discuss the importance of family case study

Why is Family Important? Unearthing the Power of Kinship in Our Lives

There’s something profoundly special about family. It’s the cornerstone of our lives, the bedrock on which we build our identities. Family is that unwavering foundation that remains steadfast, even amidst life’s most tumultuous storms. From teaching us our first words to guiding us through life’s winding paths, it’s hard to overstate just how essential families are in shaping who we become.

Not surprisingly, much of what I am today can be traced back to my own family. They’ve instilled in me a sense of integrity and resilience that has served as my North Star throughout life’s journey. My family taught me the importance of respect, love, and kindness—values I strive to uphold every single day.

The significance of family extends far beyond these personal anecdotes though. Various studies have shown how vital strong familial ties are for mental health and well-being at all stages of life—from childhood right up until old age! So let’s delve into this topic further and discuss why family is so crucial.

The Core Values of Family

Family is more than just a word. It’s a world filled with love, trust, respect, and mutual understanding. Let me dive into some of the core values that make family so integral to our lives.

Love is what binds us all together in the tapestry of a family. It’s an unspoken language that transcends words and actions. No matter how big or small our achievements are, we know there’s always someone at home waiting to share our joy or wipe away tears during tough times.

Trust forms the backbone of any familial relationship. We confide in each other knowing that our secrets are safe within those four walls. When we stumble and fall, it’s this unwavering faith we have in our family members that gives us the strength to get back up again.

A healthy dose of mutual respect goes a long way in maintaining harmony within a family. Understanding individual boundaries and acknowledging each other’s feelings play pivotal roles here.

The ability to communicate effectively can’t be overlooked either. Clear communication prevents misunderstandings and resolves conflicts swiftly ensuring peace reigns supreme at home.

And let’s not forget about support – be it emotional or financial, families always have each other’s backs.

To sum it up:

• Love: Bonds us together.
• Trust: Gives us strength.
• Respect: Maintains harmony.
• Communication: Resolves conflicts.
• Support: Provides reassurance during tough times.

These core values don’t just strengthen familial ties but also shape us as individuals influencing every aspect of our life from personal growth to career choices .

Family: The First School for Children

I’ve always believed that families play a crucial role in the early education of their children. They’re more than just blood ties and shared DNA; they’re our first teachers, imparting essential life lessons before we even step foot into a formal school setting.

Think about it – who taught you to speak your first words or tie your shoelaces? Most likely, it was someone in your family. These seemingly small skills are the building blocks of our personal development, and they often come from home.

• _ Speaking : From babbling as babies to forming complete sentences, we learn to communicate effectively through constant interaction with our family members.
• _ Social Skills : Families teach us how to behave properly, respect others, express love and handle conflicts – all vital components in socializing.
• _ Values & Morals : Our sense of right and wrong is largely shaped by the values our families instill in us at an early age.

According to data from the U.S. Department of Education,

Clearly, most parents understand the importance of being actively involved in their child’s early learning process.

On top of these basic life skills and moral teachings, families also provide emotional support during tough times. Childhood can be fraught with challenges and uncertainties; having a supportive family helps kids navigate these obstacles confidently.

In essence, families aren’t just important – they’re irreplaceable educators. So next time you see mom or dad playing ‘teacher’, know that it’s not just fun and games – they’re molding future generations one lesson at a time!

How Family Influences Our Personal Development

The influence of family on our personal development can’t be overstated. I’d go so far as to say it’s the primary architect shaping our emotional, social, and cognitive constructs. It all begins in the nurturing environment a family ideally provides.

Our earliest interactions with family members teach us about relationships , emotions, and effective communication. We learn what’s acceptable and unacceptable behavior within a societal context. Families also foster feelings of security and self-worth that are essential for healthy personal growth.

There are several ways this happens:

• Cognitive Development : The conversations we have at home often stimulate curiosity and thought processes. A simple question about why the sky is blue can ignite interest in science or nature.
• Emotional Development : Emotional intelligence develops through interactions with family members — empathy, understanding emotions, managing feelings — all these come from observing and interacting within a familial setting.
• Social Skills : Learning to share toys with siblings or negotiating an extra half-hour before bedtime cultivates negotiation skills.

In essence, families provide us with a training ground where we learn critical life skills.

Let’s look at some numbers:

Remember though, every individual’s experience varies significantly based on their unique familial circumstances. For instance, individuals from larger families may develop advanced social skills sooner due to more opportunities for interaction.

Family also instills values that shape our worldview. What’s perceived as right or wrong is largely framed by early lessons learned within the confines of our homes.

Long story short: while other factors like peer groups and education play important roles in molding us into who we become, one mustn’t underestimate the profound impact of those family dinners or Sunday afternoon board games.

Economic Benefits of a Strong Family Unit

Let’s dive right into how a strong family unit can contribute significantly to the economic stability of individuals and society as a whole. One of the primary ways this happens is through resource sharing. Within a family, resources like housing, food, and transportation often get shared among members.

• Resource Sharing : When families live together, they pool their resources together for common expenses such as rent or mortgage, utilities, groceries and vehicle costs. This joint effort typically results in lower per-person living expenses compared to people living alone or with non-family roommates.

Next up on the benefits list is childcare support. Here’s where grandparents or other family members step in to help with child rearing – an arrangement that saves parents substantial money they’d have otherwise spent on daycare or babysitters.

• Childcare Support : According to Child Care Aware of America’s 2020 report, the average cost of center-based infant care can range from $6,787 to $20,728 per year depending on the state[^1^]. It’s clear then that relatives helping out with childcare can lead to massive savings!

But it’s not just about saving money; having a strong family unit also tends to promote better financial habits which has long term implications.

• Financial Education : Families are usually the first source of financial education for children. Positive financial behaviors learned early – like saving or budgeting – can set kids up for solid financial futures.

Lastly but definitely not least, there’s evidence suggesting that close-knit families may have higher earning power.

• Earning Power : A study published by economists at University College London revealed that men who grew up in stable families earned approximately 13% more by their late 30s compared to those who did not[^2^].

In all these ways and more – be it through resource sharing, childcare support, financial education or increased earning power – a strong family unit can greatly enhance economic stability.

[^1^]: “2020 Price of Care”, Child Care Aware of America. [^2^]: Paul Gregg, Claudia Vittori and Lindsey Macmillan, “Family income and education in the next generation: exploring income gradients in education for current cohorts of youth”, Oxford Review of Economic Policy, Volume 32, Issue 4, Winter 2016.

Importance of Family in Mental Health Support

I can’t overstate the vital role family plays in supporting mental health. It’s not just about love and companionship, although these are undeniably important. Families offer an essential support system that can help us navigate through life’s toughest challenges, including those related to mental health.

Let’s delve into the statistics for a moment. According to a report by the National Alliance on Mental Illness (NAMI), approximately 1 in 5 adults in the U.S.—43.8 million, or 18.5%—experiences mental illness in a given year. That’s quite a significant number.

In such scenarios, families often become the first line of support, providing emotional comfort and understanding while also helping with practical matters like medical appointments or therapy sessions.

One real-life example comes from my friend Sarah who struggled with severe depression during her college years. She told me how her family was instrumental in her recovery process; they were there throughout – listening without judgment, accompanying her to therapy sessions and simply being present during her darkest hours.

Moreover, our loved ones can often spot changes that we might not notice ourselves – subtle shifts in behavior or mood that could be warning signs of an emerging issue. They’re more likely to encourage us to seek help when we need it most because they care about our well-being.

However, it’s crucial not just for families to be supportive but also informed about mental illnesses so they can provide appropriate help without inadvertently causing harm through misunderstanding or stigma.

• Families form an integral part of an individual’s support network
• They are often first responders during times of crisis
• Loved ones can detect early signs of trouble
• Knowledge about mental health issues enables families to provide effective support

So the importance of family in mental health support can’t be understated. They’re our safety net, cheering squad, and counsel wrapped into one irreplaceable package. In a world that’s increasingly recognizing the vital importance of mental health, our families remain an invaluable asset in this journey towards better wellbeing.

Role of Family in Society: A Broader Perspective

I can’t stress enough the importance of family in our society. They’re not just a group of people related by blood or marriage, they’re the backbone that holds us together as individuals and communities.

So why does family hold such a pivotal role? Well, to start with, families are the first social units we encounter and they shape our understanding of relationships and interactions. From an early age, we learn from our parents or guardians about love, trust, sharing, compromise – all crucial elements for any successful relationship.

Besides shaping personal relations, families also play a vital role in molding our values and beliefs. These lessons aren’t limited to moral teachings alone; they often extend to societal norms and expectations too. For example:

• How should I treat others?
• What’s my responsibility towards my community?
• How do I handle conflicts?

The answers to these questions largely come from our experiences within our family circles.

Now let me throw some light on another aspect – economic support. Families work as economic units ensuring the survival and growth of its members. Parents provide for their children until they become self-sufficient adults who in turn support their aging parents later in life.

Families also contribute hugely towards mental health stability among its members. Studies have shown that having supportive family ties can help reduce stress levels significantly.

To drive home my point about the significance of families in society, here’s some data:

In essence, families shape us into who we are today – teaching us life skills, providing emotional and financial support, and setting the foundation for our future interactions. It’s clear that without family, society as we know it would be a whole different ballgame.

Why Is It Difficult to Define ‘Family’ Universally?

I’ve often pondered why defining ‘family’ universally is such a complex endeavor. The main reason, I believe, is the sheer diversity in family structures worldwide. Traditional nuclear families, single-parent households, extended families living under one roof – these are just a few examples of how varied family setups can be.

Taking cultural nuances into consideration further complicates things. In some cultures, close friends or mentors could be considered as part of the family unit. To indigenous communities like the Maori people of New Zealand, “whanau” (a term for family) can include several generations and relatives by marriage or adoption.

Let’s take a quick look at types of families across several continents:

Another hurdle in universally defining ‘family’ is changing societal norms and attitudes towards relationships and cohabitation. Cohabiting couples who choose not to marry but share their lives together are increasingly common today. Similarly, same-sex couples and parents add another dimension to our understanding of ‘family’.

Moreover, advancements in reproductive technologies have ushered in an era where biological connections aren’t necessary for forming a family unit anymore. Surrogacy and IVF treatments allow individuals or couples – regardless of gender or marital status – to become parents.

So you see, it’s no easy task trying to pin down one universal definition for ‘family’. And perhaps that’s okay because after all, isn’t the beauty of family found within its diversity?

Conclusion: The Integral Role of Family

To wrap it all up, family plays a pivotal role in our lives. It’s not just about sharing the same bloodline or last name. With family, we learn valuable life skills, experience unconditional love and support, and build strong emotional bonds that remain unbroken through thick and thin.

Let’s take a quick recap:

• Life skills: From my first steps to learning how to cook my favorite dish, it was all thanks to my family. They’ve been my initial educators, teaching me essential social skills and values.
• Unconditional love: There are days when I’m at my best but also times when I’m far from perfect. Yet, no matter what happens or how badly I mess up, there’s always this group of people who love me just the same.
• Emotional bond: And let’s not forget the deep emotional connection we share with our families. It’s an irreplaceable bond that offers comfort during tough times and multiplies joy during happy moments.

It’d be remiss of me not to mention that every family is unique. Some might be small while others could span multiple generations living under one roof. You may have single-parent households or those with two moms or dads; some families come together through adoption while others blend due to remarriage.

Yet despite these differences in structure and dynamics, it remains true that having a loving family environment contributes significantly to personal development and overall wellbeing.

In essence, a world without families would be unimaginably different – perhaps less compassionate and more disconnected than ever before. So here’s to celebrating the integral role of families – they’re indeed our treasure troves of happiness!

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The Importance of Family (10 Powerful Reasons)

Family is important because it offers emotional support, nurtures a feeling of belonging, encourages educational growth, and fosters cognitive development. A family meets diverse needs throughout the various phases of life, from infancy through old age.

Families serve crucial societal functions, including socialization, values transmission, and social stability. Families can influence a child’s brain development, prospects of success in life, the formation of future relationships, health, and overall life satisfaction.

Table of Contents

What is family?

A family is generally a group of individuals who come together to provide a natural environment for the development of their children and the well-being of the family’s members. The relationships between the family members can be defined in many ways. Here are 4 common ways to define a family.

• Biological or blood relations : Traditionally, a family is defined as a group of blood-related people. This includes parents and their children, siblings, and extended relatives like grandparents, aunts, uncles, and cousins.
• Social and cultural definition : Socially and culturally, a family can include individuals who are not necessarily related by blood or law but are bound by emotional ties, care, and support. This can include stepfamilies, godparents, close friends, and others who play a significant role in an individual’s life.
• Legal definition : Legally, a family often includes those related by blood, marriage, or adoption. In the United States, this definition varies by the legal context. For example, the Family and Medical Leave Act (FMLA), the U.S. Supreme Court, and the Internal Revenue Service (IRS) have their own interpretations and definitions of family.
• Personal and Emotional Definition : On a personal level, family can mean different things to different people. For some, it’s about biological connections; for others, it’s about who they share their life with, who cares for them, and who they care for.

What is the importance of family?

Here are 10 reasons why family is important.

Provide emotional support

A good family is a source of emotional support and unconditional love. Adults who received emotional support from their family during childhood are associated with experiencing fewer depressive symptoms, according to a 2004 study published in the American Psychological Association’s “Psychology and Aging” journal.

A healthy family with good parenting is associated with better emotional regulation, self-confidence, mental health, social competence, and resilience. Families can be a source of support in good times and in bad.

Foster belongingness and identity

Families shape an individual’s identity and belonging from a young age. As social creatures, belonging to a group is important for our self-concept. Families provide a sense of social identity, a sense of self, and a feeling that we belong to something larger than ourselves.

Promote education

Families facilitate children’s education by creating learning opportunities, providing intellectual stimulation, and modeling literacy and language skills.

Foster cognitive development and academic performance

Families provide an environment that stimulates cognitive skills, such as problem-solving and critical thinking and supports and encourages academic achievements.

Facilitate socialization

Families play a central role in socializing children and teaching social norms, cultural differences, manners, prosocial behavior, and beliefs. Family members help children understand social relationships and navigate community dynamics.

Maintain physical health

Families instill healthy lifestyles by educating family members about nutrition, exercise, and hygiene. These efforts lay the foundation for children’s long-term physical well-being. Additionally, families provide essential care and support during illness, aiding in recovery and managing health challenges.

Guide moral development

Parents shape their children’s moral development by modeling ethical behavior and teaching right from wrong. Many cultures hold family itself as a fundamental moral value.

Preserve cultural and traditional transmission

Families pass down language, rituals, customs, stories, and belief systems from generation to generation, preserving cultural identity and traditions.

Ensure economic support and security

Families provide material support, including food, clothing, and shelter. This economic support contributes to a sense of security and stability from childhood through older adulthood.

Uphold continuity and legacy

Families preserve cultural heritage and traditions, ensuring these are passed down through generations. A 2015 study conducted by the Manchester Metropolitan University indicated that a family helps individuals gain a sense of continuity by providing a shared history and a link to the past through narratives.

Why do we need a family?

Our families are one of the most important things in our lives. We need a family for different reasons at various stages of our lives.

• When babies are born, they need a family’s care and protection to survive.
• Children need a family’s guidance to learn. They also need a family’s assistance to grow physically and mentally.
• Teenagers need a family’s continued financial and emotional support. They also need a family’s to develop their independent identity.
• Adults need a family’s emotional connection to feel loved and belong.
• Seniors need a family to have a sense of purpose in life.

Is family the most important thing?

Yes, family is the most important thing to many people. In a survey conducted at the University of London in 1995 with 2,000 adult respondents, 31% mentioned relationships with family or relatives as the most important thing in their lives – the highest percentage for any item.

However, family is not the most important thing to everyone. In a 2015 study conducted at Kean University, 43.5% of 354 graduate and undergraduate students were estranged from their families. Reasons for estrangement included disagreement, financial issues, divorce, substance abuse, and abuse.

What is the importance of family in society?

The importance of family in society includes the following 5 factors.

• Socialization : Families instill values, beliefs, and norms in children that support a peaceful, well-functioning society. They teach kids fundamental social skills like language, customs, roles, and norms. They also shape children’s prosocial behaviors like cooperation, respect, and contribution to the community. Well-socialized children grow into productive adult citizens.
• Values transmission : Families are the primary way values such as responsibility, honesty, generosity, etc., are passed down to shape future generations and society.
• Social stability and structure : There is a strong connection between family nurturing and the well-being of society. Family is a basic building block of society, performing an important role in providing structure and stability. Strong family units contribute to a stable social framework, which is essential for the overall functioning and cohesiveness of the community.
• Community engagement and development : Families often participate in community activities and local governance, contributing to developing strong, supportive, and resilient communities.
• Economic support : Families provide economic support for children, the elderly, sick, and unemployed family members, reducing the burden on society. Families also contribute to society through consumption and production.

What is the role of family in child development?

Families play 5 important roles in child development.

• Shape brain development : Family experiences can impact brain development , according to a 2011 research published in the Journal of Child Psychology and Psychiatry. The research reviewed over 50 studies on brain development and found direct evidence that factors such as maltreatment and maternal deprivation during childhood could lead to changes in brain structure, volume, growth, and activities. Early experiences lay the groundwork for developing a healthy brain, emotional regulation, social competence, and resilience. 10.1111/j.1469-7610.2010.02281.x
• Contribute to life success : Researchers have observed that parenting and the family play a crucial role in a child’s life and success in all the societies studied. For instance, a Harvard University study conducted in 1938 tried to determine the secret of raising successful kids. 268 male Harvard students were tracked for 70 years in the Harvard Grant Study, the first of its kind. Their mental and physical health, as well as their successes and failures, was analyzed. A loving family and healthy relationships are strongly linked to a successful and happy life.
• Influence future relationships : According to the attachment theory theorized by psychiatrist John Bowlby and psychologist Mary Ainsworth, family plays an important role in establishing children’s attachment styles. This early attachment influences the child’s emotional development, self-perception, and future relationships.
• Impact health and well-being : Numerous studies have consistently shown that family life is an important aspect of our well-being. A strong family unit characterized by positive, supportive relationships enhances mental and physical health. For example, a 2011 study conducted by the University of Wisconsin-Madison revealed that family structure was significantly linked to teenagers’ behavioral issues, physical health, and emotional health. A supportive family environment fosters a sense of security and belonging, contributing to lower stress levels and improved health outcomes.
• Predict life satisfaction: In a 1980 study conducted at Indiana State University, life satisfaction levels at 4 stages of adult life from early adulthood (ages 22-34) to late adulthood (ages 65 and older) were examined. A strong family life was one of the strongest predictors of life satisfaction at each stage.

Why is family important to you?

Family is important to people in many different ways. Here are 10 potential reasons why family can be important to you.

• Family can offer unconditional love.
• Family gives you strength and support to face difficulties in life.
• Family models good values.
• Family provides companionship and a sense of belonging.
• Family helps you build self-esteem.
• Family provides you with shelter and safety.
• Family teaches you vital lessons in life.
• Family gives you a sense of security and stability.
• Family teaches you moral values.
• Family enhances mental health.

How does family influence your life?

A family influences your life in many different ways. Some influences are positive, while others are negative. From our earliest moments, our families shape our understanding of the world, our beliefs and values, habits and behaviors, and even our personalities.

Our families provide our first social interactions and environments for learning. Parents, siblings, and extended family teach us through their words, actions, encouragement, and discipline. Growing up, we observe how our families communicate, solve problems, express emotions, and relate to one another and the outside world. Consciously and unconsciously, we integrate much of what we learn from our families into our ways of thinking, feeling, and acting.

The family relationships and dynamics we experience can impact our self-esteem, mental health, worldviews, communication patterns, decision-making, relationships outside the family, and more. Healthy, loving family bonds often lead to positive development and outcomes later in life. Dysfunctional family environments can negatively shape us, too.

Our families leave lasting imprints on who we become as individuals. Their influences remain with us as we mature and start our own families, determining what values, behaviors, and environments we pass on to our children. For better and worse, our families shape our lives through the lessons they teach us and the models they provide.

Why should we help our family?

We should help our families because families provide not just basic needs for children but also emotional needs. A loved one can be a source of strength during hard times. By being there for family when they need us, we reciprocate this love and care they have provided us. When we support family members,  we reinforce our relationships and embody the family values of love, responsibility, generosity, and a sense of community.

How do families develop strong foundations?

To develop strong foundations, here are 4 ways to promote a strong sense of family.

• Invest in family support: Families provide not just basic needs for children but also emotional needs. A loved one can be a source of strength during hard times. Showing children unconditional love is one of the best ways to create a support system. It is their safe haven, so they know they can always come home.
• Improve communication : Open communication is critical to building close connections. Good communication means everyone should be able to speak up, including children. They can have open discussions and share their thoughts honestly and respectfully. Happy, healthy family dynamics rely on respecting each other’s thoughts and feelings and compromising when necessary. Each family member feels connected and is part of something bigger than themselves. 
• Cherish family dinner time : A 2006 study published in the Journal of Adolescent Health highlighted its significance in the positive development of teenagers. This extensive study surveyed 99,462 high school students across the United States and discovered a notable positive correlation between regular family dinners and essential aspects such as commitment to learning, the development of positive values, social competencies, and a positive sense of identity. Conversely, it found that these family meals were inversely associated with high-risk behaviors, including substance use, sexual activity, depression, suicidal tendencies, antisocial behaviors, and violence.
• Prioritize quality time together : The value of family time lies not just in its quantity but significantly in its quality. Quality time goes beyond just engaging in enjoyable activities; it encompasses being present and supportive during your child’s challenging moments and actively participating in their life. These meaningful interactions are what constitute true quality time.

Do I need a family to be happy?

No, you don’t need a family to be happy. True happiness can come from within through personal fulfillment, self-discovery, achieving competence, a sense of purpose, and healthy relationships. What brings fulfillment varies significantly among individuals.

In addition, having a family does not automatically equate to happiness. For instance, children in abusive family environments often do not have a happy childhood . 

Similarly, parenthood doesn’t guarantee happiness. A study by the Berlin Social Science Center 2014 found that new parents were generally less happy than their childless counterparts.

Is it OK not to have a family?

Yes, it is OK not to have a family. In 2020, the U.S. Census Bureau found that married-couple households without children under 18 were more common than married-couple households with children. Not everyone feels compelled to have children or establish a traditional family structure.

Your happiness and love for your life are what matter most. If not having a family aligns with your happiness and life goals, it’s the right path for you. There is no need to conform to societal norms or feel pressured to do what everyone else does. Prioritize what brings you fulfillment and joy.

