Chinese version of the Family Resilience Assessment Scale, the Chinese version of the Connor-Davidson Resilience Scale, and the Center for Epidemiologic Studies Depression Scale for Children.

RESULTS

(1) Good language equivalency was found (Intraclass Correlation Coefficient = 0.96); (2) Item analysis indicated that the critical ratio values of all 45 items were above 0.30 (p < 0.001), except for 7 items that were dropped from further analysis; (3) The exploratory factor analysis indicated that the best model was four-factor model; (4) The confirmatory factor analysis showed that the four-factor model had good model fit; (5) Family resilience was significantly correlated with personal resilience and depression; (6) The internal consistency reliability of the scale was 0.95.

CONCLUSIONS

This study confirmed that the revised Chinese version of the Family Resilience Assessment Scale was a reliable and valid instrument to assess family resilience of Chinese children who are disadvantaged.

Reliability and Validity of the Multidimensional Scale of Perceived Social Support Among Women and Adolescent Girls With Disabilities in Selected Sub-districts of Bangladesh

Background Adequate community-based or societal collaboration and cooperation are considerably important for the overall welfare of women and adolescent girls with disabilities. "The Multidimensional Scale of Perceived Social Support (MSPSS)" has not been evaluated for reliability and validity amid women and adolescent girls with disabilities in the Bangladeshi context. Methods A Bangla-translated form of the MSPSS was constructed, and the survey was conducted among 152 women and adolescent girls with disabilities who were purposefully recruited from Bogura Sadar and Chapainawabganj Sadar sub-districts of Bangladesh. Results The Cronbach's alpha of the entire scale was 0.868, indicating high internal consistency. Cronbach's alpha for the family sub-scale was 0.763, the friends sub-scale was 0.820, and the significant others scale was 0.776. The composite reliability for the family sub-scale was 0.849677, the friends sub-scale was 0.881248, and the significant others sub-scale was 0.859668. Convergence reliability was established following sub-scale-wise scores. It affirms the consistency of measurements. The content validity score was >0.62, following the Lawshe approach. The three-factor model was adopted during confirmatory factor analysis when the three-factor model run in SPSS Amos (version 21) CFI (comparative fit index) was 0.919. Conclusions In Bangladesh, to the best of our knowledge, our study is initially to calculate the perceived societal assistance of women and adolescent girls with disabilities. We validated the Bangla-translated form of the MSPSS from the Bangladeshi perspective. Researchers and clinicians may rely on our accurate and validated MSPSS translation into Bangla when working with this group. Based on our findings, this study endorses implementing the MSPSS for assessing professed community-based collaboration using the three-factor model, especially among women and adolescent girls with disabilities.

Validation of the Chinese version of the Walsh Family Resilience Questionnaire

The Walsh Family Resilience Questionnaire (WFRQ) is one of the most widely used and strong theory-based measurement tools of family resilience. This study aimed to develop and psychometrically test the Chinese version of the WFRQ (WFRQ-C). The WFRQ was translated following Brislin's translation model. Psychometric testing, combining classical theory test and item response theory, was conducted with a sample of 800 community adult residents. The Connor-Davidson resilience scale-10 (CD-RISC-10), Self-reported Family Happiness Scale (SFHS-1), and Family APGAR (Adaption, Partnership, Growth, Affection, Resolve) Scale (Family APGAR-5) were applied for convergent validity. Six items were deleted at the item analysis level. The minimum average partial test and a parallel analysis supported a three-factor structure, which was validated by confirmatory factor analysis. The three factors were named "Family belief system," "Organization, communication and problem solving," and "Utilization of external resources." The WFRQ-C was significantly correlated with CD-RISC-10, SFHS-1, and Family APGAR-5, with r values ranged from 0.51 to 0.56. The Cronbach's α was 0.97 for the scale and 0.93, 0.95, and 0.72 for the three factors, respectively. The ICCs of 0.96 for the whole scale, and 0.95, 0.75, and 0.95 for the three factors, respectively. The mean score for the WFRQ-C was 97.00 ± 17.94, of which per capita monthly income and education level were predictors. The 26-item WFRQ-C is a stable, concise, and validated tool to measure family resilience. It is applicable for Chinese community adults in nonspecific stressful settings and has potential utility in the health care domain.

