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Who is the “family” in family research?
RESEARCH Who Is the "Family" in Family Research? Mary R. Lynn, PhD with applications in pediatric R ESEARCH nursing includes a broad spectrum of studies in which children, adolescents, and their families have served as subjects. Early research in pediatric nursing focused on the pediatric patient, whereas later research emphasized the family of the patient. Although family-focused research has become commonplace within pediatric research circles, several of the issues surrounding family research have only recently begun to be explored. Issues, such as which family members to include in data collection, measurement issues with multiple data sources, and analysis of data from multiple-sources representing a single unit, will be presented briefly in this introductory column, with elaboration of each issue occurring in subsequent columns. INDIVIDUAL VERSUS MULTIPLE VIEWPOINTS Informants or subjects in family research can be one or more individuals within the family or some approximation of all family members. When an individual (or small subset of family members) is the basis for family research, there is an assumption that the individual's (or subset's) viewpoint is a valid measure of the family or family phenomenon under investigation. If this assumption is embraced by the researcher, or if an individual's (subset's) perspective on the family is the object of the study, then collecting data about the family from the perspective of a single individual or subset is appropriate. For example, if one person in the family handles all medication administration, then that family member will be the best person to assess the impact of medication route on the acceptability of medications. However, it must be acknowledged that restricting family data to a single individual or subset as representative of the entire family has the potential to present a biased view of the family. Collecting data from a single family member or subset certainly is less complicated than
Journal of Pediatric Nursing, Vol 10, No 3 (June), 1995
considering a variety of data sources for data collection and analysis. However, the trade-off for the reprieve is a the possibility of an inaccurate or oversimplified interpretation of the family situation. With this extreme limitation for use of single-subject or subset respondents in family research, it can be concluded that this approach should be used only when one family member or subset is the ideal informant. A more comprehensive view of family probably is appropriate in most family research, despite limitations and special considerations that arise when data are collected from multiple family sources. When the entire family is used for data collection, it usually is assumed that the family is best understood with the input of the various members comprising the family unit. This requires that the family unit be defined both by role(s) and generations and that all identified members are included in the data collection. However, if the families to be studied include parent(s) and children of various ages, can all family members be sources of data, regardless of their ability to communicate? Are multiple-source data guaranteed to be more valid than single-informant data? Although it seems counterintuitive, collecting data from all members of a family can be as biasing, or perhaps even more so, than data collection from an individual family member. As an example, imagine a study of the family relationships in abusive families. It is possible that in many subject families, the abuser(s) may refuse routinely to participate. Underrepresentation of the abuser(s) in this study influences the individual family data as well as the aggregate data across families. Despite this limitation, From the School of Nursing, Universityof North Carolina at Chapel Hill, Chapel Hill, NC. Address reprint requests to Mary R. Lynn, PhD, School of Nursing, CB No. 7460, Universityof North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460. Copyright 9 1995 by W.B. Saunders Company 0882-5963/95/1003-000953.00/0
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data collection from all members of a family does increase the ability to generalize results, thus making this approach generally preferable to individual representations of a family. INSTRUMENTATION IN FAMILY RESEARCH The decision to use a single- or multiplesource sample in family research has implications for the instrument or measures used in the study. Most instruments are written at the level of the individual rather than at the level of the group or family so that the viewpoints gathered are individual perceptions of the family rather than individual's perception of the family's functioning or behavior. Consider the items, "I think we are a close-knit family" (individual's unique perception of the family) versus "We function as a close-knit family" (perception of the family as a single unit, presumably a shared perception). In the former statement, an individual is asserting an opinion about the degree of closeness of the family, whereas in the latter statement a declaration for the entire family is being made about how the respondent believes the family would respond to that item. It is important that the measurement level of the instrument (individual or family/group level) be assessed before its use because the implications for the results differ depending on the orientation of the instrument