References For Importance of Family

• 1. Bennett J. Narrating family histories: Negotiating identity and belonging through tropes of nostalgia and authenticity. Current Sociology . Published online April 20, 2015:449-465. doi:https://doi.org/10.1177/0011392115578984
• 2. Bowling A. What things are important in people’s lives? A survey of the public’s judgements to inform scales of health related quality of life. Social Science & Medicine . Published online November 1995:1447-1462. doi:https://doi.org/10.1016/0277-9536(95)00113-l
• 3. Conti RP. Family Estrangement: Establishing a Prevalence Rate. JPBS . Published online 2015. doi:https://doi.org/10.15640/jpbs.v3n2a4
• 4. Woodhams V, de Lusignan S, Mughal S, et al. Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network. BMC Health Serv Res . Published online June 10, 2012. doi:https://doi.org/10.1186/1472-6963-12-153
• 5. Ainsworth MDS. The Bowlby-Ainsworth attachment theory. Behav Brain Sci . Published online September 1978:436-438. doi:https://doi.org/10.1017/s0140525x00075828
• 6. Langton CE, Berger LM. Family Structure and Adolescent Physical Health, Behavior, and Emotional Well-Being. Social Service Review . Published online September 2011:323-357. doi:https://doi.org/10.1086/661922
• 7. Elgar FJ, Craig W, Trites SJ. Family Dinners, Communication, and Mental Health in Canadian Adolescents. Journal of Adolescent Health . Published online April 2013:433-438. doi:https://doi.org/10.1016/j.jadohealth.2012.07.012
• 8. Medley ML. Life Satisfaction across Four Stages of Adult Life. Int J Aging Hum Dev . Published online October 1980:193-209. doi:https://doi.org/10.2190/d4lg-aljq-8850-gydv
• 9. Fulkerson JA, Story M, Mellin A, Leffert N, Neumark-Sztainer D, French SA. Family Dinner Meal Frequency and Adolescent Development: Relationships with Developmental Assets and High-Risk Behaviors. Journal of Adolescent Health . Published online September 2006:337-345. doi:https://doi.org/10.1016/j.jadohealth.2005.12.026
• 10. Pollmann‐Schult M. Parenthood and Life Satisfaction: Why Don’t Children Make People Happy? J of Marriage and Family . Published online March 4, 2014:319-336. doi:https://doi.org/10.1111/jomf.12095
• 11. . Married Couple Households Made Up Most of Family Households. United States Census Bureau. Published 2023. https://doi.org/https://www.census.gov/library/stories/2023/05/family-households-still-the-majority.html

Disclaimer: The content of this article is intended for informational purposes only and should not be considered medical advice. Always consult your healthcare provider for medical concerns.

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Research: How Family Motivates People to Do Their Best Work

• Lauren C. Howe
• Jochen I. Menges

Work and family are often seen as competing for an employee’s time and energy — but that’s the wrong way to think about it.

Family is one of the most important things in most people’s lives, across cultures and geographies. Yet, the idea that family can be motivational at work has been overlooked. Instead, in the past, family has been mostly seen as competing with work for an employee’s finite resources, like their time and energy. A large body of research on work-family conflict drew on this notion and illustrated how work and family domains create conflicting demands and interfere with one another. And yet, there’s another growing body of research that finds that family can play a role in motivation at work, boosting employees’ performance and inspiring them to do their best. This article focuses on that body of research, and discusses how organizations that embrace family at work stand to benefit from attracting and retaining employees who are highly motivated and engaged.

Tennis star Serena Williams recently unveiled her next endeavor after leaving the courts behind: her new brand, Wyn Beauty. Like the decision to retire from tennis to focus on family, Williams’ choice to focus on beauty is a family affair. As Williams put it: “Motherhood has allowed me to look at beauty through the eyes of my daughter, Olympia. We’re always experimenting with makeup together, and I think about how these moments will be part of both of our beauty journeys… I also hope my daughters see how many different passions I have — from tennis to beauty — and learn that they can lead dynamic careers and lives across their many interests.”

• Lauren C. Howe is an Associate Professor in Management at the University of Zurich. As a member of the Center for Leadership in the Future of Work , she focuses on how human aspects, such as mindsets, socioemotional skills, and social relationships play a role in the changing world of work.
• Jochen I. Menges is a Professor of Leadership and Human Resource Management at the University of Zurich, the Director of the Center for Leadership in the Future of Work, and a co-founder of the Global HR Valley®, a growing people innovation ecosystem. He studies how people can feel and do their best at work, today and tomorrow. Jochen is also a faculty member at Cambridge Judge Business School.

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Article contents

Family, culture, and communication.

• V. Santiago Arias V. Santiago Arias College of Media and Communication, Texas Tech University
•  and  Narissra Maria Punyanunt-Carter Narissra Maria Punyanunt-Carter College of Media and Communication, Texas Tech University
• https://doi.org/10.1093/acrefore/9780190228613.013.504
• Published online: 22 August 2017

Through the years, the concept of family has been studied by family therapists, psychology scholars, and sociologists with a diverse theoretical framework, such as family communication patterns (FCP) theory, dyadic power theory, conflict, and family systems theory. Among these theories, there are two main commonalities throughout its findings: the interparental relationship is the core interaction in the familial system because the quality of their communication or coparenting significantly affects the enactment of the caregiver role while managing conflicts, which are not the exception in the familial setting. Coparenting is understood in its broader sense to avoid an extensive discussion of all type of families in our society. Second, while including the main goal of parenting, which is the socialization of values, this process intrinsically suggests cultural assimilation as the main cultural approach rather than intergroup theory, because intercultural marriages need to decide which values are considered the best to be socialized. In order to do so, examples from the Thai culture and Hispanic and Latino cultures served to show cultural assimilation as an important mediator of coparenting communication patterns, which subsequently affect other subsystems that influence individuals’ identity and self-esteem development in the long run. Finally, future directions suggest that the need for incorporating a nonhegemonic one-way definition of cultural assimilation allows immigration status to be brought into the discussion of family communication issues in the context of one of the most diverse countries in the world.

• parental communication
• dyadic power
• family communication systems
• cultural assimilation

Introduction

Family is the fundamental structure of every society because, among other functions, this social institution provides individuals, from birth until adulthood, membership and sense of belonging, economic support, nurturance, education, and socialization (Canary & Canary, 2013 ). As a consequence, the strut of its social role consists of operating as a system in a manner that would benefit all members of a family while achieving what is considered best, where decisions tend to be coherent, at least according to the norms and roles assumed by family members within the system (Galvin, Bylund, & Brommel, 2004 ). Notwithstanding, the concept of family can be interpreted differently by individual perceptions to an array of cultural backgrounds, and cultures vary in their values, behaviors, and ideas.

The difficulty of conceptualizing this social institution suggests that family is a culture-bound phenomenon (Bales & Parsons, 2014 ). In essence, culture represents how people view themselves as part of a unique social collective and the ensuing communication interactions (Olaniran & Roach, 1994 ); subsequently, culture provides norms for behavior having a tremendous impact on those family members’ roles and power dynamics mirrored in its communication interactions (Johnson, Radesky, & Zuckerman, 2013 ). Thus, culture serves as one of the main macroframeworks for individuals to interpret and enact those prescriptions, such as inheritance; descent rules (e.g., bilateral, as in the United States, or patrilineal); marriage customs, such as ideal monogamy and divorce; and beliefs about sexuality, gender, and patterns of household formation, such as structure of authority and power (Weisner, 2014 ). For these reasons, “every family is both a unique microcosm and a product of a larger cultural context” (Johnson et al., 2013 , p. 632), and the analysis of family communication must include culture in order to elucidate effective communication strategies to solve familial conflicts.

In addition, to analyze familial communication patterns, it is important to address the most influential interaction with regard to power dynamics that determine the overall quality of family functioning. In this sense, within the range of family theories, parenting function is the core relationship in terms of power dynamics. Parenting refers to all efforts and decisions made by parents individually to guide their children’s behavior. This is a pivotal function, but the quality of communication among people who perform parenting is fundamental because their internal communication patterns will either support or undermine each caregiver’s parenting attempts, individually having a substantial influence on all members’ psychological and physical well-being (Schrodt & Shimkowski, 2013 ). Subsequently, parenting goes along with communication because to execute all parenting efforts, there must be a mutual agreement among at least two individuals to conjointly take care of the child’s fostering (Van Egeren & Hawkins, 2004 ). Consequently, coparenting serves as a crucial predictor of the overall family atmosphere and interactions, and it deserves special attention while analyzing family communication issues.

Through the years, family has been studied by family therapists, psychology scholars, and sociologists, but interaction behaviors define the interpersonal relationship, roles, and power within the family as a system (Rogers, 2006 ). Consequently, family scholarship relies on a wide range of theories developed within the communication field and in areas of the social sciences (Galvin, Braithwaite, & Bylund, 2015 ) because analysis of communication patterns in the familial context offers more ecological validity that individuals’ self-report measures. As many types of interactions may happen within a family, there are many relevant venues (i.e., theories) for scholarly analysis on this subject, which will be discussed later in this article in the “ Family: Theoretical Perspectives ” section. To avoid the risk of cultural relativeness while defining family, this article characterizes family as “a long-term group of two or more people related through biological, legal, or equivalent ties and who enact those ties through ongoing interactions providing instrumental and/or emotional support” (Canary & Canary, 2013 , p. 5).

Therefore, the purpose of this article is to provide an overview of the most relevant theories in family communication to identify frustrations and limitations with internal communication. Second, as a case in point, the United States welcomes more than 50 million noncitizens as temporary visitors and admits approximately 1 million immigrants to live as lawful residents yearly (Fullerton, 2014 ), this demographic pattern means that nearly one-third of the population (102 million) comes from different cultural backgrounds, and therefore, the present review will incorporate culture as an important mediator for coparenting, so that future research can be performed to find specific techniques and training practices that are more suitable for cross-cultural contexts.

Family: Theoretical Perspectives

Even though the concept of family can be interpreted individually and differently in different cultures, there are also some commonalities, along with communication processes, specific roles within families, and acceptable habits of interactions with specific family members disregarding cultural differences. This section will provide a brief overview of the conceptualization of family through the family communication patterns (FCP) theory, dyadic power theory, conflict, and family systems theory, with a special focus on the interparental relationship.

Family Communication Patterns Theory

One of the most relevant approaches to address the myriad of communication issues within families is the family communication patterns (FCP) theory. Originally developed by McLeod and Chaffee ( 1973 ), this theory aims to understand families’ tendencies to create stable and predictable communication patterns in terms of both relational cognition and interpersonal behavior (Braithwaite & Baxter, 2005 ). Specifically, this theory focuses on the unique and amalgamated associations derived from interparental communication and its impact on parenting quality to determine FCPs and the remaining interactions (Young & Schrodt, 2016 ).

To illustrate FCP’s focus on parental communication, Schrodt, Witt, and Shimkowski ( 2014 ) conducted a meta-analysis of 74 studies (N = 14,255) to examine the associations between the demand/withdraw family communication patterns of interaction, and the subsequent individual, relational, and communicative outcomes. The cumulative evidence suggests that wife demand/husband withdraw and husband demand/wife withdraw show similar moderate correlations with communicative and psychological well-being outcomes, and even higher when both patterns are taken together (at the relational level). This is important because one of the main tenets of FCP is that familial relationships are drawn on the pursuit of coorientation among members. Coorientation refers to the cognitive process of two or more individuals focusing on and assessing the same object in the same material and social context, which leads to a number of cognitions as the number of people involved, which results in different levels of agreement, accuracy, and congruence (for a review, see Fitzpatrick & Koerner, 2005 ); for example, in dyads that are aware of their shared focus, two different cognitions of the same issue will result.

Hereafter, the way in which these cognitions are socialized through power dynamics determined socially and culturally by roles constitutes specific interdependent communication patterns among family members. For example, Koerner and Fitzpatrick ( 2006 ) provide a taxonomy of family types on the basis of coorientation and its impact on communication pattern in terms of the degree of conformity in those conversational tendencies. To wit, consensual families mostly agree for the sake of the hierarchy within a given family and to explore new points of view; pluralistic families allow members to participate equally in conversations and there is no pressure to control or make children’s decisions; protective families maintain the hierarchy by making decisions for the sake of achieving common family goals; and laissez-faire families, which are low in conversation and conformity orientation, allow family members to not get deeply involved in the family.

The analysis of family communication patterns is quintessential for family communication scholarly work because it influences forming an individual’s self concept in the long run. As a case in point, Young and Schrodt ( 2016 ) surveyed 181 young adults from intact families, where conditional and interaction effects between communication patterns and conformity orientation were observed as the main predictors of future romantic partners. Moreover, this study concluded that FCPs and interparental confirmation are substantial indicators of self-to-partner confirmation, after controlling for reciprocity of confirmation within the romantic relationship. As a consequence, FCP influences children’s and young adults’ perceptions of romantic behavior (e.g., Fowler, Pearson, & Beck, 2010 ); the quality of communication behavior, such as the degree of acceptation of verbal aggression in romantic dyads (e.g., Aloia & Solomon, 2013 ); gender roles; and conflict styles (e.g., Taylor & Segrin, 2010 ), and parental modeling (e.g., Young & Schrodt, 2016 ).

This suggests three important observations. First, family is a very complex interpersonal context, in which communication processes, specific roles within families, and acceptable habits of interactions with specific family members interact as subsystems (see Galvin et al., 2004 ; Schrodt & Shimkowski, 2013 ). Second, among those subsystems, the core interaction is the individuals who hold parenting roles (i.e., intact and post divorced families); the couple (disregarding particular sexual orientations), and, parenting roles have a reciprocal relationship over time (Le, McDaniel, Leavitt, & Feinberg, 2016 ). Communication between parenting partners is crucial for the development of their entire family; for example, Schrodt and Shimkowski ( 2013 ) conducted a survey with 493 young adult children from intact (N = 364) and divorced families (N = 129) about perceptions of interparental conflict that involves triangulation (the impression of being in the “middle” and feeling forced to display loyalty to one of the parents). Results suggest that supportive coparental communication positively predicts relational satisfaction with mothers and fathers, as well as mental health; on the other hand, antagonist and hostile coparental communication predicted negative marital satisfaction.

Consequently, “partners’ communication with one another will have a positive effect on their overall view of their marriage, . . . and directly result[ing in] their views of marital satisfaction” (Knapp & Daly, 2002 , p. 643). Le et al. ( 2016 ) conducted a longitudinal study to evaluate the reciprocal relationship between marital interaction and coparenting from the perspective of both parents in terms of support or undermining across the transition to parenthood from a dyadic perspective; 164 cohabiting heterosexual couples expecting their first child were analyzed from pregnancy until 36 months after birth. Both parents’ interdependence was examined in terms of three variables: gender difference analysis, stability over time in marriage and coparenting, and reciprocal associations between relationship quality and coparenting support or undermining. The findings suggest a long-term reciprocal association between relationship quality and coparenting support or undermining in heterosexual families; the quality of marriage relationship during prenatal stage is highly influential in coparenting after birth for both men and women; but, coparenting is connected to romantic relationship quality only for women.

Moreover, the positive association between coparenting and the parents’ relationship relates to the spillover hypothesis, which posits that the positive or negative factors in the parental subsystem are significantly associated with higher or lower marital satisfaction in the spousal subsystem, respectively. Ergo, overall parenting performance is substantially affected by the quality of marital communication patterns.

Dyadic Power

In addition, after analyzing the impact of marital interaction quality in families on marital satisfaction and future parental modeling, it is worth noting that marital satisfaction and coparenting are importantly mediated by power dynamics within the couple (Halstead, De Santis, & Williams, 2016 ), and even mediates marital commitment (e.g., Lennon, Stewart, & Ledermann, 2013 ). If the quality of interpersonal relationship between those individuals who hold parenting roles determines coparenting quality as well, then the reason for this association lies on the fact that virtually all intimate relationships are substantially characterized by power dynamics; when partners perceive more rewards than costs in the relationship, they will be more satisfied and significantly more committed to the relationship (Lennon et al., 2013 ). As a result, the inclusion of power dynamics in the analysis of family issues becomes quintessential.

For the theory of dyadic power, power in its basic sense includes dominance, control, and influence over others, as well as a means to meet survival needs. When power is integrated into dyadic intimate relationships, it generates asymmetries in terms of interdependence between partners due to the quality of alternatives provided by individual characteristics such as socioeconomic status and cultural characteristics such as gender roles. This virtually gives more power to men than women. Power refers to “the feeling derived from the ability to dominate, or control, the behavior, affect, and cognitions of another person[;] in consequence, this concept within the interparental relationship is enacted when one partner who controls resources and limiting the behavioral options of the other partner” (Lennon et al., 2013 , p. 97). Ergo, this theory examines power in terms of interdependence between members of the relationship: the partner who is more dependent on the other has less power in the relationship, which, of course, directly impact parenting decisions.

As a case in point, Worley and Samp ( 2016 ) examined the balance of decision-making power in the relationship, complaint avoidance, and complaint-related appraisals in 175 heterosexual couples. Findings suggest that decision-making power has a curvilinear association, in which individuals engaged in the least complaint avoidance when they were relatively equal to their partners in terms of power. In other words, perceptions of one another’s power potentially encourage communication efficacy in the interparental couple.

The analysis of power in intimate relationships, and, to be specific, between parents is crucial because it not only relates to marital satisfaction and commitment, but it also it affects parents’ dyadic coping for children. In fact, Zemp, Bodenmann, Backes, Sutter-Stickel, and Revenson ( 2016 ) investigated parents’ dyadic coping as a predictor of children’s internalizing symptoms, externalizing symptoms, and prosocial behavior in three independent studies. When there is a positive relationship among all three factors, the results indicated that the strongest correlation was the first one. Again, the quality of the marital and parental relationships has the strongest influence on children’s coping skills and future well-being.

From the overview of the two previous theories on family, it is worth addressing two important aspects. First, parenting requires an intensive great deal of hands-on physical care, attention to safety (Mooney-Doyle, Deatrick, & Horowitz, 2014 ), and interpretation of cues, and this is why parenting, from conception to when children enter adulthood, is a tremendous social, cultural, and legally prescribed role directed toward caregiving and endlessly attending to individuals’ social, physical, psychological, emotional, and cognitive development (Johnson et al., 2013 ). And while parents are making decisions about what they consider is best for all family members, power dynamics play a crucial role in marital satisfaction, commitment, parental modeling, and overall interparental communication efficacy in the case of postdivorce families. Therefore, the likelihood of conflict is latent within familial interactions while making decisions; indeed, situations in which family members agree on norms as a consensus is rare (Ritchie & Fitzpatrick, 1990 ).

In addition to the interparental and marital power dynamics that delineates family communication patterns, the familial interaction is distinctive from other types of social relationships in the unequaled role of emotions and communication of affection while family members interact and make decisions for the sake of all members. For example, Ritchie and Fitzpatrick ( 1990 ) provided evidence that fathers tended to perceive that all other family members agree with his decisions or ideas. Even when mothers confronted and disagreed with the fathers about the fathers’ decisions or ideas, the men were more likely to believe that their children agreed with him. When the children were interviewed without their parents, however, the majority of children agreed with the mothers rather than the fathers (Ritchie & Fitzpatrick, 1990 ). Subsequently, conflict is highly present in families; however, in general, the presence of conflict is not problematic per se. Rather, it is the ability to manage and recover from it and that could be problematic (Floyd, 2014 ).

One of the reasons for the role of emotions in interpersonal conflicts is explained by the Emotion-in-Relationships Model (ERM). This model states that feelings of bliss, satisfaction, and relaxation often go unnoticed due to the nature of the emotions, whereas “hot” emotions, such as anger and contempt, come to the forefront when directed at a member of an interpersonal relationship (Fletcher & Clark, 2002 ). This type of psychophysical response usually happens perhaps due to the different biophysical reactive response of the body compared to its reaction to positive ones (Floyd, 2014 ). There are two dimensions that define conflict. Conflict leads to the elicitation of emotions, but sometimes the opposite occurs: emotions lead to conflict. The misunderstanding or misinterpretation of emotions among members of a family can be a source of conflict, as well as a number of other issues, including personality differences, past history, substance abuse, mental or physical health problems, monetary issues, children, intimate partner violence, domestic rape, or maybe just general frustration due to recent events (Sabourin, Infante, & Rudd, 1990 ). In order to have a common understanding of this concept for the familial context in particular, conflict refers to as “any incompatibility that can be expressed by people related through biological, legal, or equivalent ties” (Canary & Canary, 2013 , p. 6). Thus, the concept of conflict goes hand in hand with coparenting.

There is a myriad of everyday family activities in which parents need to decide the best way to do them: sometimes they are minor, such as eating, watching TV, or sleeping schedules; others are more complicated, such as schooling. Certainly, while socializing and making these decisions, parents may agree or not, and these everyday situations may lead to conflict. Whether or not parents live together, it has been shown that “the extent to which children experience their parents as partners or opponents in parenting is related to children’s adjustment and well-being” (Gable & Sharp, 2016 , p. 1), because the ontology of parenting is materialized through socialization of values about every aspect and duty among all family members, especially children, to perpetuate a given society.

As the findings provided in this article show, the study of family communication issues is pivotal because the way in which those issues are solved within families will be copied by children as their values. Values are abstract ideas that delineate behavior toward the evaluation of people and events and vary in terms of importance across individuals, but also among cultures. In other words, their future parenting (i.e., parenting modeling) of children will replicate those same strategies for conflict solving for good or bad, depending on whether parents were supportive between each other. Thus, socialization defines the size and scope of coparenting.

The familial socialization of values encompasses the distinction between parents’ personal execution of those social appraisals and the values that parents want their children to adopt, and both are different things; nonetheless, familial socialization does not take place in only one direction, from parents to children. Benish-Weisman, Levy, and Knafo ( 2013 ) investigated the differentiation process—or, in other words, the distinction between parents’ own personal values and their socialization values and the contribution of children’s values to their parents’ socialization values. In this study, in which 603 Israeli adolescents and their parents participated, the findings suggest that parents differentiate between their personal values and their socialization values, and adolescents’ values have a specific contribution to their parents’ socialization values. As a result, socialization is not a unidirectional process affected by parents alone, it is an outcome of the reciprocal interaction between parents and their adolescent children, and the given importance of a given value is mediated by parents and their culture individually (Johnson et al., 2013 ). However, taking power dynamics into account does not mean that adolescents share the same level of decision-making power in the family; thus, socialization take place in both directions, but mostly from parents to children. Finally, it is worth noticing that the socialization of values in coparenting falls under the cultural umbrella. The next section pays a special attention to the role of culture in family communication.

The Role of Culture in Parenting Socialization of Values

There are many individual perceived realities and behaviors in the familial setting that may lead to conflict among members, but all of them achieve a common interpretation through culture; indeed, “all family conflict processes by broad cultural factors” (Canary & Canary, 2013 , p. 46). Subsequently, the goal of this section is to provide an overview of the perceived realities and behaviors that exist in family relationships with different cultural backgrounds. How should one approach the array of cultural values influencing parental communication patterns?

An interesting way of immersing on the role of culture in family communication patterns and its further socialization of values is explored by Schwartz ( 1992 ). The author developed a value system composed of 10 values operationalized as motivational goals for modern society: (a) self-direction (independence of thought and action); (b) stimulation (excitement, challenge, and novelty); (c) hedonism (pleasure or sensuous gratification); (d) achievement (personal success according to social standards); (e) power (social status, dominance over people and resources); (f) conformity (restraint of actions that may harm others or violate social expectations); (g) tradition (respect and commitment to cultural or religious customs and ideas); (h) benevolence (preserving and enhancing the welfare of people to whom one is close); (i) universalism (understanding, tolerance, and concern for the welfare of all people and nature); and (j) security (safety and stability of society, relationships, and self).

