FAMH1002A

FAMH1002A- Person, Family and Community 1

Reflection - Duvall’s Family Life Cycle 

Studying Duvall's Eight Stages of Family Life Cycle has fundamentally transformed my understanding of families, their role in health, and how I should approach them as a future healthcare practitioner. This framework has revealed that families are not static units but dynamic systems that evolve through predictable stages, each with unique characteristics, developmental tasks, and health challenges. 

1, Before engaging with Duvall's framework, I held a somewhat narrow conception of what constitutes a family, likely imagining the traditional nuclear family. However, this learning experience has expanded my perspective considerably. I now understand that family is a dynamic entity that transforms dramatically across the life cycle.

Duvall's stages have shown me how family structure changes over time. A beginning family in Stage 1 consists of a married couple making decisions about parenthood. This transforms in Stage 2 when the first child arrives, creating a permanent system. The family continues to expand and become more complex through Stages 3 and 4 as children grow. By Stage 6, when young adults begin leaving home, the family structure shifts again to include in-laws and grandchildren. Finally, in Stages 7 and 8, the family contracts back to the couple, now embedded within a multigenerational network.

However, I've also recognized that Duvall's model is based on Western, middle-class assumptions. In reality, families may be single-parent households, blended families, or multigenerational units. Economic factors, cultural traditions, and life disruptions like divorce or death can alter how families progress through these stages. This has taught me that "family" should be defined broadly as whoever provides love, support, and care, regardless of biological ties or marital status. My role as a healthcare provider is not to impose a particular family structure but to understand and work with the family configuration before me.

2. Perhaps the most significant shift in my thinking concerns the family's influence on health outcomes. Previously, I viewed health primarily as individual responsibility. Now I recognize that families are the primary context in which health behaviours are learned, modelled, and reinforced throughout life.

Each stage presents distinct health challenges. In Stage 2, childbearing families establish foundational health practices around nutrition, sleep, and exercise. During Stages 3 and 4, families face challenges related to accident prevention and communicable diseases. Stage 5 brings concerns about substance abuse, sexual health, and mental health. Stages 6 and 7 involve caring for both young adults and aging parents while managing emerging chronic conditions. Stage 8 confronts families with functional disabilities, chronic illness, and end-of-life issues.

What strikes me most is that health and illness cannot be separated from family context. When one family member becomes ill, it affects the entire family system. Conversely, family dysfunction and stress manifest as physical and psychological symptoms across members. The family is simultaneously a resource for health and a potential source of health risks.

3. This understanding has fundamentally changed my vision of clinical practice. I initially imagined treating individual patients with specific conditions. Now I understand that effective healthcare requires seeing each patient within their family system and engaging the family as partners in care.

A family-centered approach must be adapted to each life cycle stage. In early stages (1-2), I should emphasize health education, family planning, and anticipatory guidance for new parents. During Stages 3-5, my focus should be on promoting healthy development, preventing injuries, and supporting parent-child communication, including sensitive discussions about sexual health and substance abuse in Stage 5. In Stage 6, I need to recognize parents may be managing their own health issues while supporting young adults and caring for aging parents. Stages 7-8 require engagement focused on chronic illness management, supporting caregivers, and facilitating end-of-life conversations.

Several key principles should guide my practice across all stages. I must routinely assess family context and involve family members in treatment decisions when appropriate. I need to understand that treating one family member affects others and that family dysfunction often requires family-level intervention. I should offer holistic interventions including family therapy and community resources, not just individual medical treatment. I must remain sensitive to cultural variations in family structure and coordinate care across the family system.

Reflecting on Duvall's Family Life Cycle has profoundly shaped my understanding of families and my future role as a healthcare practitioner. I now see that families are dynamic systems that shape health beliefs, behaviors, and outcomes across the lifespan. As I move forward in my training, I am committed to embracing a truly family-centered approach that recognizes the family's central role in health and healing. Ultimately, excellent healthcare is not just about clinical expertise but about building therapeutic relationships with families and supporting them through the challenges and transitions of the entire family life cycle. 

