Abstract
In the family-oriented, collectivistic Korean culture, people with disabilities experience extreme challenges in finding an appropriate marital partner, due to discrimination at sociocultural levels. Such discrimination is not unique to South Korea. Because marital status and quality of life is significant for individuals with disabilities, this study examined factors associated with marital satisfaction among individuals with disabilities in South Korea using an existing data set. The sample included married individuals with disabilities, using data drawn from the 2008 Korean Disability Survey (N = 1,028; 507 women and 521 men). In this South Korean sample, major challenges to maintaining a happy marriage were related to financial demands such as securing sufficient household income, finding assistance in performing housework, and improving relational quality among family members. The study revealed interesting gender differences: For female respondents, structural factors of family and marriage—household income, housework, quality of family relations, and younger age at marriage—were significant. For their male peers, along with such structural factors, their health, activities, and quality of life were also significant. The findings of this study have implications for improving the quality of marital life among people with disabilities in South Korea and other developing countries.
A total of 2,246,965 South Koreans were diagnosed by medical professionals as disabled and identified in the disability registry system, showing a dramatic increase in reporting from 1.45 million in 2000 (Byun et al., 2008). These people with disabilities have increasingly demanded more opportunities for social participation through recognition of their rights to education, employment, and independent living. At the same time, many cases of human rights violations have continued, such as discrimination at the workplace, violence against women with disabilities, increased difficulties in transportation, and abuses within welfare institutions (Park, Yoon, & Henderson, 2007).
In many countries, marriage is considered a private matter rather than a public issue. In a family-oriented, collectivistic culture like South Korea, socially marginalized groups such as people with disabilities experience extreme challenges in finding an appropriate marital partner, because of discrimination at societal and cultural levels. The challenges are confounded by the stigma that South Korean culture attaches to people with disabilities. In the past decades, social policy and community services for people with disabilities in South Korea have focused on providing assistance with medical costs, income, and vocational rehabilitation. Only recently has attention been paid to family patterns and quality of life. Marital status can be an indicator of independence and normalization for individuals with disabilities in many cultures, with research revealing that quality of life is lower among unmarried individuals with disabilities than among their married counterparts (Putzke, Elliott, & Richards, 2001).
The impact of disabling barriers and the social meanings attributed to disability vary in different cultures and societies (Priestley, 2000). This study was a secondary analysis of data on married individuals with disabilities in South Korea, drawn from the 2008 Korean Disability Survey (Byon et al., 2008). Relatively little research has been conducted on family issues for people with disabilities not only in Western industrialized countries but also in rapidly developing Asian–Pacific countries. This study provides broader insights into marital satisfaction among people with disabilities in parts of the world that are culturally conservative but socioeconomically changing. The major research questions is to inquire about how a universal construct like marital satisfaction relates to culture-specific circumstances such as family, disability, discrimination, and life qualities.
Familial and Disability-Related Factors in Marital Satisfaction
Common predictors of marital satisfaction for able-bodied couples include higher education, higher income, financial satisfaction, sexual satisfaction, greater communication between couples, and social support (Bradbury, Fincham, & Beach, 2000; Fincham & Beach, 2010). Older age, longer duration of marriage, and having more children are associated with dissatisfaction among couples in Western industrialized countries (Orbuch, House, Mero, & Webster, 1996). Although declines in health were associated with declines in marital satisfaction, a study of 1,217 married people in the United States over 12 years found that the onset of a physical disability later in life boosted marital happiness for men, although not for women (Yorgason, Booth, & Johnson, 2008).
Research has also suggested that individuals’ perceptions of their families’ responses to disabilities, as well as family environmental factors, are related to marital satisfaction (Cano, Gillis, Heinz, Geisser, & Foran, 2004; Schwartz & Kraft, 1999). Furthermore, gender differences have been found regarding the perceived marital satisfaction between husbands and wives. In particular, reciprocity of emotional support between caregiving wives and husbands who receive care has been linked to lower levels of caregiving burden and higher levels of marital happiness for wives (Wright & Aquilino, 1998). This latter study is particularly important for persons with disabilities and their respective spouses.
