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Int J Disabil Hum Dev 2016; aop

Viviana Luca Aya-Gmez, Amalia Alexandra Ovalle Parra, Victoria Cabrera-Garcia*,


Diana Sthefania Muoz-Gmez and Claudia Alejandra Duque Romero

Validation of the family needs assessment


scale for Colombian families with children with
intellectual disability
DOI 10.1515/ijdhd-2016-0033
Received June 21, 2016; accepted August 30, 2016

Introduction

Abstract: This study documents the development and


validation of the childrens version of the Family Needs
Assessment (FNA) instrument for Colombia. The FNA is
a scale that evaluates the needs of families with children
with disabilities who are below the age of 18 years. To
validate this scale, the research team identified the theoretical background regarding family members needs and
performed a linguistic adaptation of the scale, which was
reviewed to guarantee its validity through cognitive interviews and a pilot study. Results from the exploratory factor analysis (EFA) showed 72 items distributed in a 4-factor
solution. Cronbachs alpha coefficients for each factor and
for the overall FNA scale were also estimated. Specifically,
alpha computed from the correlation among the 72 items
was 0.97 and ranged from 0.85 to 0.95 for the four factors.
Findings from this study provided evidence to support the
validity of the FNA for families with children with intellectual disability in Colombia. The findings also indicated
that the FNA has the potential of contributing to a better
understanding of inputs (e.g. needs of families with individuals with disability) with the aim of informing system
decisions, enhancing policies, improving services and
strengthening family-professional partnerships.

The importance of family for persons with disabilities


and the concrete needs of these persons have been highlighted by various authors. Specifically, studies show the
pertinence of offering support to the family members in
accordance with the different needs of the entire nuclear
family [15].
The evaluation of these needs through validated
instruments allows for their real identification and the
adequate incorporation of publications aimed at satisfying those needs. In accordance with the international
and national juridical framework in the area of disability,
Colombia is a signatory of the Convention on the Rights of
Persons with Disabilities [6], which considers the family
as the natural and fundamental collective unit of society
and, simultaneously, recognizes it as subject to special
protection, with the aim of guaranteeing the rights of
persons with disabilities through this convention.
Similarly, national legislation has established a legal
framework for the protection of persons with disabilities.
In a special way, Law 1618 of 2013 establishes the dispositions to guarantee and ensure full exercise of the rights
of persons with disabilities, establishing their definitions
and principles, their measures of protection, the obligations and duties of the State and society and strategies to
improve the programs and services directed to this population [7].
To implement public policy on disability and to
ensure the quality of its services, the direct needs of these
families must first be explored. For this purpose, the most
frequently used strategy to obtain quantitative data is
through self-reporting questionnaires because of their
pertinence in measuring variables and in their efficiency
in data collection [8, 9].
Therefore, this study is justified to the extent that it
aims to validate a questionnaire that evaluates the needs
of families with persons with disabilities in Colombia. Previous studies have used different instruments to evaluate
certain aspects related to quality of life [10, 11]. The relationship of the family with the different professionals that

Keywords: children; Colombia; family needs; intellectual


disability; scale; validation.

*Corresponding author: Victoria Cabrera-Garcia, Universidad de


La Sabana, Campus del Puente del Comn, Km. 7, Autopista Norte
de Bogot, Cha, Cundinamarca, Colombia, Chia 22645, Colombia,
E-mail: victoria.cabrera@unisabana.edu.co
Viviana Luca Aya-Gmez and Diana Sthefania Muoz-Gmez:
Universidad de La Sabana, Campus del Puente del Comn, Km.
7, Autopista Norte de Bogot, Cha, Cundinamarca, Colombia,
Chia,Colombia
Amalia Alexandra Ovalle Parra and Claudia Alejandra Duque
Romero: Universidad de Ibague, Carrera 22# 67B Ambal,
Ibague,Colombia

