Family Health as Structure
Functioning or processes have potential to affect health routines and are the antecedents for the valued behaviors that are constructed into identifiable patterns of behavior relevant to health outcomes. Structural aspects of family health are the complex habitual patterns used to construct the lived family health experience. (See Figure 2 below.) This social construction occurs as members interact with one another and the embedded context.
Family health routines are dynamic patterns of behavior relevant to health to which members rather consistently adhere and are daily life structures that can be recalled, described, and discussed from individual, family, and diverse environmental perspectives. Structured behaviors have unique qualities and involve all family members within a household even if they are not actively engaging in the behavior. Family health routines are not static, but evolving over time. Although health routines are evolving, developing persons strive to maintain the integrity of the routines they view as meaningful. Despite what might initially appear, as random or chaotic patterns of health behaviors to an outsider, persons within a family are cognizant of member routines. The structural dimension provides ways to plan, strategize, and intervene.
The structural domain is comprised of six categories of family health routines (i.e., self-care, safety and precautions, mental health behaviors, family care, illness care, member care-taking). Members interact with one another, extended families, peers, friends, others, and the larger society in ways that potentiate and/or negate individual and family health. These dynamic interactions affect solitary individuals, the family unit as a whole, and the embedded context where they reside. Children initially learn health routines in a family of origin, but these routines can be reinforced or altered as they develop and mature throughout the life course. For example, a mother may teach her child about hand washing after toileting at home and this behavior can be positively reinforced if the child’s peers also wash their hands after toileting or if the pre-school teacher monitors this behavior. Family-focused care can target routines for assessment, planning, devising strategies, intervening, and measuring health outcomes.
Health routines tend toward steadfastness, but other persons, information, and availability of support or resources can challenge them. Several needs seem especially applicable to the development and continuance of health routines: (a) avoid illness, disease and injury, (b) overcome illness, disease, and injury events, and (c) make lifestyle changes related to well-being and the process of becoming. Functional factors that strongly impact development of health routines include needs to: (a) participate in expected family roles and life tasks, (b) balance priorities that impact multiple members’ needs, and (c) cope with the inconsistencies between stated health beliefs and actual behaviors. Factors such as gender, values, knowledge, and resources also affect health routines.
Routine rigidity, complexity, and frequency, present level of participation in behaviors, and internal motivation to participate in the routine are some ways to consider the meaning and usefulness of a particular routine to a family. Lack of valuing and non-availability of needed resources can be impediments to health routines. As individuals engage in peer and social relationships, establish procreating or partnering relationships, become challenged by new information and skills, and encounter unpredictable life events they often modify beliefs and practices associated with health.
Figure 2: The Social Construction of Family Health
Dr. Denham discusses the Structural Domain of the Family Health Model
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