The Development of Family Wellbeing Index in Hong Kong

The Development of a Family

Wellbeing Index in Hong Kong

Family and Group Practice Research Centre

Department of Social Work

The Chinese University of Hong Kong

Prof. Joyce L. C. Ma

Prof. Mooly M. C. Wong

Ms. Po-san Wan

Dr. Lily Xia

Mr. Michael Fok

Agency-University Collaboration

Sponsored by the Hong Kong Family Welfare Society

A multidisciplinary research team from the Chinese

University of Hong Kong

➢ Prof. Joyce Ma, Prof. Mooly Wong, and Dr. Lily Xia

(Department of Social Work)

➢ Ms. Po-san Wan (Hong Kong Institute of Asia-Pacific Studies)

2

Gap of Knowledge

Currently, there is no self-developed family wellbeing

index in Hong Kong

The current relevant studies on family wellbeing are

➢ Studies with single dimension: e.g., family functioning and

family relationships (e.g., Ma & Lai, 2013); psychological

wellbeing (e.g., Shek, 2002)

➢General survey: e.g., Family Survey (Family Council, 2011, 2013,

2015)

➢ Adapted scale: e.g., the Beach Center Family Quality of Life

(FQOL) (HKFWS, 2017, 2018)

➢Checklist tool: e.g., Family Impact Assessment Checklist

developed by University of Hong Kong (2018)

3

Objectives

To develop a socially relevant and culturally

appropriate measuring tool

To assess the wellbeing of families in Hong Kong

4

Definition of Family

There is no single and one-size-fits-all definition of

“family”

Context-specific definition

• Legal, household, custom

General understanding

• Social relationships of a group of two or more people

Structure• Two generation-family, with a married couple living with

their children or their parents under the same roof

Functions • Core functions of the family: economic support,

emotional support, care responsibility, socialization, etc.

5

Definition of Family in This Study

Family is defined as a socially recognized group

(of at least two people in a relationship, usually joined by blood, marriage, or adoption) that

extends mutual economic support, emotional

connection, and care to its members. Such a

relationship arises from commitment and

obligation, without a pre-determined timeframe.

(adapted from University of Hong Kong, 2017)

6

Definition of Family Wellbeing

Wellbeing is a general and multidimensional concept that has been defined in several ways

Webster’s dictionary defines wellbeing as “the state of being healthy and free from want”

Family wellbeing has been explicitly defined in studies such as the following:

➢“The emotional, social and economic wellbeing of children, parents and families” (Sing et al., 2001, p. 1)

➢“The ability to perform functions and practices for the benefit of the group and individuals” (Proyor, 2007, p. 23)

7

Definition of Family Wellbeing

There are three ways of thinking about family wellbeing (Wollny et al., 2010)

➢ (1) as a multidimensional concept encompassing

different domains, and as an amalgamation of different

types of wellbeing (i.e., physical, social, economic, and

psychological)

➢ (2) there are implied criteria for families being “well” or

“unwell” that are subjective and related to culture

➢ (3) family wellbeing can be conceptualized in terms of

functions, and needs and their fulfillment

8

In this study, family wellbeing is

conceptualized as

a state of family that can perform

various functions to satisfy the diverse

needs of individual members in the

family through interaction with the

environment

9

Considerations when developing a

family wellbeing index

Family inclusiveness

Objective versus subjective indicators

Data collection method and the

response rate of the participants

10

Family Inclusiveness

Families keep changing and are becoming diversified in structure, shape, and function

Different types of familial relationships are found in Hong Kong, such as cohabitation, childless couples, homosexual relationships, and nuclear families using assisted reproductive technology (CUHK, 2018)

This index is designed for measuring family wellbeing, regardless of family type

In this study, family is operationalized as

➢consisting of at least two people (usually joined by blood, marriage, or adoption) living in the same household

11

Objective versus Subjective Indicators

Objective indicators: e.g., study on living conditions in

Macao (HKIAPS, CUHK, 2014)

Subjective indicators: e.g., studies on family wellbeing in

Malaysia (2017), the United Kingdom (2011), and Hong

Kong (Family Council, 2011, 2013, 2015; HKFWS, 2017, 2018; HKU, 2018)