With regard to gender differences, the division of household labor and its association with marital quality and satisfaction has been a central issue in family studies. Perceived inequality in the division of household labor among couples is negatively associated with marital satisfaction, especially for wives (Frisco & Williams, 2003), a relevant finding when disability is considered as a factor in marital life. In a South Korean study, research has emphasized the limited options and risk of psychological stress among able-bodied Korean wives where dual-earner couples fail to successfully share household work (Tsuya, Bumpass, & Choe, 2000). Indeed, Lee, Um, and Kim (2004) found higher levels of depression for able-bodied South Korean wives who had difficulty balancing professional work with domestic work, compared with their husbands. The onset of disability may impact the ability to share household tasks.
Regardless of culture, raising a child with a disability has long been recognized as a major source of burden and distress in family caregiving, possibly threatening marital satisfaction. Western studies demonstrate that the additional child care demands caused by a child’s disability can create significant parental stress as well as disruption in marital relationships (Stoneman, Gavidia-Payne, & Floyd, 2006). In one of the few cross-cultural studies of mothers of children with mental retardation in the United States and Korea, Shin and Crittenden (2003) found that stress for American mothers was caused by normative situations in family and workplaces, whereas among able-bodied Korean mothers, cultural values that carried social influence were strongly associated with their attitudes toward the child’s disabilities and their experience of stress. American mothers received more informal and professional support in almost all domains, whereas South Korean mothers experienced more stress, perhaps due to the stigma attached to disabilities in Korean culture (Shin, 2002). Such stigma and shame attached to physical and mental disabilities appeared to be severe in other Asian countries (Jeevanandam, 2009; Lauber & Rössler, 2007).
The 2008 Korean Disability Survey estimated that there were 55,000 adults, aged 18 to 49, with disabilities (including both physical and psychological) in South Korea. Among the disabled persons, just over half (52%) were married, and a few (5%) were partnered (Byun et al., 2008). Of those not married or partnered, the majority reported problems with their health and their disability as the primary reason for not getting married. The vast majority of South Korean married respondents with a disability have at least one child (81%). Although almost two fifths (39.6%) have reported no difficulties raising their children, a slightly larger number (42.6%) report that a major challenge to maintaining positive family relations was financial burdens (Byun et al., 2008). To date, only one study (Kim & Chae, 2006) has examined factors associated with marital satisfaction among persons with disabilities in South Korea. Among women with disabilities, they found predictors of marital satisfaction to be shorter marital duration, fewer children, better communication, greater satisfaction with sexuality, and more financial satisfaction. This study failed to examine disability-related factors in marital satisfaction, the purpose of the study reported here.
In any culture, the existence of a disability can be a source of emotional challenges for individuals and their families who are at increased risk for poor health and quality-of-life outcomes when their disability status affects their socioeconomic standing. The national survey also reported a lower socioeconomic status for South Koreans with disabilities, with a 23% unemployment rate (Byun et al., 2008). The monthly household income of 1,579,000 Korean won (equivalent to US$1,579) indicated the lowest quintile or poverty line among disabled respondents (Korea Statistical Information Service, 2011). In addition, individuals with a disability experienced increased barriers to obtaining health care due to decreased access to transportation, problems with communication, and lack of health insurance (Drainoni et al., 2006).
Regardless of disability status, absence of domestic violence, abuse, and discrimination are important predictors of marital satisfaction (Pavalko, Mossakowski, & Hamilton, 2003). A U.S. study indicated that American women with physical disabilities appear to be at the same risk for emotional, physical, and sexual abuse as able-bodied women (Young, Nosek, Howland, Chanpong, & Rintala, 1997). The prevalence of abuse by husbands or live-in partners of women with disabilities is similar to estimates of lifetime occurrences of domestic violence for women in the United States. That noted, women with physical disabilities are more at risk for abuse by attendants or health care providers. They are also more likely to experience abuse for longer periods of time than women without physical disabilities (Nosek, Foley, Hughes, & Howland, 2001).
There is variance in the literature about the relationship between the severity of disability and marital satisfaction. Some researchers report that physical impairment is the strongest predictor of personal disability, and severity of disability the strongest predictor of social functioning (Lobentanz et al., 2004; Nosek, Fuhrer, & Potter, 1995). Other studies report that the severity of disability is not a predictor of quality of life (Albrecht & Devlieger, 1999), confirming the disability paradox. The latter argue that life satisfaction clearly depends on establishing and maintaining harmonious relationships within one’s social context rather than on the severity of disability. Hence, marital satisfaction is related to satisfaction in other dimensions of life, including satisfaction with employment (Murphy, Middleton, Quirk, De Wolf, & Cameron, 2011), residential satisfaction (Llewellyn, McConnell, Honey, Mayes, & Russo, 2003), and equal division of labor (Lavee & Katz, 2002). These findings appeared to be cross-cultural.
