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Kathleen Knafl, PhD, Principal Investigator, University of North Carolina at Chapel Hill
Janet Deatrick, PhD, RN, Co-investigator, University of Pennsylvania
Agatha Gallo, PhD, RN, Co-investigator, University of Illinois at Chicago
Jane Dixon, PhD, Co-investigator, Yale University
Margaret Grey, DrPH, RN, Co-investigator, Yale University
George Knafl, PhD, Statistician, University of North Carolina at Chapel Hill
Jean O’Malley, MPH, Statistician, Oregon Health & Science University


The FaMM was developed to measure how families manage caring for a child with a chronic condition/illness. Data from the FaMM contributes to clinicians’ and researchers’ ability to understand family functioning in the context of childhood chronic conditions. By measuring key aspects of family management, the FaMM provides a more precise understanding of factors that support or impede optimal child and family functioning. It is anticipated that the FaMM will be used in conjunction with other measures of family and family member functioning to further the development interventions that enhance the family’s ability to incorporate family management into everyday family life in a way that promotes both family and family member wellbeing. Click the References tab for a complete list of funding that supported the development of the FMSF and the FaMM and reports related to the framework and measure.

Download the English FaMM Questionnaire here

The conceptual framework underlying the FaMM is the Family Management Style Framework (FMSF) (Knafl & Deatrick, 1990; 2003; Knafl, Breitmayer, Gallo, & Zoeller, 1996). The FMSF evolved through a series of qualitative studies and integrative reviews. The FMSF incorporates the views of individual family members to conceptualize overall family response to a health-related condition. The framework is comprised of three major components: Definition of the Situation, Management Behaviors, and Perceived Consequences. Each component is composed of conceptual dimensions that reflect more specific aspects of the component. The eight dimensions (Child Identity, Illness View, Management Mindset, Parental Mutuality, Parenting Philosophy, Management Approach, Family Focus, and Future Expectations) were derived both from our research and the literature (Knafl & Deatrick, 1990; 2003; Knafl et al. 1996). Although these dimensions are theoretically distinct, they would be expected to be associated with each other to some degree. The 2003 article by Knafl and Deatrick provides a detailed description of the conceptual dimensions of the FMSF and was used to develop FaMM items. A slightly revised version of the framework has since been published (Knafl, Deatrick, & Havill, 2012).

Following the development of an initial set of items, further development efforts included review of items by experts in family nursing research as well as parents of children with varied chronic conditions (Knafl et al., 2007). Based on input from experts and parents, a 65 item preliminary version of the FaMM was developed. Final testing of the FaMM entailed telephone interviews with a sample of 579 parents from 417 families of children ages 3 – 19 years old with a wide array of chronic physical conditions (Knafl et al., 2011). Parents responded to the 65-item FaMM and to measures of family functioning (Family Assessment Device), child behavior (Eyberg Child Behavior Inventory), child functional status (Functional Status II), and social desirability (Marlowe-Crowne). Analyses included exploratory and confirmatory factor analysis, reliability assessment, and hypothesis testing to evaluate construct validity.

The FaMM is comprised of 53 items with 45 items for all parents and eight additional items for partnered parents only. Items are scored from 1 to 5, meaning strongly disagree to strongly agree. There are five summated scales for all parents measuring the dimensions of Child’s Daily Life, Condition Management Ability, Condition Management Effort, Family Life Difficulty, and View of Condition Impact as well as a sixth scale only for partnered parents measuring the dimension of Parental Mutuality. Higher scores on three of the scales (Child’s Daily Life, Condition Management Ability, Parental Mutuality) indicate greater ease in managing the child’s condition. Higher scores on the other three scales (Condition Management Effort, Family Life Difficulty, View of Condition Impact) indicate greater difficulty in managing the condition.

Scales for all parents

This 5-item scale addresses parents’ perceptions of their child and his/her everyday life. Two items are positively scored; three are reverse coded. Higher values indicate a more normal life for the child despite the condition.

This 12-item scale addresses parents’ perceptions of the overall manageability of the child’s condition, including knowing what needs to be done to take care of the condition and their ability competently to carry out the management of their child’s condition. It incorporates items from the Parenting Philosophy and Management Mindset dimensions, as well as items from the Future Expectations dimension, indicating that the condition is viewed as manageable now and into the future. Eight items are positively scored; four are reverse coded. Higher values mean the condition is viewed as more readily manageable.