Contribution of subjective indicators

➢ To provide as complementary information to objective

data, so as to paint a comprehensive picture of family

wellbeing

This index uses subjective indicators to understand the

perceptions of family members

12

Data Collection Method and

Response Rate

Rationale for adopting the method of telephone survey in this study:

➢ high degree of representativeness (when compared with online surveys)

➢ low cost (when compared with household surveys)

➢ feasibility and high response rate (when compared with online surveys and household surveys)

13

Major Domains of the Family Wellbeing Index 14

Operationalization of Domains –Example 1: Care and Support (扶持共濟)

This refers to the degree of sharing and exchange of resources of family members in time of need (Ma & Wan, 2015)

Sharing and exchange of resources is one of the important functions of families, particularly for families with adult children (Ma & Wan, 2015)

The degree of reciprocal care and support among family members reflects the level of family solidarity (Bengtson & Roberts, 1991; United Nations, 2012)

In this study, care and support is operationalized in a behavioral sense, including financial support, manual labor support, information sharing, and emotional support

15

Operationalization of Domains –Example 1: Care and Support (扶持共濟) 16

Indicator Item Source of / Support for Question

Direction

Financial support Family members are willing to offer financial support to each other when required (Q20)

家人樂意幫忙解決財政困難

Bengtson & Roberts, 1991; Ma & Wan, 2015; National Population and Family Development Board, 2017 +

Manual labor support

Family members are willing to offer help in managing household

chores when required (Q21)

家人樂意幫忙處理家庭事務

Bengtson & Roberts, 1991; Ma & Wan, 2015

+Information sharing Family members are willing to

share information when required (Q22)

家人樂意就重要事情提供意見

Ma & Wan, 2015

+Emotional support Family members are willing to

listen to each other when required (Q23)

家人樂意聆聽心事

Ma & Wan, 2015

+

Operationalization of Domains –Example 2: Family Responsibilities (成長共進)

This refers to the strength of commitment of family members to raise

the next generation, particularly the young children, and to the

performance of familial roles and to meeting familial obligation (Bengtson & Roberts, 1991; Noor et al., 2014)

Core family responsibilities:

➢ for minors and the next generation: socialization and guidance (Superu, 2016; University of HK, 2017; The Vanier Institute of the Family, 2019)

➢ for adults: facilitation of familial role performance (Bengtson & Roberts,

1991)

In this study, we operationalized family responsibilities as warmth, discipline (guan), and role fulfillment

17

Operationalization of Domains –Example 2: Family Responsibilities (成長共進)

18


Direction

Warmth Family members show love and

care to children (Q18)

對子女有足夠嘅關懷同照顧

Ma, Wong, Lau & Lai,

2012

+

Discipline

(Guan)

Family members explain what is

right and wrong to the children

(Q19)

對細路有獎罰分明嘅管教

Ma,Wong, Lau & Lai,

2012

+Role fulfillment Family members can bring their

own strengths and abilities into full

play (Q17)

可以發揮各自嘅長處同能力

Bengtson & Roberts,

1991

+

Methodology

Study Design

• Pilot study • Literature review

• Focus group and expert consultations

• Cross-sectional telephone survey (N = 205)

• Reliability & validity test

Developing the index

• Main survey

• Cross-sectional telephone survey (N = 2000: landline N = 1200 & mobile N = 800)

Telephone survey

• Promoting the tool

• Training to practitioners

Application & promotion

Pilot survey: Mar 28–Apr 3, 2019 Main survey: July–Aug, 2019 Sep 2019–March 2021

20

Focus Group for

Service Users

(N = 9)

7 Domains, 26 Indicators, and

32 Questions

(dropped 1 indicator, added 1 new

indicator, and revised 5 questions)

Expert Review

(N = 13)


33 Questions

(revised 8 questions and added 1

question)

Pilot Survey

(N = 205)


29 Questions

(added 1 new domain, dropped 3

questions, and revised 2 questions)

Main Survey

(N = 2000)

