Improving Family Communication in Older Adults: A Pilot Randomized Controlled Trial (ReFrame-P)

March 19, 2026 updated by: YU Yee Man Branda, The University of Hong Kong

Pilot Evaluation of ReFrame-R: A Communication Training to Reframe Older Adults' Family Roles and Promote Active Aging

This study evaluates the effectiveness of "ReFrame-R," a communication training program designed to help older adults in Hong Kong navigate intergenerational challenges. By focusing on enhancing communication competence and clarifying role boundaries within parent-child relationships, the research seeks to determine if this specialized intervention can improve the mental well-being of both older and younger generations. The study asks whether participating in the "ReFrame-R" curriculum leads to measurable improvements in how families interact, hypothesizing that older adults in the training group will demonstrate significantly better communication quality and a stronger sense of meaning compared to those in a control group. This study also aims to evaluate the program's overall feasibility and acceptability.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

40

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Cantonese-speaking older adults
  • have regular contact with adult children
  • can comprehend traditional Chinese

Exclusion Criteria:

  • known mental health diagnosis
  • mild or higher depressive symptoms (scored ≥5 on the Patient Health Questionnaire [PHQ-9; Kroenke et al., 2001; Manea et al., 2015])
  • communication difficulties

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: ReFrame-R training
The ReFrame-R comprises four weekly 90-minute group sessions (total 6 hours), supplemented by brief weekly individual consultations to troubleshoot barriers and reinforce home practice. Adapted from an existing MI protocol for lay people (Kline et al., 2022), the program is grounded in Family Systems Theory to address over-/underfunctioning dynamics in older parent-adult child relationships, while also emphasizing empathic listening and autonomy-supportive communication. An MI skills booklet will be distributed to support and record home practice.
The ReFrame-R program is adapted from an established Motivational Interviewing (MI) protocol for laypersons (Kline et al., 2022). Grounded in Family Systems Theory, the curriculum specifically addresses over-functioning and under-functioning dynamics often found in older parent-adult child dyads and the cultural specific context of Hong Kong. Unlike general communication workshops, this program emphasizes role boundaries within parent-adult child relationship.
No Intervention: Control group
Participants in the control group will not receive active training during the study period. They will be provided with the same MI skills booklet for reference and self-directed practice.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Perceived communication competence
Time Frame: Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
Participants' self-perceived communication competence is assessed using an 11-item scale adapted from the Family Communication Scale (FCS). The scale consists of 10 items adapted from the original FCS to measure perceived ability to engage in positive communication with adult children, plus an additional item regarding overall communicagtion competence. Each item is rated on a 5-point scale (1-5), with a total score ranging from 11 to 55. Higher scores indicate a higher level of perceived communication competence.
Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
Meaning in life
Time Frame: Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
The 10-item Meaning in Life Questionnaire (MLQ; Steger et al., 2006) is used. It consists of two subscales: presence of meaning (5 items) and search of meaning (5 items). Each subscale is rated on a 7-point scale, with summed scores are calculated (ranged 5-35 for each). Higher scores indicate stronger sense of purpose and motivation to find meaning, respectively.
Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Self-efficacy
Time Frame: Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