This 4-item scale addresses the time and work needed to manage the condition. The items in this scale come primarily from the Illness View dimension. Three items are positively scored; one item is reverse coded. Higher values mean more effort is expended in managing the illness.

This 14-item scale addresses parents’ perceptions of the extent to which having a child with a chronic condition makes family life difficult. The items in this scale come primarily from the Family Focus and Management Mindset dimensions. Eleven items are positively scored; three are reverse coded. The three reverse coded items indicate that the condition does not interfere with family life. Higher values indicate more difficulty managing the condition.

This 10-item scale addresses parents’ perceptions of the seriousness of the condition and its implications for their child’s and their family’s future. In contrast to the Condition Management Ability and Family Life Difficulty scales, the focus of the View of Condition Impact scale is apprehension about the future. It incorporates items from the Future Expectations and Illness View dimensions that indicate the degree to which parents worry about their child’s condition. Six items are positively scored; four items are reverse coded. Higher scores indicate greater concern in managing the condition.

Scale for partnered parents only

This 8-item scale is used only with partnered parents and addresses perceptions of support, shared views, and satisfaction with how the partners work together to manage the child’s condition. The items in the scale come primarily from the Parental Mutuality dimension. Five items are positively scored; three are reverse coded. Higher values indicate a more shared response and greater satisfaction with how the couple works together to manage the condition.

Reliability Assessment

Internal consistency reliability (ICR) for the scales, adjusted for inter-parental correlation, ranged from .72 to .90 for mothers and .73 to .91 for fathers (Knafl, G., et al., unpublished manuscript).

ScaleICR for MothersICR for FathersInter-Parental Correlation
(p-value)
Child's Daily Life.76.79.55 (<.01)
Condition Management Ability.72.73.33 (<.01)
Condition Management Effort.74.78.58 (<.01)
Family Life Difficulty.90.91.59 (<.01)
Parent Mutuality.79.75.44 (<.01)
View of Condition Impact.73.77.58 (<.01)

Test-retest reliability was based on responses from 65 parents retested within 2-4 weeks and adjusted for inter-parental correlation. It ranged from .71 to .94.

ScaleTest-Retest Reliability
Child's Daily Life.83
Condition Management Ability.79
Condition Management Effort.81
Family Life Difficulty.94
Parent Mutuality.71
View of Condition Impact.87

Validity Assessment

Construct validity was supported by significant correlations between each of the scales and each of the related measures of family functioning, child functional status, and child behavior, with directions of relationships as expected. Construct validity correlations were computed from responses for all participating parents accounting for inter-parental correlation within families. Family functioning was assessed by the General Functioning scale of the McMaster Family Assessment Device (FAD) (Epstein, Baldwin & Bishop, 1983), with higher scores indicating unhealthier levels of family functioning. The functional status of the child with the chronic condition was assessed by the Functional Status II instrument (FSM II) (Stein & Jessop, 1990), with higher scores indicating better functional status for children with chronic conditions. Child behavior was assessed by two related scales of the Eyberg Child Behavior Inventory (ECBI) (Eyberg & Pincus, 1999; Eyberg & Robinson, 1983), with higher scores on the Intensity scale indicating more problem behaviors and higher scores on the Problem scale indicating more behaviors viewed as a problem by parents. Thus, the ECBI takes into account both the presence of behaviors as well as the meaning parents attach to a specific behavior. As shown in the tables below, family functioning, child behavior, and child functional status were significantly associated with the FaMM scales in the hypothesized directions. The FAD and ECBI (higher scores indicative of worse functioning and behavior) were significantly negatively associated with the Child’s Daily Life, Condition Management Ability, and Parental Mutuality scales and significantly positively associated with associated with the Condition Management Effort, Family Life Difficulty, and View of Condition Impact scales. On the other hand, the FSM II (higher scores indicative of better functioning) was significantly positively associated with higher scores on the Child’s Daily Life, Condition Management Abil! ity, and Parental Mutuality scales and significantly negatively associated with higher scores on the Condition Management Effort, Family Life Difficulty, and View of Condition Impact scales. The generally moderate strength of the correlations between the FaMM scales and the validation measures indicates that they are tapping related, though distinct aspects of family life in the context of a child’s chronic condition.