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serve them [12], the needs for social inclusion [13] and the
support on which families in different countries can rely
[14, 15].
The principal antecedent of this study is the validation of the Family Needs Assessment (FNA) scale for
Taiwanese families with persons with disabilities with
children with intellectual disabilities [16]. The authors
validated this scale using an exploratory factorial analysis (EFA) with the aim of obtaining the simplest and most
coherent structure. The adjustment of the model was
statistically significant, and the questions that obtained
factor loadings >0.32 were considered. The internal
consistency of the factors each obtained a Cronbachs
alpha >0.80. Similarly, seven factors were obtained
that accounted for 63.61% of the variance. These factors
included (1) disability-related services, (2) caregiving, (3)
social connection, (4) hope, (5) family resources, (6) economics and (7) recreation.
The design of the FNA questionnaire was based on the
theory of the Family Quality of Life (FQOL) model, which
explains the following:
System factors directly affect individual- and familylevel supports, services and practices. Individual-member
concepts (i.e. demographics, characteristics and beliefs)
and family-unit concepts (i.e. dynamics and characteristics) are direct predictors of FQOL and also interact with
individual- and family-level supports, services and practices to predict FQOL. Singly or combined, the model
predictors result in an FQOL outcome that produces new
family strengths, needs and priorities that re-enter the
model as new input, resulting in a continuous feedback
loop throughout the life cycle [17].
In accordance with these antecedents, the evaluation of the needs of families with persons with disabilities through various psychometric instruments has had
limitations in its comprehensiveness, accessibility, contemporariness and cultural appropriateness. Specifically,
comprehensiveness alludes to the difficulty in the comprehension of the content of the questions because of the
reduction in their number, which is a product of the factorial analysis. Accessibility refers to the difficulty in the
availability of the psychometric instruments for families
and professionals. Third, contemporariness refers to the
absence of instruments that respond to new family needs.
Finally, cultural appropriateness implies the difficulties in
translation in accordance with the linguistic and cultural
context of each country.
The FNA arose as part of an international research
project that comprised the United States, Spain, Turkey,
China, Taiwan and Colombia. The research in each of
these countries was conducted because of the need for

instruments that were appropriate for each of the cultural contexts and in such a way as to identify the needs
of families with persons with disabilities and using that
information to orient the programs, policies and services
of each country.
In this way, the current investigation aimed to answer
the following research question:
Is the FNA survey an instrument that has sufficient
psychometric properties to be considered a tool with
acceptable trustworthiness and validity for the Colombian
context?

Methods
Participants
The sample consisted of 573 participants who were residents of the
most representative cities in Colombia. All the participants were primary caregivers of children with disabilities and lived in the same
house with the children. The majority of the participants were family
members of the children, and only some participants were unrelated.
However, they were considered as the childrens primary caregivers
by the family. The children ranged in age from 1 to 17years (M=9.48
years; SD=4.60 years). All the children were diagnosed with an
intellectual disability issued by the National Council of Disability in
Colombia based on an intelligence quotient (IQ) test. Furthermore,
the participants were organized into three groups to analyze their
monthly economic income: (1) monthly income less than the minimum salary in Colombia (616,027 COP=208 US$ approximately), (2)
monthly income between 1 and 4 minimum salaries and (3) monthly
income of more than 4 minimum salaries. Table 1 shows detailed
information on the demographic variables of the participants.

Instruments
The FNA questionnaire was used. This questionnaire was designed
by a multinational team of researchers and was previously validated
with Taiwanese families [16]. It is a questionnaire oriented towards
identifying the needs of families with persons with intellectual and
development disabilities in 11 areas of family functioning: (1) family relations, (2) emotional health, (3) health, (4) family finances,
(5) social relations, (6) free time, (7) spirituality, (8) daily care, (9)
teaching, (10) access to services and (11) changes over the course of
ones life. The answer options are on a Likert-type scale and range
from 1 to 5, in which 1 corresponds to no need and 5 to very high
need.
To perform the concurrent validation, the version of the FQOL
scale validated for Colombia [Escala de Calidad de Vida Familiar
(ECVF)] was used [18]. It is a Likert-type scale with an answer range
between 1 and 5, in which 1 corresponds to low satisfaction and 5 to
very satisfied with the quality of family life. It consists of 41 items
grouped into 5 factors: (1) family interaction, (2) parental role, (3)
health and security, (4) family resources and (5) support for persons
with disabilities.