Participants' self-efficacy will be assessed using the 6-item General Self-Efficacy Scale (GSE-6; Romppel et al., 2013). It is typically rated on a 4-point scale from 1 to 4. Total scores range from 6 to 24, with higher scores reflecting greater perceived self-efficacy.
Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
Well-being
Time Frame: Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
The 5-item WHO Well-Being Index will be adopted for measuring participants' subjective well-being (Bech, 1998; Kong et al., 2016), rated on a 7-point scale. The WHO-5 score ranges from 0 to 25, zero representing worst possible mental well-being and 25 representing best possible mental well-being.
Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
Role boundaries
Time Frame: Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
We used a 5-item scale adapted from the Control subscale of the Parent-Adult Child Relationship Questionnaire's Relationship with Father component (PACQF; Peisah et al., 1999). While the original scale assess children's perceptions of parental conrtol, this adapted version is a self-report measure for parent to assess their attempt to maintain power, influence, or dominance over their adult children. Each item is rated on a 5-point scale, with a total score ranging 5-25. Higher scores indicater higher levels of parent control, reflecting weaker awareness of role boundaries in parent-adult children relationship.
Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
Family functioning
Time Frame: Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
The 5-item Family Adaption, Partnership, Growth, Affection, Resolve questionnaire (Family APGAR; Chan et al., 1988; Smilkstein, 1978) is used. This scale assesses participants' satisfaction with five aspects of family function. Each item is rated on a 3-point scale (0-2), with a total score ranged from 0 to 10. Higher scores indicate better family functioning.
Baseline, Week 4 (end of training), Week 6 (2 weeks follow-up)
Training appropriateness
Time Frame: Week 4 (end of training)
We used the 4-item Intervention Appropriateness Measure (IAM) from Weiner et al (2017) to access training appropriateness. All items are rated on a 5-point scale (1-5), with an average score being calculated. Higher scores indicate greater perceived appropriateness of training.
Week 4 (end of training)
Training acceptability
Time Frame: Week 4 (end of training)
The 4-item Acceptability of Intervention Measure (AIM) from Weiner et al (2017) is adopted to access training appropriateness. All items are rated on a 5-point scale (1-5), with an average score being calculated. Higher scores indicate greater perceived acceptability of training.
Week 4 (end of training)
Training feasibility
Time Frame: Week 6 (2 week follow-up)
This study used the 4-item Intervention Appropriateness Measure (IAM) from Weiner et al (2017) to access training feasibility. All items are rated on a 5-point scale (1-5), with an average score being calculated. Higher scores indicate greater perceived feasibility of training.
Week 6 (2 week follow-up)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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  • Youth Research Centre. (2019). Strengthening Intergenerational Understanding (Society and Livelihood, Issue. The Hong Kong Federation of Youth Groups. https://yrc.hkfyg.org.hk/2019/12/09/yi048
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  • Wu, M. Y. (2023). The concept of guan in the Chinese parent-child relationship. In C. C. Yi (Ed.), The psychological well-being of East Asian youth (pp. 29-49). Springer Netherlands. https://doi.org/10.1080/13676261.2022.2081494
  • Whitehead, A. L., Julious, S. A., Cooper, C. L., & Campbell, M. J. (2016). Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods in Medical Research, 25(3), 1057-1073. https://doi.org/10.1177/0962280215588241
  • Weiner, B. J., Lewis, C. C., Stanick, C., Powell, B. J., Dorsey, C. N., Clary, A. S., Boynton, M. H., & Halko, H. (2017). Psychometric assessment of three newly developed implementation outcome measures. Implementation science, 12(1), 108. https://doi.org/10.1186/s13012-017-0635-3