Correlation of Scales with Established Measures

ScaleFamily FunctioningChild Function Status
Child's Daily Life-.21.39
Condition Management Ability-.35.32
Condition Management Effort.16-.33
Family Life Difficulty.38-.45
Parent Mutuality-.64.20
View of Condition Impact.22-.32

Correlation of Scales with Established Measures

ScaleChild Behavior ProblemIntensity
Child's Daily Life-.21-.22
Condition Management Ability-.23-.25
Condition Management Effort.13.17
Family Life Difficulty.31.33
Parent Mutuality-.25-.28
View of Condition Impact.09*.15

p<.01 for all correlations except as noted: * p=.03.

Correlations with social desirability, as measured by the short form of the Marlowe-Crowne Social Desirability Scale (Strahan & Gerbasi, 1972), were non-significant for all but the Parental Mutuality scale (p=.01). However, Parental Mutuality had only a weak correlation (r=.11) with social desirability.

Scoring Instructions for the FaMM

The FaMM questionnaire has two sections. The items from Section 1 are answered by all parents and are used to calculate five scales: Child’s Daily Life, Condition Management Ability, Condition Management Effort, Family Life Difficulty, and View of Condition Impact. The items from Section 2 are answered only by parents who have adult partners in the household and are used to calculate a sixth scale: Parental Mutuality. Item numbers are given by the order in which they are listed on the FaMM questionnaire. Reverse coded items are indicated with an asterisk.

Calculation of Scale Scores and Scoring Template

Follow these steps to compute the FaMM scales.

  1. Determine the number of items in a scale with valid responses (i.e., values of 1-5).
    2. Compute a scale score from the valid responses as instructed in steps 3-7,but only if at least seventy percent of the items for that scale have valid responses (minimum numbers for the scales are provided below). If less than 70% of the items are answered, the scale cannot be computed.
    3. Reverse code the negative item responses (indicated by asterisks) by subtracting those item responses from the value 6.
    4. Sum the positive item responses and the reverse coded negative item responses.
    5. Divide by the number of valid responses.
    6. Multiply by the total number of items for the scale.
    7. Round to the nearest integer.

Scoring Template

Download the scoring template here (.xls format)

Child’s Daily Life Scale

This scale addresses parents’ perception of the everyday life of the child. Higher values indicate more normal life for the child despite the condition.

  1. Our child’s everyday life is similar to that of other children his/her age.
    10. Our child takes part in activities he/she wishes to despite the condition.
    5. *Our child enjoys life less because of the condition.
    16. *Our child is different from other children his/her age because of the condition.
    20. *Our child’s friendships are different because of the condition.

Total number of items = 5.
Minimum number of valid responses required to compute the scale score = 4.

Condition Management Ability Scale

This scale addresses parents’ perception of their ability to manage their child’s condition. Higher values indicate that the condition is viewed as more readily manageable.

  1. In the future we expect our child to take care of the condition.
    13. We have some definite ideas about how to help our child live with the condition.
    14. Despite the condition, we expect our child to live away from home in the future.
    15. We have enough money to manage our child’s condition.
    18. We are looking forward to a happy future for our child.
    19. When something unexpected happens with our child’s condition, we usually know how to handle it.
    25. We feel we are doing a good job taking care of our child’s condition.
    41. We have goals in mind to help us manage our child’s condition.
    17. *It is difficult to know when our child’s condition must come first in our family.
    27. *It’s often difficult to know if we need to be more protective of our child.
    28. *We often feel unsure about what to do to take care of our child’s condition.
    34. *We have not been able to develop a routine for taking care of our child’s condition.

Total number of items = 12.
Minimum number of valid responses required to compute the scale score = 9.

Condition Management Effort Scale

This scale addresses parents’ perception of the time and work required to manage their child’s condition. Higher values indicate more time and work expended in managing the illness

  1. Our child’s condition requires frequent visits to the clinic.
    7. Our child’s condition is like a roller coaster with lots of ups and downs.
    35. It takes a lot of organization to manage our child’s condition.
    12. *Our child’s condition doesn’t take a great deal of time to manage.

Total number of items = 4.
Minimum number of valid responses required to compute the scale score = 3.

Family Life Difficulty Scale

This scale addresses parents’ perception of the extent to which their child’s condition makes their life difficult. Higher values indicate more difficulty in dealing with the condition.