Later, Schwartz and Rubel ( 2005 ) applied this value structure, finding it to be commonly shared among over 65 countries. Nevertheless, these values are enacted in different ways by societies and genders about the extent to which men attribute more relevance to values of power, stimulation, hedonism, achievement, and self-direction, and the opposite was found for benevolence and universalism and less consistently for security. Also, it was found that all sex differences were culturally moderated, suggesting that cultural background needs to be considered in the analysis of coparental communication when socializing those values.

Even though Schwartz’s work was more focused on individuals and societies, it is a powerful model for the analysis of the role of culture on family communication and parenting scholarships. Indeed, Schwartz et al. ( 2013 ) conducted a longitudinal study with a sample of 266 Hispanic adolescents (14 years old) and their parents that looked at measures of acculturation, family functioning, and adolescent conduct problems, substance use, and sexual behavior at five time points. Results suggest that higher levels of acculturation in adolescents were linked to poorer family functioning; however, overall assimilation negatively predicted adolescent cigarette smoking, sexual activity, and unprotected sex. The authors emphasize the role of culture, and acculturation patterns in particular, in understanding the mediating role of family functioning and culture.

Ergo, it is crucial to address the ways in which culture affects family functioning. On top of this idea, Johnson et al. ( 2013 ) observed that Western cultures such as in the United States and European countries are oriented toward autonomy, favoring individual achievement, self-reliance, and self-assertiveness. Thus, coparenting in more autonomous countries will socialize to children the idea that achievement in life is an outcome of independence, resulting in coparenting communication behaviors that favor verbal praise and feedback over physical contact. As opposed to autonomy-oriented cultures, other societies, such as Asian, African, and Latin American countries, emphasize interdependence over autonomy; thus, parenting in these cultures promotes collective achievement, sharing, and collaboration as the core values.

These cultural orientations can be observed in parents’ definitions of school readiness and educational success; for Western parents, examples include skills such as counting, recognizing letters, or independently completing tasks such as coloring pictures, whereas for more interdependent cultures, the development of obedience, respect for authority, and appropriate social skills are the skills that parents are expecting their children to develop to evaluate school readiness. As a matter of fact, Callaghan et al. ( 2011 ) conducted a series of eight studies to evaluate the impact of culture on the social-cognitive skills of one- to three-year-old children in three diverse cultural settings such as Canada, Peru, and India. The results showed that children’s acquisition of specific cognitive skills is moderated by specific learning experiences in a specific context: while Canadian children were understanding the performance of both pretense and pictorial symbols skillfully between 2.5 and 3.0 years of age, on average, Peruvian and Indian children mastered those skills more than a year later. Notwithstanding, this finding does not suggest any kind of cultural superiority; language barriers and limitations derived from translation itself may influence meanings, affecting the results (Sotomayor-Peterson, De Baca, Figueredo, & Smith-Castro, 2013 ). Therefore, in line with the findings of Schutz ( 1970 ), Geertz ( 1973 ), Grusec ( 2002 ), Sotomayor-Peterson et al. ( 2013 ), and Johnson et al. ( 2013 ), cultural values provide important leverage for understanding family functioning in terms of parental decision-making and conflict, which also has a substantial impact on children’s cognitive development.

Subsequently, cultural sensitivity to the analysis of the familial system in this country needs to be specially included because cultural differences are part of the array of familial conflicts that may arise, and children experience real consequences from the quality of these interactions. Therefore, parenting, which is already arduous in itself, and overall family functioning significantly become troublesome when parents with different cultural backgrounds aim to socialize values and perform parenting tasks. The following section provides an account of these cross-cultural families.

Intercultural Families: Adding Cultural Differences to Interparental Communication

For a country such as the United States, with 102 million people from many different cultural backgrounds, the presence of cross-cultural families is on the rise, as is the likelihood of intermarriage between immigrants and natives. With this cultural diversity, the two most prominent groups are Hispanics and Asians, particular cases of which will be discussed next. Besides the fact that parenting itself is a very complex and difficult task, certainly the biggest conflict consists of making decisions about the best way to raise children in terms of their values with regard to which ethnic identity better enacts the values that parents believe their children should embrace. As a result, interracial couples might confront many conflicts and challenges due to cultural differences affecting marital satisfaction and coparenting.

Assimilation , the degree to which a person from a different cultural background has adapted to the culture of the hostage society, is an important phenomenon in intermarriage. Assimilationists observe that children from families in which one of the parents is from the majority group and the other one from the minority do not automatically follow the parent from the majority group (Cohen, 1988 ). Indeed, they follow their mothers more, whichever group she belongs to, because of mothers are more prevalent among people with higher socioeconomic status (Gordon, 1964 ; Portes, 1984 ; Schwartz et al., 2013 ).

In an interracial marriage, the structural and interpersonal barriers inhibiting the interaction between two parents will be reduced significantly if parents develop a noncompeting way to communicate and solve conflicts, which means that both of them might give up part of their culture or ethnic identity to reach consensus. Otherwise, the ethnic identity of children who come from interracial marriages will become more and more obscure (Saenz, Hwang, Aguirre, & Anderson, 1995 ). Surely, parents’ noncompeting cultural communication patterns are fundamental for children’s development of ethnic identity. Biracial children develop feelings of being outsiders, and then parenting becomes crucial to developing their strong self-esteem (Ward, 2006 ). Indeed, Gordon ( 1964 ) found that children from cross-racial or cross-ethnic marriages are at risk of developing psychological problems. In another example, Jognson and Nagoshi ( 1986 ) studied children who come from mixed marriages in Hawaii and found that the problems of cultural identification, conflicting demands in the family, and of being marginal in either culture still exist (Mann & Waldron, 1977 ). It is hard for those mixed-racial children to completely develop the ethnic identity of either the majority group or the minority group.

The question of how children could maintain their minority ethnic identity is essential to the development of ethnic identity as a whole. For children from interracial marriage, the challenge to maintain their minority ethnic identity will be greater than for the majority ethnic identity (Waters, 1990 ; Schwartz et al., 2013 ) because the minority-group spouse is more likely to have greater ethnic consciousness than the majority-group spouse (Ellman, 1987 ). Usually, the majority group is more influential than the minority group on a child’s ethnic identity, but if the minority parent’s ethnicity does not significantly decline, the child’s ethnic identity could still reflect some characteristics of the minority parent. If parents want their children to maintain the minority group’s identity, letting the children learn the language of the minority group might be a good way to achieve this. By learning the language, children form a better understanding of that culture and perhaps are more likely to accept the ethnic identity that the language represents (Xin & Sandel, 2015 ).

In addition to language socialization as a way to contribute to children’s identity in biracial families, Jane and Bochner ( 2009 ) indicated that family rituals and stories could be important in performing and transforming identity. Families create and re-create their identities through various kinds of narrative, in which family stories and rituals are significant. Festivals and rituals are different from culture to culture, and each culture has its own. Therefore, exposing children to the language, rituals, and festivals of another culture also could be helpful to form their ethnic identity, in order to counter problems of self-esteem derived from the feeling of being an outsider.

To conclude this section, the parenting dilemma in intercultural marriages consists of deciding which culture they want their children to be exposed to and what kind of heritage they want to pass to children. The following section will provide two examples of intercultural marriages in the context of American society without implying that there are no other insightful cultures that deserve analysis, but the focus on Asian-American and Hispanics families reflects the available literature (Canary & Canary, 2013 ) and its demographic representativeness in this particular context. In addition, in order to acknowledge that minorities within this larger cultural background deserve more attention due to overemphasis on larger cultures in scholarship, such as Chinese or Japanese cultures, the Thai family will provide insights into understanding the role of culture in parenting and its impact on the remaining familial interaction, putting all theories already discussed in context. Moreover, the Hispanic family will also be taken in account because of its internal pan-ethnicity variety.

An Example of Intercultural Parenting: The Thai Family

The Thai family, also known as Krob Krua, may consist of parents, children, paternal and maternal grandparents, aunts, uncles, grandchildren, in-laws, and any others who share the same home. Thai marriages usually are traditional, in which the male is the authority figure and breadwinner and the wife is in charge of domestic items and the homemaker. It has been noted that Thai mothers tend to be the major caregivers and caretakers in the family rather than fathers (Tulananda, Young, & Roopnarine, 1994 ). On the other hand, it has been shown that Thai mothers also tend to spoil their children with such things as food and comfort; Tulananda et al. ( 1994 ) studied the differences between American and Thai fathers’ involvement with their preschool children and found that American fathers reported being significantly more involved with their children than Thai fathers. Specifically, the fathers differed in the amount of socialization and childcare; Thai fathers reported that they obtained more external support from other family members than American fathers; also, Thai fathers were more likely to obtain support for assisting with daughters than sons.

Furthermore, with regard to the family context, Tulananda and Roopnarine ( 2001 ) noted that over the years, some attention has been focused on the cultural differences among parent-child behaviors and interactions; hereafter, the authors believed that it is important to look at cultural parent-child interactions because that can help others understand children’s capacity to socialize and deal with life’s challenges. As a matter of fact, the authors also noted that Thai families tend to raise their children in accordance with Buddhist beliefs. It is customary for young Thai married couples to live with either the wife’s parents (uxorilocal) or the husband’s parents (virilocal) before living on their own (Tulananda & Roopnarine, 2001 ). The process of developing ethnicity could be complicated. Many factors might influence the process, such as which parent is from the minority culture and the cultural community, as explained in the previous section of this article.

This suggests that there is a difference in the way that Thai and American fathers communicate with their daughters. As a case in point, Punyanunt-Carter ( 2016 ) examined the relationship maintenance behaviors within father-daughter relationships in Thailand and the United States. Participants included 134 American father-daughter dyads and 154 Thai father-daughter dyads. The findings suggest that when quality of communication was included in this relationship, both types of families benefit from this family communication pattern, resulting in better conflict management and advice relationship maintenance behaviors. However, differences were found: American fathers are more likely than American daughters to employ relationship maintenance behaviors; in addition, American fathers are more likely than Thai fathers to use relationship maintenance strategies.

As a consequence, knowing the process of ethnic identity development could provide parents with different ways to form children’s ethnic identity. More specifically, McCann, Ota, Giles, and Caraker ( 2003 ), and Canary and Canary ( 2013 ) noted that Southeast Asian cultures have been overlooked in communication studies research; these countries differ in their religious, political, and philosophical thoughts, with a variety of collectivistic views and religious ideals (e.g., Buddhism, Taoism, Islam), whereas the United States is mainly Christian and consists of individualistic values.

The Case of Hispanic/Latino Families in the United States

There is a need for including Hispanic/Latino families in the United States because of the demographic representativeness and trends of the ethnicity: in 2016 , Hispanics represent nearly 17% of the total U.S. population, becoming the largest minority group. There are more than 53 million Hispanics and Latinos in the United States; in addition, over 93% of young Hispanics and Latinos under the age of 18 hold U.S. citizenship, and more than 73,000 of these people turn 18 every month (Barreto & Segura, 2014 ). Furthermore, the current Hispanic and Latino population is spread evenly between foreign-born and U.S.-born individuals, but the foreign-born population is now growing faster than the number of Hispanic children born in the country (Arias & Hellmueller, 2016 ). This demographic trend is projected to reach one-third of the U.S. total population by 2060 ; therefore, with the growth of other minority populations in the country, the phenomenon of multiracial marriage and biracial children is increasing as well.

Therefore, family communication scholarship has an increasing necessity to include cultural particularities in the analysis of the familial system; in addition to the cultural aspects already explained in this article, this section addresses the influence of familism in Hispanic and Latino familial interactions, as well as how immigration status moderates the internal interactions, reflected in levels of acculturation, that affect these families negatively.

With the higher marriage and birth rates among Hispanics and Latinos living in the United States compared to non-Latino Whites and African American populations, the Hispanic familial system is perhaps the most stereotyped as being familistic (Glick & Van Hook, 2008 ). This family trait consists of the fact that Hispanics place a very high value on marriage and childbearing, on the basis of a profound commitment to give support to members of the extended family as well. This can be evinced in the prevalence of extended-kind shared households in Hispanic and Latino families, and Hispanic children are more likely to live in extended-family households than non-Latino Whites or blacks (Glick & Van Hook, 2008 ). Living in extended-family households, most likely with grandparents, may have positive influences on Hispanic and Latino children, such as greater attention and interaction with loving through consistent caregiving; grandparents may help by engaging with children in academic-oriented activities, which then affects positively cognitive educational outcomes.

However, familism is not the panacea for all familial issues for several reasons. First, living in an extended-family household requires living arrangements that consider adults’ needs more than children’s. Second, the configuration of Hispanic and Latino households is moderated by any immigration issues with all members of the extended family, and this may cause problems for children (Menjívar, 2000 ). The immigration status of each individual member may produce a constant state of flux, whereas circumstances change to adjust to economic opportunities, which in turn are limited by immigration laws, and it gets even worse when one of the parents isn’t even present in the children’s home, but rather live in their home country (Van Hook & Glick, 2006 ). Although Hispanic and Latino children are more likely to live with married parents and extended relatives, familism is highly affected by the immigration status of each member.

On the other hand, there has been research to address the paramount role of communication disregarding the mediating factor of cultural diversity. For example, Sotomayor-Peterson et al. ( 2013 ) performed a cross-cultural comparison of the association between coparenting or shared parental effort and family climate among families from Mexico, the United States, and Costa Rica. The overall findings suggest what was explained earlier in this article: more shared parenting predicts better marital interaction and family climate overall.

In addition, parenting quality has been found to have a positive relationship with children’s developmental outcomes. In fact, Sotomayor-Peterson, Figueredo, Christensen, and Taylor ( 2012 ) conducted a study with 61 low-income Mexican American couples, with at least one child between three and four years of age, recruited from a home-based Head Start program. The main goal of this study was to observe the extent that shared parenting incorporates cultural values and income predicts family climate. The findings suggest that the role of cultural values such as familism, in which family solidarity and avoidance of confrontation are paramount, delineate shared parenting by Mexican American couples.

Cultural adaptation also has a substantial impact on marital satisfaction and children’s cognitive stimulation. Indeed, Sotomayor-Peterson, Wilhelm, and Card ( 2011 ) investigated the relationship between marital relationship quality and subsequent cognitive stimulation practices toward their infants in terms of the actor and partner effects of White and Hispanic parents. The results indicate an interesting relationship between the level of acculturation and marital relationship quality and a positive cognitive stimulation of infants; specifically, marital happiness is associated with increased cognitive stimulation by White and high-acculturated Hispanic fathers. Nevertheless, a major limitation of Hispanic acculturation literature has been seen, reflecting a reliance on cross-sectional studies where acculturation was scholarly operationalized more as an individual difference variable than as a longitudinal adaptation over time (Schwartz et al., 2013 ).

Culture and Family Communication: the “so what?” Question

This article has presented an entangled overview of family communication patterns, dyadic power, family systems, and conflict theories to establish that coparenting quality plays a paramount role. The main commonality among those theories pays special attention to interparental interaction quality, regardless of the type of family (i.e., intact, postdivorce, same-sex, etc.) and cultural background. After reviewing these theories, it was observed that the interparental relationship is the core interaction in the familial context because it affects children from their earlier cognitive development to subsequent parental modeling in terms of gender roles. Thus, in keeping with Canary and Canary ( 2013 ), no matter what approach may be taken to the analysis of family communication issues, the hypothesis that a positive emotional climate within the family is fostered only when couples practice a sufficient level of shared parenting and quality of communication is supported.

Nevertheless, this argument does not suggest that the role of culture in the familial interactions should be undersold. While including the main goal of parenting, which is the socialization of values, in the second section of this article, the text also provides specific values of different countries that are enacted and socialized differently across cultural contexts to address the role of acculturation in the familial atmosphere, the quality of interactions, and individual outcomes. As a case in point, Johnson et al. ( 2013 ) provided an interesting way of seeing how cultures differ in their ways of enacting parenting, clarifying that the role of culture in parenting is not a superficial or relativistic element.

In addition, by acknowledging the perhaps excessive attention to larger Asian cultural backgrounds (such as Chinese or Japanese cultures) by other scholars (i.e., Canary & Canary, 2013 ), an insightful analysis of the Thai American family within the father-daughter relationship was provided to exemplify, through the work of Punyanunt-Carter ( 2016 ), how specific family communication patterns, such as maintenance relationship communication behaviors, affect the quality of familial relationships. Moreover, a second, special focus was put on Hispanic families because of the demographic trends of the United States, and it was found that familism constitutes a distinctive aspect of these families.

In other words, the third section of this article provided these two examples of intercultural families to observe specific ways that culture mediates the familial system. Because one of the main goals of the present article was to demonstrate the mediating role of culture as an important consideration for family communication issues in the United States, the assimilationist approach was taken into account; thus, the two intercultural family examples discussed here correspond to an assimilationist nature rather than using an intergroup approach.

This decision was made without intending to diminish the value of other cultures or ethnic groups in the country, but an extensive revision of all types of intercultural families is beyond the scope of this article. Second, the assimilationist approach forces one to consider cultures that are in the process of adapting to a new hosting culture, and the Thai and Hispanic families in the United States comply with this theoretical requisite. For example, Whites recognize African Americans as being as American as Whites (i.e., Dovidio, Gluszek, John, Ditlmann, & Lagunes, 2010 ), whereas they associate Hispanics and Latinos with illegal immigration in the United States (Stewart et al., 2011 ), which has been enhanced by the U.S. media repeatedly since 1994 (Valentino et al., 2013 ), and it is still happening (Dixon, 2015 ). In this scenario, “ask yourself what would happen to your own personality if you heard it said over and over again that you were lazy, a simple child of nature, expected to steal, and had inferior blood? . . . One’s reputation, whether false or true, cannot be hammered, hammered, hammered, into one’s head without doing something to one’s character” (Allport, 1979 , p. 142, cited in Arias & Hellmueller, 2016 ).

As a consequence, on this cultural canvas, it should not be surprising that Lichter, Carmalt, and Qian ( 2011 ) found that second-generation Hispanics are increasingly likely to marry foreign-born Hispanics and less likely to marry third-generation or later coethnics or Whites. In addition, this study suggests that third-generation Hispanics and later were more likely than in the past to marry non-Hispanic Whites; thus, the authors concluded that there has been a new retreat from intermarriage among the largest immigrant groups in the United States—Hispanics and Asians—in the last 20 years.

If we subscribe to the idea that cultural assimilation goes in only one direction—from the hegemonic culture to the minority culture—then the results of Lichter, Carmalt, and Qian ( 2011 ) should not be of scholarly concern; however, if we believe that cultural assimilation happens in both directions and intercultural families can benefit both the host and immigrant cultures (for a review, see Schwartz et al., 2013 ), then this is important to address in a country that just elected a president, Donald Trump, who featured statements racially lambasting and segregating minorities, denigrating women, and criticizing immigration as some of the main tenets of his campaign. Therefore, we hope that it is clear why special attention was given to the Thai and Hispanic families in this article, considering the impact of culture on the familial system, marital satisfaction, parental communication, and children’s well-being. Even though individuals with Hispanic ancentry were in the United States even before it became a nation, Hispanic and Latino families are still trying to convince Americans of their right to be accepted in American culture and society.

With regard to the “So what?” question, assimilation is important to consider while analyzing the role of culture in family communication patterns, power dynamics, conflict, or the functioning of the overall family system in the context of the United States. This is because this country is among the most popular in the world in terms of immigration requests, and its demographics show that one out of three citizens comes from an ethnic background other than the hegemonic White culture. In sum, cultural awareness has become pivotal in the analysis of family communication issues in the United States. Furthermore, the present overview of family, communication, and culture ends up supporting the idea of positive associations being derived from the pivotal role of marriage relationship quality, such that coparenting and communication practices vary substantially within intercultural marriages moderated by gender roles.

Culture is a pivotal moderator of these associations, but this analysis needs to be tethered to societal structural level, in which cultural differences, family members’ immigration status, media content, and level of acculturation must be included in family research. This is because in intercultural marriages, in addition to the tremendous parenting role, they have to deal with cultural assimilation and discrimination, and this becomes important if we care about children’s cognitive development and the overall well-being of those who are not considered White. As this article shows, the quality of familial interactions has direct consequences on children’s developmental outcomes (for a review, see Callaghan et al., 2011 ).

Therefore, the structure and functioning of family has an important impact on public health at both physiological and psychological levels (Gage, Everett, & Bullock, 2006 ). At the physiological level, the familial interaction instigates expression and reception of strong feelings affecting tremendously on individuals’ physical health because it activates neuroendocrine responses that aid stress regulation, acting as a stress buffer and accelerating physiological recovery from elevated stress (Floyd & Afifi, 2012 ; Floyd, 2014 ). Robles, Shaffer, Malarkey, and Kiecolt-Glaser ( 2006 ) found that a combination of supportive communication, humor, and problem-solving behavior in husbands predicts their wives’ cortisol and adrenocorticotropic hormone (ACTH)—both physiological factors are considered as stress markers (see 2006 ). On the other hand, the psychology of individuals, the quality of family relationships has major repercussions on cognitive development, as reflected in educational attainment (Sohr-Preston et al., 2013 ), and highly mediated by cultural assimilation (Schwartz et al., 2013 ), which affects individuals through parenting modeling and socialization of values (Mooney-Doyle, Deatrick, & Horowitz, 2014 ).

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Please note you do not have access to teaching notes, the importance of family: a case report.

Advances in Mental Health and Learning Disabilities

ISSN : 1753-0180

Article publication date: 15 March 2010

This case report highlights the importance of the role of the family in supporting a young person with a developmental disability. The young person discussed has a complex neurodevelopmental disorder with co‐morbid physical health problems. Her family have coped with a number of events in CR's life, ensuring that she has always had their support and understanding. At the time of transition there is a risk of failure to understand the complexities of the role of the family in CR's life. The implications will be discussed.

• Learning disability
• Intellectual disabilities
• Behavioural therapy

Bernard, S. , Gratton, S. and Momcilovic, N. (2010), "The importance of family: a case report", Advances in Mental Health and Learning Disabilities , Vol. 4 No. 1, pp. 17-19. https://doi.org/10.5042/amhld.2010.0053

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• Interactive Cases

Sanchez Family Case Files

Celia sanchez, hector sanchez, junior sanchez, emilia sanchez, vicki sanchez, gloria sanchez, alejandro sanchez, carmen sanchez, joey sanchez, roberto salazar.

Woman, Wife, Mother, Sister, Aunt, Immigrant, Latina

Client History

Married to Hector for more than 30 years, Celia Sanchez has been in this country for about half her life. While there are aspects of the United States Celia appreciates—particularly the economic opportunities for her family—she never imagined that she would raise her children outside of Mexico. Indeed, coming to the United States was Hector’s dream—not hers. Devoted to her family, Celia has never worked outside the home and does not drive. She delights in cooking for her children and grandchildren, talking with her neighbors and by telephone with her sister and cousin, and taking care of the home.

Given her desire to stay close to home and family, Mrs. Sanchez has not developed the proficiency with English that her husband has. This has been a barrier to her efforts to care for the family. For example, in the relatively few instances that she has been so ill that she required the services of a physician, she needed one of her sons to interpret for her. She often struggled to advocate for her children in the school system, which seldom provided interpretation or bilingual educational staff. And when one of her children came in contact with the juvenile justice system, Celia was unable to understand fully the legal implications of the choices she faced.

