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Research Article| Volume 62, P78-83, January 2022

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Measuring family communication in pediatric nursing: Psychometric properties of the Parent-Child Communication Scale – Child Report (PCCS-CR)

  • Stian Orm, MPhil
    Stian Orm
    Correspondence
    Corresponding author at: Division of Mental Health Care, Innlandet Hospital Trust, BUP Lillehammer, Anders Sandvigs gate 17, 2629, Lillehammer, Norway.
    Contact
    Affiliations
    Department of Psychology, University of Oslo, Norway

    Department of Mental Health Care, Innlandet Hospital Trust, Norway
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  • Yngvild B. Haukeland, PhD
    Yngvild B. Haukeland
      Affiliations
      Department of Psychology, University of Oslo, Norway
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    • Torun Vatne, PhD
      Torun Vatne
        Affiliations
        Frambu Resource Center for Rare Disorders, Norway
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      • Krister Fjermestad, PhD
        Krister Fjermestad
          Affiliations
          Department of Psychology, University of Oslo, Norway

          Frambu Resource Center for Rare Disorders, Norway
          Search for articles by this author
        Open AccessPublished:November 16, 2021DOI:https://doi.org/10.1016/j.pedn.2021.10.022
        Measuring family communication in pediatric nursing: Psychometric properties of the Parent-Child Communication Scale – Child Report (PCCS-CR)
        Previous ArticleParents' from Poland coping with the illness of a child—Preliminary research. Cultural adaptation and evaluation of the psychometric properties of the coping health inventory for parents - polish version
        Next ArticlePsychometric characteristics of the Turkish version of the pain flexibility scale for children with cancer
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            Highlights

            • •
              Enhancing parent-child communication is an important outcome in pediatric nursing.
            • •
              Few well-documented parent-child communication measures exists.
            • •
              The Parent-Child Communication Scale (PCCS) is one such measure.
            • •
              We confirmed the factor structure of the PCCS.
            • •
              And established convergent validity against a measure of parent-child relationship.

            Abstract

            Purpose

            Communication quality is an essential indicator of family functioning and represents an important outcome after pediatric nursing interventions. However, few well-documented child-report questionnaires for family communication exist. We aimed to document the psychometric properties of a previously developed child-rated family communication scale for use in pediatric nursing.

            Design and methods

            We examined the Parent-Child Communication Scale – Child Report (PCCS-CR) in terms of factor structure, convergent validity against the Experiences in Close Relationships-Relationship Structures scale (ECR-RS), and known-groups validity between a sample of siblings of children with pediatric health conditions and controls. The sample comprised 101 siblings of children with a pediatric health condition and 44 controls (M age = 11.5 years, SD = 2.2).

            Results

            We confirmed a two-factor structure of the PCCS-CR. One factor is communication from the child to the parent, labelled child communication (e.g., “I discuss problems with my parents”) and the other is communication from the parent to the child, labelled parent communication (e.g., “My parent is a good listener”). Convergent validity of the PCCS-CR was demonstrated through correlations with ECR-RS (r = −0.73 to −0.22, p ≤ .05). Further, construct validity through differences between families with and without a child with a pediatric health condition was demonstrated (g = 0.36–0.83, p ≤ .052).

            Conclusion

            The PCCS-CR appears to be a psychometrically sound measure of parent-child communication from the child's point of view.

            Practical implications

            The PCCS-CR can be administered in pediatric nursing care and can be used to target and measure the outcomes of interventions aimed at enhancing family functioning.

            Keywords

            • Parent-child communication
            • Pediatric health conditions
            • Developmental disabilities
            • Psychometric properties
            • Physical disabilities
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            ). The potential advantage of this scale is that it was developed to be used with children younger than 10 years of age. Further, the number of items was reduced from 20 to 8, making the scale easier to administer in pediatric nursing care. However, to our knowledge, only unpublished analyses of the PCCS-CR psychometric properties exist (
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            suggested, based on unpublished exploratory factor analysis, that the PCCS-CR comprises two subscales; (1) child communication, i.e., communication of feelings and problems from the child to their parent (three items), and (2) parent communication, i.e., children's perception of their parents' efforts to maintain open communication with them (five items). However, given that the factor analysis has not been published in peer-reviewed journals, information about the extraction method, criteria, and factor loadings is unknown and, to our knowledge, no later study has confirmed the validity of the PCCS-CR.
            The purpose of our study was to investigate the construct and convergent validity of the PCCS-CR in a sample of siblings of children with a pediatric health condition through three steps. First, we use confirmatory factor analysis (CFA) to test the proposed two-factor solution of the PCCS-CR. Second, we investigate the overlap between PCCS-CR and a measure of the child's perception of quality of the relationship with their parent. We chose this comparator because communication quality is conceptualized as a related, but distinct, phenomena to overall relationship quality in attachment theory (e.g.,
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            ) of the PCCS-CR's ability to differentiate between siblings of children with pediatric health conditions and controls.

