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

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: Intergenerational Relations
• Intervention / Treatment: Behavioral: ReFrame-R

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yee Man Branda Yu; Phone Number: +852-39173914; Email: branda.yu@hku.hk

Participation Criteria

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

How is the study designed?

Design Details

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

Number of Arms

2

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.	Behavioral: ReFrame-R; 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	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	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	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	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	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	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	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	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	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

• Sponsor: The University of Hong Kong

Publications and helpful links

General Publications

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Study record dates

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

• Keywords: Motivational interviewing; Pilot randomized controlled trial; Meaning in life; Intergenerational Communication; Parent adult±child relationship
• 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