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Table 1:Demographics (n=573).

Relationship with child with disabilities


Father

Mother

Siblings

Grandparents

Other family member

Other unrelated person

Work situation of caregiver

Full-time work

Part-time work

Unemployed

I do not work (retired, home, illness)

Monthly income
Less than 616,027 (COP)

Between 616,027 and 2,464,000 (COP)


More than 2,464,000 (COP)

Sex of person with disability


Boy

Girl

Childs age

Younger child (06 years)

School age (718 years)

Level of disability
Light

Moderate

Severe

Profound

Does not know or did not answer

Other diagnosis
Autism spectrum disorder

Physical disability

Visual disability

Auditory disability

Speech or language disorder

Attention deficit and hyperactivity disorder


None

Percentage

91
377
34
34
20
17

123
142
84
224

15.9
65.8
5.9
5.9
3.5
3
21.5
24.8
14.7
39.1

153
296
124

26.7
51.7
21.6

313
260

189
384

54.6
45.4

195
173
62
15
128

34
30
10.8
2.6
22.3

105
85
21
8
39
22
293

18.3
14.8
3.7
1.4
6.8
3.8
51.1

33
67

Third, the FNA pilot study was developed for a sample of 20


participants to obtain social validation and feedback from the participants regarding length, usability and perceived helpfulness of the
FNA [22].

Statistical analysis
The participants answers were collected using the Qualtrics software
and were subsequently exported to the SPSS program. At first, data
corresponding to 590 families were collected; however, the data of 17
of these families were not included because the answers were 15%
incomplete (the participants did not reply to more than 11 items of
the FNA). Thus, the data analysis was performed using the data of
573 participants.
The analysis of the psychometric properties of the FNA questionnaire began with the confirmation of whether the empirical structure
of the scale corresponds with the theory in the Colombian context;
for this, confirmatory factorial analysis (CFA) was used, using structural equations modeling (SEM).
Prior to the EFA, the Kaiser-Mayer-Olkin (KMO) index, Bartletts
test of sphericity and the determinant were estimated. The first two
analyses aimed to create doubt around the feasibility of performing
the factorial analysis, and the third analysis allowed for the verification of the absence of multicollinearity among the different factors of
the scale [23]. In the total sample, the extraction of the factorial model
was founded on two basic principles: parsimony, which means that
the factorial solution must be simple and composed of the smallest
possible number of factors or components; the other principle consists of the necessity for the extracted factors to be statistically significant and susceptible to substantive interpretation [24].
Given that the confirmatory analysis did not provide evidence
of a good adjustment of the theoretical model of the 11 initially proposed factors, an EFA was subsequently performed to elucidate the
proper structure in the Colombian context.
The analysis of the reliability of the questionnaire was performed using the coefficient of Cronbachs alpha for the subscales,
and a high internal consistency was considered for values >0.8 [25].
Finally, the concurrent validity was estimated using an analysis of
covariance between the FNA and the ECVF. Theoretically, heightened
family needs relate to low satisfaction with the quality of family life.

