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Crafting a Persuasive Argument: Family-Level Relational Interventions with Families Experiencing Illness

Crafting a Persuasive Argument: Family-Level Relational Interventions with Families Experiencing Illness

I’m currently doing some writing about the importance of family interventions in illness. I would like to offer some new integrative reviews and my favorite references (the oldies but goodies) that provide a convincing argument for family-level relational interventions that involve the whole family unit or part of the family unit experiencing illness (as opposed to individual interventions directed to either the patient or one family member and distinct from psychoeducational family interventions which focus on providing information and/or family support). I hope this list of references might be helpful to family scholars who wish to make a case for the importance of developing and/or examining relational family interventions that address illness experience/illness suffering.  This work is just beginning in health care and I believe it is critically needed. The MAIN TALKING POINTS of this argument are:

1. Illness impacts family relationships and family relationships influence health and illness management.

2. The provision of “good” health care needs to shift from focusing only on the individual “patient” to including families in care planning, care provision, and care evaluation. 

While knowledge development about family-level interventions in health care contexts is growing, research evidence by way of rigorous RCT designs is still limited.  However, a shift from examining “family psychoeducation” interventions to family-level relational interventions that address illness suffering and family relationships has been documented to be useful through quasi-experimental and qualitative research designs. The goal of this Talking Point is to make family care “usual care” in health care settings.

3. While the list of references below does not address this Talking Point directly, here is the MOST important argument that I want to underscore:

Nurses provide 24/7 care and there is beginning research evidence that nurses can implement relational family-level interventions that positively impact family outcomes and, in some studies, there is beginning evidence that this ability to offer family-level interventions increases the job satisfaction of the nurse.

For more information about Point #3, see:

NEW IFNA Position Statements on Family Nursing Practice and Family Nursing Education (Translations available)

International Family Nursing Association (IFNA). (2013).  IFNA Position Statement on Pre-Licensure Family Nursing Education.  Retrieved from

International Family Nursing Association (IFNA). (2015). IFNA Position Statement on Generalist Competencies for Family Nursing Practice.  Retrieved from

Internationa Family Nursing Association (IFNA). (2017). IFNA Position Statement on Advanced Practice Competencies for Family Nursing. Retrieved from

International Family Nursing Association (IFNA). (2018). IFNA Position Statement on Graduate Family Nursing Education. Retrieved from

List of Integrative Reviews, Meta-Analyses, and Synthesis Research about Relational Family-Level Interventions

Updated May 2019

Armour, T. A., Norris, S. L., Jack, L., Jr., Zhang, H., & Fisher, L. (2004). The effectiveness of family interventions in people with diabetes mellitus: A systematic review. Diabetes Medicine, 22, 1295-1305. doi: 10.1111/j.1464-5491.2005.01618.x

Bell, J. M. (2015). Growing the science of Family Systems Nursing: Family health intervention research focused on illness suffering and family healing. In F. Duhamel (Ed.), La santé et la famille: Une approche systémique en soins infirmiers [Families and health: A systemic approach in nursing care] (3rd ed.,) Montreal, Quebec, Canada: Gaëtan Morin editeur, Chenelière Éducation. [In French]. English language translation available from U of C Institutional Repository, PRISM:

Bell, J. M., & Wright, L. M. (2007). La recherché sur la pratique des soins infirmiers à la famille [Research on family interventions]. In F. Duhamel (Ed.), La santé et la famille: Une approche systémique en soins infirmiers [Families and health: A systems approach in nursing care] (2nd ed., pp. 87-105). Montreal, Quebec, Canada: Gaëtan Morin editeur, Chenelière Éducation. [in French] (an English version of this book chapter is available for public access on DSpace, University of Calgary Library:

Berry, D., Sheehan, R., Heschel, R., Knafl, K., Melkus, G., & Grey, M. (2004). Family-based interventions for childhood obesity: A review. Journal of Family Nursing, 10, 429-449. doi: doi:10.1177/1074840704269848

