A Model of Family Health: Contributors to Robust Family Health and Implications for Occupational Therapy Practice

BACKGROUND: Vital to positive child outcomes is the health of the family or family health. To date, investigation of family health has been limited to studies investigating discrete factors of family life such as family interaction, family functioning, parenting stress, and parenting styles. Given critical associations between components of family health and child development, inquiry into explicating the phenomenon of family health is warranted to reveal indicators for robust family health to strengthen current models of occupational therapy (OT) interventions aimed at supporting positive health outcomes for the family and child.

Therefore, the purpose of this study was to explicate families’ perceptions of family health for families raising typically developing children with the intent to generate a preliminary theoretical model describing the distinguishing features and construction of family health. This study addressed the following research questions: (1) What is the experience of family health and (2) what contributes to robust family health?

DESIGN: The research team used constructivist grounded theory methods.

PARTICIPANTS: Ten families were interviewed in the study, with a total of 32 people interviewed. Inclusion criteria were families who had children without a history of or suspected developmental delays or disabilities. Families were excluded from study participation if any of their children were (1) not living in the home full time, (2) <6 yr old, or (3) diagnosed with a disability.

DATA COLLECTION: Interviews with all consented family members were conducted in person, audiotaped, and transcribed. Questions examined families’ perspectives about what the experience of family health meant to them and what contributed to robust family health. Participants completed a demographic survey.

ANALYSIS: A team of analysts convened weekly for 12 sessions to triangulate analyses for development of a family health model using constructivist grounded theory methods. Researchers independently coded interview transcripts line by line and through group consensus separated data into 61 codes. Researchers collapsed codes into 14 categories from which central themes emerged. Researchers returned to the interviews to test the emerging theory. Family participants were contacted and presented findings to ensure credibility of the findings.

RESULTS: Findings informed the development of a preliminary family health model to frame families’ experiences of family health. The model captures family health being constructed of (1) living purposefully and with balance; (2) engaging in an ongoing process of occupational adaptation; and (3) being grounded in family identity and togetherness. External constraints such as work, time, finances, and occupational challenges existed across families. The presence and degree of occupational adaptation processes appeared to mediate family health.

DISCUSSION: Revealing family occupation in families with typically developing children and its relationship to family health provides another step in refining the construct of family occupation and provides a portal through which occupational scientists can investigate the integrity of occupation at a systems level. This study exposes occupational processes that can be explored and provides a platform for discussion for occupational science to be translatable to models of service delivery.

IMPACT STATEMENT: Findings from this study inform OT practice by providing practitioners with a preliminary theoretical model accounting for family health. With this knowledge, occupational therapists can be better equipped to identify families who may be at risk of poor family health and intervene to maximize family and child health.