Family matters

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By Dr. Jeremy Segrott

The concept of family is often taken for granted, perhaps because familial relationships are embedded in our everyday lives. Most of us belong to some kind of family, and the media frames many of its outputs around the family. Whilst family relationships are private and personal, their capacity to shape the health of young people makes them an important area for public debate and government policy. In popular and political discourse families are often seen as the ‘bedrock’ of society and afforded transformative potential. But concerns about deficits in parenting and moral crises regarding the breakdown of the family unit are recurring themes, especially at times of social unrest. Families have become a key target for a multitude of interventions, ranging from support for ‘troubled’ families in crisis to universal health promotion initiatives.

There is recognition effective public health interventions move beyond a narrow focus on individual behaviours to examine multiple levels of influence and their interconnections. The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) draws together researchers from Cardiff, Swansea and Bristol Universities. It is one of five UKCRC Public Health Research Centres of Excellence, which aim to generate practical solutions to key public health challenges. DECIPHer develops and evaluates multi-level interventions that have an impact on the health and wellbeing of children and young people, including diet and nutrition, physical activity, and alcohol, tobacco and drugs.

Understanding the complex social processes which take place within families and the effectiveness of family-based interventions is a key focus of DECIPHer’s work. Sarah Macdonald’s PhD research is focusing on how families negotiate roles and responsibilities for health through interaction with each other and wider social structures, particularly their relationships with schools. Samia Addis, another PhD student, is also examining school-family relationships, exploring how parents and children make decisions concerning the uptake of free school meals. And Sue Moore has investigated the feeding strategies used by mothers, including modelling, repeated taste exposure and attempts to influence children’s attitudes and norms (Moore et al., 2007). Finally, research by James White suggests that regular family interactions like family meals may protect adolescents against misusing alcohol (White & Halliwell, 2010a, 2010b).

Young people’s alcohol consumption practices are shaped by parents’ drinking behaviours and role modelling, and the rules and monitoring they put in place around substance use (Garmiene et al., 2006; Moore et al., 2010). Broader parental practices and family functioning also act as protective and risk factors (Shortt et al., 2007; Velleman & Templeton, 2007). A key DECIPHer project addressing these issues is Project SFP Cymru – a randomised controlled trial of the Strengthening Families Programme 10-14 (SFP10-14) in seven areas of Wales. The Strengthening Families 10-14 UK programme aims to strengthen areas of family life that protect against substance misuse, including parenting, communication, and young people’s resilience skills. Research in the United States has found evidence that the SFP10-14 delays and reduces substance use (alcohol, tobacco and illegal drugs) by young people (Spoth et al., 2008). Funded by the National Prevention Research Initiative, Project SFP Cymru is examining whether the results found in the US translate to a UK context. The programme is being offered as a universal prevention programme (open to any family), and the trial is assessing this delivery approach, including the recruitment and group composition strategies used.

Another programme we are evaluating is the Kids, Adults Together programme (KAT). KAT seeks to prevent alcohol use by strengthening pro-social communication in families. It comprises specially designed classroom activities, which build towards a family education evening, and a DVD to promote family communication. KAT has demonstrated high levels of programme reach and acceptability among families, suggesting it has the potential to overcome the challenges experienced by other school-based interventions which have attempted to engage parents (Rothwell & Segrott, 2011). Funded by the National Institute for Health Research (NIHR), the current exploratory trial is refining the programme’s theoretical model, and assessing the feasibility of conducting an effectiveness trial.

Researchers in DECIPHer are also utilising large-scale surveys to explore the relationships between family-based risk and protective factors and young people’s health behaviours. James White’s analysis of the British Youth Panel Survey explored the links between family relationships and the onset of smoking in young people, which found that frequent father-child conversations on ‘topics that mattered’ ‘were associated with a reduced risk of experimentation’ (White, 2012). Moore et al.’s examination of data from a Communities that Care survey highlighted the key role played by parental monitoring and family closeness in relation to young people’s drinking behaviours (Moore et al., 2010).

These studies reflect DECIPHer’s broad aim of conducting research which is methodologically rigorous and theoretically informed. Families have the capacity to shape young people’s health and wellbeing, but they comprise complex psycho-socio processes, and interventions need to be sensitive to this. Giving information to parents about the importance of parenting practices such as rule setting and monitoring will only take us so far. We need theoretically informed interventions which engage meaningfully with family relationships, and the links between families, schools and communities.

Dr. Jeremy Segrott (@DrJeremySegrott) is Research Fellow in Public Health at DECIPHer. This article will appear in the Spring 2013 issue of the Bevan Foundation Review; Jeremy gratefully acknowledges their permission to reproduce it here.

1 Comment

  1. Sarah MacDonald

    24/01/2013 16:33:37
    I enjoyed reading this and it brought together lots of different strands of DECIPHer’s research. I agree with your conclusions about the need for interventions to be sensitive to the complex social processes within families. In particular I think it is important for interventions to be sensitive to the meanings families attach to interventions and how they make sense of these interventions in their everyday lives. A couple of questions struck me as I was reading this: 1) What are the next steps for DECIPHer in terms of family-related research? 2) How is DECIPHer’s research is connecting with policy and practice, in terms of family-related research?

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