TheoreTical bases for

promoTing family healTh

DR. SHAH MD. EZAZ-UL HAQUE
MBBS, BCS (Health)
FCPS P1 (Community Medicine)
MPH (Epidemiology) (Completed), BSMMU
Medical Officer
Dhaka Medical College
USAID ACTB Fellow
FETP,B-intermediate Fellow
THE FAMILY
• The family is a primary unit in all societies. It is a group of biologically
related individuals living together and eating from a common kitchen.
• The term family differs from household in that all the members of a
household may not be blood relations, e.g., servants.
• The word, family, which is used in popular term, has made a good deal
of confusion among the professionals. It is used in very many different
senses. To avoid confusion, social scientists have used the term :
• (1) Family of origin or the family into which one is born, and
• (2) Family of procreation or the family which one sets up after
marriage.
Characteristics of family
• As a biological unit, the family members share a pool of genes
• As a social unit, they share a common physical and social environment
• As a cultural unit, the family reflects the culture of the wider society of
which it forms a part and determines the behaviour and attitudes of its
members.
• As an epidemiological unit, and a unit for providing social services as
well as comprehensive medical care.
• The family therefore has engaged the attention of sociologists,
anthropologists, demographers, epidemiologists, medical scientists, and
in fact all those who are concerned with family welfare
Family culture
Family culture is the combination of your family’s habits, traditions, purpose, values,
beliefs, and choices. It is often impacted by experiences, personalities, and external
influences.
Factors-
• Family traditions
• Countries of origin
• Geographic regions
• Ethnic identities
• Cultural groups
• Community norms
• Sexual orientations
• Gender identities
• Educational and other experiences
• Personal choices and
• Home languages
Features of family culture
-Family members share certain values that affect family behaviour
- Certain roles are prescribed and defined for family members
- A family’s culture determine its distribution and use of power
Healthy Families
• Ball and Binder (2005) identified six signs of healthy families.
1. Maintaining a spiritual foundation
2. Making the family a top priority
3. Asking and giving respect
4. Communicating and listening
5. Valuing services to other
6. Expecting and offering acceptance
Functions of the family
• Residence : One of the major social functions of the family is to
provide a clean and decent home to its members
There are two types of residence - patrilocal and matrilocal.
• Division of labour : In primitive societies, the roles and functions
performed by people in family groups were rather well defined. The
male had the sole duty to earn a living and support the family. The
female had the total responsibility for the day to day care of children
and running of the household. In industrialized and urbanized
communities, there is less marked distinction between the functions
of men and women
• Reproduction and bringing up of children : This is a very important
function of a family. The· mother takes absolute care of the infant and
children up to a certain age. The father provides for education and
teaches the child the social traditions and customs.
• Socialization : The family is a bridge between generations and
between father and sons. It is the transfer point of civilization. The
cultural patterns relating to eating, cleanliness, dress, speech,
language, behaviour, and attitudes are all transmitted through the
family.
• Economic functions : The family implies economic partnership for
the family and the progeny. The inheritance of the property and the
ownership and/or control of certain kinds of property like the farm,
shop or dwelling are controlled by the family. Eventually the property
is handed down to the children.
• Social care : The family provides social care by (a) giving status in a
society to its members, i.e.,
(a) Use of family names where it occurs. Some have a strong feeling of
kinship that they belong to a particular family it denotes some kind of
association with someone distinguished in history in that particular society
(b) Protecting its members from insult, defamation, etc.
(c) Regulating marital activities of its members
(d) regulating to a certain extent political, religious and general social
activities,
(e) Regulating sex relations through incest-taboos.
Family life cycle
Families are not constant; they are ever changing. A normal family-
cycle is generally conceived as having six phases .
Events characterizing
Phases of family life cycle Beginning of phase End of phase
Formation Marriage Birth of 1st child
Extension Birth of 1st child Birth of last child
Complete extension Birth of last child 1st child leaves home
Contraction 1st child leaves home Last child has left
home of parents
Completed contraction Last child has left home 1st spouse dies
of parents
Dissolution 1st spouse dies Death of survivor
(Extinction)
Role of family in community health
CHILD REARING

