The scores on the questionnaires were compared using correlation and multiple regression analyses. We then analyzed relationships between the questionnaires and family issues measures using Chi square, Mann—Whitney U, and logistic regression analyses. Family dysfunction excessive or impoverished Adaptability or Cohesion was not related to the presence of family issues. The online version of this article doi Practicing family medicine relies on sufficient understanding of the biopsychosocial aspects of patients. However, currently, family approaches to medicine are not widespread among Japanese family physicians.
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The scores on the questionnaires were compared using correlation and multiple regression analyses. We then analyzed relationships between the questionnaires and family issues measures using Chi square, Mann—Whitney U, and logistic regression analyses.
Family dysfunction excessive or impoverished Adaptability or Cohesion was not related to the presence of family issues. The online version of this article doi Practicing family medicine relies on sufficient understanding of the biopsychosocial aspects of patients.
However, currently, family approaches to medicine are not widespread among Japanese family physicians. For this reason, many physicians hesitate to hold family conferences, which require considerable time and skill.
A promising means of circumventing this problem, however, would be to utilize questionnaires. Because the Family APGAR consists of only five questions, it is relatively easy and quick to administer; this has made it the preferred choice for evaluating family function in primary care and general medicine settings. However, Gardner et al. Nevertheless, the test remains widely and perhaps blindly utilized.
Additionally, high levels of family loyalty and consensus are required and there is little tolerance for private space or relationships outside the family. Furthermore, such families have limited commitment to family interests, and members are often unable to turn to one another for emotional or practical support or assistance. Adaptability, on the other hand, is defined as the ability of a marital or family system to change its power structure, role relationships, and relationship rules in response to situational and developmental stress.
Foulke et al. In other words, moderate levels of Adaptability and Cohesion are optimal, but too much or too little is dysfunctional under normal circumstances.
This accords with the properties of the Circumplex model, wherein the avoidance of extremes for either dimension is emphasized. One Japanese research group was successful in identifying the curvilinearity of their original scale. The scale results are based on the sum of the score of each question multiplied by a coefficient appropriate for the content.
However, Japanese clinics often comprise only a few staff members, such as a physician, nurse, and clerk, which means that they would have little time to complete a questionnaire.
Thus, the current study had three objectives. In Japanese family practice, previous studies have noted that physicians do not like administering the full Family APGAR, despite the fact that it comprises only five questions.
Therefore, we wanted to identify the particularly effective questions for analyzing family dysfunction, thereby enabling the Family APGAR to be used in daily clinical practice more conveniently. It is generally believed that family issues occur in response to family dysfunction i. As such, the second objective was to confirm the correlations between family dysfunction and family issues, and to identify the particularly important aspects of family function by investigating the correlations between FACESKG IV scores and the family issues measured.
The third and final objective was to confirm the validity of the Family APGAR as a basis for helping families cope with family issues; for this purpose, we examined the correlation between the Family APGAR and the family issues measure. Thirteen clinicians administered the questionnaires to their patients.
If you do, please tell us about them. You are free to decline to answer. We explained the contents of the study and enrolled patients who agreed to participate. Written informed consent was then obtained from all participants.
Patients completed the questionnaire while waiting at the billing department after their medical examinations. Completed questionnaires were then brought to the front desk of the outpatient clinic. Written informed consent was obtained from all subjects. We applied for ethical approval to the Institutional Ethical Review Board of the Kawasaki Medical School through the professor in charge; however, the board deemed it exempt from ethical approval.
Participants were patients, of whom One hundred six participants had mental disorders, 45 had hypertension, 45 had hyperlipidemia, and 38 had diabetes mellitus. Seventy-six patients There were 68 In the present study, Additional file 3 : Table S3 shows the results of the multiple regression analysis using the step-down procedure.
