Family Communication: Cohesion And Change (8th Edition) 13
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Internet use and information and communication technology (ICT) have dramatically changed interpersonal communication within the family [8,9]. Advanced ICT applications, such as WhatsApp or WeChat, provide convenient instant messaging (IM) functions that allow family members to connect and share information in real-time [10,11,12]. Specifically, e-chat groups in these applications allow three or more users to simultaneously share texts, images, voice messages, short videos, and even make video calls at low or no costs. Previous studies found more family communication using IM messages and video calls was associated with higher levels of family wellbeing [13,14].
Despite the overlapping 95% CIs with other IM functions, video calls appeared to be most strongly associated with higher levels of family wellbeing. This is consistent with a previous study in 2016, which showed sharing family life information through video calls was associated with much higher levels of family wellbeing . The present study further reported its strong associations with better family communication and personal happiness. Amidst the COVID-19 pandemic, almost all face-to-face social activities are regarded as high risk. Family members of all generations faced elevated social isolation due to the physical distancing and lockdown policy. Instead of one-on-one in-person communications, online group settings allow more effective and simultaneous information exchange and interactions among many separated family members, which can evoke warm feelings of family gathering and close connection when face-to-face gatherings are impossible. Family video calls can partly overcome the barrier to traditional family reunions, such as birthday parties or other celebrations . Even the inactive family members and those who live far away can participate in and enjoy the online gathering time. The physical distancing due to COVID-19 could have motivated more people to use video calls to reduce emotional distancing within the family.
Family genogram, family circle, family APGAR (adaptation, partnership, growth, affection, and resolve) and Family Adaptability and Cohesion Evaluation Scale (FACES) are the most common tools to assess family function.6-8) Among them, FACES III, using the circumplex model, has been widely used in various fields.5) FACES III was developed by Olson in 1983 to investigate family dynamics.9,10) The reliability and validity of the Korean translation of FACES III has also been demonstrated.11) FACES III was developed to assess two major dimensions on the circumplex model: adaptability and cohesion of the family. This measure assesses the degree to which family members are adaptive and attached to their family. The circumplex model is a classification system of 16 family types and three or more general types: balanced, mid-range, and extreme (Figure 1). There are four levels of family adaptability: rigid, structured, flexible, and chaotic (very high). The two central levels (structured and flexible) are considered the balanced levels of family adaptability and the two extreme levels (rigid and chaotic) are considered the unbalanced levels of family adaptability. Also, there are four levels of family cohesion: disengaged, separated, connected, and enmeshed. Similar to that for family adaptability, the two central levels (separated and connected) are considered to be the balanced levels of family cohesion and the two extreme levels (disengaged and enmeshed) are considered to be the unbalanced levels of family cohesion.9) These measures indicate the curvilinear interpretation. In other words, according to the curvilinear hypothesis, balanced levels of cohesion and adaptability (low to high levels) tend to reflect more healthy family functioning, while unbalanced levels of cohesion and adaptability (very low or very high levels) tend to reflect more problematic family functioning.
However, the criticism of the curvilinear hypothesis of the circumplex model has always been from an empirical point of view.12-14) Some previous research supported the curvilinear relationship between family adaptability, cohesion and family function.9,11,15) However, other research indicated that family adaptability, cohesion evaluation scale, and practical family function have a linear relationship, rather than a curvilinear relationship.16-18) Within the linear interpretation, a family having the higher cohesion and adaptability levels displays greater functionality. The lower levels (disengaged and rigid) indicate worse forms of family functioning.
Especially, in a study of children and adolescents, behavioral problems were associated with extreme levels of family cohesion and adaptability.19) In addition, another study of child behavior problems found a strong relationship with low family cohesion.20) For these reasons, previous research have suggested that the problem behaviors may be closely related to family function. Therefore, this study focused on adolescent problem behaviors because family function can be explained through adolescent problem behaviors.
The general family types were balanced, mid-range, and extreme. They were determined by adaptability and cohesion scores, based on Olson's method (Figure 1). The number of families in the balanced type was the largest with 224 (56.3%), followed by the mid-range type with 111 (27.9%) and the extreme type with 63 (15.8%). Although statistically insignificant for the externalizing problem behaviors, the average scores of both the internalization of problems and the externalization of problems were the highest in the mid-range family type, but in not the extreme family type.
We recategorized family function level by adaptability and cohesion score, involving lower FACES III score, and balanced and higher FACES III (Figure 2). The number of families in the balanced type was the largest with 224 (56.7%), followed by lower FACES III group with 89 (22.4%), and higher FACES III group with 85 (21.4%). The mean scores of both adolescent internalizing problems and externalizing problems were the highest in the lower FACES III group, the next was balanced, and the higher FACES III group was the lowest.
In our study, the mean score for family cohesion was 33.0 ± 6.2 and the mean score for family adaptability was 31.6 ± 6.2. The result for family cohesion was similar to that reported in the previous studies among adolescents, but the mean score for family adaptability was much higher than previously reported.9,11,26,27) Family adaptability can be affected by socioeconomic status, education level of parents, residential areas, number of siblings, and other factors.25,26) Thus, it can be postulated that the mean score for family adaptability was higher due to the high education level of parents in our study.
Several studies reported that family function and adolescent problem behaviors have a curvilinear relationship.9,11,15) However, other studies indicated that family function and adolescent problem behaviors have not a curvilinear relationship, but a linear relationship.16-18) If the relationships of family adaptability, family cohesion, and adolescent problem behaviors satisfy the curvilinear hypothesis, then families belonging to the balanced group would have the best family function. However, in our study, the average scores of adolescent problem behaviors of the families belonging to the balanced group were not the best, compared with families in other groups. Also, according to the curvilinear hypothesis, families in the unbalanced type must have poor family function. But, in our study, in higher FACE III score families, the average scores of adolescent problem behaviors both internalizing problem and externalizing problem were better than that of families belonging to the balanced type. The present results were consistent with previous research which showed that family function and adolescent problem behaviors do not have a curvilinear relationship.16-18) In other words, as adolescents achieve progressively higher adaptability or higher cohesion scores in FACES III, they display fewer problematic behaviors. In the unbalanced type, the families with lower and higher FACES III score showed significant differences on the average score of adolescent problem behavior. This means that both the lower group and higher group for FACE III score did not belong in the same extreme family function category. This supposition was supported by general linear model analysis. It was postulated that healthy families and unhealthy families with a high FACES III score could not be discriminated using the FACES III tool. Therefore, Olson's curvilinear hypothesis was not supported.
From these results, it can be presumed that adolescent behavior problems develop because demands for attention at the time of developmental change during adolescence were not met adequately owing to low family adaptability.28) Frustration is an important factor that causes behavior problems.29) Likewise, it can be postulated that low family adaptability and cohesion exacerbate the internal complaints among youth. Thus, the results obtained from our survey indicate that clinicians and researchers should be careful while interpreting family function using FACES III.
Interactive programs can be further divided into three categories based on their focus on social influences, comprehensive life skills, and system-wide change, respectively. Of these three categories, the system-wide change programs were most effective in preventing overall drug use (including alcohol use), followed by comprehensive life skills and social influences programs (Tobler et al. 2000). System-wide change programs, in turn, are of two types: (1) school-based programs that are actively supported by family and/or community (e.g., Project Northland, which is described below in the section "Multicomponent Strategies") and (2) programs that provide a supportive school environment but do not involve the family and/or community. 2b1af7f3a8