            Method

            Participants

            Two groups were included in the current study; (1) siblings of children with a pediatric health condition (n = 101), and (2) controls (n = 44) without a sibling with a pediatric health condition. The total sample thus comprised 145 children between 8 and 16 years of age (M = 11.5, SD = 2.2; 50.3% males; 49.7% females). The majority of mothers (82.3%) and fathers (66.9%) had university education. There were no significant group differences in age, gender, or mothers' educational level. However, fathers of controls (88.6%) had significantly higher educational level than fathers of siblings (60.2%) (ꭓ2 (1) = 11.60, p = .001).
            Among the siblings of children with a pediatric health condition, the majority were siblings of children with rare genetic disorders affecting physical and/or cognitive development (52.5%; i.e., Smith-Magenis Syndrome; DiGeorge syndrome; Prader-Willis syndrome; Fragile X syndrome; Angelman syndrome; Becker/Duchenne muscular dystrophies, Friedreich's ataxia, spinal muscular atrophy), while the remaining sample were family members of children with either autism spectrum disorder (25.3%), congenital heart disease (12.1%), Down syndrome (7.1%), or cerebral palsy (3.0%).

            Procedure

            Siblings of children with pediatric health conditions were recruited to participate in an intervention for siblings and parents of children with pediatric health conditions targeting parent-child communication, called the SIBS intervention (
            Vatne, Haukeland, Mossige and Fjermestad, 2019
            • Vatne T.M.
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            • Fjermestad K.W.
            The development of a joint parent-child intervention for siblings of children with chronic disorders.
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            ). The siblings were recruited through two national resource centers for rare disorders and neurodevelopmental disorders and four user associations (autism spectrum disorder; congenital heart disease; Down syndrome; cerebral palsy). Typically developing siblings between the age of 8 and 16 years were invited. The invitation contained information letters for siblings and parents, respectively. In total, 199 siblings were invited to participate, of which 107 (54%) accepted but only 101 (51%) returned baseline data. Among the families who provided a reason for declining (17%), the most common was that the sibling did not want to participate (44%) or that participation was not possible due to family logistics (31%). For siblings of children with pediatric health conditions, the baseline pre-intervention assessments of parent-child communication and parent-child relationship were analyzed in the current study. The controls were recruited through public elementary schools in the same country as siblings of children with pediatric health conditions. The study was approved by the Regional Committee for Medical and Health Research Ethics prior to data collection and written informed consent were collected from all participating families, informing them that participation was voluntary, would not affect their service access, and that they had the right to withdraw from the study at any time. No financial incentives were provided.

            Measures

            The PCCS-CR was used to measure parent-child communication (
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            ). The PCCS-CR comprises ten items rated on a Likert-scale from almost never (1) to almost always (5). Previous studies have suggested two factors; (1) child communication comprising three items and (2) parent-communication comprising five items. The PCCS-CR has been found to have adequate inter-item reliability (α = 0.71–0.81) (
            McCarty and Doyle, 2001
            • McCarty C.M.
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            Parent-Child Communication (Child) (Technical Report).
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            ). Children completed the PCCS-CR separately for their mothers and fathers.
            The Experiences in Close Relationships-Relationship Structures scale (ECR-RS;
            Fraley, Heffernan, Vicary and Brumbaugh, 2011
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            ) was used to assess child-reported relationship quality with their mother and father. The ECR-RS comprises nine items rated on a Likert-scale from strongly disagree (1) to strongly agree (7). Psychometric investigations have suggested that the ECR-RS is reliable (α ≥ 0.81) and valid (
            Donbaek and Elklit, 2014
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            ). The ECR-RS comprises two subscales measuring the attachment dimensions avoidance (six items) and anxiety (three items) in close relationships. Higher scores indicate more avoidance and anxiety, respectively. In the current study the ERC-RS showed good inter-item reliability (α = 0.74–0.81).