Development and Validation of the Chinese Family Resilience Scale in Families in Hong Kong

Family resilience is an important protective factor mitigating the negative impact of adversities on individuals and families. As there are very few validated measures of family resilience in the Chinese context, we have developed the Chinese Family Resilience Scale (C-FRS) based on the family resilience framework of Froma Walsh. In this paper, we outline the development and the validation of the C-FRS with reference to the socio-cultural context of Hong Kong. Based on content validation involving family experts, the initial 51 items were assessed in terms of their relevance, clarity, and representativeness. The results showed that these items possessed adequate content validity. In order to validate the 51-item measure, we examined its convergent validity, its factorial validity, and its internal consistency based on the responses of 1020 Chinese families (N = 2858 participants). After removing the items with unsatisfactory psychometric properties, we retained 35 items in the final scale. The results showed that the C-FRS scores were significantly related to family functioning, thus providing support for its convergent validity. This study also provided support for the conceptual model of Walsh (i.e., three high-order domains involving nine primary indicators). Most importantly, the measurement invariance tests showed that the dimensions of the C-FRS were invariant among fathers, mothers, and adolescent children. As the findings support the reliability and the validity of the 35-item C-FRS, we suggest that this measure can be objectively used to assess family resilience in Chinese communities.

Assessing family resilience for African American college students: Confirmatory factor analysis of the Family Resilience Assessment Scale

ObjectivePsychometric properties of the Family Resilience Assessment Scale and its utility for use with African American college students were examined. Participants: Subjects were 440 university students (M age = 21.65, SD = 6.17) who were enrolled during the 2018-2019 academic year and recruited during the fall and spring semesters. Methods: A single-group confirmatory factor analysis was employed to determine the best model for assessing family resilience in an African American college student population. Results: The model fit was poor and could not be respecified due to numerous item cross-loadings. Conclusions: Further research is needed to validate a measure that adequately assesses family resilience for African American students.

Family Resilience and Psychological Responses to COVID-19: A Study of Concordance and Dyadic Effects in Singapore Households

The impacts of COVID-19 may be magnified in a shared environment like the household, especially with people spending extended time at home during the pandemic. Family resilience is the ability of a family to adapt to crisis and can be a protective factor against stress and negative affect. While there have been calls to address family resilience during the pandemic, there is a lack of empirical study on its benefit. In this dyadic observational study, we sought to investigate the concordance of family members’ psychological responses to COVID-19, whether dyad members’ risk factors (COVID-19 exposure and financial impact) mutually affected each other’s psychological responses, and importantly, whether family resilience was a significant factor in these responses. A total of 200 family dyads from the same household completed the Family Resilience Assessment Scale and questionnaires on COVID-19 threat perception, impacts, and exposure. We found concordant dyad responses for COVID-19 threat perception, but not for psychological impact. Using the Actor-Partner-Interdependence Model framework, we found that one’s psychological impact was affected by the financial impact from both dyad members. After controlling for risk factors and demographic covariates, we found that family resilience significantly associated with lower COVID-19 psychological impact, though not with threat perception. The findings suggest that both family and individual factors need to be addressed and there may be benefit in addressing multilevel risk and protective factors using an ecological systems approach, which may help prepare the population for future crises.

Cross-cultural adaptations of the Family Resilience Assessment Scale: a systematic review protocol of measurement properties

OBJECTIVE

The review aims to critically appraise the measurement properties and adaptation processes of all cross-cultural adaptations of the Family Resilience Assessment Scale.

BACKGROUND

A number of family resilience instruments have been developed over the past decade; however, the Family Resilience Assessment Scale reports the best psychometric properties among populations with health issues. Since its publication in 2005, numerous translations and adaptations have been undertaken to use with culturally diverse populations. A systematic review of the properties of the Family Resilience Assessment Scale's cross-cultural adaptations is needed to evaluate the adapted versions' quality (validity, reliability, and responsiveness).

INCLUSION CRITERIA

Studies of interest include validation and cross-cultural adaptation studies of the Family Resilience Assessment Scale as well as research publications reporting psychometric properties of cross-cultural adaptations in specific populations.

METHODS

Nine databases will be consulted: CINAHL, PubMed, Embase, PsycINFO, PubPsych, Health and Psychosocial Instruments database, ProQuest Dissertations and Theses, ScienceDirect, and Web of Science. The search will be limited to publications since 2005 without language restrictions. Articles will be screened by two independent reviewers and will undergo risk of bias assessment. The measurement properties of retrieved instruments will be assessed following COSMIN guidelines. Data extraction will be piloted and completed by two independent reviewers using an adapted extraction form. Psychometric properties will be reported in a narrative synthesis and further supported by a summary table.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO (CRD42020219938).

Measurement properties of family resilience assessment questionnaires: a systematic review

BACKGROUND

There have been numerous measurement questionnaires to estimate the level of family resilience. However, we lack published evidence regarding the most appropriate family resilience questionnaire in different adversity domains.

