Family Health Behaviors Model: A Conceptual Framework for Prevention Research and Interventions

Background: Chronic illnesses are an epidemic. Lifestyle risk factors including smoking, excessive eating, and physical inactivity explain most of their prevalence, and if they could be controlled, the incidence of cardiovascular disease and cancer will be reduced significantly. Traditional models explaining health behaviors and behavioral change have focused either on individual or larger ecological environments, overlooking the importance of the family. A model that incorporates individuals, the family, and their environments in a manner that allows health behaviors to be viewed as a function of the bridging of these components is needed. This article presents a conceptual framework to explain how individuals develop, maintain and change health behaviors within the family context, including a broader societal environment.

Family Health Behaviors Model: The Family Health Behaviors Model (FHBM) explains health behaviors as a function of family factors, behavioral intention, behavioral attitudes, knowledge and skills to perform a behavior, and personal socio-demographic and personality factors. All these constructs are determined by personal, familial and environmental interactions, where families are considered to be the fundamental social and cultural context in the development, maintenance, and change of health behaviors. Even though health behaviors are determined by multiple environments, the FHBM considers that they are ultimately individual behaviors within a familial context. The model includes volitional and non-volitional constructs, as well as modifiable and non-modifiable factors. It considers that family influences health behaviors through family practices, relationship characteristics, family members’ health status, current and past health behaviors, family health expectations, family needs, family expected outcomes, family self-efficacy, family values and preferences, and family resources. Individual determinants of behavior include previous experiences and outcomes, the perceived family support to perform a behavior, personal needs, beliefs, values and preferences, and feelings and emotions, besides the main family system determinants mentioned above. The relevance of the individual and family determinants of a behavior may vary for different behaviors, for different moments of behavioral performance (initiation, maintenance, or cessation), for different populations, and for the different life stages. Sustainable change needs to affect both the individual and family systems.

Implications and Recommendations: Because most health behaviors are developed, maintained, and changed within families, this unit deserves greater consideration in health prevention research. The Family Health Behaviors Model could be an important framework bridging family research and health prevention. Having a research-based model that explains lifestyle health behaviors and behavioral change including individuals, the family, and larger environments will inform new targets for clinical interventions in health promotion and disease prevention.