References:

Duvall, E. M., & Miller, B. C. (1985). Marriage and family development (6th ed.). New York: Harper & Row. 

Klein, D. M., & White, J. M. (1996). Family theories: An introduction. Thousand Oaks, CA: Sage Publications. 

Tutorial Reflection – Navigating Family Dynamics in Healthcare Practice 

The most significant insight I'm taking away from this tutorial is the recognition that patient autonomy and family influence are not mutually exclusive concepts that must be in conflict but rather exist in a dynamic tension that requires cultural humility and creative problem-solving to navigate effectively.

Through the case discussions, particularly the first case where a patient refuses treatment due to elder family member disapproval, I've come to understand that Western biomedical ethics often prioritizes individual autonomy in ways that may not align with the collectivist decision-making patterns prevalent in many South African families and cultures. In many communities, family elders hold legitimate authority in healthcare decisions, and excluding them from the process can actually harm the patient by creating family conflict or social isolation.

Rather than viewing the elder's disapproval as an obstacle to overcome, I now see it as an invitation to engage the family system in care. My role as a future healthcare practitioner is not to choose between respecting cultural values and protecting patient wellbeing, but to facilitate a process where both can be honoured. This might involve:

• Inviting the elder to participate in consultations to understand their concerns

• Providing culturally appropriate education to the entire family unit

• Exploring compromise solutions that address the elder's values while ensuring patient safety

• Building trust and relationship with the family over time rather than demanding immediate compliance

Ultimately, this tutorial has shifted my perspective from viewing family as simply "the patient's background" to understanding family as the primary context within which health and illness occur. Effective family medicine requires me to think systemically, act culturally, and practice with humility about the limits of biomedical knowledge in solving problems rooted in social inequality and cultural difference. 

Artifact Description: This reflective piece captures key insights gained from a tutorial session on family dynamics, healthcare decision-making, and the social determinants of health. The reflection explores the tension between individual patient autonomy and collective family decision-making in culturally diverse contexts. The artifact demonstrates critical thinking about how Western biomedical ethics must be adapted to respect cultural values while ensuring patient wellbeing and recognizes the broader social and economic structures that shape health outcomes beyond clinical interventions. This reflection represents a shift toward systemic, family-centered thinking essential for effective primary care practice in South Africa. 

Activity- Ecology of Medical Practice

Components of Medical Ecology include:

• Humans: As hosts and active participants in their environment, humans influence and are influenced by ecological factors. Their behaviours, lifestyle, and socio-economic status shape health risks. For example, poor sanitation or overcrowded housing can increase exposure to pathogens.

• Pathogens: These are disease-causing microorganisms such as bacteria, viruses, fungi, and parasites. Their presence and virulence can be affected by environmental conditions such as climate, pollution, and hygiene practices. For instance, increased temperatures can expand the range of some vectors like mosquitoes, leading to more cases of diseases like malaria or dengue.

• Environment: Comprising physical, chemical, biological, and social factors, the environment includes elements such as water quality, air pollution, climate, land use, and biodiversity. It plays a critical role in either suppressing or facilitating the spread of pathogens. For example, polluted water sources can become breeding grounds for waterborne diseases.

Interactions between these components are crucial. For instance, environmental pollution can weaken human immune defenses or create breeding sites for vectors, increasing disease transmission. Alternatively, human activities like deforestation can alter local ecosystems and pathogen distribution, leading to emerging health threats.

Reflecting on these concepts, I see that health is not just a matter of individual biology but is deeply embedded in ecological and social contexts. The health of a community depends on maintaining a delicate balance among these components. Disruptions, whether through environmental degradation, pollution, or social inequalities, can significantly elevate disease risks. This understanding reinforces the importance of adopting a holistic, ecological perspective in medicine that considers environmental sustainability, community behaviours, and pathogen ecology. It also highlights how interventions that preserve or restore ecological balance, such as conservation efforts, improved sanitation, or climate adaptation, can have profound impacts on public health.  