OBJECTIVE

This study critically assesses and contrasts the measurement properties of questionnaires measuring family resilience in two domains: health care domain and social domain.

METHODS

Ten electronic databases were searched for studies concerning the establishment, adaptation or evaluation of the measurement properties of a family resilience assessment questionnaire. The methodological quality of included studies was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. On the basis of methodological quality and scoring criteria for the quality of questionnaires, the overall evidence of each questionnaire was rated.

RESULTS

A total of 4084 initial studies were obtained, 23 of which met our inclusion criteria assessing 12 different questionnaires. The structural validity (23 studies) and internal consistency (22 studies) were the most frequently used measurement properties. Only two studies tested responsiveness, and the measurement error was not examined in any studies. The Family Resilience Assessment Scale (FRAS) and Italian version of the Walsh Family Resilience Questionnaire (Walsh-IT) showed positive evidence in health care domain. The FRAS performed well in social domain with specific adversity, and the Family Resilience Questionnaire (FRQ) received a good score in social domain without specific adversity.

CONCLUSION

For health care domain, we recommend the FRAS and Walsh-IT. For social domain with specific adversity, we recommend the FRAS questionnaire. For social domain without specific adversity, the FRQ is recommended.

Development and validation of the Family Resilience (FaRE) Questionnaire: an observational study in Italy

OBJECTIVE

Develop and validate an instrument to assess family resilience and, more specifically, the family dynamics and resources, estimating the adaptation flexibility to cancer disease. Cohesion, communication, coping style and relational style were considered as critical functional areas in the construction of the instrument.

DESIGN

Two cross-sectional studies. Study 1: identification of factorial structure of the questionnaire in two samples with different cancer sites. Study 2: validation of the questionnaire in patients with cancer in two different phases of their therapeutic pathway.

PARTICIPANTS AND SETTING

A total of 213 patients with a histologically confirmed non-metastatic breast or prostate cancer and 209 caregivers were recruited for the two studies from an oncological hospital in Italy.

OUTCOME MEASURES

The Resilience Scale for Adults and the Family Resilience (FaRE) Questionnaire, developed by the researchers, were administered to all patients and caregivers who gave consent.

RESULTS

In study 1, the 60-item version of the FaRE Questionnaire underwent discriminant and construct validity, internal consistency and factorial analysis. Comparisons between patient and caregiver populations showed that patients perceived higher levels of family resources (p=0.048) and that patients with prostate cancer perceived less social support compared with patients with breast cancer (p=0.002). Factor analysis demonstrated four domains: communication and cohesion, perceived social support, perceived family coping, and religiousness and spirituality. In study 2, the validity and factorial structure of the final scale, composed of 24 items, were confirmed. The Cronbach alpha of all subscales was above 82. Normative values for patients with breast cancer can provide indications of family resilience levels.

CONCLUSIONS

Preliminary findings showed acceptable psychometric properties for the FaRE Questionnaire to evaluate family resilience in oncological patients and their caregivers. Further research should test its sensibility to change to assess its use as a psychoemotional monitoring tool and its validity in other medical contexts.

A psychometric study of the Family Resilience Assessment Scale among families of children with autism spectrum disorder

Background

The family system represents a critical context within which children develop. Although raising a child with a disability may represent a challenge to this dynamic system, research demonstrates that families have the capacity to demonstrate both maladaptation and resilience in the face of related stressors. In the current study, we examined the psychometric properties of the Family Resilience Assessment Scale (FRAS) among families of children with autism spectrum disorder (ASD). This tool is the only measure of family resilience that seeks to identify within-family protective factors, including the extent to which they rely on adaptive belief systems, organizational patterns, and communication processes. Identifying protective processes utilized by those who show resilience is critical within both clinical practice and research, as it aligns with a strength-based perspective that builds on what families are doing well.

Methods

Participants included 174 caregivers of individuals with ASD (84% mothers). Caregivers completed the FRAS, as well as the Beach Center Family Quality of Life Scale. The 54-item FRAS was submitted to an exploratory factor analysis, using the iterated principal factor method with a promax rotation.

Results

Fifty-one items across 3 factors (Family Communication and Problem Solving, Utilizing Social and Economic Resources, Family Spirituality) were retained, explaining 52% of the total variance. The final scale demonstrated convergent validity with the Family Quality of Life assessment tool.

Conclusions

It is our hope that identifying the optimal scale structure will encourage other researchers to utilize this measure with families of children with ASD, thus continuing to advance the study of family resilience within this unique context.