Recently, the son of her sister Dolores came to the United States from Mexico (see Roberto’s history). Given her dedication to her family, there was no question Celia would welcome Roberto into her home; however, Hector does not fully support this decision.

Most of Mrs. Sanchez’s extended family still lives in Mexico. However, Celia has two cousins in California, and her ex-brother-in-law (Roberto’s father) was recently deported, after living in Chicago for several years. Celia returned to Mexico for a brief visit a few years ago for the funeral of her mother, but, given the expense and time involved, she mostly settles for telephone calls with her sister; when Alejandro can help her set it up and her sister has sufficient bandwidth, they video chat.

Mrs. Sanchez has been concerned with how to stretch their money to accommodate her family’s needs. After seeing how other neighbors stretch their budgets by utilizing some public resources, Celia wanted her husband to apply for financial assistance, but he is adamantly opposed. Unwilling to oppose Hector, Celia has secretly been obtaining commodities from her Church pantry. Since she is an active parishioner at the Our Lady of Guadalupe Church, her visits there do not raise her husband’s suspicions.

Client Concerns

• She is worried that there is not adequate income for the food the family needs, given the two extra mouths to feed and the variability in Hector’s employment, especially as his age advances.
• Mrs. Sanchez is unable to proficiently understand and communicate in English. The Sanchez family needs more information about the process of permanently adopting Celia’s grandson, Joey, especially if their daughter will contest this move.
• Celia is concerned about the tension between her husband and her over the presence of her nephew, Roberto, in their household.

Goals For Client

Keep these goals in mind throughout your analysis

• Find additional resources for food and possibly income support
• With Hector’s active involvement, seek clarification of the legal issues associated with the presence of Roberto in their home and the issues involved in Joey’s adoption
• Enroll in a class for persons learning English as a second language

Critical Questions to Consider

• How do Mrs. Sanchez’s identities—as a woman, Latina, immigrant, mother, wife—influence her experiences today? How might these dynamics affect her engagement with you, as a social worker, as you begin to work together?
• What are Mrs. Sanchez’s language rights, when, for example, she needs translation assistance within the court or school systems? Is the information available from Limited English Proficiency, an interagency federal website, helpful to you as you advocate for her language access ( www.lep.gov )?
• Does the fact that the Sanchez family is mostly Lawful Permanent Residents, not yet U.S. citizens, affect the kinds of income supports for which they might qualify? Check out the resources regarding non-citizen eligibility for means-tested benefits at the National Immigration Law Center ( www.nilc.org ).

Man, Husband, Father, Immigrant, Latino

Hector is the family patriarch of the Sanchez family. He came to this country in 1979 as a young, undocumented agricultural worker. For years, Hector endured long separations from his wife, who was also alone in Mexico, struggling to raise their young children—none of whose births Hector was able to witness. In 1986, encouraged by the passage of law allowing for a federal amnesty program, Hector applied for and was given a green card, making him a legal, permanent resident. He then applied for the same status on behalf of his wife and the children they had at the time. After waiting additional years for the processing, Celia and the children reunited with Hector in the United States. Their subsequent children were born in the U.S. after Hector left agricultural work, in pursuit of more stable employment in construction. Hector has never become a citizen. Although that has been a lifelong goal of his, Hector has never felt that he could take the time off work to study for the test, nor that the increasing application fee was something his family could readily afford. Hector often works six days per week, particularly as the housing market has experienced construction labor shortages and rising demand. However, Hector’s health is not what it once was (he now has diabetes and high blood pressure), and his job is physically demanding, which may limit the number of years he can expect to work. Having suffered much discrimination and having been victimized by hate crimes in his early years in the United States—when he was often subject to ugly slurs and accusations—Mr. Sanchez is deeply proud that he has never asked for public assistance. To get by on the family’s limited income, Mr. Sanchez skips lunch regularly, a serious problem for someone with diabetes.

• Hector is worried about what will happen to his family when he can no longer work at his physically demanding job, particularly because he has been working outside the Social Security system for much of his career.
• Even working full-time, Hector is unable to meet all his family’s needs in the way that he would like. Their house is small for the number of residents living there, and this adds to his stress.
• Roberto’s presence in the house, and his undocumented status, worries Hector. He is not sure what this could mean for his family, especially since the state in which the family lives has considered legislation that would empower local law enforcement, educators, social services, and other personnel to take on immigration enforcement duties.

Clearly review Hector’s strengths and talents and help him assess whether there is any employment available that might be less physically taxing for his health

Discuss with Celia his feelings about the crowded conditions of the house, with the goal of getting Celia to cooperate in finding a place where Roberto can safely stay

Assess the severity of his health concerns and discuss the importance of stress reduction and healthy nutrition

Begin the process of pursuing citizenship for Hector

• How might the Sanchez family’s lives have been different if he had come to the U.S. just a few years later than he did? How have immigration policies shaped their family’s journey? You can learn more about the Immigration Reform and Control Act of 1986—the policy under which Hector obtained his green card—from the Migration Policy Institute https://www.migrationpolicy.org/pubs/legalization-historical.pdf .
• How have experiences with discrimination and bias-fueled harassment affected Hector? How might the recent increases in hate crimes and anti-immigrant sentiment affect Hector’s mental and physical well-being, in light of this history? How could you explore these dynamics with him?
• How do the eligibility rules for means-tested income supports in the U.S.—like SNAP—contribute to the stigma that people like Hector feel when contemplating receiving such assistance? What messages has Hector absorbed about this kind of help, and what does this say about stereotypes about low-income people in the U.S.? Try searching for “stigma and SNAP” to see how organizations that address hunger in the U.S. are trying to combat these perceptions.

Son, Husband, Father, Latino

Junior is the oldest child, married to Lola, and the father of four children, aged two to ten. He lives close to his parents and works in the same job as his father. Junior was already in school when he, his mother, and his siblings reunited with their father in the U.S., and he took to school quickly, learning English and earning good grades. Encouraged by his successes, Junior and his parents expected he would be the first in his family to go to college. However, the tension between the need to bring honor to the family through his academic achievements and the reality that money was needed to support everyone prevented him from pursuing higher education. Although he is older now, and with responsibilities of his own, Jr. is still motivated to go to college and has been taking classes as he can at the local community college. When he graduates from there, he hopes to go to the university close by.

• While Junior’s job is secure for now, given the hot construction market and the desirability of his bilingual skills and high school diploma, he does not want to stay in manual labor, particularly as he sees the strains this has put on his father’s health.
• Junior lacks a college education, but increasing college costs and reductions in available student aid combine to make his goals of obtaining a four-year degree difficult. Additionally, he finds it hard to make time for studies, on top of his other responsibilities, and the college’s shift to online instruction was not a good fit for his learning needs.
• Learn more about college programs available in the area for Junior and the loan and grant programs that might finance his education
• Explore employment options for Lola, Junior’s wife, including childcare resources if Lola wants to work outside the home and/or home-based business options, if she wants to continue to stay home.
• How might Junior’s experiences with his family of origin influence his consideration of his future? How could you engage Lola in the helping process, as you support Junior?
• What types of policy changes would make college more affordable and, therefore, more within the reach of students like Junior? What ideas seem to have the most traction in today’s policy debates, and what would help Junior the most?
• What types of income supports might Junior’s family be eligible for—the Earned Income Tax Credit, Supplemental Nutrition Assistance Program, expanded Child Tax Credits? What would you need to know about Junior’s family—income, state of residence, tax-filing status—in order to determine exactly what they could receive?

Daughter of Celia and Hector, Sister of Junior, Vicki, Gloria, Alejandro and Carmen

As the eldest daughter, Emilia spent a great deal of her childhood helping her mother take care of the siblings and helping with the housework. Until the age of 14, she was a quiet, compliant child. At that point, however, Emilia began to change. Her mother did not know why and was too overwhelmed by the care of the younger children and the difficulties of adjusting to a new country and new cultural context to pay close attention, and her father was working a great deal. However, this is the point at which Emilia began an involvement with drugs, which continues to the present. Emilia is the mother of Joey, described below. Following the birth of Joey, as she struggled with substance use disorder, Emilia became pregnant again. After much anguish, but with great resolve, Emilia had an abortion. This has resulted in an estrangement from her family: in particular, her parents believe that she has committed a mortal sin and do not want her around their home.

• Emilia has been unable to complete treatment for addiction, despite an authentic desire to stop using drugs. It is often difficult for Emilia to secure a treatment spot quickly, when she is motivated to change, and the few treatment programs she has experienced have seldom been culturally-consistent with her identities or fully evidence-based.
• Because of her substance use history, Emilia lacks consistent work history. She did finish high school, but she has rarely worked since.
• As a Lawful Permanent Resident, Emilia’s drug problems could result in her judgment as a person of ‘poor moral character’, which, under U.S. immigration law, could result in denial of an application for U.S. citizenship, or even her deportation. While Hector and Celia do not understand these risks well, Emilia’s siblings, especially Junior and Alejandro, have a better sense of the potential repercussions if Emilia is arrested for drug offenses, but they do not know how to help their sister.
• Emilia is separated from her family due to their rejection of her following her abortion, leaving her with a limited social support system.
• Emilia needs to find a drug treatment program that will provide the guidance and supervision required to enable her to get and remain sober.
• Emilia wants to reestablish a relationship with her family.
• In the future, Emilia needs to secure training that would allow her to find a job that pays enough to support Joey and herself.
• Emilia needs ongoing therapeutic support to manage her recovery and effectively parent.
• How have Emilia’s identities, as a woman, Latina, migrant, and mother, contributed to her unique experiences with substance use disorder and recovery? How might these dimensions be leveraged as strengths, to support Emilia’s pursuit of her goals?
• Substance use disorder treatment is expensive, and, unless an individual is court-ordered to attend, it is difficult to find affordable options. Since Emilia does not have health insurance coverage, how could she obtain the treatment she needs? What options are available, if Emilia was in your community? How might you use a case like Emilia’s to advocate for expansion of substance use disorder treatment options? What messages and arguments could convince policymakers of the importance of these investments?
• How have changing attitudes about drugs and drug use altered the landscape for someone like Emilia, who is struggling with substance use disorder? How might your work with Emilia be different today, compared to a few decades ago?
• Emilia has little contact with Joey’s father, who she runs into only sporadically. Is she entitled to child support to help meet Joey’s financial needs? As Joey’s guardians, are her parents entitled to such assistance? Who could you turn to for help navigating the court system?

Daughter, Sister, Latina, Person with a Disability

When Vicki was 11, social workers from Child Protective Services visited the Sanchez house. Their identified client was actually Emilia; her problems had been brought to their attention by the school. But during that visit, they noted that Vicki’s behavior, which included repetitive motions and a failure to respond to her environment, warranted further assessment. They spoke with Vicki’s school and discovered that Vicki had, in fact, been attending special classes for students with disabilities. However, Vicki had not received therapeutic or developmental intervention—in or outside of school—to support her optimal functioning. Mrs. Sanchez, while aware of a diagnosis of autism spectrum disorder, seemed unaware of its ramifications. Speaking through Jr. at the time, she told the social workers that Vicki had been “touched,” but that she was still able to go to school and that “the other children help her.” As Vicki aged out of the school system, Celia directed her attention to Vicki’s care management, focusing on making her comfortable and keeping her content. This often means long hours in front of the television, although Vicki can also help with some household tasks and particularly enjoys working in her mother’s garden.

• Uncertainty about where Vicki will live when her parents are no longer able to take care of her
• Conflict between Vicki's parents over her ability to work (and little insight into Vicki’s preferences for how she spends her days)
• Lack of information about continuing educational or training services for Vicki as an adult
• Lack of companions outside her immediate family
• Develop a plan that will outline Vicki’s future and prepare for the time when her parents are no longer able to care for her.
• Move Vicki toward greater independence as she is able, involving Vicki as much as possible in these decisions.
• Find appropriate outside resources for Vicki, such as group homes, activity centers, and supported employment, to help her navigate adulthood and build strong relationships beyond her immediate family.
• Even if Mrs. Sanchez becomes convinced that Vicki could thrive in a group residential placement, these services for people who are developmentally disabled often have waiting lists. Since Mrs. Sanchez is unlikely to agree to group home placement for Vicki if there is uncertainty about whether the resources will be there to continue this going forward, investigate the status in your state. Is there a waiting list for these services?
• Early intervention is critical in supporting maximal functioning for those with autism, but, in Vicki’s case, services were delayed for a few years after initial diagnosis, because, as a non-citizen, Vicki was not eligible for Medicaid for her first five years as a Lawful Permanent Resident. This Medicaid change dates to 1996 and the Illegal Immigration Reform and Immigrant Responsibility Act. What were the arguments for this legislation at the time? How might you respond, in a case like Vicki’s? How are similar arguments playing out today, about immigrants’ eligibility for essential services?
• What legislative changes have been made in recent years to provide greater support for individuals with autism and their families? See the Department of Health and Human Services’ resources regarding the Combating Autism Act ( https://www.hhs.gov/autism/factsheet_autism_support.html ) for more information.

Daughter, Sister, Wife, Latina, Survivor

Gloria lives near her parents, with her husband, Leo. Leo and Gloria have been together for so long that everyone thinks of him as part of the family. Gloria’s sister, Carmen (see below), visits Gloria often at her house. For some time, Carmen has been concerned because Leo hits Gloria, often in her presence. When this happens, Gloria will send Carmen home. When Carmen returns the next day, she often finds Gloria bruised and cut, and Leo in the house, as if nothing has happened. Since these episodes began, Gloria has come to her parents’ house less and less and has many excuses for not coming over. Carmen has confronted Gloria about the need to get help, but Gloria responds that her relationship with Leo will get better when she stops making him mad.

She has considered divorce, but believes that the Church would not allow it, and she knows that it would be hard on her parents if she defied the Church’s teachings. She is also afraid to call the police, even when Leo becomes violent, because Leo is undocumented. In their community, local law enforcement often collaborate with the Department of Homeland Security, especially in domestic violence cases. As a result, Gloria is afraid that, if she called the police, Leo could end up in deportation proceedings. She wants the violence to stop, but she does not want her husband permanently removed from the United States.

• There is domestic violence in the home, endangering Gloria’s physical, mental, and social health.
• Gloria fears that her parents would abandon her if she pursued a divorce from Leo.
• Without a job, education beyond high school, or job training, Gloria has few financial prospects without Leo’s income.
• As many of her high school friends are having their second child, Gloria very much wants to be a mother, as well, but she is too afraid to bring a child into the violence of her home with Leo.
• End the violence, either by getting Leo to enter a batterers’ intervention program or by securing safe housing alternatives for Gloria.
• Connect Gloria to community resources, including health care and social supports.
• Address the barriers and fears Gloria encounters as she contemplates her options if she leaves the relationship.
• What are the arguments in favor of policies that promote cooperation between law enforcement and immigration officials, and how do such policies cause problems for immigrants and for social workers working with them? The Immigration Policy Center and American Immigration Council have some information about these local/federal agreements. You may also find coverage of policy debates in your local area, as well, as policymakers and advocates consider the human rights implications of such enforcement tools.
• What strategies and resources might help domestic violence programs to work in culturally-sensitive ways with Latinas, such as Gloria? How would your own identities affect your engagement with Gloria?

Son, Brother, Student, Latino

Alejandro recently graduated high school and lives at home, where he goes to technical school and works weekends and evenings selling cars. In high school, he was quite popular but something of a loner, primarily excelling in art. Alejandro makes money purely on commissions at his job and works very hard. He is fully bilingual in English and Spanish and is known as a resource for those in the immigrant community looking to purchase a car. He feels deeply obligated to help his parents, who have worked so hard for all of them. Alejandro has always been able to “disappear” into the family because the others were always so focused on more acute problems requiring immediate attention. However, Alejandro has a sense of unhappiness that he has decided to talk about to one of the social workers at the Center that he really likes.

• Even prior to the pandemic and its effects on his stress and isolation, Alejandro struggled with decreased energy and increased irritability.
• While he makes a good income, Alejandro dislikes his job in car sales and wants to pursue a different career.
• Alejandro has relatively few friends and has never had a romantic relationship. He has questions about his sexuality but did not feel that he fit in on the few occasions he tried out a gay club a few towns away from home.
• Get a full physical, drawing on the insurance coverage he has through his place of business, to determine if there is any physical explanation for how he feels emotionally.
• Explore the possibility of pursuing his artistic interests professionally, including through the completion of additional training and/or preparation of portfolios that could be leveraged into employment.
• If Alejandro needs mental health treatment to address his emotional well-being, laws requiring insurance parity for physical and mental health treatment will be instrumental in governing the kind of coverage he has available. What are the federal regulations that require parity? What do parity requirements look like in your state?
• Alejandro is particularly worried about his parents’ economic situation, particularly as he sees his father struggle physically at his job. He knows a fair amount about the U.S. economy and social policy systems from his classes in high school and college, and he wonders if his parents will be eligible for Social Security and Medicare when they reach retirement age. What factors determine if Hector and Celia will receive these social insurance benefits?
• While increasing attention to intersectionality has contributed to more resources for people of color and immigrants who are LGBTQ+, it can be difficult for people to find strong supports at these intersections. In your community, what organizations are working on queer rights within immigrant communities, and vice versa? How might you help Alejandro connect to allies as he navigates his own sexuality?

Daughter, Sister, Latina, Deaf Person

As a result of rubella contracted by Celia when she was pregnant, Carmen has a profound hearing impairment. Diagnosed early on when a heavy pan clattered to the floor and she did not respond, social workers were able to assist the family in finding resources to support Carmen’s development. However, the School that Carmen attended taught her American Sign Language (ASL), which her parents do not understand much at all, and which few of her siblings know fluently. Nevertheless, Carmen is very close to her family. Carmen’s school prepared her well for a college curriculum, and Carmen’s teachers are unanimous that she is bright and well-equipped to succeed in higher education. After a great deal of anguish about leaving, Carmen has decided to go to college some distance away. She will be the first child to leave the family’s home community. Carmen is excited about the opportunities in her future and anxious about the changes and how she’ll manage them alone.

• There is still some uncertainty about the finances of Carmen’s higher education. She does not know the full financial aid package she’ll receive, and she does not know how she’ll afford to travel to and from the school she has chosen (largely for its success in working with and cultivating community around deaf students).
• While she has decided on a university, Carmen is uncertain about her career options. She has few role models of deaf professionals outside educators, and she wants to explore more possibilities.
• Carmen’s close connections to her family members are strained by her impending departure, particularly as they deal with their own anxieties about the distance and uncertainty.
• Help Carmen continue to develop her self-advocacy skills and connect with mentors who can guide her decision-making.
• Support Carmen’s investigation of career options, using your assessment skills to determine areas of strong interest, talent, and skills.
• Because Carmen’s parents are not citizens, is she eligible for federal financial aid? What are the rules regarding financial aid eligibility for immigrant students?
• What supports does your higher educational institution provide to first-generation college students like Carmen? For students with disabilities? What kinds of modifications and assistance could Carmen expect to receive if she enrolled at your college? How might these influence the likelihood of her college success?
• How could you engage with Carmen separately, Celia and Hector as her parents, and with the entire family unit, as they face this large change in their lives?

Child, Son, Grandson, Nephew

Joey Sanchez, age 4, is a happy, healthy child who loves Lego and stories about the Incredible Hulk. He loves it when his Uncle Alejandro (whom he calls Ayo) reads to him from the latest adventures of the Hulk and can often be found in front of the television, watching old reruns of the adventures of the Hulk. When Joey was born , he displayed signs of drug exposure. This prompted the social worker at the hospital to take Joey into custody. Until his first court hearing when he was three months old, Joey was in foster care. During this time, his mother, Emilia, was remanded to drug treatment, which she only partially completed. His father was nowhere to be found. Thus, Joey was placed in kinship care with his grandparents, where he remains. His grandparents are in the process of adopting Joey since, under the Adoption and Safe Families Act of 1998, there must be some disposition of Joey’s case. Joey’s mother (Emilia) understands that her life is too unstable for her to be a responsible parent, but she would still like to work towards regaining a parental role in Joey’s life. She has continued to seek regular visitations with Joey during the intervening months, and she is committed to continuing her recovery process so that she can reunite with Joey permanently.

• While still too young to understand all the dynamics, Joey is a bright, curious, loving child. He is happy at his grandparents’ house and thrives with Celia’s love, but he also feels a bond to Emilia, whose affection for him is authentic and evident.
• Joey will start school in the next several months, and he is anxious about being away from Celia during the school day.
• Joey’s grandparents have every intention of adopting him, while his mother would like to regain custody. These diverging aims create conflict in the Sanchez family.
• All the adults in Joey’s life want to see him have a strong start to his education.
• What considerations should the child welfare system take in deciding to whom to award custody of Joey? Does the Adoption and Safe Families Act of 1998 provide the child welfare system with guidelines for resolving these kinds of cases?
• What special services might Joey need in school, as he copes with his attachment instabilities and lack of formal pre-kindergarten preparation? How can Celia and Hector best navigate the school resources to advocate for Joey?
• What types of income and social supports would Hector and Celia be eligible for, if they take full custody of Joey? What resources are available to help them as custodial grandparents?

Son, Cousin, Nephew, Immigrant, Latino

Roberto is a cousin to the Sanchez children and a nephew to Celia. He came to the United States across the border in Texas and is undocumented. As a young boy, he learned enough English from conversing with English-speaking tourists that he has been able, with his uncle’s help, to find day work. Injured during the traumatic border crossing and without adequate medical care in childhood or today, Roberto is plagued by a host of medical problems, including debilitating back pain and poor eyesight. Recently, he fell off a roof he was working on. Had he been in the country legally, he would have certainly received worker’s compensation, but, as it was, he was not even paid for the day’s work he had put in, and he was afraid to say anything to the boss, who was paying him in cash. He worries now that these medical concerns will make it harder for him to secure and keep employment. The Sanchez family is worried too. They are harboring an undocumented worker and do not know what will happen if the immigration authorities find out. Their landlord is very strict about non-family living in the house and tells the family he can charge extra rent if he finds such persons in residence. He insists that this is in the rental contract, but Mrs. Sanchez does not read English, and the contract language is not comprehensible to Mr. Sanchez. At the same time, the Sanchez family cannot imagine putting Roberto out of their house.

• Roberto’s health makes it difficult for him to work regularly, but he is not eligible for income supports. Even when Roberto’s employers refuse to pay him for work that he has completed, which happens fairly frequently, he is afraid to complain, because he thinks that his employers know that he is in the country illegally and may report him.
• Roberto is unable to receive medical care except in the event of true life-threatening emergencies, due to his status as an undocumented worker.
• Roberto knows that he is increasing the crowding in the Sanchez household and he wants to take the pressure off them by finding his own place to live, but he does not know how he can afford this, or whether he can even sign a contract as an undocumented immigrant.
• Roberto would like to legalize his status in the U.S. He does not know if this is even possible, and he does not know how to start this process.
• Find a job that produces as little strain on his health as possible.
• Explore any options to pursue legal immigration status.
• Find some help for his medical problems, through a medical service that will not ask him questions about his immigration status.
• Stay out of the way of the landlord, who is unaware of his presence in the home, or, ideally, find alternative housing.
• What legal remedies does Roberto have when his employers fail to pay him? Does he have a right to be paid, since he does not have work authorization in the U.S.? What about his workplace injury; are undocumented workers entitled to the same health and safety protections as citizen workers? To workers’ compensation? What organizations might be able to help Roberto in these situations?
• What health care resources are available to immigrants, without regard to their immigration status? How have recent changes--including those catalyzed by the pandemic—affected immigrants’ eligibility for and experiences with health care services in the United States?
• How might someone like Roberto be affected by the passage of federal immigration reform? What types of policy changes would be most beneficial to someone in his situation?