Co

nte

nt

Val

idit

yC

ron

bac

h’s

Alp

ha,

Exp

lora

tory

Fac

tor

An

alysi

s

Literature Review

(Research Team)7 Domains, 26 Indicators, and

32 Questions

Steps in Developing the Index21

5-point Likert Scale

(1 = strongly disagree,

5 = strongly agree)

Developing the Index

Comprehensive literature review

➢ the conceptual framework and the questionnaire draft of the index

Focus group interviews/individual interviews with different stakeholders

➢ Service user: diverse family structures (e.g., intergenerational, intact,

single parent, etc.); age groups (adolescents, adults, elderly); family

role (e.g., breadwinner, homemaker, caregiver); and family

situations (e.g., family members with mental health or physical

health issues, children with special education needs)

➢ Professional: social worker (managerial and frontline level, NGO and

Government); family lawyer; clinical psychologist; and psychiatrist

➢Government official specialized in policy making

➢ Scholar on family studies

22

Developing the Index

Pilot Test: (Cross-sectional Telephone Survey)

➢ Purposes: (1) to test the reliability and validity of the questionnaire;

(2) to revise the questionnaire for the main survey

➢ Conducted independently by the Telephone Survey Research

Laboratory of the Hong Kong Institute of Asia-Pacific Studies, CUHK

➢ Criteria for the selection of respondents:

❖ 18 years old or above; living with at least one family member

❖ Hong Kong resident

❖ Speaks Cantonese or Mandarin

➢ Respondents: N = 205 (landline N = 155; mobile N = 50)

➢ The results were weighted based on up-to-date figures on the age-sex

distribution of the population, provided by the Census and Statistics

Department

23

24

40

23

38

46

39

19

0

5

10

15

20

25

30

35

40

45

50

18-29 30-39 40-49 50-59 60-69 70 or above

Age

18-29

30-39

40-49

50-59

60-69

70 or above

25

23

130

35

2

13

2

0

20

40

60

80

100

120

140

Living with

spouse only

Parents with

unmarried child

Household of

three

generations

Single parent

family

Others Refused to

answer

Family Structure

Living with spouse only

Parents with unmarried child

Household of three generations

Single parent family

Others

Refused to answer

26

12

3

1

6

12

15

33

36

24

6

15

30

21

0

5

10

15

20

25

30

35

40

Family Income

No income

4,000 or below

4,000–9,999

10,000–14,999

15,000–19,999

20,000–24,999

25,000–29,999

30,000–39,999

40,000–59,999

60,000–79,999

80,000–99,999

100,000 or above

Don’t know

Refused to answer

27

1921

69

25

71

0

10

20

30

40

50

60

70

80

Primary or below Form 1-3 Form 4-7 or

equivalent

College (non-

degree)

College (degree or

above)

Education Level

Primary or below

Form 1-3

Form 4-7 or equivalent

College (non-degree)

College (degree or above)

28

116

22 21

39

6

1

0

20

40

60

80

100

120

140

On job Student Household Retired Unoccupied Refused to answer

Occupation Status

On job

Student

Household

Retired

Unoccupied

Refused to answer

Results of the Pilot Test –

Reliability Test

Cronbach’s Alpha of the Pilot Test

The whole index: .890 (Valid N = 205, 100%)

Family health and safety:

.440

(Valid N = 205, 100%)

3 questions

Family resources:

.759

(Valid N = 205, 100%)

7 questions

Care and support:

.737

(Valid N = 205, 100%)

4 questions

Family atmosphere:

.797

(Valid N = 205, 100%)

4 questions

Family responsibilities:

.635

(Valid N = 205, 100%)

3 questions

Work-life balance:

.567

(Valid N = 205, 100%)

2 questions

Family and community

relationships:

.518

(Valid N = 205, 100%)

3 questions

30

No. of questions in this test = 26

No. of questions originally = 33

No. of questions for main survey = 29

Question excluded in this test: Q10, Q26, Q27, Q28, Q32, Q37, Q38

Results of the Pilot Test –

Validity Test

Exploratory Factor Analysis

Total variance

explained:

61.131%

32 Communalities

Question Initial Extraction

q6 1.000 0.567

q7 1.000 0.686

q8 1.000 0.615

q9 1.000 0.703

q11 1.000 0.671

q12 1.000 0.686

q13 1.000 0.652

q14 1.000 0.690

q15 1.000 0.623

q16 1.000 0.633

q17 1.000 0.565

q18 1.000 0.691

q19 1.000 0.626

q20 1.000 0.609

q21 1.000 0.606

q22 1.000 0.553

q23 1.000 0.708

q24 1.000 0.692

q25 1.000 0.609

q29 1.000 0.807

q30 1.000 0.754

q31 1.000 0.618

q33 1.000 0.599

q34 1.000 0.605

q35 1.000 0.676

q36 1.000 0.674

Extraction Method: Principal

Component Analysis.

Rotated Component Matrixa

Domain QuestionComponent

1 2 3 4 5 6 7

Family health

and safety

q6 0.662

q33 0.453 0.464

q36 0.458 0.653

Family

resources

q7 0.788

q8 0.694

q9 0.760

q11 0.657

q12 0.761

q34 0.612

q35 0.796

Care and

support

q20 0.710

q21 0.536

q22 0.644

q23 0.723

Family

atmosphere

q13 0.452 0.561

q14 0.657

q15 0.648

q16 0.507

Family

responsibilities

q17 0.554

q18 0.761

q19 0.718

Work-life

balance

q24 0.815

q25 0.727

Family and

community

relationships

q29 0.859

q30 0.757

q31 0.498

Extraction Method: Principal Component Analysis.

Rotation Method: Varimax with Kaiser Normalization.

a. Rotation converged in 10 iterations.

No. of questions in this test = 26 No. of questions originally = 33No. of questions for main survey = 29Question excluded in this test: Q10, Q26, Q27, Q28, Q32, Q37, Q38

Revised Family Wellbeing Index

8 Domains,

26 Indicators, &

29 Questions

33

Family health and safety

身心康泰

Family resources

資源共享

Care and support

扶持共濟

Family atmosphere

和睦共處

Family responsibilities

成長共進

Work-life balance

生活平衡

Family and com-munity relationships

社會共融

Family and ICTs

資訊科技

Major Revisions to the Index Change the Likert scale from 1-5 (1 = strongly disagree, 5 = strongly

agree) to 0-10 (0 = Strongly disagree, 10 = strongly agree) to increase

the sensitivity of the scale

One new domain added:

➢ Family and ICTs (Q10 and Q28)

Questions removed from the index and changed as demographic

variables

34

Q32 Overall speaking, I have a happy family life 整體嚟講，你嘅家庭係幸福嘅

Q37 How many family members are in need of intensive care due to old age, chronic illness or

disability ?你屋企有幾多位家人因年紀大、疾病或者殘障，而需要人特別照顧佢嘅生活起居呢？

Q38 In the past year, have there been any crisis in your family, such as the death of a family

member, a severe illness in the family, un-employment, financial difficulties, or relationship

conflicts?喺過去一年，你屋企有無發生重大嘅事故，例如家人去世、重病、意外住院、失業、嚴重嘅經濟困難或者感情衝突？

Major Revisions of the Index Questions revised:

35

Question Original Revised Direction

28 The family has rules for

using social media

喺屋企有相關嘅規矩去使用社交媒體

The family has rules for using social media

for entertainment such as playing computer

games, watching movies

喺屋企有相關嘅規矩去使用社交媒體用嚟娛樂，例如玩遊戲、睇電影

+

36 Overall, family members

have good health

condition in the past

one year

整體而言, 在過去一年，你同你屋企人有良好嘅健康狀況

Overall, family members have good

physical health condition in the past one

year (Revised)

整體而言, 在過去一年，你同你屋企人有良好嘅身體健康狀況

+

Overall, family members have good mental

health condition in the past one year (New)

