Paper
Friday, July 23, 2004
Variables Affecting Well Siblings and Mothers in Families of Children With a Chronic Illness or Disability: Assessing a Family Interaction Model
Phoebe D. Williams, PhD, RN, FAAN1, Arthur R. Williams, PhD, MPA, MA2, and Todd R. Huschka, BS2. (1) University of Kansas Medical Center, School of Nursing, Kansas City, KS, USA, (2) Health Care Policy & Research, Mayo Clinic, Rochester, MN, USA
| Learning Objective #1: Appreciate that the family system encompasses complex interactions |
| Learning Objective #2: Appreciate that the family process model herein elucidates interrelationships among variables and identifies intervention points |
Objectives: 1) Examine relationships among psychosocial variables known to affect the health and development of well siblings in families in which a brother or sister has a chronic illness or disability and 2) Test the stability of a family interaction model over time using a structural equation model (SEM). Sample: Dyads of 252 well children (7-16 years old) and mothers in the USA. Design: Longitudinal; 5 time points over 12 months; analysis of data from a NIH-NINR funded RCT of a nursing intervention. Variables: Well sibling behavior problems, knowledge of illness, self-esteem, mood, social support, and attitude toward illness in the family; sibling age; mother mood; family cohesion; and socioeconomic status (SES). Variables measured on instruments with established and published psychometric properties. Method: SEM, confirmatory analysis. Findings: The SEM is stable over 5 time periods: all CFI >0.85 and RMSEA <0.06. SES and family cohesion were associated with parent-reported behavior problems of the well sibling. SES also influenced the mood of the mother that in turn influenced family cohesion. The well sibling’s knowledge about the illness, attitude toward the illness, mood, self-esteem, and feelings of social support were interrelated, and related to behavior problems of the well sibling (all path coefficients, p<0.05). Conclusions: The family interaction model herein offers opportunities to explore family dynamics and identify potential nursing intervention points. Implications: Sibling knowledge improvement leads to better outcomes on other sibling variables. Positive parent mood is associated with improved family cohesion and sibling outcomes. Interventions might focus on (a) knowledge gains of well siblings about the illness or disability of their brother or sister and (b) actions needed to enhance family cohesion. Services provided by nurses or others as well as income transfers could alleviate some burdens of chronic illness or disability in families.
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