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
Family communication is a fundamental part of the parent-child relationship. Parent-child communication starts in infancy, when children communicate to their parents through crying and their parents respond (more or less accurately) to their needs (
Acebo and Thoman, 1995
). This communication marks the beginning of an attachment process during which children and their parents reciprocally influence each other to create a parent-child relationship of great importance for later mental health and well-being (McCarty and McMahon, 2003
). Family communication represents an important outcome of several pediatric nursing interventions. This is because children's communication about their emotions and experiences, and parents' responses to this communication, are related to how children cope with difficulties (- McCarty C.A.
- McMahon R.J.
Mediators of the relation between maternal depressive symptoms and child internalizing and disruptive behavior disorders.
Journal of Family Psychology: JFP: Journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2003; 17: 545-556
Schrodt, Witt and Messersmith, 2008
). Specifically, parental acceptance and encouragement in parent-child communication are associated with more use of social support and problem-solving coping strategies in children, whereas lack of these quality indicators in parent-child communication is associated with more mental health difficulties (Chiariello and Orvaschel, 1995
; Gentzler, Contreras-Grau, Kerns and Weimer, 2005
). Further, lower quality parent-child communication is related to adolescent alcohol and tobacco use, risky sexual behavior, and suicide attempts (Ackard, Neumark-Sztainer, Story and Perry, 2006
; Riesch, Anderson and Krueger, 2006
; Ryan, Jorm, & Lubman, 2010
).In the current study, we focus particularly on parent-child communication in families of children with pediatric health conditions, using siblings as informants. A pediatric health condition is defined herein as congenital enduring conditions impairing functioning, with no known cure for the core features (
Vermaes, van Susante and van Bakel, 2012
). In general, family functioning, including parent-child communication, in families of children with pediatric health conditions has been found to affect the well-being and mental health of all family members, including parents and siblings of the child with a pediatric health condition (Fossen et al., 2021
; Haukeland et al., 2020
; Lee, Knafl, Knafl and Riper, 2020
; Liu, Yin, Zhu, Zhang and Sheng, 2021
). Murphy, Murray and Compas, 2017
recently reviewed studies of communication in families of children with a pediatric health condition. They found that the communication was characterized by lower warmth and more hostility and withdrawal compared with families of children without a pediatric health condition. The factors outlined by Murphy, Murray and Compas, 2017
can be considered quality indicators of parent-child communication. Factors like hostility, negative affectivity, withdrawal, criticism, and inconsistency characterized poor quality parent-child communication, whereas other factors such as warmth, engagement, acceptance, structure, and openness characterized high quality parent-child communication (Murphy, Murray and Compas, 2017
, Murphy et al., 2018
). Thus, parent-child communication is of uttermost importance within families of children with pediatric health conditions.Of particular importance for siblings, open and emotionally supportive communication between parents and siblings of children with a pediatric health condition has been found to be important for siblings mental health and well-being (
Haukeland et al., 2020
; Mitchell, Morawska, Vickers-Jones and Bruce, 2021
; Murphy, Murray and Compas, 2017
). Siblings of children with pediatric health conditions are at higher risk of psychosocial difficulties like depression, anxiety, and behavioral problems than other children (Schamong, Liebermann-Jordanidis, Brockmeier, Sticker and Kalbe, 2021
; Shivers, Jackson and McGregor, 2019
; Vermaes, van Susante and van Bakel, 2012
). As a consequence of their brother's or sister's pediatric health condition, siblings have to deal with many emotionally challenging experiences (Haukeland, Fjermestad, Mossige and Vatne, 2015
). Difficulties in expressing emotions and poorer parent-child communication have been found to predict mental health difficulties among siblings (Long et al., 2013
