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Denham (1999) article summary

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NUR1 221
Shari Gagne

Linked readings Class #1: Denham (1999) Part I: The Definition and Practice of Family Health - Although the literature reflects wide use of the term family health, the concept is ambiguous and lacks conceptual clarity.An ethnographic study about family health was conducted to identify how family health was actually defined and practiced within family households. - Family health was identified as a dynamic and complex construct consisting of multiple member interactions within and across the boundaries of households nested within social contexts. Family members used communication, cooperation, and caregiving to develop and sustain individual and family health routines. - Strong evidence exists that health factors are learned and experienced within a family context, but substantive evidence about the ways families define, practice, or promote health are lacking. - Continually soaring health care costs aimed at meeting the needs of individuals indicates a need to develop health care models that ensure that private and public health care resources are used to produce effective outcomes. - Methods to achieve these goals are mostly aimed at individuals rather than families  - Understanding about the interdependent relationships among complex family health variables related to individuals, families, and communities is lacking. Family health is poorly understood and little of what is known is actually incorporated into practice.  Literature Review: - Ethnographies do not usually include literature reviews, but the ambiguity found in the literature about family health provided the reason to complete this study. - The terms family health, family functioning, and healthy family are often used interchangeably with the emphasis usually placed on functional levels. - “Family health is a concept that is often referred to in the literature and is identified as a goal of nursing intervention; however, it is seldom defined”. - Family health has been viewed as a socially constructed phenomenon, best understood through beliefs and behaviors. - Alack of consensus about the meanings of health and family adds to the confusion about family health. - Family health should be holistically defined, encompass both wellness and illness variables, and focus on the interactive, developmental, functional, psychosocial, and health processes of family experience. - Curran’s (1985) survey of professional family workers is often cited in relation to family health, but these findings provide professional perspectives rather than family perspectives. Whereas Curran’s findings reflect functional or relational views, they do not include the complex interacting biophysical and contextual variables relevant to family households. - The conclusions drawn from the literature were the following: o (a) The concept of family health is poorly understood, o (b) The construct lacks definitions that include the potential confounding variable interactions, o (c) The study of family health contains methodological concerns similar to what has been described in relation to family research. - Thus family research should be base in clear conceptualizations, clearly operationalize the variables of interest, use reliable and valid family instruments, and identify potential confounding factors. - Appalachian Family Health: o Family health studies should include health-related beliefs, values, and traditions in culturally relevant frameworks. Appalachian regions are populated by less distinguishable ethnic groups and include populations characterized by diversity in education, economics, and social class. Although cultural implications relevant to the health of Appalachians have been identified, others have warned of risks associated with allowing assumptions about cultural themes relevant to the past to guide present practices. - Conceptual Framework: o The ecological framework of Bronfenbrenner (1979, 1986) was viewed as a natural way to envision family systems within their nested societal context. Methodology:  The purpose of this study was to explore ways that rural Appalachian families with preschool children defined and practiced family health within household contexts.  Ethnographic methods provided an investigative approach to family health from the participants’ perspectives and allowed the lived experience to be explored through family practices, traditions, and rituals. Use of this design allowed the study of family health from a cultural perspective (Patton, 1990) and permitted the scope of family life to be narrowed to the phenomenon of interest.  Repetitiously formatted questions were checks for consistency within and between reporting members, and discussions included questions about beliefs and practices of absent members.  Categories (N = 170) related to health beliefs, behaviors, knowledge, and family context were identified. These categories provided comparative data for contrasting beliefs and practices of children, parents, and families. Themes were identified as these data were analyzed, meanings abstracted, and interpretations made. Study Participant:  The participants were families with preschool children (N=8) who were linked by at least three generations of ancestors to a rural Appalachian area (see Table 1).  Family membership, educational attainment, employment status, community involvement, and religious beliefs differed among the participant families.  Parents were older than expected (mothers: M= 35.9 years; fathers: M= 38.1 years). One single mother participated in the study and five families included children from relationships other than the present marriage.  Community settings: o The county where the families resided is 1 of 29 in Ohio identified by the Appalachian Region Commission as economically and socially deprived. o Although some health care services are available locally, most residents travel outside the county and/or state to receive some health services. Study Findings: 1. Key findings were the following: (a) Early parental socialization contributed to important health resources, (b) Mothers were primarily responsible for family health, (c) Members participated in family health routines, (d) Family health was a lived experience affected by beliefs and practices, (e) Health knowledge was not consistently incorporated into family health routines, and (f) Community and cultural context affected family health. Family health was dynamic and influenced by complex multidimensional variables and traits of individual members. 2. Early healthy socialization: a. Parents identified childhood as the time when some health beliefs and practices that were later viewed as important and/or practiced were learned. Although parents differed in their abilities to recall childhood health experiences, all described some health beliefs and practices learned early in life. b. Participants discussed most childhood learning about health as casual, largely unplanned, and usually similar to priorities of the family of origin. c. These parents said that health was emphasized more now than when they were young, but most could describe some behaviors they learned as children that they were currently teaching to their own children. d. Example: Although Mr. Anderson was raised in a home where his parents smoked, his knowledge of smoking risks caused him to devalue the habit and he was teaching his son to abstain. e. Factors influencing these alterations included life experiences and contextual determinants f. Whereas parental beliefs and values influenced children, health knowledge and attitudes were also tempered by social context. g. In this study, spiritual values and family traditions were influential factors affecting parent’s health beliefs, values, and the health behaviours children were taught. h. Time was an important resource for these families. Time was described in relationship to family patterns and influenced the consistency of individual and family health practices and health values. i. Parents described time-associated factors that influenced individual health practices and were unconscious messages about health they were teaching children. j. Families experienced highly interactive times when approaching developmental stages, such as marriage, childbirth, school transitions and described these times as milestone events that triggered responses and affected health behaviours. Parents described developmental stages as events that affected emotional, social, and cognitive health. k. Unpredictable events
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