• One of the important functions of the family with which medical and
community health workers are concerned, is the physical care of the
dependent young in order that they may survive to adulthood and
perpetuate the family.
• The way in which child rearing is undertaken differs enormously from
society to society, and from time to time.
• Factors for child rearing are capital resources, level of knowledge, state
of technology and system of values
• Patterns of child care (e.g., feeding, nutrition, hygiene, sleep, clothing,
discipline, habit training) are passed on from one generation to another
SOCIALIZATION
• The second responsibility of the family is to socialize the ‘stream of new-born
barbarians.’
• It refers to the process whereby individuals develop qualities essential for
functioning effectively in the society in which they live.
• It is a latent function
• By socialization is meant teaching the young the values of society and
transmitting information, culture, beliefs, general codes of conduct, by
example and precept, in order to make them fit for membership in the wider
society of which the family is a part.
• Organizations such as schools and religious places perform cultural functions
for the introduction of the young into adult society.
• The young are persuaded, given punishments, rewards for good behaviour -
all these vary from time to time.
PERSONALITY FORMATION
• This is even a more latent function.
• It is an area in which sociology comes closest to psychology.
• The capacity of an individual to withstand stress and strain and the
way in which he interacts with other people is to a large extent
determined by his early experience in the family, mainly with the
father, mother and siblings who provide the earliest and most
immediate component of the child's external environment.
• The family acts as a "placenta" excluding various influences,
modifying others that pass through it and contributes some of its own
in laying the foundation of physical, mental and social health of the
child.
CARE OF DEPENDANT ADULTS
Care of the sick and injured
• In all forms of society, adults may become dependant either through injury,
illness or because of basic biological limitation for performing functions
normally expected by adults.
Care of women during pregnancy and child birth
From the public health point of view, care of women during periods of
recognized dependency, i.e., pregnancy and childbirth is an important
function of the family.
Care of the aged and handicapped
An area of increasing importance, particularly in the western societies, is the
care of the aged and infirm. Without the support of the family, no amount of
medical care can succeed.
STABILIZATION OF ADULT PERSONALITY
• The family is like a "shock absorber" to the stress and strains of life.
• The stress could be injury, illness, births, deaths, tension, emotional
upsets, worry, anxiety, economic insecurity and the like.
• In such situations, the family provides an opportunity, both for adults
and children, for release of tension so that the individual can attain
mental equilibrium and strive to maintain a stable relationship with
other people.
FAMILIAL SUSCEPTIBILITY TO DISEASE
• The members of a family share a pool of genes and a common
environment and together, these decide their susceptibility to disease
• Certain diseases such· as haemophilia, colour blindness, diabetes and
mental illness are known to run through families.
• Schizophrenia, psychoneurosis and some forms of mental deficiency
are also known to have a familial incidence.
• The family is often the playground also for such communicable
diseases as tuberculosis, common cold, scabies, diphtheria, measles,
mumps, rubella, chickenpox, dysentery, diarrhoea, and enteric fever.
• . It is generally agreed that the incidence of congenital malformation is
higher among offsprings of consanguineous as compared with non-
consanguineous marriages.
BROKEN FAMILY
• Broken family is one where the parents have separated, or where death
has occurred of one or both the parents.
• Dr. John Bowlby brought out clearly the concept of "mental deprivation" as
one of the most dangerous pathogenic factors in child development.
• Separation of the child from its father (paternal separation) and separation
of the child from both of its parents (dual-parental separation) are
important factors in child development.
• Children who are victims of broken families early in their childhood have
been found sometimes to display in later years psychopathic behaviour,
immature personality and even retardation of growth, speech and intellect
• Children from these families may drift away to prostitution, crime and
vagrancy.
PROBLEM FAMILIES
• Problem families are those which lag behind the rest of the community.
• In these families, the standards of life are generally far below the accepted
minimum and parents are unable to meet the physical and emotional needs
of their children.
• The underlying factors in most problem families are usually those of
personality and of relationship, backwardness, poverty, illness, mental and
emotional instability, character defects and marital disharmony. These
families are recognized as problems in social pathology.
• Children who are reared in such an environment are victims of prostitution,
crime and vagrancy.
• Problem families may be found in all social classes but are more common in
the lower social classes.
Family health assessment
Assessing a family health in a systematic manner require three
tools

• Conceptual framework upon which to base assessment.

• A clearly defined set of assessment categories for data collection.