Campbell, T. L. (2003) The effectiveness of family interventions for physical disorders. Journal of Marital and Family Therapy, 29(2), 263-281. doi: 10.1111/j.1752-0606.2003.tb01204.x

Carr, A. (2009). The effectiveness of family therapy and systemic interventions for child focused problems. Journal of Family Therapy, 31, 3-45. doi:10.1111/j.1467-6427.2008.00451.x

Chesla, C. A. (2010). Do family interventions improve health? Journal of Family Nursing, 16, 355-377. doi: 10.1177/1074840710383145

Deek, H., Hamilton, S., Brown, N., Inglis, S. C., Digiacomo, M., Newton, P. J….FAMILY Project Investigators (2015). Family-centred approaches to healthcare interventions in chronic diseases in adults: A quantitative systematic review. Advance online publication. Journal of Advanced Nursing. doi: 10.1111/jan.12885

Fisher, L. (2006). Research on the family and chronic disease among adults: Major trends and directions.  Families, Systems, & Health, 24(4), 373-380. doi: 10.1037/1091-7527.24.4.373

NEW Gilliss, C. L., Pan, W., & Davis, L. L. (2019). Family involvement in adult chronic disease care: Reviewing the systematic reviews. Journal of Family Nursing, 25, 3-27.

Kazak, A. E. (2005). Evidence-based interventions for survivors of childhood cancer and their families. Journal of Pediatric Psychology, 30, 29-39. doi: 10.1093/jpepsy/jsi013

Kesserling, A., Chesla, C., & Leonard, V. (2010). Why study caring practices? In G. K. Chan, K. A. Brykczynski, R. E. Malone, & P. Benner (Eds.), Interpretive phenomenology in health care research, (pp. 3-22). Indianapolis, IN: Sigma Theta Tau International.

Hartmann, M., Bazner, E., Wild, B., Eisler, I., & Herzog, W. (2010). Effects of interventions involving the family in the treatment of adult patients with chronic diseases: A meta-analysis. Psychotherapy and Psychosomatics, 79, 136-148. doi:10.1159/000286958

Lister, Z., Fox, C., & Wilson, C. M. (2013). Couples and diabetes: A 30-year narrative review of dyadic relational research.  Contemporary Family Therapy, 35(4), 613-638. doi: 10.1007/s10591-013-9250-x

Loveland-Cherry, C. J. (2006). Where is the family in family interventions? [Guest Editorial].  Journal of Family Nursing, 12(1), 4-6.  doi: 10.1177/1074840705285209

Marshall, C. A., Larkey, L. K., Curran, M. A., Weihs, K. L., Badger, T. A., Armin, J., & Garcia, F. (2011). Considerations of culture and social class for families facing cancer: The need for a new model for health promotion and psychosocial intervention. Families, Systems, & Health, 29(2), 81-94. doi: 10.1037/a0023975

Martire, L. M. (2005). The “relative” efficacy of involving family in psychosocial interventions for chronic illness: Are there added benefits to patients and family members? Families, Systems, & Health, 23(3), 312-328. doi:10.1037/1091-7527.23.3.312

Martire, L. M., Lustig, A. P., Schulz, R., Miller, G. E., & Helgeson, V. S. (2004). Is it beneficial to involve a family member? A meta-analysis of psychosocial interventions for chronic illness. Health Psychology23(6), 599–611. doi: 10.1037/0278-6133.23.6.599

Martire, L. M., Schulz, R., Helgeson, V. S., Small, B. J., & Saghafi, E. M. (2010). Review and meta-analysis of couple-oriented interventions for chronic illness. Annals of Behavioral Medicine, 40, 325-342. doi: 10.1007/s12160-010-9216-2

Mattila, E., Leino, K., Paavilainen, E., & Åstedt-Kurki, P. (2009). Nursing intervention studies on patients and family members: A systematic literature review. Scandinavian Journal of Caring Sciences, 23, 611-622. doi:10.1111/j.1471-6712.2088.00652.x