  1. Our child’s condition gets in the way of family relationships.
    6. Taking care of our child’s condition is often overwhelming.
    9. It is very hard for us to take care of our child’s condition.
    22. A condition like the one our child has makes family life very difficult.
    31. It seems as if our child’s condition controls our family life.
    33. It is hard to get anyone else to help us with our child’s condition.
    36. We are sometimes undecided about how to balance the condition and family life.
    39. Our child would do better in school if he/she didn’t have the condition.
    42. It is difficult to fit care of our child’s condition into our usual family routine.
    43. Dealing with our child’s condition makes family life more difficult.
    45. A condition like the one our child has makes it very difficult to lead a normal family life.
    23. *Our child’s condition rarely interferes with other family activities.
    38. *Even though our child has the condition, we have a normal family life.
    44. *We know when our child needs to be a child.

Total number of items = 14.
Minimum number of valid responses required to compute the scale score = 10.

Parental Mutuality Scale

This scale is calculated from the items in Section 2 of the FaMM questionnaire, answered only by parents with an adult partner living in the home. It addresses parents’ satisfaction with how the couple works together to manage their child’s condition and their perception of the degree to which they receive support from their partner and share views on the management of their child’s condition. Higher values indicate that the condition is viewed as more readily manageable.

  1. We are a closer family because of how we deal with our child’s condition.
    48. I am pleased with how my partner and I work together to manage our child’s condition.
    50. My partner and I consult with each other before we make a decision about our child’s care.
    51. My partner and I have similar ideas about how we should be raising our child.
    53. My partner and I support each other in taking care of our child’s condition.
    47. *My partner and I have different ideas about how serious our child’s condition is.
    49. *My partner and I argue about how to manage our child’s condition.
    52. *I am unhappy about the way my partner and I share the management of our child’s condition.

Total number of items = 8.
Minimum number of valid responses required to compute the scale score = 6

View of Condition Impact Scale

This scale addresses parents’ perception of the seriousness of the condition and its implications for the future. Higher values indicate a higher level of concern about the condition.

  1. Our child’s condition is the most important thing in our family.
    11. Because of the condition, we worry about our child’s future.
    24. Our child’s condition requires frequent hospital stays.
    29. Our child’s condition will be harder to take care of in the future.
    30. We think about our child’s condition all the time.
    37. It is hard to know what to expect of our child’s condition in the future.
    21.*We expect to be devoting less time to our child’s condition in the future.
    26. *People with our child’s condition have a normal length of life.
    32. *Many conditions are more serious than our child’s.
    40. *We are confident that we can take care of our child’s condition.

Total number of items = 10.
Minimum number of valid responses required to compute the scale score = 7.

Since its development the FaMM has been used in studies of families of children who have a broader array of conditions than those included in the instrument development sample, including families of adolescents and young adults who are brain tumor survivors (Deatrick, et al., in press) and families of children with Down syndrome (Van Riper, et al., in press). A special issue of the Journal of Family Nursing, (volume 18, number 1) addressed “New Directions for the Family Management Framework” and reported on it use in the context of acute illness and end-of-life and applications to adolescents, adult caregivers. Efforts currently are underway to test an intervention to improve family management in the context of adolescent and young adult brain tumor survivors (see funding awarded to Deatrick on reference list. The FaMM has been used as a predictor, correlate, and mediator of family and family member functioning.

Content coming soon.

Reference List for the Family Management Style Framework (FMSF) and Family Management Measure (FaMM)

Family Management Style Framework

1. Funded Projects – studies based on the FMSF

“How Families Define and Manage a Child’s Chronic Illness,” (RO1 NR01594), funded by National Center of Nursing Research, NIH, 5/1/87‑8/31/92, $382,504 (last two years funded by competitive continuation award), Minority Supplement, 1991-1992. (Knafl, Principal Investigator)

“Parents Interpretation and Use of Genetic Information”, (R01 HG02036) funded by National Institute of Human Genome Research, 7/1/01-6/30/05. (Gallo, Principal Investigator)

“Family Management and Survivors of Childhood Brain Tumors” funded by the Oncology Nursing Society Foundation, 05/01/05-04/30/07, $8,806. (Deatrick, Principal Investigator)

“Mothers and Fathers Perspectives: Family Management of Childhood Brain Tumor Survivors” funded by Alex’s Lemonade Stand Foundation, 01/03/11-01/02/13, $100,000 (Deatrick, Principal Investigator)

“TIPS for Caregivers of Young Adult Survivors of Childhood Brain Tumors” funded by St. Baldrick’s Foundation, 07/01/17 – 06/30/18, $50,000 (Deatrick, Principal Investigator)

2. Research Reports

Gallo, A. (1990). Family management style in juvenile diabetes: A case illustration. Journal of Pediatric Nursing, 5, 23-32.