Procedure
The participants were contacted through different institutions
that worked with children with intellectual disabilities. They were
informed of the objectives of the study and of the anonymous and
confidential use of the information according to the ethical norms
and criteria for research involving persons in Colombia. Subsequently, the principal caregivers of the children signed the informed
consent forms, and their questions about the study were answered.
During the FNA validation process [19], the linguistic adaptation of the items was first made in accordance with the Colombian
context. For this purpose, the instrument was submitted to the evaluation of 10 expert judges (linguists, experts in issues of disability and
family members of persons with disability) regarding quality and
relevance [20]. Subsequently, cognitive interviews were performed
with five primary caregivers of children with disabilities with the aim
of obtaining qualitative information to identify whether the items
evaluated what they intended to evaluate [9, 21].

Results
CFA of the original structure of the FNA
The goodness-of-fit statistics of the SEM for the original
structure of the FNA, which consists of 11 factors, showed
a low adjustment of the model to the data: the correlations matrix of the latent variables (factors) was singular;
thus, it was necessary to identify a new model adjusted to
the Colombian context. The comparative fit index (CFI) of
0.684 was not greater than the reference value of 0.95, and
the nono-normed fit index (NNFI) of 0.668 was also not
greater than the reference value of 0.90.
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In consequence, the hypothesis of these models was
rejected, and the original structure of the FNA with 11 factors
did not adjust to the Colombian context; thus, this study
sought to perform a better exploration of the structure of the
latent variables and the items that adjust to the data.

EFA of the structure of the FNA


Prior to the EFA, the KMO test was 0.95, and Bartletts
test of sphericity was X2 (2926)=30,713.540 and p=0.000.
These results show that there is no doubt in the feasibility
of performing the factorial analysis. Similarly, the determinant was 3.530, which implies the absence of multicollinearity among the factors.
To run the factorial analysis, the Promax rotation
was used. The questions with factor loadings >0.40 were
chosen and nine items that had a lower factor loading
were eliminated (#4, #14, #17, #53, #54, #62, #66, #70 and
#71). Of the 68 remaining items, four (#18, #28, #40 and
#63) had factor loadings >0.40 in more than one factor.

The EFA initially generated 13 factors; however, upon


examination of the matrix of correlation and the items that
remained, we determined to keep eight factors because
factors 9, 10, 11 and 13 had only one question and factor 12
did not group any questions.
In the model that grouped into four factors, those
factors explained a total of 49.58% of the variance. Factor
1, family and social interaction, accounted for 35.56% of the
variance and was integrated by 26 items that refer to activities and interactions among family members and with other
social groups. Factor 2, disability-related services, explained
5.74% of the variance and contained 27 items that were associated with services in different areas that can provide for
the needs of the child with disabilities and his or her family.
Factor 3, economics and planning the future, accounted for
5.08% of the variance and was integrated by 13 items related
to securing economic resources for current and future
needs. Finally, factor 4, caregiving and teaching, explained
3.20% of the variance and contained six items related to
the activities of daily care and the teaching of independent
living skills to the child with disabilities (Table 2).

Table 2:Item loading on factors.


Factors

Loading

Factor 1. Social and family interaction


3. Participating in preferred indoor community recreational activities (e.g. movies, concerts, art classes)
4. Helping others (e.g. neighbors, friends) in knowing how to socialize with my family members
6. Participating in goal-setting to enhance family members learning
14. Participating in preferred outdoor community recreational activities (e.g. swimming, playing ball, playing in the parks)
15. Helping my family members (e.g. neighbors, friends) in socializing with others
20. Managing stress
21. Teaching my child(ren) about spiritual beliefs
25. Going on family vacations
26. Helping my family members make friends
36. Doing relaxing things/activities at home
37. Helping all family members know how to respond to questions about disability
39. Teaching choice-making and problem-solving
42. Having support from other families who have a child with disabilities
46. Helping all family members know how to respond to negative situations and attitudes (e.g. bullying, teasing, staring)
47. Developing long-term goals for family members
50. Being flexible as a family in making changes when they are needed
51. Dealing with challenges related to all family members
54. Having a break from caretaking (such as respite care)
55. Participating in social occasions with friends, co-workers or others
58. Making changes in services when necessary, even when professionals disagree
59. Providing supports to include all members of my family in family activities
63. Using technological communications (such as email, Facebook) to connect socially with others
69. Teaching social and emotional skills
72. Teaching appropriate behaviour
74. Teaching communication skills
77. Helping with homework