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Critical Thinking Questions

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Defining Family: A Case Study Activity

• Emily Ruehs-Navarro
• Sarah Friedman

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Learning Goals and Assessments

Learning Goal(s):

• Goal 1: Students will be able to challenge normative definitions of the family.
• Goal 2: Identify the various institutions and social groups that define families currently and evaluate how family groups are impacted by these definitions.
• Goal 3: Reflect on the importance of defining families and the barriers faced by social groups who do not meet societal definitions of family

Goal Assessment(s):

• Assessment 1: Through discussion of case studies, students will identify social groups that consider themselves family, yet do not fall into many definitions..
• Assessment 2: Students will create a list of scenarios in which the definition of family is important. They will then identify which institutions have the power to create the definition in each scenario.
• Assessment 3: Through small group and class conversations, students will identify how social groups in the case study do or do not have access to resources based on normative definitions of families.

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Family Dynamics and Child Outcomes: An Overview of Research and Open Questions

• Published: 22 March 2017
• Volume 33 , pages 163–184, ( 2017 )

Cite this article

• Juho Härkönen 1 ,
• Fabrizio Bernardi 2 &
• Diederik Boertien 3  

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Previous research has documented that children who do not live with both biological parents fare somewhat worse on a variety of outcomes than those who do. In this article, which is the introduction to the Special Issue on “Family dynamics and children’s well-being and life chances in Europe,” we refine this picture by identifying variation in this conclusion depending on the family transitions and subpopulations studied. We start by discussing the general evidence accumulated for parental separation and ask whether the same picture emerges from research on other family transitions and structures. Subsequently, we review studies that have aimed to deal with endogeneity and discuss whether issues of causality challenge the general picture of family transitions lowering child well-being. Finally, we discuss whether previous evidence finds effects of family transitions on child outcomes to differ between children from different socioeconomic and ethnic backgrounds, and across countries and time-periods studied. Each of the subsequent articles in this Special Issue contributes to these issues. Two articles provide evidence on how several less often studied family forms relate to child outcomes in the European context. Two other articles in this Special Issue contribute by resolving several key questions in research on variation in the consequences of parental separation by socioeconomic and immigrant background, two areas of research that have produced conflicting results so far.

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1 Introduction

The recent decades of family change—including the increases in divorce and separation rates, single parenthood, cohabitation, and step family formation—led to an explosion in popular and academic interest in the consequences of family dynamics for children’s well-being and life chances (cf. Amato 2000 , 2010 ; Amato and James 2010 ; Ribar 2004 ; Sweeney 2010 ; McLanahan et al. 2013 ). Most notably, previous studies have found that children who do not live with both biological parents fare somewhat worse than those who do in terms of psychological well-being, health, schooling, and later labor market attainment, and differ with respect to their own family lives in adulthood. Scholars have interpreted these findings through a relatively small group of factors that include parental and children’s stress associated with family transitions, family conflict, changes in economic resources, and parenting styles. Beyond these established findings, however, several questions remain imperfectly answered.

This Special Issue on “Family Dynamics and Children’s Well-Being and Life Chances in Europe” consists of this introductory article and four empirical studies that address some of these open questions. In general, they give more nuance to the overall association between growing up with both biological parents and child outcomes. More precisely, do these associations differ according to the type of family structure studied? Are these differences in child outcomes due to causal effects of family structures and transitions, or do they reflect preexisting disadvantages between families? And finally, are all children equally affected by family structures and transitions?

In this introduction, we first introduce the theme of family dynamics and children’s outcomes by giving an overview of the findings of parental separation and child outcomes (Sect.  2 ). Parental separation has been the family transition that has attracted most attention among social scientists, and many of our examples later in the article consider this research too. In addition to summarizing the evidence on the relationship between parental separation and psychological well-being, education, social relationships, and own family lives, we discuss how parental separations have been conceptualized, an issue we return to in the subsequent sections.

Parental separation is, however, just one of the family transitions children can experience during their childhoods. The first open question that in our view requires more attention regards the effects of these other family transitions and forms, namely the number of transitions, stepfamilies, and joint residential custody after parental separation (Sect.  3 ). Two of the articles in this Special Issue contribute to this stream of research. Mariani et al. ( 2017 ) present the first European analysis of the effects of family trajectories on children born to lone mothers. Radl et al. ( 2017 ) investigate, in addition to parental separation effects, whether co-residing with siblings or grandparents is related to child outcomes and whether the latter condition the former effects.

The second open question concerns the causal status of the estimated effects (Sect.  4 ): Do family structures and their changes really affect child outcomes, or do the associations reflect some unmeasured underlying factors? This question has attracted deserved attention (e.g., Amato 2000 ; Ribar 2004 ; McLanahan et al. 2013 ), and we review some commonly used methods, using the effects of parental separation as our example. We pay attention to what effects the methods can estimate, in addition to assessing which unobserved variables the different methods adjust for. This discussion highlights the importance of thinking about methodological choices and interpretations of the results in light of the underlying theoretical model of parental separation. The article in this Special Issue by Bernardi and Boertien ( 2017 ) provides also an empirical contribution to this field.

Finally, the last question refers to the heterogeneity in the effects of family dynamics: Are the consequences of parental separation and other family transitions similar for all children? Existing evidence suggests that the answer is no (Amato 2000 ; Demo and Fine 2010 ), but the conclusions about who suffers and who does not remain imperfect, as discussed in Sect.  5 . Three of the articles of this Special Issue analyze these questions, one from a cross-national perspective (Radl et al. 2017 ), one by comparing parental separation effects by socioeconomic background (Bernardi and Boertien 2017 ), and one by immigrant background (Erman and Härkönen 2017 ).

In the final section of this introduction (Sect.  6 ), we discuss some ways forward for future research on family dynamics and children’s outcomes. Two articles in this Special Issue fulfill part of this research agenda by providing evidence on how several less often studied family forms relate to child outcomes in the European context (Mariani et al. 2017 ; Radl et al. 2017 ). The two other articles in this Special Issue (Bernardi and Boertien 2017 ; Erman and Härkönen 2017 ) contribute to the research on heterogeneous consequences of parental separation by clarifying some open questions regarding variation in these consequences by socioeconomic and immigrant background.

2 Parental Separation and Children’s Outcomes

In the 2000s, the share of children who experienced their parents’ separation before age 15 ranged from 10 to 12% in countries such as Bulgaria, Georgia, Italy, and Spain to 35–42% in France, Estonia, Lithuania, and Russia (Andersson et al., forthcoming). In the late 1980s/early 1990s, the corresponding figures ranged from 7 to 30% (Italy and Sweden, respectively, Andersson and Philipov 2002 ).

Parental separation changes children’s lives in many ways. Many scholars conceptualize separations as processes, which often begin way before and last well beyond the actual separation (e.g., Amato 2000 ; Demo and Fine 2010 ; Härkönen 2014 ), even if these starting and ending points can be hard to define. The pre-separation process often involves increasing estrangement and conflict between the parents. These can themselves have negative effects on children’s well-being, and parental separation might therefore already start leaving its traces even before the parents have formally broken up. Not all separations follow such a trajectory. Some families may have had long-lasting conflicts, and other separations might have ended relatively well-functioning partnerships with at least moderate levels of satisfaction (Amato and Hohmann-Marriott 2007 ). The parental separation can in such cases come as an unexpected event for children.

As a result of the separation, children cease to live full-time with both parents, which requires adjustment to the new situation and can start, intensify, or end exposure to parental conflict (Amato 2010 ; Cherlin 1999 ; Pryor and Rodgers 2001 ). Even if joint residential custody of the child post-separation (i.e., children’s alternate living with each parent) is becoming increasingly common, up to one-third and above in Sweden (Bergström et al. 2015 ), the child often receives less involved parenting from the nonresident parent (usually the father), whereas the resident parent’s (usually the mother’s) parenting styles can be affected by increasing time demands (Amato 2000 , 2010 ; McLanahan and Sandefur 1994 ; Seltzer 2000 ). Besides changes in family relationships, a breakup of a household can lead to a drop in economic resources (e.g., Uunk 2004 ). Depending on the country, separated parents may need to adjust their labor supply to meet their new time and economic demands (Kalmijn et al. 2007 ; Uunk 2004 ). Many children also need to move after their parents’ separation, which requires adjustment to a new home environment and possibly a new neighborhood and school. A separation can be followed by further changes in the family structure, such as parental re-partnering, entry of step-siblings, and sometimes, another family dissolution.

Several studies have documented that on average, the lives of children whose parents separated differ from children who lived with both of their parents throughout childhood (Amato 2000 , 2010 ; McLanahan and Sandefur 1994 ; McLanahan et al. 2013 ; Härkönen 2014 ). In the next paragraphs, we provide an overview of the associations of parental separation with some of the most commonly studied child outcomes: psychological well-being and behavioral problems, education, social relationships, and own family lives. In the subsequent sections, we will refine this basic picture by concentrating on other family forms, causality, and heterogeneity in effects.

2.1 Psychological Well-Being and Behavioral Problems

Children of divorce have lower psychological well-being and more behavioral problems than children who grew up in intact families (Amato 2001 ; Amato and James 2010 ; Gähler and Palmtag 2015 ; Kiernan and Mensah 2009 ; Mandemakers and Kalmijn 2014 ). In general, parental separation is more strongly related to externalizing than internalizing problems (Amato 2001 ), and these associations can persist, and even become stronger, into adulthood (Chase-Lansdale et al. 1995 ; Cherlin et al. 1991 ; Lansford 2009 ).

Growing up in a conflict-ridden but stable family can have more negative effects on children’s psychological well-being than parental separation (e.g., Amato et al. 1995 ; Dronkers 1999 ; Hanson 1999 ; Demo and Fine 2010 ). Kiernan and Mensah ( 2009 ) found a role for both maternal depression and economic resources when explaining the lower emotional well-being of children from separated families, whereas Turunen ( 2013 ) found that parental involvement explained part of the lower emotional well-being of children with separated parents, but economic resources did not.

2.2 Education

Children of divorce have lower school grades and test scores (Dronkers 1992 ; Mandemakers and Kalmijn 2014 ; Grätz 2015 ), have lower school engagement (Havermans et al. 2014 ), differ in the kind of track entered in high school (Dronkers 1992 ; Jonsson and Gähler 1997 ; Grätz 2015 ), and have lower final educational attainment (Bernardi and Radl 2014 ; Bernardi and Boertien 2016a ; Gähler and Palmtag 2015 ).

Lower school grades and cognitive performance explain part, but not all of the effect of parental separation on completed education (Dronkers 1992 ). A recent study found that British children of divorce were less likely to continue to full-time upper secondary education even though the parental separation did not affect their school grades (Bernardi and Boertien 2016a ). Parental separation can therefore affect the children’s educational decisions irrespective of their school performance.

Changes in parental resources are an important explanation for the lower educational performance of the children of divorce (Bernardi and Boertien 2016a ; Jonsson and Gähler 1997 ; McLanahan and Sandefur 1994 ; Thomson et al. 1994 ). Studies that have looked into the role of parenting have found differing results, some reporting that parenting partly mediates the effect of separation on educational attainment, while others found parenting to not influence the relationship between parental divorce and school outcomes (Dronkers 1992 ).

2.3 Social Relationships

Despite the increase in shared residential custody (Bjarnason and Arnarsson 2011 ), parental separation generally reduces the child’s contact frequency and relationship quality with the nonresident parent (usually the father), with grandparents and, sometimes, the mother (e.g., Kalmijn 2012 ; Kalmijn and Dronkers 2015 ; Lansford 2009 ). These effects can last into adulthood (Albertini and Garriga 2011 ; Kalmijn 2012 ). Joint residential custody, good inter-parental relations, and good early child-father relations can improve post-separation contact with the father (Kalmijn 2015 ; Kalmijn and Dronkers 2015 ). On the other hand, parental separation can improve the relationships between siblings due to mutual support (Geser 2001 ), but does not seem to trigger more support from friends and other kin (Kalmijn and Dronkers 2015 ).

Good parent–child relationships are desirable by themselves and can also improve other child outcomes (Bastaits et al. 2012 ; Swiss and Le Bourdais 2009 ). For example, having a close relationship with the nonresident parent who engages in authoritative parenting has been found to foster children’s well-being and academic success (Amato and Gilbreth 1999 ). At the same time, contact frequency alone is less important and in some cases, the nonresident parent’s involvement may have negative effects if it increases instability and stress for the child (Laumann-Billings and Emery 2000 ), for example due to continued parental conflict (Kalil et al. 2011 ).

2.4 Own Family Lives

Children of divorce tend to start dating and have their sexual initiation earlier (Wolfinger 2005 ) and many move out of the parental home at a younger age (e.g., Ní Bhrolcháin et al. 2000 ; Ongaro and Mazzuco 2009 ), often because of conflict with parents and their potential new partners (Wolfinger 2005 ). Some studies have also found that children of divorce start cohabiting earlier, are more likely to cohabit than to marry, and have partners of lower socioeconomic status (Erola et al. 2012 ; Reneflot 2009 ; but see also Ní Bhrolcháin et al. 2000 ).

The most consistent family demographic finding is that children whose parents divorced are more likely to divorce themselves as adults (e.g., Diekmann and Engelhardt 1999 ; Dronkers and Härkönen 2008 ; Kiernan and Cherlin 1999 ; Lyngstad and Engelhardt 2009 ; Wolfinger 2005 ). Differences in the life course trajectories before forming the union explain part of this association (Diekmann and Engelhardt 1999 ; Kiernan and Cherlin 1999 ). Other studies have pointed out that parental separation can lead to poorer interpersonal skills and set an example of a feasible solution to relationship problems (Wolfinger 2005 ).

3 What About Other Family Forms?

We have so far focused on parental separation and its relation to child outcomes. Parental separation is not the only family transition children can experience. Between <5% (much of Europe) and up to 15% (Czech Republic, Russia, UK, and USA) of children are born to lone mothers (Andersson et al., forthcoming; Mariani et al. 2017 , this Special Issue). Furthermore, between 14% (Italy and Georgia) and 60% (Belgium) of European children whose parents separate end up living with a stepparent within 6 years (Andersson et al., forthcoming) and often, with step-siblings (Halpern-Meekin and Tach 2008 ). Children’s residence arrangements likewise vary, with some residing primarily with one parent (usually the mother), whereas others alternate between parents (joint residential custody). Extending the focus of research beyond parental separation is necessary to form a more comprehensive view of the effects of the changing family landscape on children’s lives (King 2009 ; Sweeney 2010 ). Footnote 1

One argument puts forward that family stability rather than family structure matters for children’s well-being (cf. Fomby and Cherlin 2007 ; Waldfogel et al. 2010 ). From this perspective, children born to lone mothers who do not experience any family transitions during their childhood (such as the entrance of a stepparent) should do better than children who were born in a two-parent family but experienced a family transition (such as parental separation). Others claim that specific family forms and movements between them do matter beyond general family instability (Magnuson and Berger 2009 ; Lee and McLanahan 2015 ). The findings of Mariani et al. ( 2017 , this Special Issue) are among those that speak against the general instability thesis and show that the types of family transitions experienced by children born to lone mothers matter for their well-being.

Stepfamilies have gained the attention of many scholars. Children in stepfamilies tend to have poorer outcomes compared to those from intact families and display patterns of well-being closer to single-parent families (Amato 1994 , 2001 ; Gennetian 2005 ; Jonsson and Gähler 1997 ; Thomson et al. 1994 ). Indeed, children in stepfamilies can even have lower psychological well-being and educational achievement than children living with a single mother (Amato 1994 ; Biblarz and Raftery 1999 ; Thomson et al. 1994 ).

Reasons for the poorer performance of children with stepparents include the added complexity in family relationships that is often introduced by the presence of a stepparent. This can lead to ambiguity in roles and to conflict in the family (Thomson et al. 1994 ; Sweeney 2010 ), which is among the reasons why having a stepparent often leads to an earlier move from the parental home, especially among girls (Ní Bhrolcháin et al. 2000 ; Reneflot 2009 ). Another explanation points to the presence of step-siblings as stepparents may put less time and effort into their stepchildren than their biological ones (Biblarz and Raftery 1999 ; Evenhouse and Reilly 2004 ). However, having a stepparent can also have positive effects as (s)he can provide financial resources or help in monitoring the children (Thomson et al. 1994 ; King 2006 ; Sweeney 2010 ). Erola and Jalovaara ( 2016 ) showed how a stepparent’s SES was more predictive on adulthood SES than the nonresident father’s SES, and as predictive as the biological father’s SES in intact families. All in all, the effects of step-parenthood are complex and can differ between children who experienced a parental separation and those who never lived with their biological father (Sweeney 2010 ).

The increase in joint residential custody after parental separation has raised interest in its consequences for children. Many studies have reported that children in joint residential custody fare better than children who reside with only one of the parents (usually the mother) on outcomes such as health and psychological well-being, and contact and relationships with their parents and grandparents (Bjarnason and Arnarsson 2011 ; Turunen 2016 ; Westphal et al. 2015 ). However, questions of causality remain unresolved and parents who opt for joint custody might have been particularly selected from those with higher socioeconomic status and lower levels of post-separation conflict. Indeed, many studies find that joint custody may have negative consequences for children in case of high parental conflict (e.g., Vanassche et al. 2014 ; also, Kalil et al. 2011 ). This suggests that policy changes toward joint custody as a default solution may produce unwanted consequences.

4 But What About Causality?

There is a long-standing debate that concerns whether associations between family types and child outcomes reflect causal effects, or whether they are confounded by unmeasured variables. For example, parents who separate can have different (unmeasured) personality traits from those who do not. Other examples include parental unemployment, mental health, or a developing substance abuse problem, which may not only lead to separation, but also affect the parent’s children.

Researchers have used increasingly sophisticated methods to control for different unmeasured sources of bias (for reviews, Amato 2000 , 2010 ; Ribar 2004 ; McLanahan et al. 2013 ). In this section, we discuss some of these methods. We focus on studies that have estimated the effects of parental separation, which serves to illustrate some of the questions involved.

Like most similar reviews, we discuss which (un)measured confounders can be controlled for by the different methods and provide examples of studies that have used them. We also discuss some of the limitations to causal inference in these methods, particularly in light of the underlying theoretical model of parental separation that is assumed. Above, we discussed how parental separations are often theorized as processes that can follow quite different trajectories for different families (Amato 2000 ; Demo and Fine 2010 ; Härkönen 2014 ). Some separations are characterized by a downward spiral of increasing conflict, which can leave its mark on children already before the parents physically separate. Other separations end relatively well-functioning families and can come as a surprise to the children, whereas in some cases the families had high conflict levels for a long time. In this section, we discuss causal inference in light of these underlying models. In the next section, we discuss how these different types of parental separations can have different effects on children.

In addition, we engage in a related but much smaller discussion of what causal questions the different methods can be used to answer (cf., Manski et al. 1992 ; Ní Bhrolcháin 2001 ; Sigle-Rushton et al. 2014 ). A major issue in this regard concerns the counterfactual scenario assumed by different methods. In most studies, the estimated effects are interpreted as telling about how the parents’ physical separation (the separation event) affected the children compared to the counterfactual case in which the parents did not separate. This is, however, not the only possible effect that can be estimated, nor is this interpretation necessarily the correct one in each case.

First, knowing about the effects of the parental separation event is obviously important, but scholars, parents, counselors, and policy makers could likewise benefit from knowing about the “total” effects of parental separation that include the effects of the preceding separation process as well. Second, instead of asking what the effect of the parental separation (compared to them staying together) is, one can ask what the effect is of the parents separating at a specific point in time (the effect of postponing separation) (cf. Furstenberg and Kiernan 2001 ). Our discussion below points to these issues and suggests how some methods can be more appropriate for answering certain questions than others. Rather than providing a comprehensive discussion on this relatively uncovered topic, we wish to stimulate closer consideration of these issues in future research.

4.1 Regression Models

Before discussing methods that adjust for unmeasured confounding factors, we briefly discuss estimation of parental separation effects with linear and logistic (or similar) regression models, which are by far the most common methods used. With these methods, one compares the outcomes of children who experienced parental separation to the outcomes of children from intact families, adjusting for observed confounding variables. Because the possibilities for controlling for all factors that may bias the results are limited, the estimates from regression models cannot usually be interpreted as causal effects (e.g., McLanahan et al. 2013 ; Ribar 2004 ).

Pre-separation parental conflict is often pointed out as an omitted variable that can threaten causal claims. Controlling for pre-separation conflict generally leads to a substantial reduction in the effect of parental separation (e.g., Hanson 1999 ; Gähler and Garriga 2013 ), suggesting that exposure to the parental conflict rather than the parental separation event is largely responsible for the poorer performance of the children of divorce. This example can be used to think about the correspondence between the specified regression model and the underlying theoretical model of parental separation. Controlling for the level of pre-separation parental conflict (or related measures of the family environment) is most appropriate if it is reasonable to assume that families’ conflict levels remain stable; comparing children from separated and intact families at similar levels of earlier conflict can then inform about how the children of divorce would have fared had the parents remained together. However, this is not obvious if the separation followed an increase in parental conflict, because the family environment may have continued to worsen had the parents not separated.

If the above and other conditions for making causal claims are met, which effects do they inform us about? A regression model that controls for pre-separation parental conflict or other related measures is best seen as telling about the effects of the parental separation event. However, an increase in parental conflict is often an inherent part of the parental separation process, and controlling for levels of parental conflict close to the parental separation would not be warranted if one is interested in understanding how exposure to the parental separation process, in addition to the separation event, affects children’s outcomes (cf. Amato 2000 ). The choice of control variables should thus be done with a consideration to the underlying model of parental separation and the effect one wants to estimate.

4.2 Sibling Fixed Effects

Sibling fixed effects (SFE) models compare siblings from the same family who differ in their experience of parental separation before a certain age or life stage, or in the amount of time spent in a specific family type (cf. McLanahan et al. 2013 ; Sigle-Rushton et al. 2014 ). SFE controls for factors and experiences that are shared by the siblings, such as parental SES and many neighborhood and school characteristics. This has made SFE a popular method, not least in Europe. Some SFE studies found no effects of parental separation or other family forms on educational outcomes (Björklund and Sundström 2006 ). Others have found a weak to moderate negative effect on various outcomes even in an SFE design (e.g., Ermisch et al. 2004 ; Sandefur and Wells 1999 ; Sigle-Rushton et al. 2014 ; Grätz 2015 ).