Gallo, A. (1991). Family adaptation in childhood chronic illness. A case report. Journal of Pediatric Health Care, 5, 78-85.
doi: 10.1016/0891-5245(91)90095-8

Knafl, K., Breitmayer, B., Gallo, A., & Zoeller, L.  (1992). Parents’ views of health care providers: An exploration of the components of a positive working relationship.  Children’s Health Care, 21, 90-95.
doi: 10.1207/s15326888chc2102_4

Obrecht, J., Gallo, A., & Knafl, K.  (1992). A case illustration of family management style in childhood end-stage renal disease.  American Nephrology Nurses Association Journal, 19, 255-260.

McCarthy, S. & Gallo, A. (1992). Family management style: A case illustration. Journal of Nursing, 8, 318-324.

Gallo, A., Schultz, V., & Breitmayer, B. (1992). Description of the illness experience by adolescents with chronic renal disease. American Nephrology Nurses’ Association Journal, 19, 190-194

Gallo, A., Breitmayer, B., Knafl, K., & Zoeller, L. (1992). Well siblings of children with chronic illness: parents’ reports of their psychological adjustment. Pediatric Nursing, 18, 23-27.

Gallo, A., Breitmayer, B., Knafl, K., & Zoeller, L. (1993).  Mother’s perceptions of family life and sibling adjustment in childhood chronic illness.  Journal of Pediatric Nursing, 8, 318-324.

Knafl, K., Gallo, A., Zoeller, L., & Breitmayer, B.  (1993). Family response to a child’s chronic illness: A description of major defining themes.  In S. Funk & E. Tornquist (Eds.), Key aspects of caring for the chronically ill: Home and hospital (pp. 290-303).  New York: Springer.

Knafl, K., Ayres, L., Gallo, A., Zoeller, L., & Breitmayer, B. (1995).  Learning from stories: Parents’ accounts of the pathway to diagnosis.  Pediatric Nursing, 21, 411-415.

Knafl, K., Breitmayer, B., Gallo, A., Zoeller, L. (1996).  Family response to childhood chronic illness: Description of management styles.  Journal of Pediatric Nursing, 11, 315-326.
doi 10.1016/S0882-5963(05)80065-X

Gallo, A., & Knafl, K. (1998). Parents’ reports of tricks of the trade for managing childhood chronic illness. Journal of the Society of Pediatric Nurses, 3, 93-100.
doi: 10.1111/j.1744-6155.1998.tb00213.x

Knafl, K., & Zoeller, L. (2000). Childhood chronic illness: A comparison of mothers’ and fathers’ experiences. Journal of Family Nursing, 6, 287- 302.
doi: 10.1177/107484070000600306

Sullivan-Bolyai, S., Knafl, K., Deatrick, J., & Grey, M. (2003). Maternal management behaviors . MCN, The American Journal of Maternal/Child Nursing, 28, 160-166.

Weigand, D., Deatrick, J., & Knafl, K. (2008).  Family management styles related to withdrawal of life-sustaining therapy from adults who are acutely ill or injured. Journal of Family Nursing, 14, 16-32.
doi: 10.1177/1074840707313338

Gallo, A., Knafl, K., & Angst, D. (2009). Information management in families with a child with a genetic condition. Journal of Pediatric Nursing, 24, 194-204.
doi: 10.1016/j.pedn.2008.07.010

Knafl, K., Darney, B., Gallo, A., Angst, D. (2010). Parental perceptions of the outcome and meaning of normalization. Research in Nursing & Health, 33, 87-98.
doi: 10.1002/nur.20367

Rearick, E., Sulllivan-Bolyai, S., Bova, C., & Knafl, K. (2011). Parents of children newly diagnosed with type 1 diabetes: Experiences with social support and family management. Diabetes Educator, 37, 508-518.
doi: 10.1177/0145721711412979

Rempel, G., Catriona, B., Rogers, L., & Ravindran, V. (2012). The process of family management when a baby is diagnosed with a lethal congenital condition. Journal of Family Nursing, 18, 35-64.
doi: 10.1177/1074840711427143

Wiegand, D. (2012). Family management after the sudden death of a family member. Journal of Family Nursing, 18, 146-163.
doi: 10.1177/1074840711428451