            Statistical analyses

            We conducted CFA using JASP (JASP
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            ). We used the Diagonally Weighted Least Squared (DWLS) estimator (
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            ). We used the following indicators of good fit: non-significant chi-square test of model fit, Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) ≥ 0.95, Root Mean Square Error Approximation (RMSEA) < 0.06, and Standardized Root Mean Square Residual (SRMS) < 0.10. Missing data were imputed using the fully conditional specification method (MCMC) in SPSS version 27.
            We used SPSS version 27 to conduct independent samples t-tests (two-tailed) to analyze group differences between siblings of children with pediatric health conditions and controls and calculated Hedges g as the effect size measure. Hedges g of 0.20, 0.50, 0.80, were interpreted as respectively a small, medium, and large effect size (
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            ). We reconducted analyses using analysis of covariance (ANCOVA) to control for fathers' educational level. We used Pearson's r to investigate the degree of overlap between the PCCS-CR and the ECR-RS.

            Results

            Factor structure of the PCCS-CR

            The two-factor solution of the PCCS-CR comprising a child communication subscale of three items and a parent communication subscale of five items showed good model fit for both report about mother and report about father (see Table 1; Table 2; Table 3).
            Table 1Fit indices from CFA of PCCS-CR report about mother and about father.
            χ2pRMSEAp-closeCFITLISRMR
            Model
             Report about mother21.0250.3350.0270.7030.9950.9930.067
             Report about father17.8780.5310.0000.9551.0001.0020.051
            • Open table in a new tab
            Table 2Factor loadings on PCCS-CR about mother.
            95% Confidence Interval (CI)
            FactorItemFactor loadingLowerUpper
            Child communicationDo you discuss problems with your mother?0.7560.6140.898
            Do you think you can tell your mother how you really feel about some things?1.0100.8391.181
            Can you let your mother know what's bothering you?0.8790.7161.041
            Parent communicationIs your mother a good listener?0.5260.4250.627
            Can your mother tell how you are feeling without asking you?0.6720.5410.803
            Does your mother try to understand what you think?0.5620.4350.689
            Does your mother insult you when she is angry with you?−0.243−0.335−0.151
            Can you have your say even when your mother disagrees with you?0.6310.4850.777
            Items are obtained from
            The Fast Track Project, n.d

            The Fast Track Project. (n.d.). Parent-child communication (child). Retrieved June 11, 2021, from https://fasttrackproject.org/techrept/p/pcc/parentchldcommchld.pdf

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            • Open table in a new tab
            Table 3Factor loadings on PCCS-CR about father.
            95% Confidence Interval (CI)
            FactorItemFactor loadingLowerUpper
            Child communicationDo you discuss problems with your father?0.9640.8501.077
            Do you think you can tell your father how you really feel about some things?0.9810.8651.097
            Can you let your father know what's bothering you?0.7850.6830.886
            Parent communicationIs your father a good listener?0.5110.4300.591
            Can your father tell how you are feeling without asking you?0.8560.7450.967
            Does your father try to understand what you think?0.6540.5550.752
            Does your father insult you when she is angry with you?−0.170−0.230−0.110
            Can you have your say even when your father disagrees with you?0.5930.4960.690
            Items are obtained from
            The Fast Track Project, n.d

            The Fast Track Project. (n.d.). Parent-child communication (child). Retrieved June 11, 2021, from https://fasttrackproject.org/techrept/p/pcc/parentchldcommchld.pdf

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            : https://fasttrackproject.org/techrept/p/pcc/parentchldcommchld.pdf.
            • Open table in a new tab