  • Wang, Y. L., Wang, Y. H., Leung, D. K. Y., Wong, S. M. Y., Ng, Z. L. Y., Chan, R. C. L., Chan, O. L. H., Chan, W. C., Wong, G. H. Y., & Lum, T. Y. S. (2025). Peer-supported mindfulness-based intervention for managing depressive symptoms in community-dwelling older adults: Protocol for a randomized controlled trial. Contemporary Clinical Trials, 155, 107991. https://doi.org/10.1016/j.cct.2025.107991
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  • Tierney, L., & Beattie, E. (2020). Enjoyable, engaging and individualised: A concept analysis of meaningful activity for older adults with dementia. International journal of older people nursing, 15(2), e12306. https://doi.org/10.1111/opn.12306
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  • Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53(1), 80-93. https://doi.org/10.1037/0022-0167.53.1.80
  • Smilkstein, G. (1978). The Family APGAR: A proposal for family function test and its use by physicians. The Journal of Family Practice, 6, 1231-1239.
  • Sánchez-Cazalla, V., & Gutiérrez-Domingo, T. (2025). Impact of intergenerational programmes on older adults for active ageing. A systematic review. Archives of Gerontology and Geriatrics Plus, 2(3), 100176. https://doi.org/10.1016/j.aggp.2025.100176
  • Romppel, M., Herrmann-Lingen, C., Wachter, R., Edelmann, F., Düngen, H. D., Pieske, B., & Grande, G. (2013). A short form of the General Self-Efficacy Scale (GSE-6): Development, psychometric properties and validity in an intercultural non-clinical sample and a sample of patients at risk for heart failure. GMS Psycho-Social-Medicine, 10, Doc01. https://doi.org/10.3205/psm000091
  • Plys, E., Jacobs, M. L., Allen, R. S., & Arch, J. J. (2023). Psychological flexibility in older adulthood: a scoping review. Aging & mental health, 27(3), 453-465. https://doi.org/10.1080/13607863.2022.2036948
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  • Peisah, C., Brodaty, H., Luscombe, G., Kruk, J., & Anstey, K. (1999). The Parent Adult-Child Relationship Questionnaire (PACQ): The assessment of the relationship of adult children to their parents. Aging & mental health, 3(1), 28-38. https://doi.org/10.1080/13607869956415
  • Olson, D. H., & Barnes, H. L. (2004). "Family communication". In D. H. Olson, D. M. Gorall, & J. W. Tiesel (Eds.), Faces IV package (pp. 1-9). Life Innovations.
  • Nelson, L. J., Duan, X. X., Padilla-Walker, L. M., & Luster, S. S. (2013). Facing adulthood: Comparing the criteria that Chinese emerging adults and their parents have for adulthood. Journal of Adolescent Research, 28(2), 189-208. https://doi.org/10.1177/0743558412467685
  • Moon, H., Park, T., Park, Y., Bae, Y., & Chi, C. (2024). Psychological Dynamics in the Development Process of Panic Disorder: A Qualitative Study on a Family Therapy Case. Journal of Contemporary Psychotherapy, 54(3), 225-233. https://doi.org/10.1007/s10879-024-09616-y
  • Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford Press.
  • Miller, E. A., & Elder, C. R. (2025). Balanced parenting: Proposing a differentiation-based parenting approach informed by Bowen family systems theory. Family Process, 64(1), e13092. https://doi.org/10.1111/famp.13092
  • Marquez, M. P. N. (2019). Family Support and Intergenerational Exchanges. In G. T. Cruz, C. J. P. Cruz, & Y. Saito (Eds.), Ageing and Health in The Philippines. Economic Research Institute for ASEAN and East Asia.
  • Luk, K. W., & Joe-Laidler, K. (2023). Care and Control Revisited: Parent-Youth Co-residence and the Negotiation of Adulthood in Hong Kong. Journal of Youth Studies, 26(10), 1273-1292. https://doi.org/10.1080/13676261.2022.2081494
  • Lo Cricchio, M. G., Lo Coco, A., Cheah, C. S., & Liga, F. (2019). The good parent: Southern Italian mothers' conceptualization of good parenting and parent-child relationships. Journal of Family Issues, 40(12), 1583-1603. https://doi.org/10.1177/0192513X19842598
  • Liu, Y. (2024). The relationship and heterogeneity of family participation and social participation among older adults: from an intersectionality perspective. BMC Geriatrics, 24, 949. https://doi.org/10.1186/s12877-024-05545-6