Comparison of siblings from the same family is a core aspect of the SFE design. This affects the data requirements and the interpretation of the results. To fix ideas, we can use an example of the effects of parental separation on children’s school grades at age 15. For an SFE analysis, one needs data on multiple siblings, some of whom experienced the parental separation before age 15 whereas others did not. This requirement reduces the effective sample size. The sibling who did not experience the parental separation is always the older one, and her grades are used to infer about the counterfactual grades of her younger sibling, had she not experienced the parental separation. SFE controls for everything shared by the siblings, but additional controls are needed to adjust for differences between them. Some of these—such as birth order and birth cohort and/or parental age (Sigle-Rushton et al. 2014 )—are available in many datasets, but remaining unobserved differences (as well as measurement error) can cause important bias to the estimates (Ermisch et al. 2004 ; Frisell et al. 2012 ).

SFE models are most informative of the effects of parental separation if it is reasonable to assume that the family environment (including levels of parental conflict) would remain stable in the absence of the parental separation (Sigle-Rushton et al. 2014 ). In such a case, it is most likely that the younger sibling would have experienced a similar family environment as the older sibling, had the parents not separated. The interpretation of SFE results becomes more problematic if the parental separation is the culmination of a deterioration of the family environment (such as increased parental conflict). It is likely that the family environment would have continued to deteriorate had the parents not separated, and the younger sibling would have been taking her grades in a more conflictual family (than her older sibling experienced). Without additional measures, SFE models thus generally rely on the assumption of the stability of the family environment (cf. Sigle-Rushton et al. 2014 ).

SFE models estimate the effect of the event of the parental separation rather than the separation process. Because SFE models are estimated from a subsample of families that dissolved, the estimates are difficult to generalize without making additional assumptions. Also, because the estimates tell about differences between siblings who experienced parental separation but at different ages, or experienced a different amount of time in a separated family, the estimates are best interpreted as effects of the timing of the separation, as argued in detail by Sigle-Rushton and colleagues (2014).

4.3 Longitudinal Designs

Research with longitudinal data has been more applied  in the USA than in Europe (McLanahan et al. 2013 ), possibly because of data access issues. Such data can be analyzed using many methods, but unlike with SFE, these methods can only be used to analyze outcomes that are measured more than once. Similar to SFE models, longitudinal studies generally report weaker effects on child outcomes of parental separation and other family transitions than found in cross-sectional analyses.

4.3.1 Lagged Dependent Variables

In lagged dependent variable (LDV) analyses, one controls for the dependent variable at an earlier measurement point (before parental separation) (Johnson 2005 ; McLanahan et al. 2013 ). The idea is to adjust for initial differences in outcomes between children from separated and intact families. LDV is mostly used in cohort and other studies with just two or few measurement points. Early examples include studies in Britain, which found that although children of divorce had lower psychological well-being already pre-divorce, parental divorce had negative long-term effects (Cherlin et al. 1991 ; Chase-Lansdale et al. 1995 ). Limitations of LDV models include that the estimates are sensitive to omitted variables that affect both the separation and the pre-separation outcome, as well as measurement error in the latter (Johnson 2005 ).

The pre-separation measurement point can correspond poorly to the stages of the parental separation process, especially in cohort studies in which measurements are often done several years apart. LDV models are therefore most appropriate if the differences in the outcome between children who experienced parental separation and those who did not can be assumed to be stable. If one assumes that the child’s well-being deteriorated prior to the separation, the lagged dependent variable can capture part of the effect of the separation process. However, if the measurements are taken several years apart, it is even more difficult than usual to tell whether the outcome was measured before or during the pre-separation deterioration in well-being and consequently, how the estimated coefficient should be interpreted.

4.3.2 Individual Fixed Effects

Individual fixed effects (IFE) models are based on comparing individuals before and after the parental separation and in effect, use individuals as their own control groups to control for time-constant unobserved factors. In an early British IFE study, Cherlin et al. ( 1998 ) concluded that experience of parental separation had weak to moderate negative effects on adulthood psychological well-being, and Amato and Anthony ( 2014 ) reported similar effects on educational, psychological, and health outcomes in the USA. Other American studies have used IFE designs to analyze the effects of the number of transitions (e.g., Fomby and Cherlin 2007 ), of different family transitions (e.g., Lee and McLanahan 2015 ), or combined SFE and IFE approaches (Gennetian 2005 ).

IFE methods estimate the effect of parental separation if it is reasonable to assume that the child whose parents separated would have experienced similar (age-specific) outcomes in the absence of separation as observed before the separation (Aughinbaugh et al. 2005 ). Again, this is most feasible if the child’s level of well-being can be assumed to have remained stable. This is less likely if the child’s well-being began to deteriorate already before the separation, because this deterioration could have continued had the parents not separated. Two US studies attempted to address this issue by tracing behavioral problems and academic achievement before and after the parental separation (Aughinbaugh et al. 2005 ) and by using a triple-difference approach, which compares trends (and not just levels) in the outcome between children from separated and intact families (Sanz-de-Galdeano and Vuri 2007 ). Neither study found the event of parental separation to have appreciable effects.

Furthermore, as in SFE models, IFE effects are estimated only from those children who actually experienced the separation. This generally means a reduction in sample size. For the same reason, IFE results generalize primarily to that group.

4.3.3 Placebo Tests and Growth-Curve Models

Longitudinal data can also be used to conduct “placebo tests,” that is, to analyze whether future separation (e.g., t  + 1) predicts earlier outcomes ( t , or earlier). Bernardi and Boertien (in this Special Issue) found with British data that although children who experienced parental separation before age 16 had a lower probability of transitioning to post-compulsory secondary education, this was not the case for children whose parents separated between ages 17 and 19 (i.e., after the educational transition age). This supports the view that the separation, and not the family environment that preceded it, had an effect on educational decisions.

Finally, longitudinal data have been analyzed with growth-curve models (GCM) to track trajectories in children’s outcomes. Cherlin et al. ( 1998 ) reported that the effects of parental separation on psychological problems increased through adolescence and young adulthood. Even though growth-curve models enable analysis of how effects develop, they are not immune to confounding from unmeasured variables that can affect both the initial level of well-being and its development over time (McLanahan et al. 2013 ). To address this, Kim ( 2011 ) combined matching methods with GCM and found that cognitive skills and non-cognitive traits developed negatively already through the separation period and the effects were amplified by the separation event.

4.4 Interpreting Causal Effects

Controlling for measured and unmeasured confounders practically always leads to reduced effect sizes, which means that children who experienced parental separation would have fared differently to children from intact families regardless. Some studies have found no effects, but the prevailing conclusion is that parental separation can have weak to moderate negative effects (Amato 2000 , 2010 ; McLanahan et al. 2013 ; Ribar 2004 ).

Increasing adoption of advanced methods to control for unmeasured variables improves our understanding of the consequences of family change. None of the methods are, however, completely immune to confounding by unobserved variables. Relatedly, they also correspond differently to underlying theoretical models of parental separation, which affects their interpretation.

We repeatedly mentioned how the methods are most robust if it is reasonable to assume that the family environment, and the children’s well-being, remained stable before the separation and would have remained stable in its absence. Such a scenario characterizes some separations but provides a poorer description of many others where separation was a culmination of a deteriorating family environment (Amato 2000 ; Demo and Fine 2010 ; Härkönen 2014 ). In some cases, additional (time-varying) control variables (e.g., Ermisch et al. 2004 ; Lee and McLanahan 2015 ) or more complex research designs (e.g., Sanz-de-Galdeano and Vuri 2007 ) can be used to alleviate these problems. When choosing the appropriate variables or designs, one should decide whether one is interested in the effects of the separation event or the exposure to the whole separation process. Both are relevant, and their analysis each carries specific challenges. We also discussed how some estimates might be better interpreted as indicators of the influence of the timing of parental separation (cf. Furstenberg and Kiernan 2001 ), another relevant yet different question. All in all, scholars should pay attention to which effects their methods estimate and think of this in light of the underlying theoretical model of parental separation or other family dynamics they are interested in (cf. Manski et al. 1992 ; Ní Bhrolcháin 2001 ).

5 For Whom, When, and Where are Family Transitions Most Consequential?

Most studies reviewed above analyzed what happens on average . Whereas the finding that children growing up in non-traditional families have different outcomes is very consistent, this result hides a large variation in effects at the individual level. A minority of children suffer from a parental separation, but a somewhat smaller minority shows improvements in well-being and performance, and even if parental separation can be a taxing experience associated with sadness and feelings of loss, a large minority or even a majority of children do “just fine” without robust effects in either direction (Amato 2000 , 2010 ; Amato and Anthony 2014 ; Amato and James 2010 ; Demo and Fine 2010 ). Next, we discuss how this heterogeneity in effects is related to pre-separation parental conflict and children’s and parents’ socio-demographic attributes. After that, we review what is known about variation in the effects over time and cross-nationally.

5.1 For Whom Does It Matter?

Which children are more likely to suffer from parental separation than others? Studies both from the USA (Amato et al. 1995 ; Hanson 1999 ; Booth and Amato 2001 ) and Europe (Dronkers 1999 ) have found that pre-separation parental conflict moderates the effects of the separation. Parental separation can be beneficial for children from high-conflict families, but is more likely to have negative effects when parental conflict was low and the separation came as a relative surprise.

Other studies have analyzed variation in the effects of parental separation by demographic characteristics. Although some studies have found gender-specific effects, most have not, leading Amato and James ( 2010 ) to conclude that the gender differences in effects are modest at most. Similar variation in findings characterizes research on effects of stepfamilies (Sweeney 2010 ).

Child’s age at parental separation has been another moderator of interest. Breakups occurring while children are adults have no or the smallest effects (Cherlin et al. 1998 ; Kiernan and Cherlin 1999 ; Furstenberg and Kiernan 2001 ; Lyngstad and Engelhardt 2009 ). Studies on educational outcomes often find the effects to be most pronounced when parents divorced close to important educational decision points (Jonsson and Gähler 1997 ; Lyngstad and Engelhardt 2009 ; Sigle-Rushton et al. 2014 ). Otherwise, findings differ in their conclusions about the childhood stages most sensitive to family disruption, and the specific pattern of heterogeneity is likely to depend on the outcome studied.

Recently, scholars have become increasingly interested in whether effects of parental separation differ by parental socioeconomic status (Augustine 2014 ; Grätz 2015 ; Mandemakers and Kalmijn 2014 ). Although having resources can help families to deal with family transitions, children from resourceful families could also lose more from parental separation (Bernardi and Radl 2014 ; Bernardi and Boertien 2016a ). In line with these contrasting predictions, empirical results are mixed, with some findings pointing to stronger negative effects in families with high (Augustine 2014 ; Grätz 2015 ; Mandemakers and Kalmijn 2014 ) or low socioeconomic status (Bernardi and Boertien 2016a ; Bernardi and Radl 2014 ; Biblarz and Raftery 1999 ; Martin 2012 ; McLanahan and Sandefur 1994 ). Bernardi and Boertien ( 2017 , this Special Issue) address this inconsistency. They show that methodological choices underlie part of this variation in results, but their substantive conclusion is that the negative effect of parental separation on educational choices is stronger for children whose high-socioeconomic status father moves out. The greater financial losses are an important part of the explanation, which also suggests that the results might be different for outcomes that are less responsive to financial resources.

Other studies have compared the effects of parental separation and single parenthood between ethnic, racial, and migrant groups. Many US studies have found that Black children are less affected by growing up in a non-intact family than White children (Fomby and Cherlin 2007 ; McLanahan and Bumpass 1988 ; McLanahan and Sandefur 1994 ; Sun and Li 2007 ). Some European studies have found variation in family structure effects by ethnic and immigrant background (Kalmijn 2010 , forthcoming; Erman and Härkönen, this ‘Special Issue’). In general, the family structure effects are weaker in groups in which parental separation and single motherhood are more common, which has been explained by less stigma, better ways of handling father absence, a broadly disadvantaged position with less to lose, or differential selection by unobserved factors, as argued by Erman and Härkönen in this Special Issue.

Instead of analyzing different predictors of separation separately, Amato and Anthony ( 2014 ) used several of these predictors together to, first, predict the children’s propensity to experience parental separation, and second, analyze whether parental divorce effects vary by this propensity. They found that the effects were the strongest for children with the highest risk of experiencing parental divorce, a result seemingly at odds with the above-mentioned findings of weaker effects in groups with higher separation rates.

5.2 Stability Over Time

It is straightforward to expect that the effects of family transitions on child outcomes should have waned over time. As non-traditional family forms have become more common, the social stigma attached to them should decrease (Lansford 2009 ). Children of divorce are also increasingly likely to retain close contact with both of their parents (e.g., Amato and Gilbreth 1999 ; Gähler and Palmtag 2015 ) and families and societies may have in general become better in handling the consequences of family change. Yet, several studies have reported remarkable stability in the negative associations between parental separation and educational attainment, psychological well-being, and own family dissolution risk (Albertini and Garriga 2011 ; Biblarz and Raftery 1999 ; Dronkers and Härkönen 2008 ; Sigle-Rushton et al. 2005 ; Li and Wu 2008 ; Gähler and Palmtag 2015 ). Some studies have found changing effects, but in opposite directions: a waning intergenerational transmission of divorce (Wolfinger 2005 ; Engelhardt et al. 2002 ), but a strengthening effect of parental separation on educational attainment (Kreidl et al. 2017 ).

Why this general stability? One possibility is that although some factors associated with parental separation, such as stigma, have become less common, other proximate consequences—including shock, grief, and anger over the separation of the parents (Pryor and Rodgers 2001 )—have remained stable. Another potential explanation refers to changing selection into separation. Parental separation has become increasingly associated with low levels of maternal education (Härkönen and Dronkers 2006 ). The motives for divorce have also changed over time. Fewer parental separations are today preceded by severe conflict and violence, whereas more are characterized by psychological motives and disagreements upon the division of labor (De Graaf and Kalmijn 2006 ; Gähler and Palmtag 2015 ). In general, changing selectivity of parental separation can have offset any weakening trend in its effects. The data requirements to disentangle these explanations are high, but those studies which have appropriate variables support the conclusion of a generally stable effect (Sigle-Rushton et al. 2005 ; Gähler and Palmtag 2015 ).

5.3 Cross-National Variation

Associations between family structure and child outcomes are robust in the sense that they are generally found in each country (cf. Amato and James 2010 ) and are often more similar than one might expect (Härkönen 2015 ). However, many studies have reported cross-national variation in the strength of associations (e.g., Brolin Låftman 2010 ; Radl et al. 2017 , this Special Issue). A series of studies found that countries with policies aimed at equalizing the living conditions between different types of families had smaller family structure gaps in educational achievement (Pong et al. 2003 ; Hampden-Thompson 2013 ; however, see Brolin Låftman 2010 ). Larger family structure differences have also been reported in economically more developed societies, where the nuclear family plays a more important role (Amato and Boyd 2014 ).

Dronkers and Härkönen ( 2008 ) found that the intergenerational transmission of divorce was weaker in countries where parental divorce was more common. This fits the intuition of weaker penalties when certain family behaviors are more common. However, other studies have found the opposite (Pong et al. 2003 ; Kreidl et al. 2017 ). An explanation is that in societies in which separation is uncommon, it is more often a solution to ending very troubled relationships and therefore more likely to be beneficial for the children.

6 Discussion and Recommendations for Future Research

We set the stage for future research in four directions. First, understanding the effects of heterogeneous family forms and transitions will be a research priority in the future as well (Amato 2010 ). Most of the research reviewed in this introduction has focused on the effects of parental separation, but scholars have been increasingly aware of and interested in the complexity of family forms in today’s societies. Some of this research was addressed in this article, and the analyses by Mariani, Özcan, and Goisis, and Radl, Salazar, and Cebolla-Boado in this Special Issue are further contributions to this topic: the former being the first to look at the outcomes of children born in lone mother families within one European country (the UK), and the latter providing a cross-national overview of the effects of various types of family structures. Future research, particularly in Europe, should continue addressing questions such as the effects of experiencing multiple family transitions and of complex family life course trajectories during childhood. Family complexity can also mean that the boundaries between family forms become blurred. An example is the increasing popularity of joint residential custody, which questions earlier divisions into single-parent and two-parent families. Understanding the effects of family forms under family complexity thus also means an update in conceptual thinking.

Second, children react to (changes in) family circumstances in remarkably different ways (e.g., Amato and Anthony 2014 ), which is hidden under the average effects reported in most studies. Three of the papers in this Special Issue address these questions and identify subgroups for which effects appear to be more limited compared to other groups such as low SES families and children from ethnic minorities. Better understanding the sources of vulnerability and resilience in the face of family change will continue to be a priority for research, and in this task, future research will benefit from combining theoretical and methodological approaches from sociology, demography, psychology, and genetics (cf. Amato 2010 ; Demo and Fine 2010 ).

Another related task for future research will be to systematize the research on variation in family structure effects across individuals and families, groups, and societal contexts. As reviewed in this article, the findings often point to confusingly different directions. Many studies, including the ones by Erman and Härkönen and Bernardi and Boertien in this Special Issue, have found that parental separation effects on educational outcomes are weaker in socioeconomic and ethnic groups where it is more frequent, but Amato and Anthony ( 2014 ) reported that the effects are more negative for children who had the highest risk of experiencing parental separation. Yet another group of studies have reported that the effects of parental separation are more negative when the parents had lower levels of conflict—and presumably, low likelihood of separating—before the separation (Amato et al. 1995 ; Dronkers 1999 ; Hanson 1999 ; Demo and Fine 2010 ). Many cross-national studies have concluded that these effects are stronger in societies in which parental separation is more common (Pong et al. 2003 ; Kreidl et al. 2017 ). At the same time, most studies continue to find that parental separation effects have remained stable even though more children have been experiencing it. Understanding these seemingly contradictory results will need theoretical development and appropriate data and designs to test them. Bernardi’s and Boertien’s study in this Special Issue provides a good example of such research.

Third, future research will undoubtedly continue employing sophisticated methods to analyze whether family structures and transitions have causal effects on children’s lives. Yet as discussed above, conceptual thought of what effects can be estimated with different methods and what effects are of most theoretical interest has not necessarily kept up with the methodological advances (for exceptions: Manski et al. 1992 ; Ní Bhrolcháin 2001 ; Sigle-Rushton et al. 2014 ). Using parental separation as our example, we distinguished between the effects of separations as events and separations as processes, as well as between the experience of separation and its timing. Researchers should pay more attention to these differences in the conceptualization of effects, which essentially boils down to the consideration of the underlying theoretical model of parental separation. Better recognition of these differences can contribute to theory-building and methodological advancement and help in formulating advice to parents, family counselors, and policy makers.

Last, these issues have implications for understanding social inequality in a time of family change. The “diverging destinies” thesis (McLanahan and Percheski 2008 ) holds that socioeconomically uneven family change, in which the retreat from stable two-parent families is happening particularly among those with low levels of education, can reduce social mobility. Yet whether this is the case depends not only on differences in family structures by socioeconomic background, but also on the strength of the effects of these family structures on the outcomes in question; if the effects are nil or weak, it does not matter who lives in which kind of family. The inequality-amplifying effects of socioeconomic differences in family structures can furthermore be shaped by heterogeneity in family structure effects (Bernardi and Boertien 2016b ). Bernardi’s and Boertien’s (2017, this Special Issue) findings, that the negative effects of parental separation are weaker for children whose parents have low levels of education, imply that the socioeconomic differences in family instability are less important in affecting intergenerational inequality than often thought. Erman’s and Härkönen’s ( 2017 , this Special Issue) results show that parental separation effects are weaker among ancestry groups where parental separation is more common suggest the same for ethnic inequalities. Together, these findings refine arguments stating that divergence in family structures will lead to an increase in inequality. Instead, the results imply that whether this happens or not is contingent on the strength of these effects and on whether they are similar across groups.

This quest will likely continue in the future; Ultee ( 2016 ) anticipated that in 2096, the book awarded for preservation of European sociological research will be called “Growing Up With Four Parents”.

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Acknowledgements

This Special Issue features research done within work package 5 (Family Transitions and Children’s Life Chances) of FamiliesAndSocieties ( www.familiesandsocieties.eu ). We thank the members of the consortium and our work package for productive collaborations and fruitful discussions during the project. We also thank the editorial team of European Journal of Population for the opportunity to publish this Special Issue and their feedback on earlier drafts. In addition, we are grateful to the reviewers for constructive comments to earlier versions to each of the articles in this Special Issue. The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7/2007–2013) under Grant Agreement No. 320116 for the research project FamiliesAndSocieties and from the Strategic Research Council of the Academy of Finland (Decision Number: 293103) for the research consortium Tackling Inequality in Time of Austerity (TITA).

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Department of Sociology, Stockholm University, 106 91, Stockholm, Sweden

Juho Härkönen

Department of Political and Social Sciences, European University Institute, Via dei Roccettini 9, 50014, San Domenico di Fiesole, Italy

Fabrizio Bernardi

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Diederik Boertien

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Härkönen, J., Bernardi, F. & Boertien, D. Family Dynamics and Child Outcomes: An Overview of Research and Open Questions. Eur J Population 33 , 163–184 (2017). https://doi.org/10.1007/s10680-017-9424-6

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Accepted : 12 March 2017

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Issue Date : May 2017

DOI : https://doi.org/10.1007/s10680-017-9424-6

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The Implementation of Evidence-Informed Family Nursing Practices: A Scoping Review of Strategies, Contextual Determinants, and Outcomes

Eva thürlimann.

1 University of Zurich, Institute for Implementation Science in Health Care, Switzerland

Lotte Verweij

2 University Hospital Zurich, Center of Clinical Nursing Science, Switzerland

Associated Data

Supplemental material, sj-docx-1-jfn-10.1177_10748407221099655 for The Implementation of Evidence-Informed Family Nursing Practices: A Scoping Review of Strategies, Contextual Determinants, and Outcomes by Eva Thürlimann, Lotte Verweij and Rahel Naef in Journal of Family Nursing

There is a lack of knowledge about the successful implementation of family nursing practices. This scoping review maps current knowledge about the implementation of evidence-informed family nursing practices across settings and populations. A systematic search (CINAHL, PubMed, Medline) identified 24 publications, published between 2010 and 2020. We found nurses’ implementation experience to be one of disruption, learning, and moving to new ways of practicing. The implementation resulted in benefits to families and self but was marked by fluctuation and partial integration of evidence-informed family nursing practices into care delivery. Uptake was shaped by various contextual determinants, with barriers mainly at the team and organizational levels. We identified low-quality, tentative evidence that capacity-building strategies coupled with dissemination-educational strategies may enable family nursing practice skills and increase the quality of family care. More rigorous research is needed to build further knowledge about effective implementation. Future implementation endeavors should utilize the evolving knowledge base in family nursing and tailor implementation strategies to contextual barriers.

Health care systems across the globe are challenged to better integrate evidenced-based practices into routine care delivery to increase the quality and effectiveness of care ( Curtis et al., 2017 ). Over the last decade, attention has been given to implementation efforts that aim to narrow the know-do gap in health care delivery to patients and their families ( Rapport et al., 2018 ; Wensing & Grol, 2019 ). Despite these efforts, recent estimates suggest that only about 60% of health care practices are based on research evidence, about 30% is of low value or unnecessary, whereas about 10% is even harmful ( Braithwaite et al., 2020 ). Scientific knowledge of effective implementation processes is necessary to ensure sustainable and cost-effective integration efforts ( Dolansky et al., 2017 ; Wensing & Grol, 2019 ; Zullig et al., 2020 ).

