Changes in, and factors associated with family functioning: results of four cross-sectional household surveys from 2011 to 2017 in Hong Kong

From a family systems perspective [1], family members’ interactions shape the behaviors of individual members and individual members contribute to the overall well-being of the family. Such interconnectedness means that any impairment in the functioning at the family level may lead to changes in the functioning of individual members. Family functioning, which is the extent to which family members are able to resolve problems and communicate effectively and ensure proper role allocation, emotional response and involvement within the family [2], has been widely studied in understanding individuals’ physical and mental health [3, 4] and it is considered one of the key contributors to life satisfaction [5]. In the study of children and adolescents, there has been mounting evidence supporting the relationship between family functioning and various outcomes such as children and youth’s substance use [6], internalizing and externalizing behaviors [7, 8], depression [9], and risk of maltreatment [10]. Given that family functioning is so closely related to individuals’ physical and mental health, scholars have argued that family factors should be considered as a key social determinants of health [11]. In a broader context, routine data collection and monitoring of family functioning at the population level has long been advocated for to inform decision making in addressing social and public health issues [12], but relevant research has been very little. The most relevant work is the Australia’s National Framework for Protecting Australia’s Children (NFPAC), which includes measures that report on children’s safety and well-being at the population level [13]. Within this framework, family functioning is one of the outcome indicators of whether children are living in safe and supportive families and communities, and routine data on family functioning has been collected since 2010 to inform longer-term policy planning [13]. Apart from the experience in Australia, no other studies have examined the trends in family functioning in the general population across time.

During the global COVID-19 pandemic, numerous studies have found that social distancing measures had profound impacts on family life and family functioning [14, 15]. Meanwhile, higher levels of family functioning buffered against negative impacts of the pandemic, such as children’s quality of life [16]. One of the important lessons learned from the pandemic is that we should establish preventive measures to promote individual and family resilience before occurrence of a crisis [17]. Hence, research to identify factors that predict family functioning will provide useful information for the development of such preventive measures. According to the Stress Process Model [18, 19], predictors of family functioning can be categorized into contextual variables, primary stressors, secondary stressors, and resources. Contextual variables include demographic characteristics, primary stressors are sources of stress, and secondary stressors are responses to the primary stressors and are usually interpersonal in nature. The Stress Process Model concerns both the stressors and the availability of coping resources associated with family functioning. In the family functioning literature, research work has primarily focused on the stressors (risk factors) that impair the functioning of families, including work-family conflict [20, 21], chronic illnesses of family members [22, 23], and interparental conflict [24]. However, relatively little research work has evaluated the resource (protective) factors that promote family functioning. Among the relevant studies, social support, including perceived levels of social support and actual utilization of support, are found to be an important predictor of family functioning [25, 26]. Apart from social support, spending more time with family members such as in form of family meals and family-based activities are also found to be associated with increased family connectedness [27‐29]. Frequency of communication is another potential protective factor for family functioning. Recent studies looked into the benefits of family communication via new technologies, showing that more daily messages exchanged between family members via instant messengers is associated increased family functioning [30].

To add an additional layer to the study of predictors of family functioning, there is a need to examine how these predictors differ by family structures. Research has paid increasing attention to family structure in the study of family functioning [31]. Family structure is a term used to describe the type of household in which members are related to each other by marital/partnership status or bloodline [32]. Viewing from a social capital perspective, households of different family structures may have different levels of intra and extra-familial social networks, which may influence family process and subsequently family functioning [31]. Past studies suggested a relationship between different types of family structure and family functioning, albeit inconclusive [3, 33, 34]. A more recent study conducted during the pandemic found lower levels of family functioning in families without children, compared with families with children [34]. As the functioning of a family may be related to its structure, it is important to explore the similarities and differences of the predictors of family functioning across different family structures. Such understanding would encourage the development of tailored interventions to promote family functioning for different types of family, which in turn better benefit individuals’ well-being and development.

Regarding the research context, family and family functioning may be more influential to populations with a strong emphasis on collectivist values and the importance of interdependence among family members. Taking Hong Kong as an example, although it is the most westernized city in China, traditional cultural values about the importance of family, family hierarchy and harmony underlie many aspects of family lives [35]. Exploring the family functioning construct in families in Hong Kong will provide useful reference to inform further study and development of preventive programs to improve family health and resilience in other collectivist cultures with similar socioeconomic backgrounds. Using data from four representative household surveys in Hong Kong, the objectives of this study were (1) to explore the changes in family functioning in Hong Kong from 2011 to 2017 and (2) to examine the resource (protective) factors associated with family functioning and the extent to which these factors are the same or different across various family structures.