McBroom, L. A., & Enriquez, M. (2009). Review of family-centered interventions to enhance the health outcomes of children with type 1 diabetes. The Diabetes Educator, 35, 428-438. doi:10.1177/0145721709332814

Meyler, E., Guerin, S., Kiernan, G., & Breatnach, F. (2010).  Review of family-based psychosocial interventions for childhood cancer.  Journal of Pediatric Psychology, 35(10), 1116-1132. doi:10.1093/jpepsy/jsq032

Östlund, U., & Persson, C. (2014). Examining family responses to Family Systems Nursing interventions: An integrative review.  Journal of Family Nursing, 20, 259-286. doi:10.1177/1074840714542962

Prchal, A., & Landolt, M.A. (2009). Psychological interventions with siblings of cancer patients: A systematic review.  Psycho-Oncology, 18, 1231-1251. doi: 10.1002/pon.1565

Rosland, A.M., Heisler, M., & Piette, J.D. (2011). The impact of family behaviours and communication patterns on chronic illness outcomes: A systematic review.  Journal of Behavioral Medicine, 35(2):221-39. doi:10.1007/s10865-011-9354-4

Shields, C. G., Finley, M. A., Chawla, N., & Meadors, P. (2012). Couple and family interventions in health problems. Journal of Marital & Family Therapy, 38(1)265-280. doi: 10.1111/j.1752-0606.2011.00269.x

Sprenkle, D. H. (2012). Intervention research in couple and family therapy: A methodological and substantive review and an introduction to the special issue. Journal of Marital and Family Therapy, 38(1), 3-29. doi: 10.1111/j.1752-0606.2011.00271.x

Stehl, M. L., Kazak, A. E., Alderfer, M. A., Rodriguez, A., Hwang, W. T., Pai, A. L. H., . . . Reilly, A. (2009). Conducting a randomized clinical trial of a psychological intervention for parents/caregivers of children with cancer shortly after diagnosis. Journal of Pediatric Psychology, 34, 803-816. doi:10.1093/jpepsy/jsn130

Tomlinson, P. S. & Astedt-Kurki, A. (2008).  A systemic view of family health [Guest Editorial]. Scandinavian Journal of Caring Sciences, 22(1), 1-4. doi: 10.1111/j.1471-6712.2007.00587.x

Torenholt, R., Schwennesen, N. & Willaing, I. (2014). Lost in translation—the role of family in interventions among adults with diabetes: A systematic review. Diabetic Medicine, 31, 15–23. doi: 10.1111/dme.12290

Weihs, K., Fisher, L., & Baird, M. (2002). Families, health, and behavior: A section of the commissioned report by the Committee on Health and Behavior: Research, Practice, and Policy Division of Neuroscience and Behavioral Health and Division of Health Promotion and Disease Prevention Institute of Medicine, National Academy of Sciences. Families, Systems, & Health, 20(1), 7-46. doi:10.1037/h0089481

Resources for Developing an Integrative Reviews/Synthesis Research

Cooper, H. M. (2010). Research synthesis and meta-analysis: A step-by-step approach (4th ed.). Thousand Oaks, CA: SAGE.

Knafl, K. A. (2015). Family synthesis research: Possibilities and challenges [Editorial]. Journal of Family Nursing, 21(1), 3-10. doi:10.1177/1074840714568740

Gough, D., Oliver, S., & Thomas, J. (2012). An introduction to systematic reviews. London, United Kingdom: SAGE.

Higgins, J., & Green S. (Eds.). (2008). Cochrane Handbook for systematic reviews of interventions. New York, NY: Wiley-Blackwell.

Sandelowski, M., & Barroso, J. (2007). Handbook for synthesizing qualitative research. New York, NY: Springer.

Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546-553. doi: 10.1111/j.1365-2648.2005.03621.x. Retrieved from

The Joanna Briggs Institute (JBI) is the international not-for-profit, research and development arm of the School of Translational Science based within the Faculty of Health Sciences at the University of Adelaide, South Australia. This Institute has played a leading role in the synthesis of family research.