In sum, previous research focuses on familial factors in marital satisfaction noting gender differences. Although notable gender disparities have been documented in terms of unequal division of household labor, challenges of balancing work and family, and the caregiving burden of rearing a child with disability, limited research has identified disability-related factors relating to the marital satisfaction of men and women with disabilities. It is hypothesized that marital satisfaction among individuals with disabilities will be associated with a variety of factors, including marriage, family, disability, discrimination, and quality of life. The present study therefore further examines specific factors of marital satisfaction among husbands and wives who are disabled or who are married to a person with a disability.
Method
Sample
The study sample was drawn from the South Korean Disability Survey, designed to provide the data needed to devise and implement effective socioeconomic policies to address issues for persons with disabilities. The sample frame included potential survey respondents of 12,342 persons with disability in all age groups. The Anti-Discrimination Against and Remedies for Persons With Disabilities Act (Republic of Korea, 2007) defines disability, with respect to a cause of discrimination prohibited by this act, as “an impairment or loss of physical or mental functions that substantially limits an individual’s personal or social activities for an extended period” (Article 2, para. 1). Based on a stratified two-phase sampling method, the population was divided into 16 provinces, and then random samples were obtained from each province group. Among these groups, 7,000 South Korean adults with documented disabilities, who were registered with the Korean Ministry of Health, Welfare, and Family (KMHWF) in March 2008 as disabled, participated in this national survey, for a response rate of 56.7% among the persons with a disability (Byun et al., 2008).
The survey was administered in the fall of 2008 at respondents’ homes. Trained interviewers from KMHWF conducted computer-assisted personal interviews. Given the relationship that has been found between age and marital satisfaction (Yorgason et al., 2008), married individuals aged 50 and older were excluded from the analysis. Therefore, the study sample consisted of the 1,028 adults with disabilities aged 18 to 49 (507 women and 521 men) who reported being married at the time of the survey.
Measures
The main outcome variable in this study was marital satisfaction, defined as subjective rating of one’s experiences in marriage using a 5-point Likert-type scale (0 = not at all satisfied, 4 = very satisfied; Bradbury et al., 2000). Based on the literature, predictor variables were five categories of predictors as noted below: marriage (four predictors), family (five predictors), disability (five predictors), discrimination (five predictors), and quality of life (seven predictors).
Marital factors included age at marriage, presence of disability at the time of marriage, disability status of spouse at marriage, and participation in housework, based on previous research on South Korean couples with disabilities (Kim & Chae, 2006). The division of labor in performing housework (e.g., meal preparation, cleaning, laundry) was assessed on a 3-point Likert-type scale (0 = not doing any housework, 1 = provide occasional help, 2 = do all the housework; Lavee & Katz, 2002).
Familial factors considered in the analysis were number of children, presence in the family of a child with a disability, household income, home ownership status, and home accessibility (Kim & Chae, 2006). The degree to which respondents’ homes were designed to be accessible to people with disabilities was assessed on a 5-point Likert-type scale, with higher scores representing greater accessibility.
Disability-related factors included severity of disability, activities of daily living (ADLs), additional expenses, degree of independent living, and disability-related service use (Drainoni et al., 2006). In South Korea, the degree of disability is determined by medical professionals on a 6-point scale according to the guidelines provided by the KMHWF. The first and second degrees are considered to be severe and the fifth and sixth degrees, mild.
Functional limitation was assessed by 12 ADL categories, which include using the bath or shower, using the toilet, getting dressed or putting on outdoor clothing, combing or brushing hair, getting into and out of bed, and feeding (Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963). Respondents are asked whether they have been able to perform each of the 12 activities without assistance from another individual for at least 3 months. Higher scores are indicative of more functional limitations. Respondents were also asked to provide the average monthly amount of expenses they had related to their disability. One question inquired about respondents’ independent living in the survey. Respondents were asked to rate the degree of their independence on a 5-point Likert-type scale (0 = do it myself, 4 = receive help from others), with higher scores indicating more dependence on others. Only one question was used to assess whether respondents have used disability-related services.