0.530
0.607
0.634
0.657
0.634
0.551
0.667
0.548
0.700
0.644
0.692
0.638
0.661
0.648
0.618
0.695
0.741
0.527
0.720
0.646
0.759
0.537
0.658
0.674
0.655
0.593

Factor 2. Disability-related services


1. Monitoring health conditions (having a regular doctor/health checks)
5. Feeling supported by professionals at the time of learning about my child(ren)s disability

0.511
0.690

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Table 2(continued)
Factors

Loading

7. Having educational services where my child(ren) is(are) making progress


8. Having a clear understanding of each family members strengths and needs
9. Feeling hope about the future for our family members
10. Having a spiritual community that includes my child(ren)
11. Paying for basic needs (such as food, house, clothing)
12. Coordinating medical care among two or more physicians
19. Talking about feelings, opinions and challenges with all members in my family
23. Having appropriate vision and eye care
28. Knowing when my child(ren) is(are) making progress
29. Having access to necessary services, such as speech therapy, physio/physical therapy, orientation and mobility,
occupational therapy, audiology and nursing care
30. Solving problems together
31. Enhancing each family members self-esteem
32. Understanding my family members challenges within my familys spiritual beliefs
40. Having a trusting partnership with professionals
41. Establishing close emotional bonds among members of the family
44. Having appropriate dental care
48. Teaching safety at home and other places
49. Monitoring services to make sure that they are beneficial
61. Having healthy life style (such as healthy diet/exercising)
66. Knowing and acting on my child(ren)s educational rights
67. Preventing substance abuse and other addictions (e.g. alchohol, drugs)
70. Getting information necessary to make sound decisions about services
71. Feeling supported by professionals to manage the difficulties associated with daily living
73. Feeling informed and helped by teachers about the improvement and the difficulties of my child(ren)
76. Teaching my child(ren) about sexuality
Factor 3. Economics and planning future
16. Getting new childcare
18. Having appropriate extracurricular/holiday care
22. Paying school fees and/or child care (babysitter)
27. Moving within the same community or to a different community
33. Paying for special therapies, equipment, or special foods (e.g. adapted switches, behavioral services, gluten-free items)
for children with disability
38. Planning for my child(ren)s successful transition from preschool to primary school or from primary school to
secondary school
43. Saving money for the future
45. Getting childcare
52. Getting or keeping a job
56. Starting a new school year
60. Applying for government benefits and addressing government benefit denials
62. Having appropriate transportation
64. Planning for the future after Im no longer able to takecare of my family members
Factor 4. Caregiving and teaching
2. Attending to daily care activities (e.g. bathing, brushing teeth, dressing, eating)
13. Going to the bathroom
24. Giving medications
57. Teaching independent living skills (such as eating and dressing)
65. Teaching child(ren) to attend to toileting needs
75. Teaching motor skills (e.g. riding a bike, walking, climbing stairs)

0.621
0.734
0.745
0.646
0.630
0.630
0.611
0.692
0.729
0.640
0.599
0.732
0.684
0.775
0.666
0.668
0.667
0.694
0.722
0.680
0.625
0.723
0.722
0.698
0.300
0.600
0.498
0.708
0.390
0.496
0.317
0.513
0.641
0.551
0.610
0.525
0.595
0.426
0.680
0.736
0.469
0.698
0.792
0.583

Items removed due to low loadings on factors: 17. Helping my child(ren) reach goals during every day routines; 34. Having appropriate
care for hearing-related needs; 35. Getting regular and special resources (such as technology equipment and materials, adapted switches,
special foods) needed by family members; 53. Getting a full nights sleep; and 68. Ensuring that home and community settings are
accessible.