整體而言, 在過去一年，你同你屋企人有良好嘅精神健康狀況

+

Contributions of Our Study36

To construct a comprehensive tool with cultural

competence

To provide useful references to related parties,

such as government officials, scholars, service

operators, and human resources professionals, to

formulate policies, and to develop, evaluate,

and monitor services

Potential Social Impact

To construct a positive and a healthy social

discourse on families in Hong Kong

To counter-act society’s prejudiced views of

marginalized types of families

37

Limitations of Our Pilot Study

Focus group:

➢Biased views of service users

Household-based survey:

➢Missed some important family members such as non-

residential parent in a divorce family, grandparents

who lived apart from their adult children, and other

family members (e.g., children, elderly people, disabled

family members living in residential care homes)

Telephone survey:

➢Some people were not reached by either landline or

mobile phone

38

Future Plan

Refining the index by reviewing updated

references, exchanging views with different

stakeholders, and receiving comments from

experts

39

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interface. Journal of management, 25(4), 491-511.

Bengtson, V. L., & Roberts, R. E. (1991). Intergenerational solidarity in aging families: An example offormal theory construction. Journal of Marriage and the Family, 53(4), 856-870.

Bowling, A. (2002). Research Methods in Health: Investigating health and health services. Secondedition. Buckingham, Open University Press.

Epstein, N.B., Baldwin, L.M., & Bishop, D.S. (1983). The McMaster family assessment devise. Journalof Marital and Family Therapy, 9(2), 171-180.

Garson, G. D. (2015). Statistical associaties blue book series: Structural equation modeling.Statistical publishing associates.

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Ma, J. L. C., Wong, T. K. Y., Lau, Y. K., & Lai, L. Y. (2012). The effect of socio-economic status andfamily structure on parental warmth and parental control in a Chinese context. Asia Social Workand Policy Review. Doi:10.1111/aswp.12002.

Ma, J. L., Wong, T. K., Lau, Y. K., & Lai, L. L. (2011). Parenting stress and perceived familyfunctioning of Chinese parents in Hong Kong: Implications for social work practice. Asian SocialWork and Policy Review, 5(3), 160-180.

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References

National Population and Family Development Board (2017). Report on Malaysian familywell-being index 2016. Kuala Lumpur, Malaysia: Population and family research.

Policy 21 Limited. (2016). Family Survey 2015 (Rep.). Hong Kong.

Scholz, E., Jutz, R., Edlund, J., Ö un, I., & Braun, M. (2014). ISSP 2012 family and changinggender roles IV: Questionnaire development.

Shek, D. T. (2002). Family functioning and psychological well-being, school adjustment,problem behavior in Chinese adolescents with and without economic disadvantages.Journal of Genetic Psychology, 163(4), 497-502.

Superu (2016). Famliy wellbeing in Auckland. Auckland: Superu

The Chinses University of Hong Kong (2018). A Study on Family Research in Hong Kong:

A Critical Review and Annotated Bibliography. Hong Kong: CUHK

The University of Hong Kong (2018). A study of family impact assessment in Hong Kong: achecklist approach – making better public policies for family. Hong Kong: The university ofHong Kong

Van Steenbergen, E. F., Ellemers, N., & Mooijaart, A. (2007). How work and family canfacilitate each other: Distinct types of work-family facilitation and outcomes for womenand men. Journal of occupational health psychology, 12(3), 279.

Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample Size Requirementsfor Structural Equation Models. Educational and Psychological Measurement, 73(6), 913-934. doi:10.1177/0013164413495237

41

References

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Thank You ☺

43

Family Health and Safety (身心康泰)

Health means a state of complete physical, mental and social wellbeing

and not merely the absence of disease or infirmity (World Health

Organization, 2019). Safety refers to family members’ sense of physical

security in home environment (Noor et al., 2014)

4 Indicators and 4 Questions

44

Indicator Item Source of / Support for Question Direction

Family safety Family members feel safe while at home (Q6)喺家庭感到安全

Hong Kong Family Welfare Society & POP, HKU, 2018; National Population and Family Development Broad, 2017; Superu, 2016 +

Physical health condition

Overall, family members have good

physical health condition in the past one year (RevisedQ36)整體而言, 在過去一年，你同你屋企人有良好嘅身體健康狀況