Discrimination factors included personal experiences of domestic violence, perceived social discrimination in general, discrimination against persons with disabilities in particular, degree of deprivation, and any problem(s) caused by disability (Young et al., 1997). Respondents’ experiences of domestic violence and problems caused by their disability were assessed and dummy coded with a value of 1 (yes). Respondents rated perceived levels of social discrimination in general and discrimination against people with disabilities in particular on a 5-point Likert-type scale (0 = no perception of discrimination, 4 = frequent perception of discrimination). The number of incidents in which respondents had experienced deprivation was also reported.
Quality of life was assessed in terms of satisfaction with family, friends, health, and work, on a 5-point Likert-type scale. Respondents’ level of satisfaction was rated in the following domains: family relations, number of friends, house, health status, financial satisfaction, leisure activities, and job satisfaction (Albrecht & Devlieger, 1999; Nosek et al., 1995).
Research Design and Data Analysis
The present study utilizes correlation research design to first identify factors associated with marital satisfaction. Multicollinearity and bivariate correlations were examined to ensure that certain measures were not highly correlated in the models (i.e., variance inflation factor [VIF] < 2.5 for all measures; Kutner, Nachtsheim, & Neter, 2004). More often than not, the use of secondary data can limit the selection of certain variables that do not necessarily satisfy all assumptions for regression analysis. For example, degree of disability variable was not linear, and it was treated as a dichotomous variable (severe, moderate, and mild) for the better fit.
Gender differences in major study variables were compared at the bivariate level, using the independent sample t test for continuous variables and chi-square analysis for categorical variables (Table 1). Multiple regression analysis was then conducted to assess the unique explanatory contribution of marital, familial, disability-related, discrimination, and quality of life factors (Table 2). The researchers ran separate analyses for men and women to examine gender differences.
Gender Comparison of Factors Associated With Marital Satisfaction (N = 1,028)
Note. ADL = activity of daily living; QOL = quality of life.
p < .05. **p < .01. ***p < .001.
Correlates of Marital Satisfaction Among South Koreans With Disabilities (N = 1,028)
Note. ADL = activity of daily living; QOL = quality of life.
p < .05. **p < .01. ***p < .001.
Results
Differences by gender in major study variables are presented in Table 1. Married respondents with disabilities rated the neutral point in terms of their marital quality—neither satisfied nor dissatisfied (M = 2.238, SD = 1.558). Female respondents were less satisfied (M = 1.947, SD = 1.561) than their male counterparts (M = 2.522, SD = 1.503), and this gender difference was statistically significant (t = 6.202, p < .001).
The mean age at the time of marriage for the sample was 27.4 years (SD = 5.00). Women at the time of marriage were younger (M = 25.8, SD = 4.7) than men (M = 29.1, SD = 4.7), and this age difference was also significant (t = −13.128, p < .001). Almost half of the respondents (49.4%) reported disability status at the time of marriage, and the other half acquired their disability following their marriage. No gender difference was found in the disability status at the time of marriage.
About one tenth (10.8%) of the respondents had spouses with a disability. However, the existence of a spouse’s disability was higher among women with a disability (15.2%) than among their male counterparts (7.6%), suggesting a disadvantage for women with disabilities in selecting able-bodied marital partners (χ = 18.501, p < .001). Not surprisingly, the division of labor between husbands and wives in performing housework was not equal, with women taking more responsibility than men for housework (t = 4.319, p < .001).
No gender differences were reported in number of children and having a child with a disability. The socioeconomic indicators of household income, home ownership, and home accessibility also did not differ by gender. The vast majority of respondents had at least one child, and the average number of children was 1.83 (SD = 0.89).
A gender difference was found in the degree of disability: Married women with disabilities had more severe disabilities (χ2 = 20.505, p < .001) and reported more limitations with ADL (t = 2.768, p < .01), than their male counterparts. Married women with disabilities also were more dependent on others in performing daily activities (t = 2.57, p < .01). However, no gender difference was found in expenses related to disability and disability-related service use.
Female respondents perceived more social discrimination and more deprivation in general, whereas their male counterparts reported more disability-related discrimination. These gender differences were not significant. However, married women were significantly more likely to experience domestic violence (χ2 = 30.847, p < .001). Male respondents reported more problems caused by their disability, but this difference was not significant.
