Family Vulnerability, Disruption, and Chaos Predict Parent and Child COVID-19 Health-Protective Behavior Adherence

Introduction: This study examined the role of family functioning in predicting family adherence to health-protective behaviors (HPBs) aimed at reducing COVID-19 spread. Pre-COVID-19 family functioning, disruptions to family functioning (cohesion, conflict, routines), and family chaos during the COVID-19 pandemic were tested as pathways to HPB adherence. Method: We utilized a sample of N = 204 families, comprising parents who had children (M_age = 4.17). Parents (M_age = 27.43) completed one survey prior to COVID-19 onset in the United States, and twice during COVID-19, at a 2-week interval. Structural equation modeling was used to test three potential pathways between prepandemic family-level functioning and HPB adherence during the COVID-19 pandemic. Results: Findings indicated that families with higher levels of chaos during COVID-19 demonstrated consistently lower HPB adherence across all three models. Additionally, disruptions in family cohesion from pre-COVID was associated with lower levels of parent and child HPB adherence. Family conflict was indirectly associated with HPB adherence via family chaos during COVID-19; whereas family routines were not associated with HPB adherence at all. Discussion: These findings suggest that family functioning is a meaningful predictor of HPB adherence. Family-based support may be effective in improving HPB adherence by focusing on promoting cohesion and reducing conflict and chaos for families coping with reduced community support and resources. Strategies for family-based supports are discussed.