Wollenhaupt, J., Rodgers, B., & Sawin, K. (2012). Family management of a chronic health condition: Perspectives of adolescents. Journal of Family Nursing, 18, 65-90.
doi: 10.1177/1074840711427545

Knafl, K., Deatrick, J, Knafl, G., Gallo, A. Grey, M., Dixon, J. (2013). Patterns of family management of childhood chronic conditions and their relationship to child and family functioning. Journal of Pediatric Nursing, 28, 523-535.
doi: 10.1016/j.pedn.2013.03.006

Young, Linda (2013). The family experience of bone marrow or blood cell transplantation. Journal of Advanced Nursing, 69, 2274-2284.
doi 10.1111/jan.12111

Knafl, K., Deatrick, J, Knafl, G., Gallo, A. Grey, M., Dixon, J. (2013). Patterns of family management of childhood chronic conditions and their relationship to child and family functioning. Journal of Pediatric Nursing, 28, 523-535.
doi: 10.1016/j.pedn.2013.03.006

Gibson-Young, L., Turner-Henson, A., Gerald, L., Vance, D., & Lorenzo, D. (2014). The relationship among family management behaviors and asthma morbidity in maternal caregivers of children with asthma. Journal of Family Nursing, 20, 442-461.
doi: 10.1177/1074840714552845

Koplow, S., Gallo, M., Knafl, K., Vincent, C., Paun, O., & Gruss, V. (2015). A case study approach to nursing home place: Smooth and difficult cases and implications for nursing. Journal of Gerontological Nursing, 7, 58-65.
doi: 10.3928/00989134-20150413-08

Koplow, S., Gallo, M., Knafl, K., Vincent, C., Paun, O., & Gruss, V. (2015). Family caregivers define and management home placement. Journal of Family Nursing, 21, 469-493.
doi: 10.1177/1074840715571365

Zhang, Y., Wei, M., Zhang, Y., Shen, N. (2014). Chinese family management of chronic childhood conditions: A cluster analysis. Journal for Specialists in Pediatric Nursing, 19, 39-53.
doi: 10.1111/jspn.12046

Beacham, B., & Deatrick, J. (2015). Children with chronic conditions: Perspectives on condition management. Journal of Pediatric Nursing, 30, 25-35.
doi: 10.1016/j.pedn.2014.10.011

Zhang, Y., Wei, M., Shen, N. Zhang, Y. (2015). Identifying factors related to family management during the coping process of families with childhood chronic conditions: A multi-site study. Journal of Pediatric Nursing, 30, 160-173.
doi: 10.1016/j.pedn.2014.10.002

Fleming, L., Knafl, K., Knafl, G., & Van Riper, M. (2017). Parental management of adrenal crisis in children with congenital adrenal hyperplasia. Journal for Specialists in Pediatric Nursing, August 3, epub ahead of print.
doi: 10.1111/jspn.12190

Deatrick, J., Barakat, L., Knafl, G., Hobbie, W., Ogle, S., Ginsberg, J. …. Knafl, K. (in press).  Patterns of family management for adolescent and young adult brain tumor survivors. Journal of Family Psychology.

Van Riper, M., Knafl, G., Roscigno, C., Knafl, K. (in press). Family management of childhood chronic conditions: Does it make a difference if the child has an intellectual disability. American Journal of Medical Genetics – Part A.

3. Concept & Theory Development

Knafl, K. A., & Deatrick, J.  (1986). How families manage chronic conditions: An analysis of the concept of normalization.  Research in Nursing and Health, 9, 215‑222.
doi: 10.1002/nur.4770090306

Knafl, K. A., & Deatrick, J. A.  (1987). Conceptualizing family response to a child’s chronic illness or disability.  Family Relations, 36, 300‑304.

Deatrick, J., & Knafl, K.  (1990). Family management behaviors: Concept synthesis.  Journal of Pediatric Nursing, 5, 15‑22.

Knafl, K., & Deatrick, J.  (1990). Family management style: Concept analysis and refinement.  Journal of Pediatric Nursing, 5, 4‑14.

