Table 3 Family systems theory-related concepts and measurement tools included in interventions (n = 27)
From: Family systems approaches in pediatric obesity management: a scoping review
FST concept and definitiona | Nb of interventions with concept included | Examples | References | Tools used to measure the FST concept (if applicable) |
|---|---|---|---|---|
Parenting Skills Skills and strategies that can be useful to parents who are supporting a child in a obesity-management intervention. Effective parenting skills may vary based on existing dynamics within the family but may include limit-setting, active listening and communication, autonomy-support, parental role-modeling, etc. | 16 | Families Improving Together (FIT): Focused on improving parenting skills around communication, autonomy support, and social support [36] Families on the Move (FOTM): Focused on limit setting, re-framing the problem, re-framing parent role and child responsibility, exercising parental leadership, exercising parental general skills, promoting parent–child effective communication, promoting problem-solving skills, increasing self-efficacy in parental role of providing a positive family environment [43] | [28,29,30, 32,33,34,35,36,37,38,39,40,41, 43,44,45,46,47, 52, 53, 56, 61,62,63, 65,66,67,68, 70,71,72, 75,76,77] | The Parenting Strategies for Eating and Activity Scale (PEAS) [53] The Parenting Dimensions Inventory (PDI-S) [56] The Parenting Stress Index [67, 68] The Authoritative Parent Index [39] The Child Feeding Questionnaire [39, 41] Newest Vital Sign [46] Parenting practices scale [33] |
Family Communication Strengthening both verbal and non-verbal communication among family members to create a supportive environment within the home. Communication strategies (e.g., active listening, openness, respect) can enhance emotional connections, foster productive discussions that can help in problem-solving and decision-making, and allow individuals to feel heard and validated within the family unit | 14 | Families Improving Together (FIT): Targeted family communication strategies, including active listening, using push–pull language, and problem solving [35] | [29,30,31,32,33,34,35,36,37,38,39,40, 42,43,44,45,46,47, 60, 65,66,67,68, 70,71,72,73,74] | The Dyadic Communication Scale (DOCS) [73] The Family Interactions Topics questionnaire [73] The Family Relations Scale [33] |
Social / Family Support Encouragement and support from the family and the broader social context to help a child/adolescent succeed in an obesity-management intervention. Support may include emotional, motivational, physical, financial and types of support and resources, as well as fostering a sense of community and solidarity for the individual | 13 | Families Improving Together (FIT): Aimed to foster social support within families through take-home bonding activities, and between families through group activities [35, 37] Multifamily Therapy plus Psychoeducation: Promoted enlisting social support; e.g., determining the type of support needed, who can provide it, and how to ask for it [60] SHINE: Emphasized the importance of peer relationships during adolescence and the role parents play in managing peer relationships and healthy lifestyle behaviours. Adolescents were encourage to bring a friend to [one] session, and friends were integrated into the activities [71] | [29, 33, 35,36,37,38,39,40, 42, 43, 47, 49, 50, 56, 60,61,62,63, 70,71,72] | The Youth Quality of Life (YQOL) Inventory, including a social relationship subscale [49] The Support for Exercise Scale (revised version) [56] The Social Support for Eating Habits and Exercise Scale [61] Parent Relationship with Peer Group Scale [33] |
Family Functioning Family member roles and interactions that affect day-to-day living within the home environment, including acceptance and understanding of one another, family decision-making and problem-solving processes, and general communication among family members. Simply described as the overall healthiness of a family unit | 10 | Multidisciplinary FBBT: Nutrition-related topics and systemic interventions to facilitate family functioning by reinforcing family resources and improving the emotional climate for adolescents with obesity [57] | [30, 31, 33, 35,36,37,38,39,40, 47, 56, 57, 60, 64, 70,71,72] | The Self-Report Family Inventory (SFI), including the conflict resolution, cohesion, and family nurturance subscales [60] The Family Adaptability and Cohesion Evaluation Scales IV (FACES IV) [67, 68] The Family Climate Scale [72] Family Questionnaire (FQ) [31] Family Assessment Device General Functioning [29] |
Parental Role Modelling The ability of a parent to act as a role model and model healthy lifestyle behaviours through their actions. Recognizing parents as agents of change for their child’s habits and behaviours | 8 | Families on the Move (FOTM): The intervention emphasizes parents as change agents who role model behavioural change by setting goals themselves [43] Family Connections: Parents provide an example of healthy lifestyle behaviours for their child, and model enjoyment of healthy foods and physical activity [44] | The Comprehensive Feeding Practices Questionnaire [53] The Weight Control Strategies Scale (WCSS) [74] Family Experiences Related to Food Questionnaire (FERFQ) [74] Spanish version of the Home Environment Survey-Physical Activity (HES-S) [30] | |
Autonomy Support Creating a family environment that fosters autonomy specific to health behaviours, with the goal of building intrinsic motivation for sustainable lifestyle changes (e.g., encouraging the child/adolescent to provide input, problem-solve, negotiate, participate in shared decision-making, and self-monitor their health behaviours) | 6 | SHINE: Targeted autonomy-supportive communication within the family and parental monitoring specific to activity and dietary behaviours. Intervention curriculum included tools for self-monitoring, and encourages adolescents to monitor their chosen target behaviours with weekly check-ins with their families [71] Families Improving Together (FIT): Intervention facilitators create a climate which fosters autonomy, competence, and belongingness. Adolescents have choices and are provided with opportunities to give input. Parents seek input from adolescents and negotiate rules and behaviour changes together [35] | None mentioned | |
Shared Decision-Making Encouraging collaboration when making decisions, particularly those surrounding health behaviours and activities such as meal planning, physical activity preferences, etc. | 5 | Family Connections: The intervention promoted the involvement of children in decision making for enjoyable physical activity [44] | None mentioned | |
Home Environment Addressing barriers to healthy living that exist within the physical home environment | 6 | Multidisciplinary Treatment Program: Focused on removing unhealthy food triggers from the home environment [58] Family Connections: Provided strategies to restructure the home environment to support healthy food and activity options, while reducing options for unhealthy choices [44] | Home Monitoring Checklist [28] Confusion, Hubbub, and Order Scale [28] | |
Empowerment Providing adequate tools, resources, support, and information to enhance an individual’s confidence surrounding certain tasks or behaviours and helping them achieve a sense of autonomy and self-efficacy to control a given aspect of their life | 3 | LiLi: Empowered parents with the knowledge they need to be able to suggest strategies and set meaningful goals for the family [51] Multisystemic Therapy: Empowered caregivers with the skills and resources to address difficulties inherent in raising adolescents, and empowered adolescents to cope with family, school, and neighborhood problems [61] | None mentioned | |
Family Goal setting Working together to set goals that are important to the family unit as a whole, while taking into consideration things that are important to each individual within the family | 7 | Family Connections: Parents were trained to lead their family through regular goal setting related to physical activity and eating. They learned the process of goal setting using the 5As (assess, advise, ask, assist, arrange), learned how to keep objectives clear, and created a family action plan [44] SHINE: Families worked on target health behaviours in the order of their choice by setting goals, self-monitoring, and receiving weekly feedback [71] | None mentioned | |
Family Problem-Solving Collaboration between a child/adolescent and their parent to identify and resolve a problem | 6 | SHINE: Families learned strategies for effective problem solving (e.g., defining the problem, brainstorming all possible solutions, making a joint decision, and discussing a plan for follow through) [71] | None mentioned |