). On the opposite side, emotionally supportive communication with parents have been found to be protective of sibling mental health difficulties (Haukeland et al., 2020
; Incledon et al., 2015
). Moreover, emotionally supportive mother-sibling communication has been found to be related to sibling strengths such as prosocial behavior (Orm, Haukeland, Vatne, Silverman and Fjermestad, 2021
).Because of the enduring and often incurable nature of many pediatric health conditions, pediatric nurses often need to focus on family dynamics and processes in their interventions. In order to assess family processes and measure relevant outcomes, psychometrically sound measures of family communication are needed. In fact, a meta-analysis of effective components in parent-training programs found that components targeting parent-child interactions and parent skills in emotional communication were associated with larger intervention effects (
Wyatt Kaminski, Valle, Filene and Boyle, 2008
). Further, recent studies targeting parent-sibling communication in families of children with pediatric health conditions have found improvements in both sibling and parental mental health (Fjermestad et al., 2021
; Haukeland et al., 2020
). This underscores the importance of including parent-child communication training in pediatric nursing interventions for families.Family communication can be measured by observation, and some observational measures of parent-child communication have been validated (e.g.,
Murphy et al., 2018
). However, observational measures are time- and labor consuming, making them impractical for clinical practice and intervention research. Thus, self-report measures represent an important supplement. In terms of self-report, both parents and children can rate their perception of family communication quality. Generally, in the field of pediatric nursing, parent-report dominates over child-report (Harrison, 2010
). Furthermore, the overlap between parents and children in reports about psychosocial factors tend to be moderate at best (De Los Reyes and Kazdin, 2005
). From a patient advocacy perspective, listening to children's own voices is important in pediatric nursing. Therefore, questionnaires that measure family communication from the child's perspective may be particularly relevant for the field.Many different measures of family processes have been developed for use in pediatric clinical settings and research (
Alderfer et al., 2008
; Zapf et al., 2021
). However, some limitations exist in regard to communication measures. First, many measures are measuring domain general family processes instead of specific processes such as family communication (Alderfer et al., 2008
; Murphy, Murray and Compas, 2017
). Second, insufficient attention has been paid to the psychometric properties of these measures (Alderfer et al., 2008
; Zapf et al., 2021
), and the use of non-validated scales is common (e.g., Paclikova, Dankulincova Veselska, Filakovska Bobakova, Palfiova and Madarasova Geckova, 2019
; Su, Li, Lin, Xu and Zhu, 2013
; Xin et al., 2021
). However, a few child-report measures of family communication have been developed. Two widely used measures are the 26-item Revised Family Communication Pattern (RFCP; Ritchie and Fitzpatrick, 1990
) and the 20-item Parent-Adolescent Communication Scale (PACS; Barnes and Olson, 1985
). The RFCP and PACS have demonstrated adequate reliability (Houck, Rodrigue and Lobato, 2007
; Jackson, Bijstra, Oostra and Bosma, 1998
; Keim et al., 2017
; Ritchie and Fitzpatrick, 1990
; Sillars et al., 2014
), and have been used with children as young as 12 and 10 years of age, respectively (Jackson, Bijstra, Oostra and Bosma, 1998
; Keim et al., 2017
; Ritchie and Fitzpatrick, 1990
).In the current report, we focus on an adapted version of the PACS, the Parent-Child Communication Scale – Child Report (PCCS-CR;
Conduct Problems Prevention Research Group, 1994
). The PCCS-CR is widely used in recent observational and interventional studies (e.g., Fjermestad et al., 2021
; Fjermestad, Silverman and Vatne, 2020
; Haukeland et al., 2020
; Orm, Haukeland, Vatne, Silverman and Fjermestad, 2021
; Reedtz et al., 2019
; Schulte et al., 2017
). 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 (McCarty and Doyle, 2001
). McCarty and Doyle, 2001
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.,
Ehrlich, Cassidy and Dykas, 2011
; McCarty and McMahon, 2003
). Third, we investigate the known-groups validity (- McCarty C.A.
- McMahon R.J.
Mediators of the relation between maternal depressive symptoms and child internalizing and disruptive behavior disorders.