Married men with a disability reported greater satisfaction with their family relationships (χ2 = −2.828, p < .01), number of friends (χ2 = −4.149, p < .001), and work (χ2 = −9.005, p < .001) than their female counterparts. No significant gender differences were found in respondents’ satisfaction with their residence, financial status, health status, and leisure activities.
Table 2 presents the results of a regression analysis that examined factors associated with marital satisfaction for the sample as a whole and by gender. Significant indicators for the total sample were older age at marriage (β = .14, p < .001) and less involvement in housework (β = −.08, p < .05). One gender difference was noted: More housework involvement for women (β = .19) and less involvement for men (β = −.23) led to greater marital satisfaction. Among familial factors, a larger number of children (β = .09, p < 001) and higher household income (β = .16, p < .001) were significantly related to marital satisfaction. The only disability-related factor associated with marital satisfaction was no use of community services for people with disabilities (β = −.07, p < .05). The absence of domestic violence (β = −.11, p < .001) significantly improved respondents’ marital satisfaction. Satisfaction with family, family relations, health status, quality of residence, and work were also significant factors, explaining 37% of the variance in marital satisfaction (R2 = .367, F = 21.295, p < .001).
Determinants of marital satisfaction among married women with disabilities were older age at marriage (β = .142, p < .001), more involvement with housework (β = .189, p < .001), higher household income (β = .21, p < .001), and greater satisfaction with family relations (β = .382, p < .001). The amount of variance in marital satisfaction explained was smaller for women (36%, F = 10.432, p < .001) than for men (45%, F = 15.673, p < .001) because more factors were associated with men’s marital satisfaction.
For married men with disabilities, older age at marriage (β = .140, p < .001), less involvement in housework (β = −.225, p < .001), more children (β = .119, p < .01), higher household income (β = .092, p < .05), fewer limitations in performing ADLs (β = −.101, p < .05), and absence of domestic violence (β = −.161, p < .01) predicted greater satisfaction with their marriage. In addition, greater satisfaction with family relations (β = .329, p < .001), friendship (β = .084, p <.05), and work (β = .192, p <.001) were associated with greater marital satisfaction for men. Surprisingly, financial satisfaction was inversely related to marital satisfaction among male respondents (β = −.127, p < .05).
Discussion
For people with disabilities, marital satisfaction can be a significant indicator of their social integration and quality of life, particularly in collectivistic cultures such as South Korea. The findings of this study are consistent with research in Western industrialized countries, demonstrating that the degree to which people with disabilities are satisfied with their marriage can be influenced by a variety of factors, including gender, perceived discrimination, accessibility of the home, social services, socioeconomic status, and subjective well-being (Cano et al., 2004; Geisser, Cano, & Leonard, 2005; Kersh, Hedvat, Hauser-Cram, & Warfield, 2006; Mead, 2002). When it comes to marriage, factors for disabled and able-bodied couples appeared to be universal.
In this Korean sample, major challenges to maintaining a happy marriage among married persons with disability were related to the need to secure sufficient household income, amount of assistance received performing housework, and relational quality among family members. Among familial factors, ensuring financial security with a stable household income was most essential for both men and women with disabilities. Hence, the predictors of marital satisfaction are very similar in a disabled population as they are in a healthy population across cultures.
Gender differences in perceived marital quality are a major finding of this study, which can be replicated in the able-bodied population (Lee et al., 2004; Tsuya et al., 2000). For South Korean wives with disabilities, structural and temporal factors of family and marriage—household income, housework, quality of family relations, and younger age at marriage—were significant. For their male peers, along with such structural factors, contextual factors related to their health, activities, and quality of life were also significant. South Korea has been a patriarchal society; that is, men have enjoyed higher socioeconomic status than women in families and in the society, and consequently have benefited from higher level of access to formal education, employment, health care, and other resources during their life course. These findings were consistent with other Asian patriarchic societies (Chung, Tucker, & Takeuchi, 2008).
Disability-related factors, the main interest of this study, were found to be relatively insignificant in marital satisfaction for this sample. Unexpectedly, the necessity of using disability-related services reduced marital satisfaction among the respondents residing in a rapidly industrializing country. Perhaps, the increased burden of seeking help outside of home already restrained their marital quality. In addition, significantly more women than men sought outside help. This is not surprising in a patriarchal society where men may be less apt to reach outside their familial domain for assistance. Given a short history of social services in South Korea, another factor here may be that these Korean respondents have not had positive experiences receiving disability-related services in past years, which is an important area to explore in the future research.