            Correlations between PCCS-CR and ERC-RS

            There was significant overlap between the PCCS-CR and the ERC-RS (r = −0.22–0.73, p < .05; see Table 4), meaning that better parent-child communication is associated with less avoidance and anxiety in the parent-child relationship. There were small to large correlations between the PCCS-CR subscales and between report about mother and report about father on the PCCS-CR (r = 0.24–0.74, p < .05; see Table 4), meaning that children reporting higher quality mother-child communication also reports higher quality father-child communication and vice versa.
            Table 4Correlations between PCCS-CR and ERC-RS.
            1.2.3.4.5.6.7.8.
            1. PCCS-CR child communication (mother)–
            2.. PCCS-CR parent communication (mother)0.37**–
            3. PCCS-CR child communication (father)0.74**0.24**–
            4. PCCS-CR parent communication (father)0.64**0.41**0.64**–
            5. ERC-RS avoidance mother−0.61**−0.48**−0.50**−0.48**–
            6. ERC-RS anxiety mother−0.22*−0.34**−0.19*−0.22**−0.25**–
            7. ERC-RS avoidance father−0.63**−0.39**−0.73**−0.59**0.67**−0.29**–
            8. ERC-RS anxiety father−0.23*−0.42**−0.24**−0.27**−0.24**0.78**−0.35**–
            ⁎p ≤ .05, ⁎⁎p ≤ .01.
            • Open table in a new tab

            Group differences in PCCS-CR

            Siblings of children with pediatric health conditions scored their parent-child communication significantly lower than controls on all scales except of the parent-communication subscale for mothers (p = .052; see Table 5). Differences in child communication were large (g = 0.75–83) whereas differences in parent communication were small to medium (g = 0.36–52). When including fathers' educational level as covariate, there was significant group differences in child communication with mother (F (1,138) = 13.285, p < .001) and with father (F (1,137) = 12.068, p = .001). Fathers' educational level was a significant covariate in all four comparisons (p ≤ .020), associated with better parent-child communication, and there was no longer a significant group effect for parent communication with mothers nor fathers. This suggests that group differences in fathers' educational level could explain the observed differences in parent communication.
            Table 5Comparison of siblings and controls on the subscales of the PCCS-CR.
            SiblingsControlsGroup difference
            SumSDSumSDp-valueHedges g
            Report about mother
             Child communication10.792.9613.092.20< 0.0010.83
             Parent communication20.263.2121.362.800.0520.36
            Report about father
             Child communication10.183.1212.362.22<0.0010.75
             Parent communication18.843.5720.602.870.0050.52
            • Open table in a new tab

