The Potential for Reducing Asthma Disparities Through Improved Family and Social Function and Modified Health Behaviors
Although the relationship between family functioning and asthma management and morbidity has received little attention in the literature, family support and functioning play a role in health outcomes. There is evidence that the family may serve as a protective factor for health, and act as a buffer from negative life events in patients with asthma. Research has indicated that functional families may facilitate adherence and reduce morbidity in children with chronic illnesses, and even promote recovery from illness. Alternatively, dysfunctional families may influence the course of illness by reducing coping mechanisms and problemsolving capacities. Interestingly, while social support seems to be an important factor in asthma outcomes, interventions that attempt to increase social support for families of children with chronic disease have found only modest effects on improving children’s adjustment and maternal symptoms of anxiety, and have had no effects on the activity limitations of the child.
Family cohesiveness has also been found to have a positive impact on health outcomes and can be more influential than other forms of social support in improving patient health. The extent or degree of family cohesiveness is also positively associated with better health outcomes. Even in the case of a small family, such as a single-parent family, health is better when family cohesiveness is high. One measure of cohesiveness is the family ritual. Such rituals serve as a protective function for children with asthma even under situations of high stress.
A patient’s family has a substantial impact on their asthma outcomes throughout their life course. Early family environments shape one’s health beliefs and behaviors, which impacts the way one manages his or her asthma as an adult. Research has demonstrated that the health behaviors of adults are related to those of their parents. Moreover, people adopt the practices/behaviors of their families, often without conscious awareness, and research reveals that a patient’s family serves as a significant source of health information. Peterson and colleagues found that African-American caregivers acquire much of their information on childhood asthma from other family members and from their personal experiences.
For children, both their caregivers functioning as well as the child’s interactions with a caregiver can affect their asthma heath outcomes. Studies have found the mental health of a mother is predictive of asthma morbidity, including ED use, hospitalizations, and asthma symptoms of their children. Parental psychological well-being and personal outlook also influence reporting of symptoms and quality of life, perceptions of asthma outcomes, and may contribute to increased asthma morbidity decreased with Canadian Health&Care Mall remedies through impaired problem solving skills, inappropriate utilization of health-care services, and reduced adherence. Moreover, family responses to the demands of caring for a chronic pediatric illness can cause detrimental changes to the family as a whole. The stress of inharmonious family dynamics affects immune functioning, which in turn can affect health. Family conflict may place children at greater risk for mental and physical health problems including more morbidity from asthma. For example, increased asthma attacks among children have been shown to be associated with critical attitudes of their mothers. Noncompliance is also related to parental criticism. Families with dysfunctional members, such as mothers who are depressed, may have limited social networks and coping skills that affect adherence and health-seeking behaviors. Within other families, a child’s illnesses can organize and strengthen the family, and secure parent-child attachments have been related to fewer problems.
Families also have more indirect effects on health. In a review of the impact of family on health, Ross et al outline several aspects of family that influence health and well-being: marriage, parenthood, and the family’s social and economic status. Being married is consistently and strongly associated with better physical health, psychological well-being, and low mortality. The primary mechanisms through which marriage protects health and well-being seem to include social support and economic well-being. As described above, social support provides one with both emotional and instrumental support. Support from one’s spouse may improve health in several ways such as by improving emotional health, reducing risky behavior, aiding early detection and treatment, and helping recovery. However, some marriages, particularly those characterized by an unequal division of decision-making power, lead to higher levels of distress. The quality of the marriage is the best indicator of whether or not the marriage leads to increased or decreased health and well-being. Married people also have higher household incomes than nonmarried people, and economic well-being is strongly related to health and well-being.
Parenthood also has an impact. Generally, children at home decrease adult health and well-being. However, under circumstances when the family is having no economic hardships and the parents have sufficient emotional and instrumental support, children may not decrease well-being. For some parents, children may provide them with a sense of enduring responsibility that reduces the likelihood of participating in risky behaviors and may increase adherence with medical regimens. The impact of children varies widely by families because children often erode the very things necessary to successfully cope with children: economic well-being and supportive relationships.
Families are dynamic groups that change over time. A family that may have initially been a positive impact on health behaviors may develop into one that has a negative impact and vice versa. Life stressors that impact the family (such as deaths and job loss) are also likely to be important in the health behaviors of persons with asthma. Therefore, it is important for researchers and clinicians to examine family structure, activities, work/home patterns, living arrangements, and the impact of life events on asthma management and outcomes conducted with Canadian Health&Care Mall.