Journal of Family Psychology: JFP: Journal of the Division of Family Psychology of the American Psychological Association (Division 43). 2003; 17: 545-556
Davidson, 2014
) 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
). 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 (
Conduct Problems Prevention Research Group, 1994
). 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
). 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
) 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
; Fraley, Heffernan, Vicary and Brumbaugh, 2011
). 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 ). We used the Diagonally Weighted Least Squared (DWLS) estimator (
Li, 2016
). 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 (
Cohen, 1988
). 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.
| χ2 | p | RMSEA | p-close | CFI | TLI | SRMR | |
|---|---|---|---|---|---|---|---|
| Model | |||||||
| Report about mother | 21.025 | 0.335 | 0.027 | 0.703 | 0.995 | 0.993 | 0.067 |
| Report about father | 17.878 | 0.531 | 0.000 | 0.955 | 1.000 | 1.002 | 0.051 |
Table 2Factor loadings on PCCS-CR about mother.
| 95% Confidence Interval (CI) | ||||
|---|---|---|---|---|
| Factor | Item | Factor loading | Lower | Upper |
| Child communication | Do you discuss problems with your mother? | 0.756 | 0.614 | 0.898 |
| Do you think you can tell your mother how you really feel about some things? | 1.010 | 0.839 | 1.181 | |
| Can you let your mother know what's bothering you? | 0.879 | 0.716 | 1.041 | |
| Parent communication | Is your mother a good listener? | 0.526 | 0.425 | 0.627 |
| Can your mother tell how you are feeling without asking you? | 0.672 | 0.541 | 0.803 | |
| Does your mother try to understand what you think? | 0.562 | 0.435 | 0.689 | |
| 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? | 0.631 | 0.485 | 0.777 | |
Items are obtained from
The Fast Track Project, n.d
: https://fasttrackproject.org/techrept/p/pcc/parentchldcommchld.pdf.The Fast Track Project. (n.d.). Parent-child communication (child). Retrieved June 11, 2021, from https://fasttrackproject.org/techrept/p/pcc/parentchldcommchld.pdf
Table 3Factor loadings on PCCS-CR about father.
| 95% Confidence Interval (CI) | ||||
|---|---|---|---|---|
| Factor | Item | Factor loading | Lower | Upper |
| Child communication | Do you discuss problems with your father? | 0.964 | 0.850 | 1.077 |
| Do you think you can tell your father how you really feel about some things? | 0.981 | 0.865 | 1.097 | |
| Can you let your father know what's bothering you? | 0.785 | 0.683 | 0.886 | |
| Parent communication | Is your father a good listener? | 0.511 | 0.430 | 0.591 |
| Can your father tell how you are feeling without asking you? | 0.856 | 0.745 | 0.967 | |
| Does your father try to understand what you think? | 0.654 | 0.555 | 0.752 | |
| 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? | 0.593 | 0.496 | 0.690 | |
Items are obtained from
The Fast Track Project, n.d
: https://fasttrackproject.org/techrept/p/pcc/parentchldcommchld.pdf.The Fast Track Project. (n.d.). Parent-child communication (child). Retrieved June 11, 2021, from https://fasttrackproject.org/techrept/p/pcc/parentchldcommchld.pdf
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.
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.
| Siblings | Controls | Group difference | ||||
|---|---|---|---|---|---|---|
| Sum | SD | Sum | SD | p-value | Hedges g | |
| Report about mother | ||||||
| Child communication | 10.79 | 2.96 | 13.09 | 2.20 | < 0.001 | 0.83 |
| Parent communication | 20.26 | 3.21 | 21.36 | 2.80 | 0.052 | 0.36 |
| Report about father | ||||||
| Child communication | 10.18 | 3.12 | 12.36 | 2.22 | <0.001 | 0.75 |
| Parent communication | 18.84 | 3.57 | 20.60 | 2.87 | 0.005 | 0.52 |
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
) 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
; Gentzler, Contreras-Grau, Kerns and Weimer, 2005
). 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
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
). 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
; Haukeland et al., 2020
). 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
). 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
; Fjermestad, Haukeland, Mossige and Vatne, 2019
; Rum, Zachor, & Dromi, 2021
).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
).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.
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© 2021 The Author(s). Published by Elsevier Inc.
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