National Population and Family

Development Broad, 2017; Superu, 2016

+

Mental health condition

Overall, family members have good mental health condition in the past one year (New)整體而言, 在過去一年，你同你屋企人有良好嘅精神健康狀況

National Population and Family Development Broad, 2017; Superu, 2016 +

Family prospect Family life will be better than now after 3 years Q33)三年後嘅生活狀況會比現在好

Ma & Wong, 2010

+

Family Resources (資源共享) Family resources refers to the optimal utilization of time, income, human capital,

psychological capital, and social capital of family members (Zubrick et al., 2000)


45

Indicator Item Source of / Support for Question DirectionEconomic situation

Family has sufficient money to manage household expenses in the past one year (Q7)過去一年，家庭收入足夠應付日常嘅開支


Living environment

Family has a comfortable living place (Q8)有舒適嘅居住環境


Family time Family members has sufficient time together (Q11)有足夠嘅相處時間

Hong Kong Family Welfare Society & POP, HKU, 2018; National Population and Family Development Broad, 2017

+

Family members enjoy the time together (Q12)享受一起相處嘅時間

Hong Kong Family Welfare Society & POP, HKU, 2018 +

Life skill Family members have ability to cope with daily life issues Q9)有能力解決生活難題


Accessibility of resources

Family members can seek help from friends, relatives or neighbors when encountered unmanageable difficulties (Q34)容易找到親戚、朋友或鄰居幫忙


Family members can access services from government departments or community units when encountered unmanageable difficulties (Q35)容易找到政府部門或社會機構幫忙


Family Atmosphere (和睦共處)

Family atmosphere means the positive climate and constructiveinteractions among the family members in the home environment

(Ma & Wan, 2015)


46


Direction

Trust Family members can trust each other (Q13)可以互相信賴

Ma, Wong, Lau & Pun, 2009; Ma & Wong, 2010 +

Give and take Family members can give and take (Q14)可以彼此遷就

adapted by informants+

Appreciation Family members can appreciate each other’s contribution to the family (Q15)感激各人為家庭嘅付出

adapted by informants+

Harmony Family members usually get along well (Q16)經常相處融洽


Work-life Balance (生活平衡)

Work-life balance refers to the time that family members make

available for themselves and for one another (Zubrick et al., 2000)

1 Indicator & 2 Questions

47


Direction

Work-life conflict Family members have come home from work too tired to do the chores which need to be done (Q24)工作令你哋攰到做唔到應做嘅家庭事務R

Scholz et al., 2014, Lau et al., 2012

-

Because family members often stressed from responsibilities at home, we have a hard time concentrating on their work (Q25)家庭煩惱或問題，令你哋難以專心工作R

Van Gsteenbergenet al., 2007

-

Family and Community Relationships (社會共融)

Family and community relationships mean the positive connection

of family with the wider environment (Superu, 2016)


48

Indicator Item Source of / Support

for Question

Direction

Participation in social activities or religion associations

Family members participate social activities or religion associations frequently (Q29)經常參加社會或宗教團體嘅聚會或者活動

Committee on the promotion of civic education, 2010 +

Contribution to society

Family members participate volunteer work or give donation frequently (Q30)經常參與義工服務或慈善捐款

Wan, Cheng & Law, 2014

+

Social justice Current family standard of living is comparable to family’s efforts 目前嘅生活水平同家人嘅努力比較，係相當公平 (Q31)

adapted by informants

+

Family and ICTs (資訊科技)

Family and ICTs refers to the positive influence of new

information and communication technologies on family

life


49


Direction

Control The family has rules for using social media for entertainment such as playing computer games, watching movies (revised Q28)喺屋企有相關嘅規矩去使用社交媒體用嚟娛樂，例如玩遊戲、睇電影

National Population and Family Development Broad, 2017 +

Communication Family members use social media to communicate with each other frequently (Q10)經常用社交媒體與家人聯絡同溝通

Wang et al., 2018

+

The Development of Family Wellbeing Index in Hong Kong

Documents

Transcript of The Development of Family Wellbeing Index in Hong Kong