used in the study. Study results based on items written at the individual level should be understood to represent how an individual perceives the family, whereas results based on items written at the family level should be understood as representing what the family members think the entire family believes or how the entire family behaves. An instrument with items written at the individual level might be used for the single family member data collection approach to family research or the "individuals summed" approach because each person is still free to assert an opinion about the family situation. Items written at the group or family level are used best with a consensus approach to family research or when responses will be averaged across respondents to assert the family's views. An additional instrumentation consideration pertains to the readability of the measures used in the study (Lynn, 1989). Although readability always is an issue in research, it becomes a special consideration when young children are
included as subjects along with adolescents and/or adults. It is rare that an instrument has alternate versions for various reading levels, making it critical that the reading level of the tool be assessed to ensure its adequacy with young readers. ANALYSIS OF FAMILY DATA Use of multiple data sources to develop a view of the family leads to some knotty analysis issues. What constitutes the family score on a measure or measures requires some innovation in the analysis of multiple-source family data. Common approaches to analysis of multiplesource family data include: (1) summing all data to arrive at a family score, which poses problems when families of different sizes are included in the same study; (2) averaging the individual data for a family score using the highest (or lowest) score from any particular family member; or (3) considering discrepancy scores between family members as representative of the family. Further information on these and other approaches can be found in Fisher, Kokes, Ransom, Phillips, and Rudd (1985), Thomas (1987), and Uphold and Strickland, (1989) and will be presented in subsequent columns. DISCUSSION What has been presented is an overview of some of the issues in family research. Because these issues-sampling, measurement, and analysis-are important to address in family research, each of them will be discussed more fully in subsequent columns. However, researchers interested in further reading on the subject should consult the references and additional readings (Box 1).
BOX 1. AdditionalReadings Feethan, S.L. (1984). Family research: Issues and directions for nursing. In Werley, H. & Fitzpatrick, J.J. (Eds.), Annual Review of Nursing Research (Vol. 2). New York, Springer, pp. 3-25. Gilliss, C.L. (1983). The family as a unit of analysis: Strategies for the nurse researcher. Advances in Nursing Science, 5, 50-59. Thompson, L., & Walker, A.J. (1982). A note on correlated measurement error in wife-husband data. Journal of Marriageand the Family, 46, 643-649. Uphold, C.R., & Harper, D.C. (1986). Methodological issues in intergenerational family nursing research. Advances in Nursing Science, 8, 38-49.
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REFERENCES Fisher, L., Kokes, R.F., Ransom, D.C., Phillips, S.L, & Rudd, P. (1985). Alternative strategies for creating "relationar' family data. Family Process, 24, 213-224. Lynn, M.R. (1989). Readability: A critical instrumentationconsideration.Joumalo, f Pediatric Nursing, 4, 295-297. Thomas, R.B. (1987). Methodological issues and prob-
lems in family health care research. Journal of Marriage and
the Family, 49, 65-70. Uphold, C.R. & Strickland, O.L. (1989). Issues related to the unit of analysis in family nursing research, tVestem Journalof Nursing Research, 11, 405-417.
Journal of Pediatric Nursing, Vol 10, No 3 (June), 1995
considering a variety of data sources for data collection and analysis. However, the trade-off for the reprieve is a the possibility of an inaccurate or oversimplified interpretation of the family situation. With this extreme limitation for use of single-subject or subset respondents in family research, it can be concluded that this approach should be used only when one family member or subset is the ideal informant. A more comprehensive view of family probably is appropriate in most family research, despite limitations and special considerations that arise when data are collected from multiple family sources. When the entire family is used for data collection, it usually is assumed that the family is best understood with the input of the various members comprising the family unit. This requires that the family unit be defined both by role(s) and generations and that all identified members are included in the data collection. However, if the families to be studied include parent(s) and children of various ages, can all family members be sources of data, regardless of their ability to communicate? Are multiple-source data guaranteed to be more valid than single-informant data? Although it seems counterintuitive, collecting data from all members of a family can be as biasing, or perhaps even more so, than data collection from an individual family member. As an example, imagine a study of the family relationships in abusive families. It is possible that in many subject families, the abuser(s) may refuse routinely to participate. Underrepresentation of the abuser(s) in this study influences the individual family data as well as the aggregate data across families. Despite this limitation, From the School of Nursing, Universityof North Carolina at Chapel Hill, Chapel Hill, NC. Address reprint requests to Mary R. Lynn, PhD, School of Nursing, CB No. 7460, Universityof North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460. Copyright 9 1995 by W.B. Saunders Company 0882-5963/95/1003-000953.00/0
