Structural and Contextual Patterns in Family Health History Knowledge among African American Adults: A Mixed-Methods Social Network Analysis Study*

Abstract

Background: Family health history is a strong risk factor for many chronic diseases. Ethnic minorities have been found to have a low awareness of their family health history (FHH), which may pose a contributing factor to health disparities. Purpose: The purpose of this mixed-methods social network analysis study was to identify structural and contextual patterns in African American adults' FHH knowledge based on interpersonal communication exchanges with their family members. Methods: African American adults completed individually administered family network interviews. Participants' 3-generation family pedigree served as a visual aid to guide their interview. Our primary outcome of interest for this analysis was whether a family member was reported as someone who talks to the participant about their own (i.e., the family member's) health, which we refer to as a "personal health informant." To contextualize quantitative findings, participants were asked to describe how they learned about the health history of the relatives they identified during their interview. Results: Participants (n=37) reported an average family network size of 29.4 relatives (SD = 15.5; Range = 10-67). Each participant, on average, named 17% of their familial network as personal health informants. Multivariate regression results showed that participants __________ Study funding was provided by the Indiana Clinical and Translational Sciences Institute Project Development Teams (PDT) pilot grants (Grant#UL1TR001108) and the Walther Cancer Foundation, Inc. (Grant # 4479705). We would also like to thank Dr. James Moody for guidance on this manuscript as a mentor to Dr. Hood in the Duke Social Networks and Health Training Program (NIH grant R25HD079352).were more likely to name an alter as a personal health informant if the alter was female (OR = 2.14, p = 0.0519), from the maternal side of the participant's family (OR = 1.12, p = 0.0006), had one or more chronic health conditions (OR = 2.41, p = 0.0041), was someone who has discussions with the participant about the participant's health (OR = 16.28, p < 0.0001), was a source of family health information (OR = 3.46, p = 0.0072), and was someone whose health the participant helps to monitor or track (OR = 5.93, p = 0.0002). Complementary qualitative findings indicate that FHH knowledge is facilitated by open, direct communication among relatives. Personal health informants were described as disclosing information for the purposes of informing others for preventive purposes and for gaining social support. Participants also learned about FHH via other methods, including direct observation, during caretaking, and following a relative's death. Conclusions: Communication and disclosure practices is an important determinant of African Americans' FHH knowledge. More culturally and contextually meaningful public health efforts are needed to promote family health history sharing, especially regarding paternal family health history, siblings, and extended relatives.

Formative Evaluation of the Families SHARE Disease Risk Tool among Low-Income African Americans

“…Qualitative and mixed-methods research has found that compared to white Americans, African Americans may communicate less with their family members about FHH [26,27] and that diverse patterns of communication about FHH within African American families are impacted by family member characteristics and relationship quality [28,29]. Overall, more research is needed to understand the acceptability and effectiveness of FHH to change behavior among low-income, African American families and to understand how interventions can be tailored to family structures and systems.…”

Prevalence and Correlates of Family Cancer History Knowledge and Communication Among US Adults

“…The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. ences in FCH communication (6,8). Thus, a potential limitation of this study is that the HINTS survey did not capture diverse conceptualizations of "family" that may include nonbiological relatives who nonetheless engage in FCH discussions (eg, spouses, inlaws, godparents).…”

“…To this end, digital tools, such as the US Surgeon General's My Family Health Portrait, could be promoted to support tracking of family health history (29)(30)(31). However, effective use of family cancer histories will entail supporting communication among individuals, families, and health care providers as well as health care systems-level support for systematic FCH collection and clinical decision making (8,17,26). Continued surveillance of FCH communication behavior is recommended as personalized medicine advances and access to genetic testing expands among the population.…”

“…However, to benefit from screening recommendations, people must know their FCH and be able to share this information with health care providers (6). Some families do not communicate about or know their FCH despite the potential benefits of sharing this information (7)(8)(9)(10)(11)(12)(13)(14).…”