For more than a decade, family nurses have pointed to the need to optimize family nursing and care knowledge translation into practice ( Bell, 2014 ; Duhamel, 2010 ; Duhamel & Dupuis, 2011 ; Leahey & Svavarsdottir, 2009 ; van Achterberg et al., 2008 ). Several knowledge translation research projects have been conducted ( Davidson & Zisook, 2017 ; Duhamel et al., 2015 ; Kläusler-Troxler et al., 2019 ; Svavarsdottir et al., 2012 ). At present, however, there is still a lack of knowledge synthesis about the context, process, and outcomes of implementation efforts that focus on the integration of evidence-based family nursing practices across populations and health care settings.

Proactive engagement of and support for families who are affected by acute health events and persistent illnesses have long been called for ( Bell, 2013 ; Carman et al., 2013 ; Smith et al., 2020 ; Wright & Leahey, 1984 , 2013 ). Redesign of health care delivery to encompass an active partnership among patients, families, and health professionals is now the gold standard to achieve better quality and more effective care and to ensure improved health and well-being ( Carman et al., 2013 ; Frampton et al., 2017 ; Giap & Park, 2021 ). Nurses who work at the point of care play a key role in engaging family members in care and in supporting patients and families in their individual and family-level self-care and illness management ( Kaakinen et al., 2018 )

Several reviews have been undertaken to determine the evidence of an active partnership with families, operationalized here as any nursing practices that involve, engage, and support family members and family systems in care delivery and in disease or illness management processes ( Chesla, 2010 ; Giap & Park, 2021 ; Gilliss et al., 2019 ; Smith et al., 2020 ). In the context of persistent illness, a beneficial impact of psycho-educational and relationship-focused family interventions on the individual patient and family member’s mental health has been found ( Deek et al., 2016 ; Hartmann et al., 2010 ; Hopkinson et al., 2012 ; Park et al., 2018 ). Patient’s physical health and self-care ability may also be improved ( Hartmann et al., 2010 ; Hopkinson et al., 2012 ; Park et al., 2018 ; Smith et al., 2020 ). There is also some indication of improved family functioning ( Östlund & Persson, 2014 ; Smith et al., 2020 ) and reduced health care utilization, such as length of stay ( Park et al., 2018 ). Family engagement practices have also been found to improve patient safety outcomes, such as a reduction in adverse events or a sense of safety and satisfaction ( Giap & Park, 2021 ; Lee et al., 2021 ; Mackintosh et al., 2020 ; Park & Giap, 2020 ).

Despite the mounting evidence and encouraging empirical insights about the usefulness and effectiveness of engaging and supporting families in care during acute and persistent illness processes, integration of family nursing into routine care delivery has been slow and partial ( Bell, 2014 ; Leahey & Svavarsdottir, 2009 ). While several implementation efforts have been undertaken, there remains a lack of knowledge on how to best integrate family nursing knowledge into practice to ensure the consistent delivery of evidence-informed family nursing care and interventions. No review to date has been undertaken to synthesize current research knowledge on the implementation of evidence-based family nursing practices. Knowledge synthesis research is necessary to build an empirical foundation on family nursing implementation, namely, on implementation barriers and context-sensitive, effective implementation strategies ( Bauer & Kirchner, 2020 ). To contribute to the growing body of knowledge in family nursing implementation science, we undertook a scoping review that mapped the current knowledge on the implementation of evidence-informed family nursing practices into clinical care delivery across settings and populations. The research questions to guide this scoping review were as follows:

• Research Question 1: How have evidence-informed family nursing practices been implemented into care delivery across settings and populations?
• Research Question 2: What are contextual determinants (enabling-limiting factors) of family nursing practices uptake and care delivery across settings and populations?
• Research Question 3: What is the effectiveness of family nursing practices implementation to provide quality care and to achieve positive family health outcomes?

Study Design

A scoping review methodology was chosen as the most fitting approach to identify the knowledge landscape about the implementation of evidence-informed family nursing practices. Scoping reviews investigate broad research questions and are particularly useful when mapping a new terrain ( Colquhoun et al., 2014 ; Peters, Godfrey, McInerney, et al., 2015 ). We used the methodological steps outlined by Arksey and O’Malley (2005) and Levac et al. (2010) , which include (a) developing a research question; (b) identifying relevant studies through a comprehensive search strategy; (c) selecting the studies; (d) extracting and charting the data; and (e) and collating, summarizing, and reporting the findings. For the reporting of the scoping review, we followed the PRISMA 2020 guideline ( Page et al., 2021 ) and an extension for scoping reviews ( Tricco et al., 2018 ).

The Model of Implementation Research ( Proctor et al., 2009 ) served as the overall framework to organize the concepts for our scoping review. The model specifies four concepts, namely, the intervention (i.e., the what), the implementation strategies (i.e., the how), the context of the implementation, and outcomes (including implementation, service, and health outcomes). For this scoping review, we defined “evidence-informed family nursing practices” as the intervention. We then focused our analysis on (a) implementation strategies and experiences; (b) the context and how contextual determinants influence implementation and intervention delivery; and (c) the outcomes of the implementation efforts.

Data Sources and Search Strategy

We conducted an iterative search by first identifying key publications based on a rapid electronic data search. In a second step, we developed a detailed search strategy. Searches of the electronic databases, CINAHL, PubMed, and Medline, were undertaken in December 2020. The search strategy included various combinations of the following search terms: (a) “family nursing”, “family systems nursing”, “family centered care”, family focused care”, “family engagement”, “family involvement”, “family support”; (b) “knowledge translation, “knowledge transfer”, “implementation science”, “implementation strategy”; (c) “evidence-based models,” “knowledge”; and (d) “enablers,” “barriers,” “facilitator”, “behavior” and “attitude”. Search terms were a mixture of database-controlled keywords, including MeSH headings, subject headings, and keywords (see Supplementary File 1 ). Reference lists were also screened for relevant publications.

Study Selection Criteria and Process

Publications were included if they were systematic reviews or peer-reviewed research publications, including qualitative, quantitative, or mixed-methods designs, and had been published in published ≥2010, either in English or German. Hence, studies needed to (a) target nursing care delivery in any setting, clinical area, and population; (b) focus on the implementation of evidence-informed family nursing practices, such as Family Systems Nursing, family-centered care, family engagement practices, or family-focused interventions; and (c) investigate implementation processes or contexts. No restrictions were applied to the investigated outcomes. In addition, the study population needed to include nurses, among others, and/or patients and family members. Non-data-based publications, and those not focusing on the implementation of an evidence-informed family nursing practice, were excluded.

Search results from databases were imported into Endnote to remove duplicates and manage the selection process. No systematic review management system or automation tool was used. First, one reviewer (E.T.) screened all records for eligible studies based on title and abstract. If uncertain, the potential study was included for full-text review. Full texts were then retrieved. Next, two reviewers (E.T. and R.N.) independently assessed full texts for eligibility, classifying them into “include,” exclude,” and “to be discussed.” Discrepancies were discussed among the two reviewers. In case of disagreement, a third reviewer (L.V.) was consulted until consensus was reached, which was the case for all discrepancies.

Data Extraction

Data items were extracted for each study using an extraction template on study characteristics (year, country, and aim); methods (design, theoretical framework, setting, population, data collection, and measures); intervention and implementation information (type of evidence-informed family nursing practices and type of implementation focus, such as strategy or context); and study outcomes by one reviewer (ET) and verified by a second reviewer (RN). We then extracted data according to the constructs of interest (i.e., evidence-informed family nursing practices, implementation strategy/process, context, and outcomes according to Proctor) in an Excel sheet. Next, we displayed extracted data in a mind map to create a preliminary overview of the knowledge landscape. Finally, we extracted qualitative and quantitative data in separate tables for further analysis. Consistent with the scoping review methodology, no study risk of bias or quality assessment was undertaken ( Peters, Godfrey, McInerney, et al., 2015 ; Peters, Godfrey, Khalil et al., 2015 ).

Data Charting and Synthesis

To analyze and synthesize qualitative insights, we first organized qualitative findings into four preliminary categories that we had identified after a first reading of the extracted data and informed by the Model of Implementation Research, namely, implementation strategy, experience with implementation and integration of evidence-informed family nursing practices, contextual determinants, and benefit/outcomes. Two researchers (ET and RN) then coded the extracted qualitative findings for each category separately, discussed emerging themes, and organized them into overarching themes. Next, the researchers organized the identified contextual determinants influencing and shaping the implementation process and uptake according to different levels of aggregation, mapped them to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009 ), and assessed whether they were described as enabling, limiting, or both. Finally, one researcher (R.N.) categorized the investigated outcomes using Proctor’s implementation (i.e., uptake, fidelity, cost, sustainability), service (i.e., safety, patient-centeredness, effectiveness), and health outcomes (i.e., symptoms, satisfaction.; Proctor et al., 2009 ), which was verified by a second researcher (E.T.). As many studies investigated outcomes on nurse characteristics, we added the category “nurse outcomes.” Subsequently, one researcher (R.N.) analyzed the direction of study results and narratively summarized them according to each outcome, paying attention to the type of implementation strategy that was used. Regular analytical meetings were held to ensure a systematic and transparent process. Each analytical step was discussed among the involved researchers, and analytical decisions were made as a team.

Study Characteristics

The search yielded 857 records of which 636 were retrieved. After removal of duplicates and screening of title and abstract, 116 records remained that were assessed for eligibility based on full text. Twenty-four publications met the inclusion criteria. Reasons for the exclusion of the 92 publications are listed in Figure 1 . The rate of concordance between the two raters (E.T. and R.N.) was 72% ( n = 84).

PRISMA flow.

Of the 24 included studies, 11 studies implemented a family-centered care approach ( Boztepe & Kerimoğlu Yıldız, 2017 ; Gomes da Silva et al., 2016 ; Hamilton et al., 2020 ; Kleinpell et al., 2019 ; MacKay & Gregory, 2011 ; Maree et al., 2017 ; Mirlashari et al., 2019 ; Shah-Anwar et al., 2019 ; Toivonen et al., 2019 ; Weis et al., 2014 ; Wells et al., 2014 ). Ten studies implemented Family Systems Nursing ( Beierwaltes et al., 2020 ; Blöndal et al., 2014 ; Eggenberger & Sanders, 2016 ; Naef, Kaeppeli et al., 2020 ; Naef, Kläusler-Troxler et al., 2020 ; Petursdottir et al., 2019 ; Svavarsdottir et al., 2015 ; Wong, 2014 ; Zimansky et al., 2018 , 2020 ). Three studies implemented a family-focused intervention program ( Antolick et al., 2020 ; Duke et al., 2020 ; Wells et al., 2014 ; see Table 1 ). Only eight studies reported on the use of an implementation science framework of which five used the Knowledge-to-Action (KTA) Framework. The Consolidated Framework for Implementation Research (CFIR), Promoting Action on Research Implementation in Health Services (PARIHS), and Plan-Do-Study-Act (PDSA) cycle were each used once.

Overview of Included Studies ( n = 24).

Note. FCC = Family-Centered Care; NICU = neonatal intensive care unit; EPDS = Edinburgh Postnatal Depression Scale; PHAG = Post-Hospitalization Action Grid; FFI = Family-Focused Intervention; CFIR = Consolidated Framework for Implementation Research; PSPIC = Provider and Staff Perception of Integrated Care Survey; FSN = Family Systems Nursing; KTA = Knowledge-to-Action Framework; FNPS = Family Nursing Practice Scale; ICE-FPSQ = Iceland Family Perceived Support Questionnaire; FINC-NA = Families Importance in Nursing Care-Nurses Attitudes; NPT = Normalization Process Theory; PDSA = Plan-Do-Study-Act; FSC = Family System Care; CDI = Caring Dimensions Inventory; ICE-HCP-IBQ = Icelandic Health Care Practitioner Illness Beliefs Questionnaire; NKC = Nurses’ Knowledge and Confidence Scale; EBP = Evidence-Based Practice; QSC-R23 = Questionnaire on Stress in Cancer Patients; AMS- R = Adjective Mood Scale-Revised Version; BSSS = Berlin Social Support Scales; STPI State = Anxiety part of the State-Trait Personality Inventory; FS-ICU24 = Family Satisfaction with Care in the ICU Survey; GSCL-24 = Giessen Subjective Complaints List; ICU = Intensive Care Unit; i-PARIHS = integrated Promoting Action on Research Implementation in Health Services; n/a = not applicable.

Study characteristics are reported in Table 2 . Studies were conducted predominantly in Europe ( n = 13), followed by the United States, and Canada ( n = 6). A majority of the studies were carried out in acute-critical care (83.3%). Eight studies used a qualitative design, seven were uncontrolled pre–post quantitative studies, six were mixed- or multimethod studies, two were process evaluations, and one was a literature review. Sample sizes in qualitative studies (including qualitative components of mixed-methods studies) were adequate, with a median sample size of n = 20 (interquartile range [IQR] 16–31; minimum 11–max 214) participants. Median sample sizes in quantitative designs included n = 65 (IQR 46.0—115.5; minimum 11–maximum 4,647) participants during pre-data collection, and a median of n = 54 (IQR 30.5–111.5; minimum 11–maximum 1,882) participants for post-data collection.

Study Characteristics.

Implementation Strategies and Experiences

A total of 18 studies specified their implementation strategies. Most implementation efforts entailed an educational component, which was, except for one study ( Wong, 2014 ), combined with the use of a local implementation team or champion/facilitator roles that provided clinical mentoring and supervision ( Ahlqvist-Björkroth et al., 2019 ; Beierwaltes et al., 2020 ; Blöndal et al., 2014 ; Eggenberger & Sanders, 2016 ; Naef, Kaeppeli, et al., 2020 ; Naef, Kläusler-Troxler, et al., 2020 ; Petursdottir et al., 2019 ; Svavarsdottir et al., 2015 ; Toivonen et al., 2019 ; Weis et al., 2014 ; Zimansky et al., 2018 , 2020 ). Others used a quality improvement methodology that combined feedback loops and local capacity-building strategies ( Antolick et al., 2020 ; Duke et al., 2020 ; Kleinpell et al., 2019 ; Maree et al., 2017 ), and one study did not provide sufficient detail ( Wells et al., 2014 ). Most studies reported using more than one strategy (83%), with a median of three (minimum 1–maximum 5). None reported having tailored implementation strategies to identified barriers. The median duration of the implementation efforts was 8 months (3–24 months, reported by 11 of 18 studies).

Three thematic threads were identified that depicted nurses’ and clinicians’ experience of implementing evidence-informed family nursing practices, based on the findings of 15 studies ( Boztepe & Kerimoğlu Yıldız, 2017 ; Duke et al., 2020 ; Gomes da Silva et al., 2016 ; Hamilton et al., 2020 ; Kleinpell et al., 2019 ; MacKay & Gregory, 2011 ; Mirlashari et al., 2019 ; Naef, Kaeppeli, et al., 2020 ; Naef, Kläusler-Troxler, et al., 2020 ; Petursdottir et al., 2019 ; Shah-Anwar et al., 2019 ; Toivonen et al., 2019 ; Wells et al., 2014 ; Wong, 2014 ; Zimansky et al., 2018 ; see Figure 2 ).

Overview of thematic findings related to implementation strategy and context.

First, implementation entailed disruption , learning , and moving to new ways of practicing with families, which was reported in nine studies ( Boztepe & Kerimoğlu Yıldız, 2017 ; Duke et al., 2020 ; MacKay & Gregory, 2011 ; Mirlashari et al., 2019 ; Naef, Kaeppeli, et al., 2020 ; Naef, Kläusler-Troxler, et al., 2020 ; Petursdottir et al., 2019 ; Shah-Anwar et al., 2019 ; Wong, 2014 ). The introduction of evidence-informed family nursing practices involved the disruption of habitual practices and care processes, as Duke and colleagues (2020) reported: “(It) pulled apart their practice (by) flipping conversations to focus on the family” (pp. 7–8). It required exploring different ways of working with families and a need for conscious learning or unlearning. Nurses were challenged to rethink their role, their view of family, and their understanding of family responses to illness; that is, develop a “new ability to think family” ( Wong, 2014 , p. 215). The movement toward the use of the evidence-informed family nursing practices became evident in statements such as “family defines who constitutes their members (and) copes in their own ways” ( MacKay & Gregory, 2011 ), “new awareness for family with intentional engagement” ( Naef, Kaeppeli, et al., 2020 ), “parents know their child best, (need to be) near to the child, (and want to) participate in care” ( Boztepe & Kerimoğlu Yıldız, 2017 ), or “offering empathy and create a win-win situation” ( Mirlashari et al., 2019 ).

Second, the implementation process was marked by fluctuation and incompleteness , which was reported in four studies ( Naef, Kaeppeli, et al., 2020 ; Naef, Kläusler-Troxler, et al., 2020 ; Wong, 2014 ; Zimansky et al., 2018 ). Moving to new ways of practicing involved tensions and frictions within teams and the organizational context and was supported by nurse insights about the evidence-informed family nursing practices as feasible and fitting within their clinical area and population served. Studies report that it was not a linear, progressive process but occurred in waves, involving resistance, stand-still, and forward movement. For example, Naef, Kläusler-Troxler and colleagues (2020) found that nurses experienced implementation like a “wheel that moved forward or stood still, depending on the amount of challenges faced in everyday clinical work and organizational context” (p. 7). As a result, evidence-informed family nursing practices were often not fully integrated into routine care after the active implementation efforts were completed. This partial or incomplete (or unfinished) uptake occurred in relation to the intervention’s or model’s core components but also may have pertained to the extent to which eligible families could be reached. Some components tended to be incorporated more readily into practice, such as providing information and advice, or involving families in care ( Naef, Kläusler-Troxler, et al., 2020 ; Wong, 2014 ). In contrast, family assessment or family-focused intervention strategies were less often or only partially adopted ( Naef, Kläusler-Troxler, et al., 2020 ; Zimansky et al., 2018 ).

Third, nurses and other clinicians observed benefits in quality of care ( Duke et al., 2020 ; Petursdottir et al., 2019 ; Toivonen et al., 2019 ; Wells et al., 2014 ; Wong, 2014 ), which encouraged implementation. For example, nurses experienced their work as “more effective” ( Petursdottir et al., 2019 ) and as “enhancing family care” ( Duke et al., 2020 ). They experienced “improved relationships that led to increased collaboration and partnership with families” (Wells et a., 2014) and “deeper understanding and respect for family care” ( Duke et al., 2020 ). They also reported finding their own clinical work to be “more meaningful and satisfying” ( Duke et al., 2020 ; Wong, 2014 ). One study also reported benefits for families, including “empowerment and self-confidence” ( Wells et al., 2014 ).

Contextual Determinants Enabling or Limiting Implementation

Fourteen studies reported findings about the contextual determinants of implementation efforts ( Boztepe & Kerimoğlu Yıldız, 2017 ; Duke et al., 2020 ; Gomes da Silva et al., 2016 ; Hamilton et al., 2020 ; Kleinpell et al., 2019 ; MacKay & Gregory, 2011 ; Naef, Kaeppeli, et al., 2020 ; Naef, Kläusler-Troxler, et al., 2020 ; Petursdottir et al., 2019 ; Shah-Anwar et al., 2019 ; Toivonen et al., 2019 ; Wells et al., 2014 ; Wong, 2014 ; Zimansky et al., 2018 ). We found that implementation was shaped by determinants pertaining to the strategy, individual (i.e., nurse, family), interpersonal (i.e., team), and community or organizational factors (see Table 3 ).

Contextual Determinants ( n = 14).

Note. CFIR = Consolidated Framework for Implementation Research.

Strategy-Related Determinants

We identified two enablers pertaining to the implementation strategy. First, strategies were supportive when they created a space for mutual learning and encompassed ongoing opportunities through experiential learning methods and guidance from mentors.

Nurse Determinants

Attitudes, role understanding, and beliefs were most often reported as barriers to the integration of evidence-informed family nursing practices. Motivation and willingness to learn arose as both enabling and limiting factor, whereas clinical experience and skills were predominantly enablers.

Family Determinants

Seeing benefits for the families and self was enabling integration. In terms of family-related determinants, the complexity of family situations played a role, with family presence or availability enabling engagement and support, whereas cultural differences between families and clinicians, or tensions within the family or between the family and clinicians increased the complexity, thereby posing barriers.

Team Determinants

Team-related factors arose as core determinants for successful integration, with their absence stifling implementation efforts. Hence, a shared understanding, commitment, and governance that include all members of an interprofessional team together with participatory models of care delivery were essential success factors.

Organizational Determinants

Organizational level factors were named most frequently (30 codes). Except for leadership, which was also reported to be an enabler, organizational determinants often disabled uptake and in particular long-term integration. Cultural aspects, including policy, and available resources (workload, staffing) were the main barriers.

When matching the identified barriers/enablers to the CFIR, those determinants relating to CFIR inner setting (i.e., organizational context) and process (i.e., strategy) domains were most frequently reported, followed by the CFIR individual (i.e., nurse and other professionals) and intervention (i.e., family) domains. No societal or system-level determinants; that is, constructs within the CFIR outer setting domain were described. It is noteworthy that most implementation strategies were targeting an individual or interpersonal determinants and only a few employed strategies targeting organizational determinants although most barriers were described in the CFIR inner context domain.

Outcomes of Implementation

A total of 15 studies assessed the impact of implementation efforts on outcomes (see Table 4 ).

Impact of Implementation Strategies on Outcomes (Quantitative Findings; n = 15).

Note. FCC = Family-Centered Care; FO = Family Outcome; EPDS = Edinburgh Postnatal Depression Scale; PHAG = Post-Hospitalization Action Grid; FFI = Family-Focused Intervention; IO = Implementation Outcome; PSPIC = Provider and Staff Perception of Integrated Care Survey; EBFN = Evidence-Based Family Nursing; FSN = Family Systems Nursing; NO = Nursing Outcome; FNPS = Family Nursing Practice Scale; ICE-FPSQ = Iceland Family Perceived Support Questionnaire; FINC-NA = Families Importance in Nursing Care-Nurses Attitudes; SO = Service Outcome; IPFCC = Institute for Patient- and Family-Centered Care; FS-ICU24 = Family Satisfaction with Care in the Intensive Care Unit Survey; PDSA = Plan-Do-Study-Act; CDI = Caring Dimensions Inventory; ICE-HCP-IBQ = Icelandic Health Care Practitioner Illness Beliefs Questionnaire; NKC = Nurses’ Knowledge and Confidence Scale; EBP = Evidence-Based Practice; EBN = Evidence-Based Nursing; AMS-R = Adjective Mood Scale-Revised Version; BSSS = Berlin Social Support Scales; STPI State = Anxiety part of the State-Trait Personality Inventory; GSCL-24 = Giessen Subjective Complaints List.

