Family functioning integrated with diabetes self-management: a concept analysis

Instrument	Study	Item dimensions	Instrument characteristics
FAD survey	Miller et al.²⁰	- Problem-solving - Communication - Role function - Affective response - Involvement - Behavioral control - Overall functioning	5-point Likert scale: (1) strongly disagree, (2) disagree, (3) agree, (4) strongly agree
FFI	Satterwhite et al.³⁷	- Marital satisfaction - Frequency of divergence - Communication - Problem-solving - Happiness and intimacy	15 self-report dyadic and whole family questions (yes/no and 5-point rating scale)
AFGAR	Smilkstein et al.³⁸	- Adaptation - Cooperation - Growth - Emotion - Problem-solving	10-point scale: highly dysfunctional (0–3), moderately dysfunctional (4–6), and highly functional (7–10)
FAM	Skinner et al.¹⁵	- Task accomplishment - Role performance - Communication - Affective expression - Involvement - Control - Values - Norms	3 levels: (1) general scale (50 items, nine subscales, (2) dyadic relationship scale (42 items, seven subscales), (3) self-rating scale (42 items, seven subscales)
The Chinese version of the FFFS (Chinese FFFS)	Honda et al.³⁹	- Relationship between family members - Relationship between the family and subsystem - Relationship between the family and society	5-point Likert scale: (1) dissatisfied (2) somewhat dissatisfied, (3) neither satisfied nor dissatisfied, (4) somewhat satisfied, (5) satisfied

Family functioning attributes	Items/components/skills
Problem-solving	Problem identification and agreement; creating options and alternatives surrounding the identified problem; ensuring quality of the family emotional problem; taking proper measures to solve problems; monitoring progress and successful plan of action
Communication	Instrumental communication such as the exchange of factual information that enables individuals to fulfill common family functions; affective communication is a means by which individual family members share their emotions with one another
Family roles	Instrumental roles concerned with the provision of physical resources (providing food, clothing, and shelter) and affective roles, including the ability to provide emotional support and encouragement to family members; development of life skills (physical, emotional, educational, and social development of all children and adults)
Affective responsiveness	The ability to respond to a situation with appropriate emotions. This includes affection, warmth, tenderness, love, consolation, and happiness
Affective involvement	Emotional distance between family members; family members respect each other's personality, interest, hobbies, and satisfaction
Behavioral control	Determining the family's style of behavioral control; suggestions for developing a healthy family behavioral style

Study	Dimension of family functioning
Olson et al.³⁵	- Family intimacy (relationships between family members) - Family adaptability (the family needs to change the power structure, role assignment, or ability of family roles to cope with external environmental pressures) - Family communication (communication between family members)
Beavers and Hampson³⁶	- Rigid index (family structure, family relationship, and family reaction force - Soft index (family members' communication style)
Miller et al.²⁰	- Problem-solving (ability to solve problems) - Communication (ability to share information between family members) - Family role (ability of family members to establish behavior patterns) - Affective response (degree of emotional responses to a problem) - Affective involvement (degree of concern regarding activities related to behaviors) - Behavioral control (ability to control behavior in different family situations)
Skinner et al.¹⁵	- Task completion - Role - Communication - Emotional expression - Family involvement - Family behaviors, values, and roles