Deatrick, J., Knafl, K., Murphy-Moore, C. (1999). Clarifying the concept of normalization. Image, 31, 209-214.
doi: 10.1111/j.1547-5069.1999.tb00482.x

Knafl, K., & Deatrick, J. (2003). Further refinement of the family management style framework. Journal of Family Nursing, 9, 232-256.
doi: 10.1177/1074840703255435

Knafl, K., Darney, B., Gallo, A., Angst, D. (2010). Parental perceptions of the outcome and meaning of normalization. Research in Nursing & Health, 33, 87-98.
doi: 10.1002/nur.20367

Knafl, K., Deatrick, J., & Havill. N (2012). Continued development of the Family Management Style Framework. Journal of Family Nursing, 18, 11-34.
doi: 10.1177/1074840711427294

Beeber, A. & Zimmerman, S. (2012) Adapting the Family Management Style Framework for families caring for older adults with dementia. Journal of Family Nursing, 18, 123-145.
doi: 10.1177/1074840711427144

Bousso, R., Misko, M., Mendes-Castillo, A. Rossato, L. (2012). Family Management Style Framework and its use with families having a child undergoing palliative care. Journal of Family Nursing, 18, 91-122.
doi: 10.1177/1074840711427038

4. Methodological Papers

Knafl, K. A., & Breitmayer, B.  (1989). Triangulation in qualitative research: Issues of conceptual clarity and purpose.  In J. Morse (Ed.), Qualitative nursing research: A contemporary dialogue (pp. 209‑220).  Rockville, MD: Aspen
doi: 10.4135/9781483349015

Breitmayer, B., Ayres, L., & Knafl, K. (1993).  Triangulation in qualitative research:  Evaluation of confirmation and completeness purposes.  Image, 25, 237-243.
doi: 10.1111/j.1547-5069.1993.tb00788.x

Knafl, K., Gallo, A., Breitmayer, B., Zoeller, L., & Ayres, L.  (1993). One approach to conceptualizing family response to illness.  In S. Feetham, J. Bell, S. Meister, & K. Gilliss (Eds.), The nursing of families (pp. 70-78).  Newbury Park, CA: Sage.

Knafl, K., & Ayres, L. (1996).  Managing large qualitative data sets in family research.  Journal of Family Nursing, 2, 350-364.
doi: 10.1177/107484079600200402

Ayres, L., Kavanaugh, K, & Knafl, K. (2003). Within and across-case approaches to qualitative data analysis. Journal of Qualitative Health Research, 13, 871-883.
doi: 10.1177/1049732303013006008

Hadley, E., Smith, C., Gallo, A., Angst, D., & Knafl K. (2008). Parents’ perspectives on interviewing their children for research. Research in Nursing & Health, 31, 4-11. 10.1002/nur.20231

Knafl, G., Dixon, J., O’Malley, J., Grey, M., Deatrick, J., Gallo, A., & Knafl, K. (2009). Analysis of cross-sectional univariate measurements for family dyads using linear mixed modeling. Journal of Family Nursing, 15, 130-151.
doi: 10.1177/1074840709331641

5. Practice Applications

Knafl, K., Deatrick, J., Kirby, A. (2001). Normalization promotion. In M. Craft-Rosenberg & J. Denehy (eds.). Nursing Interventions for Infants, Children, and Families (pp. 373-388). Thousand Oaks, CA: Sage.
doi: 10.4135/9781452220284.n23

Knafl, K., & Deatrick, J. (2002). The challenge of normalization for families of children with chronic conditions. Pediatric Nursing, 28, 49-56.

Alderfer, M. (2006). Use of family management styles in family intervention research. Journal of Pediatric Oncology Nursing, 23, 32-35.
doi: 10.1177/1043454205283573

Deatrick, J., Thibodeaux, A., Mooney, K., Schmus, C., Pollacki, R., & Davey, B. (2006). Family management style framework: A new tool with potential to assess families who have children with brain tumors. Journal of Pediatric Oncology Nursing, 23, 19-27.
doi: 10.1177/1043454205283574

Nelson, A., Deatrick, J., Knafl, K., Alderfer, M., & Ogle, S. (2006). Consensus statements: The Family Management Style Framework and its use with families of children with cancer. Journal of the Association of Pediatric Oncology Nurses, 23, 36-37.
doi: 10.1177/1043454205283577

Ogle, S. (2006). Clinical application of family management styles to families of children with cancer. Journal of Pediatric Oncology Nursing, 23, 28-31.
doi: 10.1177/1043454205283586

Gallo, A., Hadley, E., Angst, D., Knafl, K., & Smith, C. (2008). Parents’ concerns about issues related to their children’s genetic conditions. Journal of the Society of Pediatric Nursing, 13, 4-14.
doi: 10.1111/j.1744-6155.2008.00129.x

