The effectiveness of single-session group interventions to promote positive changes in family well-being in Hong Kong Chinese parents

Abstract

Family is the cornerstone of all societies and cultures. In Hong Kong, typical urban families are under multiple demands to make ends meet. The stressful city lifestyle seems to have undermined the importance of quality family communication and hindered the enhancement of family wellbeing.

This thesis aimed to (1) investigate what behaviors or communication methods relate most to family wellbeing and could be included as target outcomes in inexpensive, brief preventive intervention programs potentially reaching multitudes of people, (2) test the effectiveness of interventions designed to promote positive behavioral changes (more appreciation and less criticism), and (3) evaluate whether these positive behavioral changes mediated family wellbeing.

A cross-sectional study based on a random telephone survey among 1,506 Hong Kong Chinese residents was conducted in 2010 and 2011. Data on socio-demographic characteristics, frequency of using six communication methods to enhance family relationship (identified by earlier qualitative studies; greeting one’s family, showing appreciation, giving small gifts, serving one’s family, hugs, and spending time), and level of family harmony were collected. Forward stepwise regression was used to examine which of these behaviors contributed most variance to family harmony. A cluster randomized controlled trial was conducted during 2012 to 2013 among 803 participants from 56 clusters. Participants from two intervention arms targeting more appreciation or less criticism respectively, and control arm targeting fruit and vegetable intake, were assessed at baseline, immediate, 2-week, and 6-week post-intervention. Data on behavior and Health Action Process Approach (HAPA) constructs associated with more appreciation, less criticism, fruit and vegetable intake, and family wellbeing were collected. Intention-to-treat and per-protocol analyses using Generalized Estimating Equations were used to examine effectiveness of the interventions as well as the program delivered to the control arm. Mediation of behavioral changes on family wellbeing was examined by the product-of-coefficients approach and bootstrapping.

Spending time with one’s family and showing appreciation contributed most variance to family harmony (p<.001). Increases in appreciation were significantly greater in the HAPA-based appreciation and criticism intervention arms than the control arm at two and six weeks post-intervention (Wald X^2 =6.26-15.57, p<.01, ES=.11-.19) with small to medium effects. Decreases in criticism were only significant across time but not among groups. More appreciation, but not less criticism, mediated the pathway to increases in family wellbeing (95% CI 0.01-0.09). In addition, in an adjunct study, increases in fruit and vegetable intake were significantly greater in the intervention arm than the control arm (Wald X^2 = 4.70-6.07, p<.05, ES=.08-.12) with small effect size.

Single-session, inexpensive, HAPA-based interventions were effective in promoting positive behavioral changes in appreciation (and fruit and vegetable intake). Such increases in appreciation behavior translated into an enhancement in family wellbeing. This study should have public health significance because it has addressed the need for brevity in population-based preventive interventions, as well as identified likely precursors of family wellbeing in Hong Kong.