The findings of this study should be interpreted in light of the limitations inherent in secondary data analyses. For example, selection of the most appropriate variables was limited because the survey included one self-reported measure to assess level of independence and disability-related services. In the future research, the National Disability Survey needs to incorporate more sophisticated assessment of disability-related factors, level of independence, and patterns of service utilization to understand how individuals with disability can direct their life at home and in the community. Such detailed assessment about the disability-specific factors can help policy makers to identify specific disability-related service needs (e.g., transportation, personal attendants, assistance with housework, readers, language interpreter, etc.). Future research should also assess the adequacy of support for those with different disabilities. Finally, cross-cultural study can compare and contrast the marital satisfaction and service needs in a sample residing in Western industrialized counties.
Because of the cross-sectional nature of the data, no conclusions regarding causality can be drawn. The relationships between marital and familial issues, disability, discrimination, life quality, and marital satisfaction can only be described in terms of associations. Clearly, more longitudinal research is needed to note the change of marital quality over time. This is particularly true when studying persons with disability as the natural history of the disability, and its impact on marital satisfaction, may progress over time. Despite its limitations, this study was one of the first to work on a national survey with representative samples from South Korea.
Implications
Passed following years of struggle and demonstrations led by self-advocacy groups of persons with disabilities and other civil society organizations in South Korea, the Anti-Discrimination Against and Remedies for Persons With Disabilities Act (Republic of Korea, 2007) prohibits discrimination based on disability over the whole domains of life—with relation to the family, home, and welfare facilities. Thus, this landmark legislation, enacted in 2009, can provide the legal foundation for the realization of the civil rights of persons with disabilities through their full social participation. Along with this recent legislation, the findings of this study have implications for improving the quality of marital life among people with disabilities in South Korea. Overall, as factors for disabled and fully functional couples are much the same, couples with disability need to be treated, therefore, similar to the able-bodied population.
In a rapidly developing country like South Korea, ensuring financial security with a stable household income is most essential for married couples with disabilities. In spite of recent policy to enhance the welfare of people with disabilities, current spending on all social welfare programs by the South Korean government, at 7.5% of gross domestic product, remains well below the Organization for Economic Co-operation and Development’s [OECD; 2011] average of 20%. The South Korean government should expand public financial assistance to secure minimum living expenses for low-income households headed by persons with disabilities.
The Anti-Discrimination Act mandated that governments, medical facilities, and health care providers take into account the gender of persons with disabilities (Republic of Korea, 2007). Under the act, women with disabilities are entitled to information and services related to contraception, pregnancy, childbirth, and child care. Due to their lower socioeconomic status and high exposure to violence, women with disabilities are considered to be one of the most socially marginalized, at-risk populations in South Korea. This study’s findings on gender disparities and lower marital satisfaction among women with disabilities suggest that gender-specific interventions are needed.
To improve marital satisfaction for women with disabilities, who are at risk for unequal division of labor at home, more functional limitations, and poorer quality of life, services should focus on assistance with housework and improving satisfaction with family relations. Provision of personal attendants can ease the burden of housework, child care, and postnatal care. Rehabilitation professionals can design interventions that address conflict in family relations. Proactive social policy should be implemented to provide education and/or vocational training that would enable women with disabilities to be independent in integrated settings.
Multidimensional approaches are needed to improve marital quality among men with disabilities, who present more diverse needs. Programs and services for these men should focus on increasing satisfaction with work, residence, friends, finance, and degree of independence. Culturally sensitive counseling for men who have experienced domestic violence should be developed to strengthen the family’s potential for carrying out their responsibilities. Given the deleterious impact of domestic violence on marital satisfaction, mental health practitioners should pay special attention to assessing and treating trauma related to family violence.
Finally, a family-centered approach in which the family unit is the focus of attention should be used for assessment, case planning, and decision making. Special attention should be paid to dyads (e.g., couples with disabilities, parent–child dyads with disabilities) who are at a risk for double jeopardy, poorer quality of life, and cumulative disadvantages. Family-centered interventions can assist in mobilizing resources to maximize communication, shared planning, and collaboration among community and neighborhood systems that are directly involved with the family.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.