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Does the family APGAR effectively measure family functioning?
W Gardner1, P A Nutting, K J Kelleher
1Department of Medicine, University of Pittsburgh School of Medicine, CRHC Data Center, Montefiore University Hospital, Pennsylvania 15213-2593, USA. gardnerwp@msx.upmc.edu
Insights
The Family APGAR tool showed poor reliability in identifying family dysfunction in primary care. Its results frequently differed from clinician assessments and varied significantly over time.
Area of Science:
- Pediatric primary care
- Family medicine research
Background:
- The Family APGAR is a tool used to assess family function in relation to child health.
- Its utility in primary care settings requires further investigation.
Purpose of the Study:
- To evaluate the reliability and validity of the Family APGAR in identifying family dysfunction in pediatric primary care.
Main Methods:
- Data from 22,059 children (aged 4-15) were collected from 401 physicians.
- Parents completed the Family APGAR and Pediatric Symptom Checklist.
- Clinicians documented child psychosocial problems and referrals.
Main Results:
- Family dysfunction assessment by the Family APGAR showed low agreement between initial and follow-up visits (kappa=0.24).
- There were significant discrepancies between Family APGAR scores and clinician assessments of family dysfunction (kappa=0.06).
- The Family APGAR failed to identify dysfunction in 73% of cases identified by clinicians.
Conclusions:
- The Family APGAR is not a reliable measure of family dysfunction in primary care.
- Further research is needed to determine the specific utility of the Family APGAR.
Background:
The Family APGAR has been widely used to study the relationship of family function and health problems in family practice offices.
Methods:
Data were collected from 401 pediatricians and family physicians from the Pediatric Research in Office Settings network and the Ambulatory Sentinel Practice Network. The physicians enrolled 22,059 consecutive office visits by children aged 4 to 15 years. Parents completed a survey that included the Family APGAR and the Pediatric Symptom Checklist. Clinicians completed a survey that described child psychosocial problems, treatments initiated or continued, and specialty care referrals.
Results:
Family dysfunction on the index visit often differed from dysfunction at follow-up (kappa=0.24). Only 31% of the families with positive Family APGAR scores at baseline were positive at follow-up, and only 43% of those with positive scores at follow-up had a positive score at the initial visit. There were many disagreements between the Family APGAR and the clinician. The Family APGAR was negative for 73% of clinician-identified dysfunctional families, and clinicians did not identify dysfunction for 83% of Family APGAR-identified dysfunctions (kappa=0.06).
Conclusions:
Our data do not support the use of the Family APGAR as a measure of family dysfunction in the primary care setting. Future research should clarify what it does measure.
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