Dr. Sharon Denham discusses the Family Health Model
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Family Health Model (Denham, 2003)
The Family Health Model was created as a result of a comprehensive literature review, the author’s professional nursing practice and life experiences, and findings from a series of three qualitative studies about how Appalachian families defined and practiced family health within their households (Denham, 1997, 1999a, 1999b, 1999c).
This research was completed to learn about family health from a family and household perspective rather than institutional ones.
The aims of the research were to:
- Identify the ways families’ defined family health.
- Identify the routine family patterns, behaviors and daily activities perceived as part of the family health construction.
- Describe behaviors perceived as deleterious and adjuncts to family health.
- Identify the ways families modified their family health construction.
- Identify the contextual influences that affected family health.
Over a period of five years, three ethnographic studies about family health were completed with Appalachian families in two southeastern Ohio counties (Table). Taped and later transcribed interviews (n = 125) lasting 1 to 2 hours captured data about 24 families (80 interviews), eight families in each study, and a total of 45 community informants (Denham, 1997, 1999a, 1999b, 1999c). Participants were well families referred by informants at community agencies. A series of semi-structured questions guided the data collection. Approximately 6 to 9 months was spent collecting data for each study. The length of time for the series of interviews to be completed varied (i.e., 6 weeks to 6 months) with either 3 or 4 interviews conducted with multiple members of each family in their homes. Ethnographic methods were used to investigate family health from a community perspective. Data were analyzed using HyperResearch, a qualitative software package. Spradley’s (1979, 1980) ideas about domains and Yin’s (1994) ideas about continuous comparison and cross case analysis provided the basis for analysis. Expert checks with those familiar with the Appalachian culture facilitated interpreting cultural inferences and identifying themes.
Participants in two studies were Appalachian families with school age or pre-school children (Denham, 1997, 1999a, 1999c) and subjects in the third study were bereaved families who had recently experienced a member’s death (Denham, 1999b). Family was operationalized individuals who were committed to the general well-being of one another and identified themselves as family (Landesman, Jaccard, & Gunderson, 1991). The first study, dissertation research about family health in rural Appalachian families with preschool children, was conducted in a rural southeastern Ohio county where employment was limited and a consistently high poverty rate prevailed for several decades (Denham, 1997, 1999a). The other two studies were conducted in a more urban county within the same region. The dissertation provided findings pertinent to family health, but other dimensions also seemed important to enhance understandings (i.e., family health during change or transition, family health of economically disadvantaged families) and resulted in the follow-up studies.
The second study, funded by the American Nurses Foundation, provided a chance to learn about family health after hospice families had cared for a dying member and were experiencing the losses from deaths (Denham, 1999b). While nurses often work with ill individuals when they seek cure or care from health care systems, but most have less understandings about the ways families incorporate prescribed care into households to meet members’ health needs. Participants were members from different generations, used hospice services while the member was dying, and some were still receiving bereavement care.
The Family Health Model (Denham, 2003) has some major points of difference related to the provision of care when compared with the Medical Model of care. See the Table below to identify these differences.
| Medical Model | Family Health Model |
|---|---|
| Systems models | Contextually embedded family systems |
| Focus on illness and disease | Focus on well-being and processes of becoming |
| Aim is treatment and cure | Aim also includes health promotion and prevention |
| Health as an outcome | Health as an interactive contextual, functional, structural process |
| Target is individual | Target is family |
| Episodic care | Care over the life course |
| Care viewed from individual perspectives | Care viewed from contextually embedded perspectives |
| Client as care-seeker | Care-provider as collaborator and partner |
| Individual and environment | Family in embedded context |
| Individual as the reservoir of health and illness | Household as the reservoir of health and illness |
| Individual behavior as threat or initiator of health | Community as threat or initiator of health |
| Physicians as primary health care provider | Mother/Family as primary health care provider |
| Medical providers as experts | Family as expert |
| Expert as decision-maker | Family as decision-maker |
| Institutional and agency based care | Care targeted at family household and context |
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