Reflection: Understanding Medical Ecology and Social Determinants of Health

Studying medical ecology has fundamentally shifted my perspective from a biomedical focus on pathogens and treatments to recognizing that health outcomes emerge from complex interactions between humans, pathogens, and their environments. Clinical symptoms are merely visible manifestations of these underlying ecological dynamics.

The most significant realization is that sustainable health improvements require addressing root causes, not just treating symptoms. If children repeatedly present with diarrheal diseases, prescribing medication treats individual cases but doesn't prevent future ones. Investigating environmental factors, such as water quality, sanitation, housing conditions, and implementing community-level interventions creates lasting change.

This ecological perspective is particularly relevant in South Africa, where health disparities reflect social and environmental inequalities. Informal settlements with inadequate infrastructure create environments where infectious diseases thrive. Addressing these requires moving beyond individual clinical care to population-level interventions that modify environments and strengthen communities.

Medical ecology provides the theoretical foundation for Community-Oriented Primary Care (COPC). COPC extends healthcare beyond clinic walls into communities to address the ecological factors shaping health. Community health workers embody this approach; they assess home environments, identify hazards, connect families with resources, and advocate for community improvements like better sanitation.

Understanding medical ecology and social determinants of health will transform my future practice. I must ask not only "What are your symptoms?" but also "Where do you live? What is your water source? What is your housing situation?" When I see disease patterns, I must investigate shared environmental exposures rather than treating cases in isolation. My role extends beyond individual care to advocating for policies addressing environmental determinants and collaborating with housing authorities, schools, and community organizations.

Ultimately, medical ecology teaches that achieving health equity requires addressing upstream social determinants—poverty, education, housing, food security. Clinical excellence alone cannot overcome the health impacts of inadequate living conditions. True population health improvement requires an ecological approach that identifies and modifies environmental determinants while strengthening individual and community resilience. This understanding will guide me toward practicing medicine that is clinically competent, socially conscious, community-engaged, and ultimately more effective in improving health outcomes.

References:

Merson, Black, and Mills. (2011). Global Health. [online] Available at:  9781284122626_FMxx_16094_1.pdf (jblearning.com) [Accessed 13 August 2025].

White, K.L., Williams, T.F. and Greenberg, B.G., 1961. The Ecology of Medical Care. New England Journal of Medicine, 265(18), pp.885-892.

Artifact Description: This portfolio entry explores the components of medical ecology (host, agent, and environment) and their dynamic interactions in determining health outcomes. It includes a response to the spark question prioritizing environmental assessment in addressing recurring childhood illness, and a reflection on how understanding medical ecology and social determinants of health transforms clinical practice from symptom-focused treatment to addressing root causes through community-oriented, population-level interventions essential for health equity in South Africa. 

Activity- Assessment of Community Needs and Mapping Community Assets

What are the main differences between needs assessment and asset mapping?

Needs assessment focuses on identifying gaps, deficits, and unmet health and social needs in a community, often highlighting problems to be resolved. In contrast, asset mapping emphasizes recognizing and leveraging existing community strengths, resources, capacities, and capabilities that can promote health and wellbeing. The asset-based approach views communities as having inherent strengths rather than only deficits, aiming to empower them by building on these assets rather than solely addressing needs. 

What examples of community assets did the authors mention?

The authors mention diverse examples of community assets including community demographic characteristics (like literacy rates and age groups), natural resources and geographical location, economic capitals (such as businesses and income), community infrastructure (technology access, transportation, parks), social and educational facilities (such as schools, faith communities, community organizations), health and social facilities (clinics, traditional medicine providers), and social and cultural values (family bonds, community cohesion, cultural diversity, spirituality). 

How can identifying assets influence planning future interventions?

