Using an Ecological Lens to Empower Families
An ecological model is a way to conceptualize the complex interactive relational systems relevant to families and their health. It is important to note that the Family health Model is a model of family health, not merely a theory or model to explain the functions of families. Thus, the context and variables are more inclusive than merely considering family processes. In other words, family health is influenced by its contextual aspects as well as those related to members, family as a whole, and family processes. In order to provide the reader clear understanding of some of the underlying premises of the model, foundational assumptions have been stated as succinctly as possible (Table 1.2). Family health involves all members who reside in the household, but includes ways relationships and environments affect health over time. Findings from the qualitative research conducted by the author have provided evidence that indicate a need to conceptualize family health from ecological and process perspectives.
Table 1.2: Assumptions about Family Health Routines and Family Health
- All families have systemic behavioral patterns related to family health.
- Individuals, family sub-systems, and families vary in the ways they participate in family health routines.
- Members participate in individual, sub-system, and family health routines that are characterized by patterned behaviors that can be described by household members.
- Family health routines are impacted by the household’s embedded contextual systems and the functional interactions of the household members.
- Beliefs, values, traditions, culture, personal experiences, information exposure, resources, and encounters with health care professionals influence the unique social constructions of family health routines.
- Children’s socialization about health processes is largely imposed by the family’s social construction of health routines.
- Family households are the primary places where children learn about health, develop health attitudes, and establish health behaviors.
- Family themes and goals provide undergirding for the ways family health routines are socially constructed.
- Families use accommodation processes to create, deconstruct, and reconstruct family health routines.
- In most cultures and families, mothers are often the initiators and keepers of family health routines.
- Once family health routines are initiated, members adjust the character of the patterns over time so that they retain consistency with their family health paradigm.
- Family health routines that lose their meaningfulness are dissolved.
- Families create new health routines or alter familiar ones to accommodate normative and non-normative life experiences over the life course.
In the Family Health Model (Denham, 2003), health is defined as an adaptive state experienced by persons as they seek opportunities and wrestle with liabilities found within self, family, households, and diverse contexts throughout the life course. Health is experienced when a person can fulfill personal goals and enjoy life. Family health suggests the interactions that occur within the household environment affect members as they seek to obtain, sustain, and regain maximum health. Family health includes the systems, interactions, relationships, and processes with potential to maximize processes of becoming, enhance well-being, and capitalize on the household production of health. The model emphasizes the biophysical, holistic, and environmental factors that impact health. A way to operationalize family health is to view the concept in terms of member interactions and processes of those that identify as family or dwell together in a household niche dynamically impacted by complex contextual systems with potentials to affect health. In other words, families use many processes to individually and collectively achieve individual and family health.
The household is a pivotal point for coping with needs and the world where they live. Family health includes the idea of person-process-context. In other words, family health is less a goal and more a process that includes the complex interactions of individuals, family sub-systems, family, and their context over the life course. A game of tug-of-war is an analogy to understand the balancing-rebalancing that occurs as family systems interact with their embedded contexts. Family health implies a striving to enhance “processes of becoming” and strive toward individual and family “well-being.”
Person-in-context implies that unique personal characteristics and contextual perspectives both impact health. Persons-in-context implies interactions occurring between the household members as a response to the contextual systems that permeate family life and presents ambiguous and contradictory influences integral to health.
Figure: Russian Dolls as Conceptualization
Russian Dolls can be a great metaphor to explain different levels of society, with the individual being inside other institutions, such as the family, the neighborhood, the city, etc., just as the smallest Russian Doll is within many other dolls at the same time.
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Diabetes: A Family Matter
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