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Table 3:FNA domain descriptive information (n=573).
Factor

Number of items

Social and family interaction


Disability-related service

Economics and planning future


Caregiving and teaching

26
27
13
6

The reliability of the total scale, which was composed of


72 items, was 0.97. The Cronbachs alpha coefficients for the
four factors were as follows: family and social interaction,
=0.95; disability-related services, =0.95; economics and
planning the future, =0.85; and caregiving and teaching,
=0.86. The factors that generated the greatest level of need
were economics and planning the future (M=3.90, SD=0.60)
and disability-related services (M=3.78, SD=0.76).
The concurrent validity was examined in terms of the
covariance among the factors of the FNA and their total
points and the factors of the FQOL scale (ECVF) and their
total points. In the results obtained in this analysis, no
negative or significant correlations were found among any
of the factors or with the total points.
Finally, the mean points of the four factors of the
Colombian FNA were estimated (Table 3). The factor that
showed the highest level of need according to the participants responses was the economics and planning the
future factor (M=3.90, SD=0.69). In contrast, the participants reported the lowest level of need for the caregiving and teaching factor (M=3.32, SD=1.12). Similarly, the
greatest percentage of explained variance was attributed
to the latter factor.

Discussion
The objective of this article was to perform the validation
of the FNA scale by evaluating its psychometric properties, with the aim of determining whether it is possible
to establish it as a reliable and valid tool for Colombian
families with children with intellectual disabilities. The
FNA evaluates the needs of these families, which allows
for their identification and for generating adequate strategies to provide for them.

Summary of major results and connection


tothe literature
The evaluation of the psychometric properties of the
FNA produced evidence of validity and reliability for the

Cronbachs alpha

3.59 (0.77)
3.79 (0.76)
3.90 (0.69)
3.32 (1.12)

0.95
0.95
0.85
0.86

M (SD)

Rank order

3
2
1
4

72 items that were kept on the scale. In accordance with


the responses of the study participants, the family needs
were grouped into four factors that accounted for 49.58%
of the variance: family and social interaction, disabilityrelated services, economics and planning the future and
caregiving and teaching.
In the literature, there is an antecedent for the validation of the FNA, which was performed by Chiu etal. [15]
with Taiwanese families with children with disabilities.
In contrast to the results obtained in Colombia, the scale
items in that study were grouped into seven factors that
accounted for 63.61% of the variance.
Thus, the way in which the factors were grouped was
different in each study. Nevertheless, some of these factors
contained similar items. Specifically, in a comparison of
the factorial structures generated by the FNA studies in
Colombia and Taiwan, the social and family interaction
factor conserved six items from the social connection
factor and two items from the family resources factor, the
disability-related services factor maintained 11 items from
the disability-related services factor, the economics and
planning the future factor conserved five items from the
economics factor and the caregiving and teaching factor
maintained six items from the caregiving factor.
Within the four final factors of the FNA for Colombia,
the participants expressed more elevated needs in the
economics and planning the future factor. These results are
consistent with those reported in the studies of families
with children with disabilities. In Colombia, the families
have highlighted needs related to financial resources and
access to services [26, 27].
In the same vein, studies from different countries
show elevated needs for factors related to the administration of family finances [2830]. In turn, other studies have
reported that these families have greater expenses associated with the needs of their child with disabilities [31] and,
in addition, that they are more prone to experience conditions of poverty [32].
Meanwhile, within the four final factors of the FNA for
Colombia, the caregiving and teaching factor showed the
lowest levels of need reported by the participants. These
findings can be explained in accordance with the results
of previous studies of quality of family life in Colombia.
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Those studies explain that the caretakers provide the