            Discussion

            Few studies have investigated the psychometric properties of family communication scales rated from the child's perspective. We found that the PCCS-CR, a child-report scale of family communication, had a solid two-factor structure, converged with a family relations measure, and discriminated between children who were siblings of children with pediatric health conditions and controls. Thus, the PCCS-CR can be considered a convenient and valid scale for pediatric nursing care providers to examine parent-child communication from the child's point of view.
            The two-factor solution for the PCCS-CR suggests that children perceive their communication of feelings and problems towards their parents as separate from parents' efforts to maintain open communication. However, the two subscales were moderately to strongly correlated, suggesting that children who perceive that their parents make an effort to maintain open communication are more likely to tell their parents about their feelings and problems or vice versa. Further, there were small to large correlations between children's report about mothers and about fathers. This suggests that children perceive their communication with their mothers and fathers as similar. If a child feels comfortable communicating his/her feelings and problems to their mother, chances are high they also feel comfortable communicating about their feelings and problems with their father. This could suggest that open and supportive communication with a parent forms the child's internal working models (
            Pietromonaco and Barrett, 2000
            • Pietromonaco P.R.
            • Barrett L.F.
            The internal working models concept: What do we really know about the self in relation to others?.
            Review of General Psychology. 2000; 4: 155-175
            https://doi.org/10.1037/1089-2680.4.2.155
            • Crossref
            • Scopus (307)
            • Google Scholar
            ) and make them more comfortable communicating their feelings and problems in general.
            Children's report of their communication with their parents overlapped substantially with how they reported the relationship quality with their parents, suggesting that the PCCS-CR is valid and that parent-child communication is an important part of the parent-child relationship (
            Ackard, Neumark-Sztainer, Story and Perry, 2006
            • Ackard D.M.
            • Neumark-Sztainer D.
            • Story M.
            • Perry C.
            Parent-child connectedness and behavioral and emotional health among adolescents.
            American Journal of Preventive Medicine. 2006; 30: 59-66
            https://doi.org/10.1016/j.amepre.2005.09.013
            • Abstract
            • Full Text
            • Full Text PDF
            • PubMed
            • Scopus (314)
            • Google Scholar
            ;
            Gentzler, Contreras-Grau, Kerns and Weimer, 2005
            • Gentzler A.L.
            • Contreras-Grau J.M.
            • Kerns K.A.
            • Weimer B.L.
            Parent–child emotional communication and Children’s coping in middle childhood.
            Social Development. 2005; 14: 591-612
            https://doi.org/10.1111/j.1467-9507.2005.00319.x
            • Crossref
            • Scopus (53)
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            ). Better parent-child communication related to less avoidance and anxiety in the parent-child relationship. This finding can be interpreted in light of
            Murphy, Murray and Compas, 2017
            • Murphy L.K.
            • Murray C.B.
            • Compas B.E.
            Topical review: Integrating findings on direct observation of family communication in studies comparing pediatric chronic illness and typically developing samples.
            Journal of Pediatric Psychology. 2017; 42: 85-94
            https://doi.org/10.1093/jpepsy/jsw051
            • Crossref
            • PubMed
            • Scopus (33)
            • Google Scholar
            framework of family communication which distinguish between positive and negative family communication. Positive family communication is characterized by warmth and structure with positive statements and cohesion. Negative communication is on the opposite side characterized by hostile-intrusive and withdrawn communication, including negative statements, criticism, and disengagement. Negative parent-child communication such as criticism and withdrawnness can probably underpin children's avoidance and anxiety in the parent-child relationship, whereas open and warm communication attenuates anxiety and probably reinforce approach behaviors rather than avoidance.
            Our study also supports the results of previous studies using observational measures who have found poorer family communication in families of children with pediatric health conditions compared with controls (
            Murphy, Murray and Compas, 2017
            • Murphy L.K.
            • Murray C.B.
            • Compas B.E.
            Topical review: Integrating findings on direct observation of family communication in studies comparing pediatric chronic illness and typically developing samples.
            Journal of Pediatric Psychology. 2017; 42: 85-94
            https://doi.org/10.1093/jpepsy/jsw051
            • Crossref
            • PubMed
            • Scopus (33)
            • Google Scholar
            ). This emphasizes the importance of assessing and intervening on family communication in families of children with a pediatric health condition (
            Fjermestad, Silverman and Vatne, 2020
            • Fjermestad K.W.
            • Silverman W.K.
            • Vatne T.M.
            Group intervention for siblings and parents of children with chronic disorders (SIBS-RCT): Study protocol for a randomized controlled trial.
            Trials. 2020; 21: 851
            https://doi.org/10.1186/s13063-020-04781-6
            • Crossref
            • PubMed
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            ;
            Haukeland et al., 2020
            • Haukeland Y.B.
            • Czajkowski N.O.
            • Fjermestad K.W.
            • Silverman W.K.
            • Mossige S.
            • Vatne T.M.
            Evaluation of “SIBS”, an intervention for siblings and parents of children with chronic disorders.
            Journal of Child and Family Studies. 2020; 29: 2201-2217
            https://doi.org/10.1007/s10826-020-01737-x
            • Crossref
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            ). Opportunities for siblings to discuss their emotional experiences and thoughts regarding their brother or sister with the condition is essential and parents are the most natural interlocutor in this matter (
            Incledon et al., 2015
            • Incledon E.
            • Williams L.
            • Hazell T.
            • Heard T.R.
            • Flowers A.
            • Hiscock H.
            A review of factors associated with mental health in siblings of children with chronic illness.
            Journal of Child Health Care. 2015; 19: 182-194
            https://doi.org/10.1177/1367493513503584
            • Crossref
            • PubMed
            • Scopus (32)
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            ). Strengthening parents' communication skills is important in order to consider siblings' needs, and enhanced sibling well-being can possibly have a positive influence on the child with a disability (
            Ferraioli, Hansford and Harris, 2012
            • Ferraioli S.J.
            • Hansford A.
            • Harris S.L.
            Benefits of including siblings in the treatment of autism spectrum disorders.
            Cognitive and Behavioral Practice. 2012; 19: 413-422
            https://doi.org/10.1016/j.cbpra.2010.05.005
            • Crossref
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            ;
            Fjermestad, Haukeland, Mossige and Vatne, 2019
            • Fjermestad K.W.
            • Haukeland Y.B.
            • Mossige S.
            • Vatne T.M.
            Children’s perspectives on the experiences of their siblings with chronic disorders.
            Clinical Social Work Journal. 2019; 47: 290-299
            https://doi.org/10.1007/s10615-019-00705-3
            • Crossref
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            ;
            Rum, Zachor, & Dromi, 2021
            • Rum Y.
            • Zachor D.A.
            • Dromi E.
            Prosocial behaviors of children with autism spectrum disorder (ASD) during interactions with their typically developing siblings.
            International Journal of Behavioral Development. 2021; 45: 293-298
            https://doi.org/10.1177/0165025420971042
            • Crossref
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            ).
            It is important to note that our results suggested that paternal education could explain group differences in child-reported parent-communication, but not child-communication. This could imply that parents' communication skills are adequate, and that greater focus should be placed on siblings' communication. It could be that siblings of children with a pediatric health condition do not discuss their emotions and problems with their parents because they are afraid of placing a greater burden on their parents, who already have to take care of their brother or sister with the pediatric health condition. Thus, perhaps greater clinical focus should be placed on providing siblings with opportunities to discuss their emotions and problems, for example in sibling support groups or individually with pediatric nurses responsible for family support (
            Incledon et al., 2015
            • Incledon E.
            • Williams L.
            • Hazell T.
            • Heard T.R.
            • Flowers A.
            • Hiscock H.
            A review of factors associated with mental health in siblings of children with chronic illness.
            Journal of Child Health Care. 2015; 19: 182-194
            https://doi.org/10.1177/1367493513503584
            • Crossref
            • PubMed
            • Scopus (32)
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            ).