Using four cross-sectional representative household surveys conducted in Hong Kong, the present study is the first to examine changes in family functioning over time. Regarding overall family functioning, although there was no significant difference between the mean scores in 2011 and 2017, there were some fluctuations between 2013 and 2015, implying that there was no obvious trend during the 6-year period. As family functioning is a multidimensional construct consisting of various aspects related to family communication and interaction, this study also measured and looked into the changes in different dimensions of family functioning across time. During the short-term period from 2011 to 2013, there were significant improvements in terms of family communication and concern, followed by decreases in 2015. These declines coincided with the worsening of public mental health after the large-scale social movement (the umbrella movement) in Hong Kong in 2014 [38]. It may be that this deterioration in public mental health spilt over to families, resulting in impaired family functioning, or that the social movement may have had a direct impact on perceptions of family relationships and family functioning, hence causing the declines in family functioning. Although a previous study revealed increased conflicts among families, with disagreements on political views, after the social movement in 2014 [39], the current study found a stable trend of family conflict from 2011 to 2015, suggesting that the overall level of family conflict at the population level was not affected. Apart from fluctuations in some dimensions of family functioning, this study found a steady decline in perceived parental control across the study period, implying an improvement in parenting. However, these explanations of the changes in the population’s family functioning are speculations; additional evidence is needed to verify these hypotheses.

In accordance with our prediction, there were commonalities and differences between predictors of family functioning for different types of family structure. The findings of the current study indicated that frequent communication with family members and between generations is a common predictor of high family functioning shared by most family types (i.e., never married, married/cohabiting with children, and married/cohabiting with no children). However, although family communication is found to be one of the keys to positive family functioning [40], our study revealed that it was not the case for structurally non-intact families due to widowhood, separation, or divorce. Non-intact families may experience higher levels of stress and challenges, which may influence their family communication patterns, and hence do not necessarily benefit from frequent communication with their family members [41]. Interestingly, regarding family communication, married/cohabiting families with children benefited more from frequent communications via technology than from in-person interactions. A possible explanation is that Chinese families generally have close ties with extended family, especially for families with children, frequent communications via technology may enhance intergenerational communications, which in turn enhance family functioning. This finding is also in alignment with a study which shows that the benefits of technology-based communication tend to vary across different family types and different stages of the family life cycle [42]. It is noteworthy that while we found that frequent family communication is associated with higher family functioning in some family types, the study only assessed the frequency, not the quality of family interactions, which is an important variable mediating the association between frequent interaction among family members via technology and higher levels of family functioning [30]. Other factors, such as the technological resources that families have, may also come into play in understanding the association [43].

The effects of family gatherings on family functioning depend on family structure. The findings of this study indicated that a high frequency of family gatherings significantly enhanced family functioning for never-married individuals and married/cohabiting families with children. Spending time with parents may be viewed by this group of respondents as more private and intimate, hence improving the perception of family functioning. However, high frequency of family gatherings was associated with lower odds of high family functioning in the widowed group, though the association was non-significant. A possible explanation is that individuals suffering the loss of loved ones may find family gatherings stressful, especially when gatherings take place during holidays and festive seasons. This finding is consistent with the view that family could function as resources as well as situational demands [44]. In contrast to the existing literature suggesting that family meals promote the perception of family communication and functioning [27, 45, 46], the current study did not find a significant association between the frequency of family meals and family functioning for any of the family types. One possible explanation for this finding is that the association may be dependent on factors such as meal type (breakfast, lunch, or dinner) and the quality of interaction during mealtimes, which were not captured in the current study.

Although previous studies consistently found social support to be an important predictor and buffer for mental health [47, 48], the source of social support may play a differential role in different situations. For example, one study found that friend support was associated with psychological well-being for women and family support was associated with self-rated health for men [49]. Another study found that social support from friends, but not from family members, can buffer against suicidal ideation among high-risk women [50]. While previous research shows that intra-familial support has a strong influence on family functioning [31], the current study found that perceived family social support may be more beneficial for individuals who have never married and those who are widowed, but not individuals from other household types. In contrast to previous studies [25, 26], the perception of informal social support from friends and colleagues, as well as formal social support, did not have significant effects on the participants’ perception of family functioning, regardless of the family type. One possible reason could be related to the study’s question items, which only captured whether or not the respondents received support when they had emotional and financial difficulties, but not the quality of the support and other types of support they received.

Finally, being male was associated with lower odds of high family functioning in the two non-intact family types (divorced/separated and widowed). This finding can be interpreted in terms of sex-role expectation. Men who conform to certain masculine norms, such as self-reliance and emotional toughness may be less likely to seek family, friends, or professional support despite the challenges related to the separation and loss [51], resulting in an overall lower level of perceived family functioning.

This study provides one of the first pieces of evidence on changes in family functioning at a population level across time. Regarding the protective factors of family functioning, the current study showed that frequent family communication is a protective factor commonly shared by most family types. Future public education and community programs could focus on improving family communication as a way to promote family functioning, which in turn may enhance families’ resilience against a variety of crisis and hardships.