The relationship between family psychosocial functioning and compliance with treatment for familial hyperlipidemia

Kathleen Culbertson Laundy (1989)

Over 20% of the American population consumes a diet high enough in saturated and hydrogenated fats (cholesterol and triglycerides) to cause risk for coronary heart disease. Approximately 0.5% of Americans inherit a biological disposition to this disorder, which is called familial hyperlipidemia (FH). FH cannot be cured, but damaging effects on the body can be slowed significantly. The earlier dietary and medical compliance are instituted, the better the results. Treatment compliance has been linked to family psychosocial functioning (FPF) in other chronic health disorders, but has not been systematically studied in FH. This study examines that relationship with the hypothesis that healthy FPF is associated with treatment compliance in FH, throughout both the course of the disorder and the family life cycle. A research design incorporating a 25 family sample was developed, involving families who attend an FH clinic at Yale/New Haven Hospital. Subjective and objective measurements of data collection were used to assess FPF and treatment compliance. Instruments employed for the study were the Family Assessment Device and the Family Adaptability and Cohesion Evaluation Scale III (FACES III); both include self report questionnaires and clinical rating scales (CRS) to assess FPF. To measure compliance, a methodology which also incorporated subjective and objective aspects was created. A Compliance Profile was established for each family by the treatment team. It included clinical judgments based on medical, nutritional, and attendance data, and measurements of percentage change in lipid levels over time. A canonical correlation analysis confirmed a strong relationship between FPF and treatment compliance. Specific pragmatic skills such as behavior control, affective involvement and problem solving emerged as stronger contributors to successful compliance than how emotionally connected families are. Findings suggest that timely intervention with FH families to facilitate the development of such skills may help foster treatment compliance.