Development of an eHealth tool for cancer patients: monitoring psycho-emotional aspects with the Family Resilience (FaRe) Questionnaire

In the last decade, clinicians have started to shift from an individualistic perspective of the patient towards family-centred models of care, due to the increasing evidence from research and clinical practice of the crucial role of significant others in determining the patient's adjustment to cancer disease and management. eHealth tools can be considered a means to compensate the services gap and support outpatient care flows. Within the works of the European H2020 iManageCancer project, a review of the literature in the field of family resilience was conducted, in order to determine how to monitor the patient and his/her family's resilience through an eHealth platform. An analysis of existing family resilience questionnaires suggested that no measure was appropriate for cancer patients and their families. For this reason, a new family resilience questionnaire (named FaRe) was developed to screen the patient's and caregiver's psycho-emotional resources. Composed of 24 items, it is divided into four subscales: Communication and Cohesion, Perceived Family Coping, Religiousness and Spirituality, and Perceived Social Support. Embedded in the iManageCancer eHealth platform, it allows users and clinicians to monitor the patient's and the caregivers' resilience throughout the cancer trajectory.

Cognition, health-related quality of life, and mood in children and young adults diagnosed with a glioneuronal tumor in childhood

AIMS

The aim of this study was to investigate long-term cognitive outcome, health-related quality of life (HRQoL), and psychiatric symptoms in children and young adults diagnosed with a glioneuronal tumor in childhood.

METHODS

Twenty-eight children and adolescents (0-17.99years) with a minimum postoperative follow-up time of five years were eligible for the study; four persons declined participation. A cross-sectional long-term follow-up evaluation was performed using the following study measures: Wechsler Intelligence Scale for Children (WISC-IV) or Wechsler Adult Intelligence Scale (WAIS-IV), Reys Complex Figure Test (RCFT), Short Form 36 version 2 (SF-36v2), Short Form 10 (SF-10), Quality of Life in Epilepsy 31 (QOLIE-31), Hospital Anxiety Depression Scale (HADS) or Beck Youth Inventory Scales (BYI), and Rosenberg Self-Esteem Scale. Historical WISC-III and RCFT data were used to compare cognitive longitudinal data.

RESULTS

Mean follow-up time after surgery was 12.1years. Sixty-three percent (15/24) were seizure-free. Despite a successive postoperative gain in cognitive function, a significant reduction relative to norms was seen in the seizure-free group with respect to perceptual reasoning index (PRI), working memory index (WMI), and full-scale intelligence quotient (FSIQ). Seizure freedom resulted in acceptable HRQoL. Thirty-two percent and 16% exceeded the threshold level of possible anxiety and depression, respectively, despite seizure freedom.

CONCLUSION

Although lower than in corresponding reference groups, cognitive outcome and HRQoL are good provided that seizure freedom or at least a low seizure severity can be achieved. There is a risk of elevated levels of psychiatric symptoms. Long-term clinical follow-up is advisable.

Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis

OBJECTIVE

As young people experience added demands from living with epilepsy, which may lead to poor psychosocial adjustment, it is essential to examine mechanisms of change to provide practitioners with knowledge to develop effective interventions. The aim of this study was to examine individual and family-level factors - stress and illness perceptions, coping behaviors and family resilience - that promote or maintain young people's self-esteem.

METHODS

From November 2013 to August 2014, young people attending a neurology clinic in KK Women's and Children's Hospital, Singapore, participated in a cross-sectional survey (n=152; 13-16years old). Multiple mediation analyses were conducted to evaluate whether these variables mediated the relationship between illness severity (i.e., low, moderate, high) and self-esteem.

RESULTS

Multiple mediation analyses demonstrated that illness severity had a direct effect on young people's self-esteem. Compared to those with moderate illness severity (reference group), young people with low severity had significantly higher self-esteem (c=3.42, p<0.05); while those with high severity had a more negative view of themselves (c=-3.93, p<0.001). Illness severity also had an indirect influence on self-esteem through its effects on mediators, such as perceived stress, illness perceptions and family resilience (D₁: Total ab=3.46, 95% CI 1.13, 5.71; D₂: Total ab=-2.80, 95% CI -4.35, -1.30). However, young people's coping levels did not predict their self-esteem, when accounting for the effects of other variables.

SIGNIFICANCE

The continued presence of seizure occurrences is likely to place greater demands on young people and their families: in turn, increased stress and negative illness perceptions negatively affected family processes that promote resilience. As the mediating effect of these modifiable factors were above and beyond the contributions of illness characteristics and young people's levels of coping, this has implications for developing individual and family interventions aimed to support young people living with epilepsy.