Identifying community assets helps planners design interventions that are more culturally relevant, sustainable, and empowering by leveraging existing resources and capabilities within the community. This strength-based approach encourages community participation and ownership, fosters resilience, and can enhance trust and collaboration between service providers and community members. It also helps in making efficient use of limited resources by building on what the community already has, rather than duplicating or ignoring local capacities. 

Artefact description: This activity involved critically reading and reflecting on an academic article about community health needs and asset assessments. The goal was to understand the concepts of assessing community health from both deficit (needs) and strength (assets) perspectives. This included comparing needs assessment and asset mapping, identifying examples of community assets, and exploring how recognizing these assets can guide planning effective, community-based health interventions. The exercise aimed to deepen understanding of population health approaches and to prepare for applying these concepts in future community health planning or research. 

Introduction to COPC tools- Situational Analysis; LISA tool; SWOT tool

Reflection- Analysing the community that I live in

Artefact description: This portfolio entry applies the SWOT analysis tool to analyse the community that i live in. The analysis identifies internal strengths and weaknesses, alongside external opportunities and threats.

Activity- Situational Analysis Template for Community- based Learning Task, Day 1

1. Community Description:

• Location and demographics (age, gender, socio-economic status)

• Cultural and social characteristics

• Community identity and cohesion

2. Health Needs Assessment:

• Key health challenges identified (e.g., chronic diseases, mental health issues)

• Gaps in healthcare services and accessibility

• Unmet social determinants of health

3. Community Assets Mapping:

• Existing healthcare services and resources (clinics, therapists, nurses)

• Community strengths (e.g., active community groups, skilled staff, recreational activities)

• Social support networks (families, volunteers, local organizations)

• Physical infrastructure and facilities (elderly care centers, parks, transport)

4. Stakeholder Analysis:

• Main stakeholders (community members, health workers, local government)

• Roles and influence on community health

• Collaboration and communication channels

5. SWOT Analysis:

• Strengths (e.g., personalized care plans, therapy programs)

• Weaknesses (e.g., staff training gaps, limited mental health support)

• Opportunities (e.g., workshops, social media engagement)

• Threats (e.g., funding constraints, increasing dementia cases)

6. Intervention Priorities and Recommendations:

• Training and capacity building (e.g., dementia workshops, shadowing programs)

• Enhancing community and family involvement (e.g., family workshops)

• Communication and awareness strategies (e.g., social media presence)

• Resource mobilization and sustainability plans

Reflection- Applying COPC Elements to Ron Smith Care Centre

Through my community-based learning visit to Ron Smith Care Centre, I can apply several key COPC elements to working with residents who have intellectual disabilities. 

Community health diagnosis is essential: systematically assessing residents' health status, functional abilities, common conditions (mobility challenges), available resources (staff, facilities), and barriers to care (communication difficulties, transportation) provides the foundation for targeted interventions. 

Comprehensive and continuous care integrates promotion (skills development, social engagement), prevention (medication management, safety measures), curative care (medical treatment), and rehabilitation (occupational therapy) demonstrating that health extends beyond treating illness to maintaining function and quality of life. 

Intersectoral collaboration is critical, as residents' wellbeing requires partnerships between healthcare providers, social workers, disability services, families, and government departments to address needs beyond the health sector's control. 

Addressing social determinants of health, such as secure housing, social support, protection from stigma and abuse, income security, is fundamental because medical treatment alone cannot overcome the health impacts of inadequate social conditions. 

Applying these COPC elements at Ron Smith has shown me that effective care for vulnerable populations requires moving beyond individual clinical treatment to holistic, community-engaged approaches addressing the broader determinants shaping health outcomes.

Artifact Description: This reflection identifies key COPC elements applicable to community-based learning at Ron Smith Care Centre. The reflection demonstrates how COPC frameworks inform care for vulnerable populations with intellectual disabilities through holistic, collaborative approaches beyond individual medical treatment.