189
190
MARY R. LYNN
data collection from all members of a family does increase the ability to generalize results, thus making this approach generally preferable to individual representations of a family. INSTRUMENTATION IN FAMILY RESEARCH The decision to use a single- or multiplesource sample in family research has implications for the instrument or measures used in the study. Most instruments are written at the level of the individual rather than at the level of the group or family so that the viewpoints gathered are individual perceptions of the family rather than individual's perception of the family's functioning or behavior. Consider the items, "I think we are a close-knit family" (individual's unique perception of the family) versus "We function as a close-knit family" (perception of the family as a single unit, presumably a shared perception). In the former statement, an individual is asserting an opinion about the degree of closeness of the family, whereas in the latter statement a declaration for the entire family is being made about how the respondent believes the family would respond to that item. It is important that the measurement level of the instrument (individual or family/group level) be assessed before its use because the implications for the results differ depending on the orientation of the instrument used in the study. Study results based on items written at the individual level should be understood to represent how an individual perceives the family, whereas results based on items written at the family level should be understood as representing what the family members think the entire family believes or how the entire family behaves. An instrument with items written at the individual level might be used for the single family member data collection approach to family research or the "individuals summed" approach because each person is still free to assert an opinion about the family situation. Items written at the group or family level are used best with a consensus approach to family research or when responses will be averaged across respondents to assert the family's views. An additional instrumentation consideration pertains to the readability of the measures used in the study (Lynn, 1989). Although readability always is an issue in research, it becomes a special consideration when young children are
included as subjects along with adolescents and/or adults. It is rare that an instrument has alternate versions for various reading levels, making it critical that the reading level of the tool be assessed to ensure its adequacy with young readers. ANALYSIS OF FAMILY DATA Use of multiple data sources to develop a view of the family leads to some knotty analysis issues. What constitutes the family score on a measure or measures requires some innovation in the analysis of multiple-source family data. Common approaches to analysis of multiplesource family data include: (1) summing all data to arrive at a family score, which poses problems when families of different sizes are included in the same study; (2) averaging the individual data for a family score using the highest (or lowest) score from any particular family member; or (3) considering discrepancy scores between family members as representative of the family. Further information on these and other approaches can be found in Fisher, Kokes, Ransom, Phillips, and Rudd (1985), Thomas (1987), and Uphold and Strickland, (1989) and will be presented in subsequent columns. DISCUSSION What has been presented is an overview of some of the issues in family research. Because these issues-sampling, measurement, and analysis-are important to address in family research, each of them will be discussed more fully in subsequent columns. However, researchers interested in further reading on the subject should consult the references and additional readings (Box 1).
BOX 1. AdditionalReadings Feethan, S.L. (1984). Family research: Issues and directions for nursing. In Werley, H. & Fitzpatrick, J.J. (Eds.), Annual Review of Nursing Research (Vol. 2). New York, Springer, pp. 3-25. Gilliss, C.L. (1983). The family as a unit of analysis: Strategies for the nurse researcher. Advances in Nursing Science, 5, 50-59. Thompson, L., & Walker, A.J. (1982). A note on correlated measurement error in wife-husband data. Journal of Marriageand the Family, 46, 643-649. Uphold, C.R., & Harper, D.C. (1986). Methodological issues in intergenerational family nursing research. Advances in Nursing Science, 8, 38-49.
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REFERENCES Fisher, L., Kokes, R.F., Ransom, D.C., Phillips, S.L, & Rudd, P. (1985). Alternative strategies for creating "relationar' family data. Family Process, 24, 213-224. Lynn, M.R. (1989). Readability: A critical instrumentationconsideration.Joumalo, f Pediatric Nursing, 4, 295-297. Thomas, R.B. (1987). Methodological issues and prob-
lems in family health care research. Journal of Marriage and
the Family, 49, 65-70. Uphold, C.R. & Strickland, O.L. (1989). Issues related to the unit of analysis in family nursing research, tVestem Journalof Nursing Research, 11, 405-417.