• A method of measuring family’s level of functioning

Conceptual Framework
• A Conceptual Framework is a sets of concepts integrated into
meaningful explanation that helps one to understand human
behaviors or situations.
• Three conceptual frameworks are particularly useful in family health
assessment.
- Interactional framework
-Structural-functional framework
-The developmental framework
Interactional framework
Describe the family as-
Unit of interacting
Personalities
Emphasize communication
Role
Managing decisions
Decision-making process
Mainly focuses on internal relationship
Structural-functional framework
Describes the family as a social system relating to other social systems
in the external environment, such as-
School
Work
Religion places
Healthcare system
The developmental framework
Studies family from lifecycle perspective by examine members’
changes roles and tasks in each progressive life cycle.
Family developmental task
• Beginning family
Establishing a mutually satisfying marriage
Planning to have or not to have a child

• Childbearing family
Having and adjusting to infant
Support needs of all three members
Renegotiating marital relationship
• Family with pre-school children
Adjusting to cost of family life
Adapting to needs of pre-school children to motivate growth and
development
Managing and parental loss of energy and privacy

• Family with school age children

Adjusting to the activity of growing children
Promoting joint decision-making between children and parents
Encouraging and supporting children’s educational achievements
• Family with teenagers ang young adults
Maintaining open communication among members
Supporting ethical and moral values within the family
Balancing freedom with responsibilities of teenagers
Releasing customs and assistance
Strengthening marital relationship
Maintaining supporting home based young adults with appropriate
care
• Post-parental family
Preparing for retirement
Maintaining ties with younger and older generations

• Aging family
Adjusting to retirement
Adjusting to loss of spouse
Closing family house
Data collection categories
• A list of 12 data collection categories

1. Family demographic (Composition, Socio-economic)

2. Physical environment
a) Housing and the conditions inside, outside and surrounding it
b) Any existing safety or environmental hazards
c) The amount and quality of services available
d) Geography and climate
3. Psychological and spiritual environment such as-
a) Mutual respect, support, promotion and members’ self esteem
4. Family structure and roles include-
a) Family organization
b) Division of labour and allocation
c) Use of authority and power
5. Family functions refers to a family’s ability to carry out appropriate
developmental tasks and provide for its members’ need.
6. Family values and beliefs influence all aspects of family life. e.g.
making and spending money, education, work and religion
7. Family communication pattern includes the frequency and quality
of communication with a family and between the family and its
environment
8. Family decision-making pattern
9.Family problem solving
10. Family coping patterns, Family support system, response to
stressors
11. Family health behavior
12. Family social and cultural pattern
Family health assessment methods
1. Ecomap : Ecomap is a key visual aid in social work, aimed at mapping
and understanding a client’s personal and social connections. It
provides an in-depth view of the complex interactions and influences
in a person’s life, especially in relation to their environment.
Public health expert can use an ecomap to identify-
• Family resources that are present
• Family needs
• Conflicts
• Connection that are present and absent
• The balance or lack of balance between family’s needs and resources
available for family
• 2. Genogram: A picture of family history, usually used over three or
more generation.
The genogram maps such as information as-
• Relationship among family members
• Important life events
• Place of residence
• Characteristics such as race, culture and religious associations
3. Family health tree: A record of diseases that occur in the family.
It can be used to path:
 Diseases that have genetic bases
 Environmental diseases
 Mental health disorders
Attitudes of family
• The ideas people have about nutrition, exercise, sleep and clothing have a
large social component which varies from society to society and from time to
time.
• For instance child care is more permissive in the East starting with the "on
demand" schedule at mother's breast : in the West, child care is more rigid
and confined to a set of rules. When the community health worker seeks to
improve the health of the child, he meets several obstacles
• . These obstacles are the traditional ways which are supported by appeals to
religion and other sanctions.
• For example, the problem of overcrowding is not merely a question of room
space, but in many instances a question of sleeping habits, a part of a
pattern of social customs which foster better relations between groups.
Once again, variations between societies may be complex and difficult to
change
Attitudes of family
The attitude of the family in regard to individuals who need care and
attention varies considerably.
• In some societies, there is a great deal of harshness in respect of
those who are sufferers. Such individuals are excluded from the full
range of benefits. The kind of illness is also of great importance in
determining the attitudes of society where the illness arouses fear
(e.g., leprosy).
• However, the family is charged with the responsibility of care of such
individuals. The family is expected to provide the front-line care,
particularly the mother.
Attitudes of family
• The attitude of family to pregnancy and child-bearing may have an
important bearing on the infant deaths, premature and stillbirths,
maternal morbidity and mortality.
• In many societies today, women are given financial help, maternity
leave facilities, diet and nutritional supplements and decreased
responsibilities during pregnancy and puerperium
THANK YOU