            Limitations

            Our sample mainly comprised siblings of children with pediatric health conditions, as well as controls. This poses some limits on the conclusions that can be drawn with respect to validity. The PCCS-CR showed good convergent validity and sensitivity to differences in parent-child communication in the current sample. However, it is uncertain if the PCCS-CR is equally valid for use with families of children with, for example, behavioral and emotional problems. It is also uncertain whether the PCCS-CR is equally valid as a measure of the communication between parents and children with a pediatric health condition (i.e., not their sibling). Thus, there is a need for further studies investigating the validity of PCCS-CR used with different populations.

            Clinical implications

            The PCCS-CR discriminated between parent-child communication quality rated by siblings of children with a pediatric health condition versus controls. This suggests that the PCCS-CR might be useful in pediatric nursing care with families of children with a health condition to assess communication in the family. The brevity of the PCCS-CR makes it useful in clinical practice where the PCCS-CR may be used for screening purposes with a low score indicating a need for a more comprehensive assessment, for example using observational measures. The brevity of the scale is also an advantage in interventional research, where parent-child communication is a relevant outcome variable. Given the array of screeners that are already routinely used in pediatric departments, the PCCS-CR may be considered an additional screening tool when there are concerns about poor family functioning or sibling mental health difficulties already exist. However, given that many pediatric health conditions have no cure, so that families need to learn to live with the condition over time, family communication is an important factor that can be easily screened with the PCCS-CR. As a clinical tool, the PCCS-CR can be useful in a range of different fields, including social work with families, child welfare, child and adolescent's mental health services, and pediatric departments. The PCCS-CR comprises both child and parent communication efforts, and both positive and negative aspects of family communication, and can thus be used to tailor family interventions. For example, if a parent-child dyad is scoring particularly low on parent communication, enhancing parental communication skills can be a particular focus in intervention. In contrast, if a parent-child dyad is scoring particularly low on child communication, this could suggest that pediatric nursing care is needed for the sibling to be able to address his or her feelings and problems. Further, assessing parent-child communication from the child's point of view may make pediatric nurses and parents more aware of siblings' experiences. Such processes may enhance parents' meta-awareness of their communication patterns.

            Declaration of Competing Interest

            The authors declare no conflict of interest.

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            Article info

            Publication history

            Published online: November 16, 2021
            Accepted: October 31, 2021
            Received in revised form: October 16, 2021
            Received: August 10, 2021

            Footnotes

            ☆We would like to thank all the participants for taking part in this study.

            Identification

            DOI: https://doi.org/10.1016/j.pedn.2021.10.022

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