  • Li, X. (2021). How do Chinese fathers express love? Viewing paternal warmth through the eyes of Chinese fathers, mothers, and their children. Psychology of Men & Masculinities, 22(3), 500-511. https://doi.org/10.1037/men0000312
  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine, 16(9), 606-613.
  • Kong, C. L., Lee, C. C., Ip, Y. C., Chow, L. P., Leung, C. H., & Lam, Y. C. (2016). Validation of the Hong Kong Cantonese Version of World Health Organization Five Well-Being Index for People with Severe Mental Illness. East Asian Archives of Psychiatry, 26(1), 18-21.
  • Kline, E. R., Thibeau, H., Davis, B. J., Fenley, A., Sanders, A. S., Ipekci, B., Oblath, R., Yen, S., & Keshavan, M. S. (2022). Motivational interviewing for loved ones: Randomized controlled trial of brief training for first episode psychosis caregivers. Schizophrenia research, 250, 43-49. https://doi.org/10.1016/j.schres.2022.10.005
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  • Hong Kong Census and Statistics Department. (2023). Hong Kong Population Projections for 2022 to 2046 (Hong Kong Population Projections, Issue. HKSAR government. https://www.censtatd.gov.hk/en/EIndexbySubject.html?scode=190&pcode=FA100061
  • Ho, H. C., Mui, M., Wan, A., Stewart, S. M., Yew, C., Lam, T. H., & Chan, S. S. (2017). Happy Family Kitchen: Behavioral outcomes of a brief community-based family intervention in Hong Kong. Journal of Child and Family Studies, 26(10), 2852-2864.
  • Dong, X. Y., Ling, H. X., Yang, T. Y., & Wang, K. (2023). Grandchild care and life satisfaction of older adults: Empirical evidence from China. Frontiers in Psychology, 14, 1081559. https://doi.org/10.3389/fpsyg.2023.1081559
  • Chan, D., Ho, S., & Donnan, S. (1988). A survey of family APGAR in Shatin private ownership homes. Hong Kong Practitioner, 10, 3295-3299.
  • Campbell, F., Whear, R., Rogers, M., Sutton, A., Robinson-Carter, E., Barlow, J., Sharpe, R., Cohen, S., Wolstenholme, L., & Thompson-Coon, J. (2023). Non-familial intergenerational interventions and their impact on social and mental wellbeing of both younger and older people-A mapping review and evidence and gap map. Campbell Systematic Reviews, 19(1), e1306. https://doi.org/10.1002/cl2.1306
  • Caldwell-Harris, C., Kronrod, A., & Yang, J. (2013). Do more, say less: Saying "I love you" in Chinese and American cultures. Intercultural Pragmatics, 10(1), 41-69. https://doi.org/10.1515/ip-2013-0002
  • Boreham, I. D., & Schutte, N. S. (2023). The relationship between purpose in life and depression and anxiety: A meta-analysis. Journal of Clinical Psychology, 79, 2736-2767. https://doi.org/10.1002/jclp.23576
  • Bordone, V., & Arpino, B. (2019). Grandparenthood, grandchild care and depression among older people in 18 countries. Journal of Family Research, 31(2/2019), 216-239. https://doi.org/10.3224/zff.v31i2.06
  • AshaRani, P. V., Lai, D., Koh, J., & Subramaniam, M. (2022). Purpose in Life in Older Adults: A Systematic Review on Conceptualization, Measures, and Determinants. International journal of environmental research and public health, 19(10), 5860. https://doi.org/10.3390/ijerph19105860
  • Ahmed, S. K., Mohammed, R. A., Nashwan, A. J., Ibrahim, R. H., Abdalla, A. Q., Ameen, B. M. M., & Khdhir, R. M. (2025). Using thematic analysis in qualitative research. Journal of Medicine, Surgery, and Public Health, 6, 100198. https://doi.org/10.1016/j.glmedi.2025.100198

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

April 1, 2026

Primary Completion (Estimated)

February 1, 2028

Study Completion (Estimated)

February 1, 2028

Study Registration Dates

First Submitted

March 16, 2026

First Submitted That Met QC Criteria

March 19, 2026

First Posted (Actual)

March 27, 2026

Study Record Updates

Last Update Posted (Actual)

March 27, 2026

Last Update Submitted That Met QC Criteria

March 19, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Other Study ID Numbers

  • EA260121
  • 2501262488 (Other Grant/Funding Number: The University of Hong Kong)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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