Family APGAR Smilkstein, G. 1978 Description of Measure Purpose To assess a family member s perception of family functioning by examining his/her satisfaction with family relationships. Conceptual Organization The measure consists of five parameters of family functioning: Adaptability, Partnership, Growth, Affection, and Resolve. (The acronym APGAR is comprised of the first letter of each parameter.) The response options were designed to describe frequency of feeling satisfied with each parameter on a 3-point scale ranging from 0 (hardly ever) to 2 (almost always). Item Origin/Selection Process The items were developed on the premise that a family member s perception of family functioning could be assessed by reported satisfaction with the five dimensions of family functioning listed above (Smilkstein, 1978). Materials See Smilkstein (1978). Time Required Less than five minutes Administration Method Interviewer-administered Training Minimal 209
Scoring Score Types The scale is scored by summing the values for the five items for a total score that can range from 0 to 10. Score Interpretation A higher score indicates a greater degree of satisfaction with family functioning. Psychometric Support Reliability Cronbach s alpha values reported across studies using Family APGAR have ranged from.80 to.85, and item-to-total correlations ranged from.50 to.65 (Smilkstein, 1978). Validity The author s initial assessment of validity was to establish correlations with the previously validated instrument, the Pless-Satterwhite Index, as well as with clinician reports. The former yielded a correlation of.80, the latter.64 (Smilkstein, 1978). The Family APGAR questionnaire has been used in numerous studies (mostly clinical) investigating family functioning. A literature search using PsychInfo yielded 16 articles in the past ten years that have used the Family APGAR. In clinical practice, Family APGAR scores have been associated with physician visits, immune responses, emotional distress and depressive symptoms (Bluestein, 1993; Clover, 1989; Greenwald, 1999). Although it is recommended that Family APGAR scores from each member of a household be collected, it has been suggested that an estimate of family satisfaction by the female head of the household will provide an accurate assessment of family functioning (Chao, 1998). In Chao's study, poorer family satisfaction was highly correlated with poorer individual spirits, greater degree of recent individual stress, poorer subjective rating of health, greater number of office visits, and increased number of missed appointments. 210
LONGSCAN Use Data Points Pre-Age 4: MW & NW sites only Age 4: all sites Respondent Primary maternal caregiver Mnemonic and Version FAMA Rationale This instrument was selected because of its acceptable reliability and validity. In addition, in the study by Reeb and colleagues (1987) of low-income Black women, the Family APGAR score was the best predictor of low birthweight and labor complications. The instrument was also chosen because of the ease with which it could be administered. Administration and Scoring Notes Longscan changed the scale for the response categories to values of 1 (hardly ever) to 3 (almost always) from Smilkstein's original values of 0 (hardly ever) to 2 (almost always), so that the total score range is 5-15. Mengel (1987) suggests categorizing the Family APGAR and defines family dysfunction as a score of less than 6. This would translate into a score of less than 9 using the LONGSCAN scoring method. Results The table lists the means, standard deviations, and Cronbach s alpha values on the Family APGAR as reported by the maternal caregivers at the Age 4 interview. Values are listed by race and study site. We observed very few differences in mean scores on the Family APGAR across race and study site. The mean score across all respondents at Age 4 was 12.4. Internal consistency coefficients ranged from.78 to.87. 211
Table 1 about here Several strategies were explored to assess the concurrent validity of the measure. First, we hypothesized that primary maternal caregivers who report high levels of satisfaction with family functioning would also report high amounts of social support, as measured on the Duke- UNC Functional Social Support Questionnaire. This was the case (r = 0.53, p <.0001). We also compared the Family APGAR results with the Center for Epidemiologic Studies Depression scale (CES-D), hypothesizing that low satisfaction with family functioning would be associated with higher depression scores among caregivers. The results of t-tests to assess mean depression scores across those who were satisfied with their family functioning and those who were not (using item 1 on the Family APGAR, "I am satisfied that I can turn to my family for help when something is troubling me".) showed that maternal caregivers who reported dissatisfaction tended to have significantly higher mean depression scores than those who were satisfied with family functioning (M = 23.38 and M = 11.37, respectively, p <.0001). References and Bibliography Bluestein, D., & Rutledge, C. (1993). Family relationships and depressive symptom preceding induced abortion. Family Practice Research Journal, 13, 149-156. Chao, J., Zyzanski, S., & Flocke, S. (1998). Choosing a family level indicator of family function. Families, Systems and Health, 16, 367-373. Clover, R., Abell, T., Becker, L., & Crawford, S. (1989). Family functioning and stress as predictors of influenza B infection. Journal of Family Practice, 28, 535-539. Good, M. J. D., Smilkstein, G., Good, B. J., Shaffer, T., Arons, T. (1979). The family APGAR index: A study of construct validity. Journal of Family Practice, 8, 577-82. Greenwald, J., Grant, W., Kamps, C., & Haas-Cunningham, S. (1998). The Genogram Scale as a predictor of high utilization in family practice. Families, Systems and Health, 16, 375 391. Hillard, R., Gjerde, C., & Parker, L. (1986). Validity of two psychological screening measures in family practice: Personal Inventory and Family APGAR. Journal of Family Practice, 23, 345-349. Mengel, M. (1987). The use of the family APGAR in screening for family dysfunction in a family practice center. Journal of Family Practice, 24, 394-398. 212
Reeb, K. G., Graham, A. V., Zyzanski, S. J., & Kitson, G. (1987). Predicting low birthweight and complicated labor in urban black women: A psychosocial perspective. Social Science and Medicine, 25, 1321-1327. Smilkstein, G. (1978). The Family APGAR: A proposal for family function test and its use by physicians. Journal of Family Practice, 6(6), 1231-1239. Smilkstein, G., Ashworth, C., & Montano, D. (1982). Validity and reliability of the Family APGAR as a test of family function. Journal of Family Practice, 15, 303-311. 213
Table 1. Family APGAR Mean Scores and Cronbach s Alpha Coefficients by Race and Study Site Age 4 Interview N M (SD) α Total 1142 12.4 (2.58).84 Race White 397 12.4 (2.62).84 Black 581 12.4 (2.58).85 Hispanic 81 12.9 (2.47).85 Multiracial 36 12.2 (2.68).85 Other 44 12.5 (2.37).78 Study Site EA 234 12.4 (2.67).87 MW 122 12.4 (2.52).87 SO 221 12.2 (2.81).87 SW 315 12.9 (2.35).83 NW 250 12.2 (2.55).79 Source. Based on data received at the LONGSCAN Coordinating Center by 7/8/97. 214