These results indicate that the Family APGAR partially measures family cohesion and the Resolve and Partnership items could be used to capture family disengagement; however, the sensitivity of the total Family APGAR score for family adaptability was only Interestingly, neither dysfunctional Cohesion excessive or impoverished nor dysfunctional Adaptability was significantly related to family issues. This indicates that family dysfunction i. Next, we analyzed the relationships between each item of the Family APGAR and the family issues measure by utilizing a Chi square test.
Differences by gender, age, or disease were not observed in any of the analyses. Furthermore, family issues did not always occur in the presence of family dysfunction excessive or impoverished Cohesion and Adaptability.
This latter result is important because in the past it was generally believed that family issues occur in response to family dysfunction, while our results indicate that improving family function might not help solving family issues. It is possible that excessive or impoverished family cohesion and adaptability are not dysfunctions but rather are coping styles for dealing with family issues.
Thus, family physicians should avoid blindly attempting to change family dynamics. We found that the Family APGAR, especially the Resolve item, has the potential to become a tool for measuring family function, at least in terms of family issues. Most importantly, the Resolve item was able to distinguish patients with family issues from those with no such issues. This finding may be important to general practitioners who operate busy clinics or are inexperienced with the family approach. The Resolve item may be useful for identifying patients for whom a family conference—wherein the physician assembles family members and encourages them to communicate without employing special techniques—would be beneficial, and can be the first step in implementing a family approach for physicians who might normally avoid it.
We note several limitations to our study. First, the cross-sectional design did not allow us to examine changes in family function over time. We also excluded participants with acute disease because their conditions precluded their answering the questionnaire. Further study will be required to confirm whether the results generalize across cultures. A further limitation concerns the publication of our results, which has taken a considerable amount of time and effort because of a struggle to translate our findings into English while also performing our clinical duties.
Considering the extensive gap between data collection and publication, it is possible that the Japanese family structure and social context differ nowadays compared to when the study was first conducted. In order to translate our ideas successfully, we required repetitive checking and translation by a native English speaker.
However, this process was highly costly. Furthermore, there were few specialists available to us who were familiar with general medicine and family approaches and who were native English speakers. Thus, we experienced little recognition of the necessity of and accompanying financial support for this study. In addition, all authors of this study were both researchers and practicing physicians, which made it difficult to complete the manuscript. It must be noted that our study remains important despite the time taken to publish it.
We are releasing these results because of their importance; however, we do intend to perform follow-up studies to further validate them. In addition, family dysfunction excessive or impoverished Adaptability or Cohesion was not related to the presence of family issues.
Takenaka is the corresponding author. He wrote this manuscript and researched data, contributed to written informed consent, and discussion. Ban contributed to discussion, edited and helped translation.
Both authors read and approved the final manuscript. We appreciate the work of everyone who supported us and all participated in this study.
Hiroaki Takenaka, Email: pj. Nobutaro Ban, Email: pj. National Center for Biotechnology Information , U. Asia Pac Fam Med.
Published online May 5. Hiroaki Takenaka and Nobutaro Ban. Author information Article notes Copyright and License information Disclaimer. Takenaka Clinic, Osaka, Japan. Corresponding author. Received Dec 8; Accepted Apr Electronic supplementary material The online version of this article doi Keywords: Family, Family research, Family members.
Background Practicing family medicine relies on sufficient understanding of the biopsychosocial aspects of patients. Procedures We explained the contents of the study and enrolled patients who agreed to participate. Ethics Written informed consent was obtained from all subjects. Results Participants were patients, of whom Open in a separate window. The correlations between family dysfunction and family issues We concluded our investigation by analyzing the relationships between family dysfunction as measured by the FACESKG IV and family issues utilizing a Chi square test.
Acknowledgements We appreciate the work of everyone who supported us and all participated in this study. Competing interests The authors declare that they have no competing interests. Additional files Contributor Information Hiroaki Takenaka, Email: pj. References 1. Smilkstein G. J Fam Pract. St Paul: University of Minnesota;
The family APGAR: a proposal for a family function test and its use by physicians.
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. This paper introduces a brief questionnaire that is designed to test five areas of family function. View PDF.