Chronic Disease Among African American Families

A Systematic Scoping Review

Katrina R. Ellis, PhD, MPH, MSW; Hillary K. Hecht, MSW; Tiffany L. Young, PhD; Seyoung Oh, MSW; Shikira Thomas, MSPH; Lori S. Hoggard, PhD; Zaire Ali, EdM; Ronke Olawale, MPA, MSW; Dana Carthron, PhD, RN; Giselle Corbie-Smith, MD, MSc; Eugenia Eng, DrPH

Disclosures

Prev Chronic Dis. 2020;17(12):e167 

In This Article

Abstract and Introduction

Abstract

Introduction: Chronic diseases are common among African Americans, but the extent to which research has focused on addressing chronic diseases across multiple members of African American families is unclear. This systematic scoping review summarizes the characteristics of research addressing coexisting chronic conditions among African American families, including guiding theories, conditions studied, types of relationships, study outcomes, and intervention research.

Methods: The literature search was conducted in PsycInfo, PubMed, Social Work Abstracts, Sociological Abstracts, CINAHL, and Family and Society Studies Worldwide to identify relevant articles published from January 2000 through September 2016. We screened the title and abstracts of 9,170 articles, followed by full-text screening of 530 articles, resulting in a final sample of 114 articles. Fifty-seven percent (n = 65) of the articles cited a guiding theory/framework, with psychological theories (eg, social cognitive theory, transtheoretical model) being most prominent. The most common conditions studied in families were depression (70.2%), anxiety (23.7%), and diabetes (22.8%), with most articles focusing on a combination of physical and mental health conditions (47.4%).

Results: In the 114 studies in this review, adult family members were primarily the index person (71.1%, n = 81). The index condition, when identified (79.8%, n = 91), was more likely to be a physical health condition (46.5%, n = 53) than a mental health condition (29.8%, n = 34). Among 343 family relationships examined, immediate family relationships were overwhelmingly represented (85.4%, n = 293); however, extended family (12.0%, n = 41) and fictive kin (0.6%, n = 2) were included. Most (57.0%, n = 65) studies focused on a single category of outcomes, such as physical health (eg, obesity, glycemic control), mental health (eg, depression, anxiety, distress), psychosocial outcomes (eg, social support, caregiver burden), or health behaviors (eg, medication adherence, disease management, health care utilization); however, 43.0% (n = 49) of studies focused on outcomes across multiple categories. Sixteen intervention articles (14.0%) were identified, with depression the most common condition of interest.

Conclusion: Recognizing the multiple, simultaneous health issues facing families through a lens of family comorbidity and family multimorbidity may more accurately mirror the lived experiences of many African American families and better elucidate intervention opportunities than previous approaches.

Introduction

African Americans experience high incidence rates and poor health outcomes for many common chronic health conditions.[1–7] Consequently, African American families may be simultaneously managing multiple chronic conditions. At the intersection of family health and chronic health problems, Burton and Whitfield[8] introduced the concept family comorbidity as the existence of physical or mental health problems in a primary caregiver (mother or grandmother) and/or a child in a family. This definition was later refined to include "the presence of multiple co-occurring physical and/or mental health problems within individuals or families" beyond parent/child dyads.[9] Theories and research on cumulative disadvantage[9,10] support the propositions that family comorbidity may be associated with individual and familial stressors, burdens, and constraints, which could affect disease onset, development, and management. The concept of family comorbidity highlights an opportunity to increase understanding of health experiences within families, with specific attention to current health status and day-to-day needs of multiple household members (often representing several generations).

The objective of this scoping review was to document family comorbidity among African Americans across a range of health disciplines and types of research. Given the disproportionate burden that chronic diseases place on the lives of African Americans,[1–7] persistent racial inequities in health across the lifespan,[11,12] and the importance of the familial context for health promotion and disease prevention,[13–15] it is useful to understand how family comorbidity has been examined to identify opportunities for future research and interventions to improve outcomes among this population. Moreover, research from the fields of psychology, public health, medicine, social work, sociology, and nursing is of particular interest given their attention to chronic disease (including causes, prevention, and management), the family context, and racial and ethnic disparities in health.

Several key questions guide this scoping review and attend to the fundamental aspects of this research. First, what theories have been used to examine family comorbidity? The choice of theoretical frameworks has implications for the design and conduct of studies and data interpretation.[16,17] Second, what chronic conditions have been included in these studies? Bidirectional relationships between physical and mental health are well documented,[18–20] and it is important to understand whether conditions studied align with the physical and mental health needs of this population.[21–24] Moreover, examining physical and mental health conditions at the family level speaks to interconnectedness observed within these systems.[25,26] Third, does a particular family member or condition drive study objectives? Comorbidity is traditionally defined in individuals as the combined effects of multiple health conditions in reference to an index condition.[27] This review investigates comorbidity at the family level, identifying index persons and/or index conditions in families. Fourth, what types of familial relationships are included? Family roles and norms can vary by degree of relationship[28–30] and play a critical role in chronic disease prevention and management efforts.[31,32] Fifth, what outcomes have been studied? Living with multiple health conditions has been associated with outcomes such as increased disability and poorer quality of life;[33] identifying key outcomes associated with multiple conditions among families can highlight trends and gaps in this research. Lastly, existing intervention strategies to promote and maintain positive individual- and family-level chronic disease outcomes can be informative for future efforts. Thus, the final guiding question for this review is, what are the characteristics of interventions designed to address chronic conditions among multiple family members?

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