Deatrick, J.A. Mullaney, E.K., & Mooney‐Doyle, K. (2009). Exploring Family Management of Childhood Brain Tumor Survivors. Journal of Pediatric Oncology Nursing, 26, 303‐311.
doi: 10.1177/1043454209343210

Family Management Measure

1. Funded Projects – studies using the FaMM

 “Assessing Family Management of Childhood Chronic Illness.  Funded by National Institute for Nursing Research (R01 NR08048), 04/01/03-03/31-07, $1,111, 312 (K. Knafl, Principal Investigator)

“Mothers as Caregivers for Survivors of Pediatric Brain Tumors” (R01 NR009651-01A1), 7/17/2007-5/31/10, $1, 014,000 (Deatrick, Principal Investigator)

2. Publications – articles addressing development of the FaMM, reporting FaMM results, or using FaMM data for analyses demonstrating methods

Knafl, K., & Deatrick, J. (2006). Family management style and the challenge of moving from conceptualization to measurement. Journal of the Association of Pediatric Oncology Nurses, 23, 12-18.
doi: 10.1177/1043454205283585

Knafl, K, Deatrick, J., Gallo, A., Holcombe, G., Bakitas, M., Dixon, J., & Grey M. (2007). The analysis and interpretation of cognitive interview for instrument development. Research in Nursing & Health, 30, 224-234.
doi: 10.1002/nur.20195

Knafl, G., & Grey, M. (2007). Factor analysis model evaluation through likelihood cross-validation. Statistical Methods in Medical Research, 16, 77-102.
doi: 10.1177/0962280206070649

Zhang, Y., & Wei, M. (2009). Validity and reliability of the Chinese version of Family Management Measure. Chinese Journal of Practical Nursing, 25, 19-22.

Knafl, G., Dixon, J., O’Malley, J., Grey, M., Gallo, A., & Knafl, K. (2009). Analysis of cross sectional univariate measurements of family dyads using linear mixed modeling. Journal of Family Nursing, 15, 130-151.
doi: 10.1177/1074840709331641

Knafl. K., Deatrick, J., Gallo, A., Dixon, J., Grey, M., Knafl. G., O’Malley, J. (2011). Assessment of the psychometric properties of the Family Management Measure. Journal of Pediatric Psychology, 36, 494-505.
doi: 10.1093/jpepsy/jsp034

Knafl, G., Dixon, O’Malley, J., Grey, M., Deatrick, J., Gallo, A., & Knafl, K. (2012). Scale development based on likelihood cross-validation. Statistical Methods for Medical Research, 21, 599-619.
doi: 10.1177/0962280210391444

Kim, D.H., & Im Y.J. (2013). Validity and reliability of Korean version of the Family Management Measure (Korean FaMM) for families with children having chronic illness. Journal of Korean Academy of Nursing. 43. 123-132.
doi: 10.4040/jkan.2013.43.1.123

Knafl, G., Knafl, K., Grey, M., Dixon, J., Deatrick, J., & Gallo, A. (2016). Incorporating nonlinearity into mediation analysis, BMC: Medical Research Methodology, 17, 45.
doi: 10.1186/s12874-017-0296-6

3. Validation Measures Used in FaMM Development

Epstein, N., Baldwin, L., & Bishop, D. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9, 171-180.

Eyberg, S., & Pincus, D. (1999). Eyberg Child Behavior Inventory and Sutter-Eyberg Student Behavior Inventory: Revised Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc.

Eyberg, S., & Robinson, E. (1983). Conduct problem behavior: Standardization of a behavior rating scale with adolescents. Journal of Clinical Child Psychology, 12, 347-354.

Stein, R., & Jessop, D. (1990). Functional Status II: A measure of child health status. Medical Care, 28, 431-438.

Strahan, R., & Gerbasi, K. (1972). Short, homogeneous versions of the Marlowe-Crowne Social Desirability Scale. Journal of Clinical Psychology, 28, 191-193.

Copyright and Permissions

FaMM is a copyrighted instrument. It is made available through this website for use in research and clinical practice. There is no charge for using the FaMM. FaMM can be used in its entirety or selected scales can be used. If you do use the FaMM in your research and clinical practice, we ask that you send us a copy of any publications reporting your work. We will add them to the reference list on this website. We will continue to update this website with new information on the FaMM.

Acknowledgements

Financial support for the development of the Family Management Measure came from the National Institute of Nursing Research, National Institutes of Health (R01 NR08048) and the Donaghue Medical Research Foundation.