Implementation Outcomes

Quantitative assessment of implementation outcomes was undertaken in three very small studies with 6 to 45 participants ( Antolick et al., 2020 ; Weis et al., 2014 ; Wells et al., 2014 ). Antolick and colleagues (2020) , in their pilot evaluation of a family-focused discharge planning process for children with medical complexity, found that 30% of eligible families were followed up, of which 28% completed the discharge planning process. Provider-perceived usability was mixed ( n = 6). Weis and colleagues (2014) , reporting on a systematic implementation process for introducing guided, family-centered care and communication in the neonatal intensive care unit (NICU), reported protracted and partial uptake, with about half (55%) of nurses completing the training ( n = 45). Finally, Wells and colleagues (2014) , analyzing the implementation of a strengths-based, solution-focused, and evidence-based family-focused intervention in community mental health, found high acceptability (92.6%) and willingness to use the evidence-based interventions (100%; n = 27) but did not report on the actual results of the implementation efforts. Overall, assessment of implementation outcomes was very limited, and reporting was of moderate to poor quality.

Nurse Outcomes

Nurse outcomes, such as skills ( n = 6), attitudes ( n = 4), and knowledge ( n = 3), were the most frequently investigated type of outcome ( n = 8 studies; Beierwaltes et al., 2020 ; Blöndal et al., 2014 ; Eggenberger & Sanders., 2016; Naef, Kaeppeli, et al., 2020 ; Naef, Kläusler-Troxler, et al., 2020 ; Petursdottir et al., 2019 ; Svavarsdottir et al., 2015 ; Wong, 2014 ). Educational strategies, coupled with clinical supervision, training activities, or local champion roles, improved nurse’s skill in working with families (as measured with the Family Nursing Practice Scale; Beierwaltes et al., 2020 ; Eggenberger & Sanders, 2016 ; Naef, Kaeppeli, et al., 2020 ; Naef, Kläusler-Troxler, et al., 2020 ; Petursdottir et al., 2019 ; Wong, 2014 ) and reached statistical significance in half of the studies ( Naef, Kaeppeli, et al., 2020 ; Naef, Kläusler-Troxler, et al., 2020 ; Petursdottir et al., 2019 ). Nurses’ attitudes toward families, as assessed with the Families’ Importance in Nursing Care—Nurses’ Attitudes, did not change because of these implementation efforts ( Blöndal et al., 2014 ; Naef, Kaeppeli, et al., 2020 ; Naef, Kläusler-Troxler, et al., 2020 ; Svavarsdottir et al., 2015 ). Findings on nurses’ knowledge are very limited and nonsignificant (Eggenberger & Sanders., 2016; Svavarsdottir et al., 2015 ). They unanimously focused on the implementation of family nursing knowledge or Family Systems Nursing in a variety of clinical settings, most often in acute-critical care, and used the same or similar outcome measures.

Service Outcomes

Services outcomes, including the level of family-centeredness ( Kleinpell et al., 2019 ; Maree et al., 2017 ) or integrated care ( Antolick et al., 2020 ), were obtained in three studies. Two studies, which focused on the implementation of a family engagement or family-centered care practices in intensive care unit (ICU), using quality improvement strategies coupled with local capacity building ( Kleinpell et al., 2019 ; Maree et al., 2017 ), found an increase in family-centeredness. Kleinpell and colleagues (2019) , in their multicenter study that included almost 4,000 adult ICU clinicians (pre n = 2,924, post n = 1,057), identified statistically significant improved opportunities for families to participate in care on most of the assessed dimensions. Improved levels of family-centeredness in NICU were also found by Maree and colleagues (2017) from both nurses’ and parents’ perspectives, but the small sample size did not allow for statistical testing. One study pilot-implemented a family-focused discharge planning process for children ( Antolick et al., 2020 ) and was unable to show improvements in staff-perceived care integration, which may be due to the very small sample size. Conclusions on service outcomes remain predominantly based on the largest study included in this scoping review ( Kleinpell et al., 2019 ), which suggests that capacity-building strategies might be potentially effective in improving the intended service outcome, that is, family-centered engagement practices.

Family Health Outcomes

Family outcomes, including perceived nurse support ( Beierwaltes et al., 2020 ; Eggenberger & Sanders, 2016 ), families’ satisfaction with care ( Kleinpell et al., 2019 ; Zimansky et al., 2020 ), and mental health outcomes ( Ahlqvist-Björkroth et al., 2019 ; Zimansky et al., 2020 ), were measured in five studies. Two small studies in adult ICU ( Beierwaltes et al., 2020 ; Eggenberger & Sanders, 2016 ) investigated families’ perception of cognitive and emotional support received by nurses. One study found statistically significant improvements in half of the items measured (Iceland Family Perceived Support Questionnaire), with two showing a decrease in family-perceived support ( Beierwaltes et al., 2020 ), whereas the other study did not provide post-implementation data ( Eggenberger & Sanders, 2016 ).

The multicenter study in adult ICU ( Kleinpell et al., 2019 ) found a statistically significant increase in families’ satisfaction with care as measured with the well-established FS-ICU-24 (Family Satisfaction with Care in ICU: pre mean 85.2 vs. post mean 86.3 out of a score ranging from 0 to 100, p < .05). In contrast, Zimansky and colleagues (2020) were unable to demonstrate an increase in family member satisfaction, using a self-developed tool, following the implementation of Family Systems Nursing in cancer care. The same study was also unable to identify a difference in family member stress, anxiety, or physical complaints when comparing an independent pre- and post-sample of 122 family members in total ( Zimansky et al., 2020 ). In contrast, Ahlqvist-Björkroth and colleagues (2019) were able to demonstrate a reduction in maternal postpartum depression (change of 2.54 points in depression score, p < .001) following an educational implementation strategy introducing family-centered care (Close Collaboration with Parents) in the NICU. Overall, findings on family outcomes are modest and mixed and difficult to interpret, given the uncontrolled nature of study designs, mostly small sample sizes, and variety of measures used.

This scoping review of 24 publications stemming from 14 countries identified nurses’ implementation experience to be one of disruption, learning, and moving to new ways of practicing, which resulted in observable benefits to families and self. However, it was marked by fluctuation and partial uptake of evidence-informed family nursing practices in routine care delivery. Uptake was shaped by various contextual determinants, which were more often perceived to be barriers than enablers, particularly at the organizational or inner context level. We identified low-quality and very tentative evidence that capacity-building strategies coupled with dissemination-educational strategies may be beneficial to enable nurse skills and family-centered care delivery.

The findings of individual studies included in this review were quite homogeneous in terms of implementation experience, identified barriers/enablers, and investigated outcomes, which increases the credibility of the synthesized findings in this review. The included studies focused most often on acute-critical care settings. Interestingly, we found few cultural variations although studies from 14 countries were represented in this review. One reason may be that the majority stemmed from Western cultures of which one included international data ( Hamilton et al., 2020 ). Our findings are also in line with a recent global study on ICU family engagement, which found few differences across countries ( Naef et al., 2021 ). However, methodological limitations make it difficult to draw reliable conclusions. Small sample sizes and uncontrolled designs mean that the knowledge gained regarding the impact of implementation strategies on outcomes is provisional at best. Most studies were monocentric. Only about half used an implementation science theory or model to guide their implementation processes, and none reported tailoring implementation strategies to previously identified barriers to implementation. The knowledge-to-action model ( Duhamel, 2017 ; Graham et al., 2006 )—a process model used to guide implementation process—was most often used, particularly in research-to-action projects in family systems care based on the Calgary Family Assessment and Intervention Models ( Shajani & Snell, 2019 ; Wright & Leahey, 2013 ). Several studies used some form of stakeholder engagement or participatory methodology, which is key for tailoring implementation strategies to the local context ( D. H. Peters et al., 2017 ; van Rooijen et al., 2021 ), but descriptions of the strategy design or clear operationalization were often not given. To build a body of knowledge around family nursing implementation, the use of implementation science knowledge, including theory, is important and should be enhanced ( Esmail et al., 2020 ; Lynch et al., 2018 ; Nilsen, 2015 ).

Implementation Process

Integration of evidence-based working with families arose as a complex, fluctuating, and multifaceted process of change at different levels—it involved disruption, learning, and changing ways of seeing and doing things and is determined by individual, team, family, and organizational factors. The complexity of implementation and the bidirectional interaction of implementation strategy with contextual determinants has been previously stressed ( Baker et al., 2015 ; Nilsen & Bernhardsson, 2019 ; Powell et al., 2019 ), suggesting that an adaptive, iterative process is necessary to ensure full integration of a new, evidence-informed practice. We observed high variability in terms of type and number of implementation strategies, which is in line with a review focusing on the implementation of nursing guidelines ( Spoon et al., 2020 ). Educational strategies tend to be the most frequently used implementation strategy when attempting to integrate new knowledge of evidence-informed practices, but their effectiveness in achieving the desired changes remains unclear ( Gutiérrez-Alemán et al., 2021 ).

Facilitation roles were the second most often used implementation strategy. Facilitation and the use of champion roles have been previously found to be key strategies for achieving practice change ( Albers et al., 2020 ), and some studies within nursing found them to be promising ( Dahl et al., 2018 ; Lessard et al., 2015 ; Seers et al., 2018 ). Strategies combining local capacity-building and creating opportunities for an ongoing process with feedback loops were also used, but many did not evaluate their effectiveness, except for one large study, which identified a positive impact on staff-perceived family-centeredness of the service and family-reported satisfaction with care ( Kleinpell et al., 2019 ). Overall, strategies were poorly defined and operationalized, and none reported a tailoring process, that is, deciding on, matching, and adapting implementation strategies to previously identified or known contextual barriers in the given practice environment, which is a well-known challenge in implementation ( Baker et al., 2015 ; Powell et al., 2019 ). Within implementation science, tailoring implementation strategies to context is considered a key factor for achieving successful integration of evidence-based intervention in routine care ( Colquhoun et al., 2017 ; McCullough et al., 2015 ; Pfadenhauer et al., 2017 ).

Among the assessed outcomes, nurses’ clinical competencies were most often measured, whereas implementation outcomes, as suggested by Proctor and colleagues (2009) , were rarely evaluated. Some studies, however, provided qualitative insight into the uptake and reach. Our review found that integration is often partial in terms of components and reach, suggesting that some components of the evidence-informed intervention, practice, or programs were not, or not consistently taken up. For example, while family-centered engagement practices were often taken up, specific family assessment and intervention processes that were offered in form of (additional) family conversations, were not at all or not regularly delivery.

Some studies investigated service and family outcomes of the implementation effort, yielding a mixed picture. The small database and methodological limitation of included studies make it difficult to draw reliable conclusions. Nonetheless, our analysis showed that educational strategies alone may be insufficient to achieve uptake of evidence-informed family nursing practices. A recent review focusing on educational programs in family nursing that also included four of the studies included in our review found them to be effective in increasing nurse knowledge, attitudes, and skills in the short-term but was unable to assess whether they translated into clinical competence and application in practice ( Gutiérrez-Alemán et al., 2021 ). In our review, we also found increased nurse skills following educational implementation activities but not in relation to attitudes and knowledge. Strategies that combine capacity-building and an ongoing process of feedback and support may be more promising in increasing quality of family care. Overall, there is a lack of methodologically sound research addressing the effectiveness of implementation strategies on implementation, service, and family outcomes, including quality of life and mental health outcomes.

Contextual Determinants

We found that the integration of evidence-informed family nursing practices is influenced by the interplay of implementation-related, nurse-related, family-related, team-related, and organization-related determinants. None of the studies investigated the outer setting domain, that is, the health system and societal aspects influencing family care ( Damschroder et al., 2009 ). While many of the determinants identified may be both barriers and enablers, it is noteworthy the identified team and organizational determinant is perceived only, or mostly, as a barrier. These CFIR inner setting constructs ( Damschroder et al., 2009 ), however, have rarely been targeted by the reported implementation efforts. Team communication and collaboration evolved as key determinants of implementation success. Culture, leadership, available resources, and compatibility with preexisting policies and models of care acted as barriers. Future implementation efforts need to address inner context barriers, in addition to leverage enablers identified in the other domains, such as the process (i.e., strategy), individual (i.e., nurse), and intervention domains. Hence, future implementation efforts should address organizational barriers and tailor implementation strategies to the locally identified organizational and team barriers. A context-specific implementation at the organizational level will be key to enabling successful, initial implementation of family nursing practices, and to develop a support system that will allow sustainability and sustainment of integrated family nursing practices over time ( Fleiszer et al., 2016 ; Shelton et al., 2018 ).

Limitations

Our review is not without limitations. To map the knowledge terrain of evidence-based family nursing practices, we included a diversity of theoretical constructs underlying family nursing in diverse settings and populations. The heterogeneity of study designs and intervention/practice components together with the diversity of settings and populations require caution when using the findings of our scoping review. In line with a scoping review methodology ( Peters, Godrey, Khalil et al., 2015 ), no quality appraisal was undertaken. It may be possible that we were unable to identify all eligible studies, despite the use of a systematic and iterative search strategy in two major databases. For instance, we noticed that most included studies were performed in the acute clinical care setting and not within other areas such as community care or mental health care. Despite these limitations, which need to be taken into consideration when transferring findings, this scoping review provides a knowledge map to family nursing implementation on which to build on.

Recommendations for Research and Practice

More implementation research with rigorous designs and guided by specific implementation science theory and evidence is needed to verify our tentative findings and to build further knowledge on how to effectively implement evidence-informed family nursing practices. Better reporting of the evidence- and/or theory-base of the implemented practice is also called for. Knowledge synthesis research about specific family nursing interventions or family engagement practices in distinct settings or populations is necessary. Research insights into the effect of implementation efforts, particularly in terms of implementation outcomes, such as uptake, reach, cost, appropriateness, or sustainability ( Proctor et al., 2009 ) and also on quality of family care and family health outcomes is clearly needed.

The results of this review propose a roadmap for future family nursing implementation projects. Family nursing implementation projects should use the body of knowledge evolving in the field of implementation and family science in three ways. First, use implementation theory to inform and specify the implementation endeavor and its evaluation. Second, tailor implementation strategies to contextual determinants, either by drawing on preexisting knowledge or by analyzing the specific practice environment. Third, use strategies that include capacity-building, facilitation, and participatory approaches and target the “inner context” (team, organizational) factors and not only individual nurse competence and skills.

This scoping review provides an overview of the current state of knowledge around family nursing implementation science. It demonstrates that family nursing practice uptake is fluctuating and partial, hampered by organizational constraints, which are often not specifically targeted through implementation strategies. Family nursing implementation strategies therefore need to target organizational barriers. Capacity-building strategies coupled with dissemination-educational strategies may be most promising to enable nurse skills, ensure consistent family care delivery, and create supportive systems. To further build the family nursing implementation science body of knowledge, systematic reviews focusing on specific aspects of implementation, such as culture, leadership, and resources as key organizational determinants, or the effect of implementation strategies on family health outcomes, are necessary. More research on implementation and knowledge translation efforts in family nursing are also needed to better understand the mechanisms through which sustainable, evidence-informed family nursing practices that translate into improved service and family health outcomes can be achieved and maintained.

Supplemental Material

Author biographies.

Eva Thürlimann , MScPT, is a research associate at the Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Switzerland. Her research focuses on the implementation of family-focused care practices and the impact of COVID-19 on care provision. Her physiotherapeutic practice focuses on the rehabilitation and physical recreation of adults with chronic conditions, particularly stroke. Recent publications include “Changes in Stroke Rehabilitation During the Sars-Cov-2 Shutdown in Switzerland” in Journal of Rehabilitation Medicine (2022, with J. P. O. Held et al.).

Lotte Verweij , PhD, RN, is a research associate at the Institute for Implementation Science in Health Care at the Faculty of Medicine, University of Zurich, and at the Centre of Clinical Nursing Science, University Hospital Zurich in Switzerland. Her current research projects focus on family engagement and family well-being in the acute-care setting. She specifically focuses on implementation strategies to support optimal intervention uptake in clinical practice. Recent publications include “The Nurse-Coordinated Cardiac Care Bridge Transitional Care Programme: A Randomised Clinical Trial” in Age and Aging (2021, with P. Jepma et al.), “Cardiac Care Bridge Transitional Care Program for the Management of Older High-Risk Cardiac Patients: An Economic Evaluation Alongside a Randomized Controlled Trial” in PLOS ONE (2022, with A. C. M. Petri et al.), and “The Cardiac Care Bridge Randomized Trial in High-Risk Older Cardiac Patients: A Mixed-Methods Process Evaluation” in Journal of Advanced Nursing (2021, with D. F. Spoon et al.).

Rahel Naef , PhD, RN, is an assistant professor of Implementation Science in Nursing at the Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, and a research group head at the Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland. Her research focuses on the health and well-being of families in vulnerable situations, such as families engaged in caregiving and on families experiencing acute-critical illness and bereavement. Drawing on a wide range of methodological approaches, she investigates the impact of relational Family Systems Nursing interventions and models of care on individual and family illness management ability and health outcomes. Rahel has a particular interest in the study of knowledge translation strategies to promote the systematic uptake of evidence-based, interprofessional care delivery for people with cognitive impairment and their families entering acute care as well as for those bereaved. Her research work is at the intersection of nursing science and implementation science with a focus on family nursing. Recent publications include “Intensive Care Nurse-Family Engagement From a Global Perspective: A Qualitative Multi-Site Exploration” in Intensive and Critical Care Nursing (2021, with P. Brysiewicz et al.), “Translation and Psychometric Validation of the German Version of the Family Nursing Practice Scale (FNPS)” in Journal of Family Nursing (2021, with P. Brysiewicz et al.), and “Impact of a Nurse-Led Family Support Intervention on Family Members’ Satisfaction With Intensive Care and Psychological Wellbeing: A Mixed-Methods Evaluation” in Australian Critical Care (2021, with S. von Felten, H. Petry, J. Ernst, & P. Massarotto).

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental material: Supplemental material for this article is available online.

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5 Benefits of Learning Through the Case Study Method

• 28 Nov 2023

While several factors make HBS Online unique —including a global Community and real-world outcomes —active learning through the case study method rises to the top.

In a 2023 City Square Associates survey, 74 percent of HBS Online learners who also took a course from another provider said HBS Online’s case method and real-world examples were better by comparison.

Here’s a primer on the case method, five benefits you could gain, and how to experience it for yourself.

Access your free e-book today.

What Is the Harvard Business School Case Study Method?

The case study method , or case method , is a learning technique in which you’re presented with a real-world business challenge and asked how you’d solve it. After working through it yourself and with peers, you’re told how the scenario played out.

HBS pioneered the case method in 1922. Shortly before, in 1921, the first case was written.

“How do you go into an ambiguous situation and get to the bottom of it?” says HBS Professor Jan Rivkin, former senior associate dean and chair of HBS's master of business administration (MBA) program, in a video about the case method . “That skill—the skill of figuring out a course of inquiry to choose a course of action—that skill is as relevant today as it was in 1921.”

Originally developed for the in-person MBA classroom, HBS Online adapted the case method into an engaging, interactive online learning experience in 2014.

In HBS Online courses , you learn about each case from the business professional who experienced it. After reviewing their videos, you’re prompted to take their perspective and explain how you’d handle their situation.

You then get to read peers’ responses, “star” them, and comment to further the discussion. Afterward, you learn how the professional handled it and their key takeaways.

HBS Online’s adaptation of the case method incorporates the famed HBS “cold call,” in which you’re called on at random to make a decision without time to prepare.

“Learning came to life!” said Sheneka Balogun , chief administration officer and chief of staff at LeMoyne-Owen College, of her experience taking the Credential of Readiness (CORe) program . “The videos from the professors, the interactive cold calls where you were randomly selected to participate, and the case studies that enhanced and often captured the essence of objectives and learning goals were all embedded in each module. This made learning fun, engaging, and student-friendly.”

If you’re considering taking a course that leverages the case study method, here are five benefits you could experience.

5 Benefits of Learning Through Case Studies

1. take new perspectives.

The case method prompts you to consider a scenario from another person’s perspective. To work through the situation and come up with a solution, you must consider their circumstances, limitations, risk tolerance, stakeholders, resources, and potential consequences to assess how to respond.

Taking on new perspectives not only can help you navigate your own challenges but also others’. Putting yourself in someone else’s situation to understand their motivations and needs can go a long way when collaborating with stakeholders.

2. Hone Your Decision-Making Skills

Another skill you can build is the ability to make decisions effectively . The case study method forces you to use limited information to decide how to handle a problem—just like in the real world.

Throughout your career, you’ll need to make difficult decisions with incomplete or imperfect information—and sometimes, you won’t feel qualified to do so. Learning through the case method allows you to practice this skill in a low-stakes environment. When facing a real challenge, you’ll be better prepared to think quickly, collaborate with others, and present and defend your solution.

3. Become More Open-Minded

As you collaborate with peers on responses, it becomes clear that not everyone solves problems the same way. Exposing yourself to various approaches and perspectives can help you become a more open-minded professional.

When you’re part of a diverse group of learners from around the world, your experiences, cultures, and backgrounds contribute to a range of opinions on each case.

On the HBS Online course platform, you’re prompted to view and comment on others’ responses, and discussion is encouraged. This practice of considering others’ perspectives can make you more receptive in your career.

“You’d be surprised at how much you can learn from your peers,” said Ratnaditya Jonnalagadda , a software engineer who took CORe.

In addition to interacting with peers in the course platform, Jonnalagadda was part of the HBS Online Community , where he networked with other professionals and continued discussions sparked by course content.

“You get to understand your peers better, and students share examples of businesses implementing a concept from a module you just learned,” Jonnalagadda said. “It’s a very good way to cement the concepts in one's mind.”

4. Enhance Your Curiosity

One byproduct of taking on different perspectives is that it enables you to picture yourself in various roles, industries, and business functions.

“Each case offers an opportunity for students to see what resonates with them, what excites them, what bores them, which role they could imagine inhabiting in their careers,” says former HBS Dean Nitin Nohria in the Harvard Business Review . “Cases stimulate curiosity about the range of opportunities in the world and the many ways that students can make a difference as leaders.”

Through the case method, you can “try on” roles you may not have considered and feel more prepared to change or advance your career .

5. Build Your Self-Confidence

Finally, learning through the case study method can build your confidence. Each time you assume a business leader’s perspective, aim to solve a new challenge, and express and defend your opinions and decisions to peers, you prepare to do the same in your career.

According to a 2022 City Square Associates survey , 84 percent of HBS Online learners report feeling more confident making business decisions after taking a course.

“Self-confidence is difficult to teach or coach, but the case study method seems to instill it in people,” Nohria says in the Harvard Business Review . “There may well be other ways of learning these meta-skills, such as the repeated experience gained through practice or guidance from a gifted coach. However, under the direction of a masterful teacher, the case method can engage students and help them develop powerful meta-skills like no other form of teaching.”

How to Experience the Case Study Method

If the case method seems like a good fit for your learning style, experience it for yourself by taking an HBS Online course. Offerings span seven subject areas, including:

• Business essentials
• Leadership and management
• Entrepreneurship and innovation
• Finance and accounting
• Business in society

No matter which course or credential program you choose, you’ll examine case studies from real business professionals, work through their challenges alongside peers, and gain valuable insights to apply to your career.

Are you interested in discovering how HBS Online can help advance your career? Explore our course catalog and download our free guide —complete with interactive workbook sections—to determine if online learning is right for you and which course to take.

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