Advancing the family management style framework: incorporating social ecology

Advancing family science and health equity through the 2022-2026 National Institute of Nursing Research strategic plan

BACKGROUND

Consistent with the National Institute of Nursing Research's mission of leading nursing research to address current health challenges, the new Strategic Plan identifies five research lenses: health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care. Family research, central to nursing research and practice, is the cornerstone of social ecology and represents a critical intersection of social and structural determinants of health.

PURPOSE

We argue why family health is essential to the 2022-2026 Strategic Plan and how the lenses can strengthen family research.

METHODS

Drawing from collective expertise and existing literature in family research, sociology, psychology, and nursing science, the authors present a new conceptual model that integrates structural racism and heteropatriarchy to examine the salience of family structure statuses for family outcomes and discuss approaches to research design, empirical measurement, and interpretation in order to bring this new model into practice.

DISCUSSION

The NINR Strategic Plan has the potential to dismantle structures that perpetuate racism and health inequity within and across family structures. An underaddressed research area under the new Strategic Plan relates to how social determinants of health influence and are influenced by families.

CONCLUSION

We challenge all investigators, not just family scientists, to expand the scope of their research to conceptualize the role of family on health inequities.

Adapting the Family Management Styles Framework to Include Children

EMPIRICAL STUDY PURPOSE

Propose an adapted Family Management Style Framework that includes the perspectives of children with chronic health conditions.

DESIGN AND METHODS

Building on the current Family Management Style Framework, the authors used recent empirical studies with children to further develop the framework. Definitions of each dimension and component of the framework were reviewed and revised to reflect the perspectives of the child, based on the child data and prior work.

RESULTS

The Family Management Style Framework was adapted to reflect children's perspectives of themselves and their family. Based upon our understanding of the components of the framework, we expanded the components and revised the definitions of the dimensions to reflect the child perspectives.

CONCLUSIONS

Incorporating the perspectives of children allows us to consider the transactions that occur during condition management between parents, children and families. Additional research is needed to explore this interaction and the implications it has on the outcomes.

PRACTICE IMPLICATIONS

Children experience the way their family manages their chronic health condition and incorporate those experiences as part of their developing understanding of themselves and their condition. Practitioners should encourage children to express their understanding of their condition and its management to model and encourage them to dialogue about management with their families.

Chinese family management of chronic childhood conditions: a cluster analysis

PURPOSE

This study compared the management of chronic childhood conditions in Chinese families and identified predictors of management style.

DESIGN AND METHOD

A survey was conducted in 2008-2009 on a convenience sample of 387 caregivers of children with chronic conditions.

RESULTS

Six family management styles (FMSs) were identified: accomplished, uncertain managing, joint managing, managing with difficulty, struggling, and competent managing. The FMSs were related to the functioning of the family and the child. Changes in parents' employment, geographic location, and diagnosis predicted family placement in a cluster.

PRACTICE IMPLICATIONS

Understanding Chinese FMSs will further aid in providing culturally appropriate family-centered care. Awareness of the predictors of FMSs can assist nurses in detecting which families need more help.

Testing the Applicability of the Family Management Style Framework to Chinese Families

Family management is an important concept in caring for chronically ill children. The purpose of this study is to determine the applicability of the Family Management Style Framework for Chinese families with a child who has a chronic condition. The children ranged in age from 6 to 16 years. The structural equation modeling approach was utilized to examine the relationships among the contextual variables, the family management, the child, and the family functioning. A total of 538 caregivers from seven hospitals in China were included in this study. The final model adequately fitted the data. The predictor variables accounted for 23%, 26%, 7.8%, and 12% of the variance in the easy and the challenging parts of family management and the child and family unit, respectively. These findings indicated that the framework is applicable to Chinese families. This result reinforces the importance of interventions designed to enable caregivers to improve family management.