majority of the support to the children with disabilities
and to the rest of the family members. In the majority of
cases, the mothers act as principal caregivers and, therefore, show elevated levels of overwork and stress, which
are related to the need to rely on external support and
leisure and recreation spaces [3336].
Similarly, studies in other countries report similar
results in relation to the overwork experienced by the
principal caregiver [37]. The overwork is found to be associated with the fact that they spend the majority of their
time on caregiving activities for their child with disabilities, combined with the lack of time to rest and perform
other activities, which leads to a negative effect on their
levels of personal satisfaction [38].
Finally, with regard to the concurrent analysis of
validity, correlations were made between the different
factors obtained in the factorial analysis of the FNA with
the factors of the FQOL scale. The proposed hypothesis
was that there should be negative correlations between
each of the factors of the two scales and also correlations
with the total points of each scale. That is, lower points
in the dimensions of family needs should correlate with
higher points in the dimension of quality of family life.
The results obtained contradicted the hypothesis because
no factors correlated with any others or with the total
points of the scales.
The factors may not have correlated for the following
reasons: in accordance with Chiu [39] and based on the
validation study of the FNA scale in Taiwan, even if one
supposes a linear correlation between family needs and
family quality of life as a base, the absence of a correlation
between the two constructs can be explained by the difficulties in measuring these constructs. Specifically, this
measurement could be permeated by a subjective perception of the level of need and its relation with the level of
quality of life. In other words, although the families with
persons with intellectual disabilities may not have some
of their needs satisfied, the very fact of being able to identify the necessary support to satisfy those needs leads the
families to believe that they have a high quality of family
life because they could potentially be able to supply those
needs through that support.
Another reason for the lack of correlation consists of
the applicability of the items, i.e. some participants found
themselves forced to respond to questions in the format of
a Likert-type scale from 1 (very unsatisfied) to 5 (very satisfied), even when the questions did not concretely apply to
their own family context.
Similarly, the hypothesis of the correlation between
family needs and quality of family life was based on a

theoretical model of quality of family life, on antecedents


of family studies and on the researchers assumptions.
From the theoretical framework, various factors were considered that could interact with family needs:
On the one hand, the correlation could be influenced
by the familys strengths and other systems proposed in
the model, such as family-unit, individual member and
support factors [17, 38].
On the other hand, it is probable that the correlation between the needs and quality of life could depend
on other variables that could influence the family [38];
therefore, the two constructs would not have a linear
correlation.

Future directions for the FNA


The FNA will continue to be developed using the work
assembled between professionals and families from different countries. The validation of this instrument for
Colombia aims to use the study results to improve the programs and services directed toward this population.

Future directions for research


With respect to the study, we recommend that a diverse
and representative sample be included in accordance with
the country where the study is being performed. In addition, we recommend continuing the efforts to conduct
transcultural data collection, which allows for the identification of differences and similarities between different
contexts. Finally, we recommend analyzing the effectiveness of the FNA as an intervention tool.
Specifically, a second phase of data collection must
be conducted in Colombia with the objective of confirming
the initial factorial structure of the FNA proposed in this
study, using CFA. In turn, subsequent analyses with the
data must be performed to explore how other variables
affect family needs and to gain a greater understanding of
the real needs of this group. Ideally, it would be pertinent
to consider the family unit, i.e. all members of a family as
participants when completing the FNA.
Meanwhile, the international research team of the
FNA aims to develop a transcultural version of the FNA.
This development will require finalizing the validations
that are being developed in the countries that are already
linked to the team. Similarly, it is important to link other
countries to the team to understand family needs globally.
Finally, the identification and prioritization of family
needs using the FNA will contribute to strengthening the
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teamwork between families and the professionals that
serve them and, as a consequence, will contribute to the
improvement in the quality of family life and of the lives of
children with disabilities.
Future studies should evaluate the effectiveness and
pertinence of the tools as part of an intervention that provides real support for the priority needs of the families and
the children. In the same vein, the instruments should be
able to respond to their real needs.

Future directions for practice


It is hoped that the FNA will be able to contribute to the
framework of programs designed for families with children with disabilities, such that in the same program
where the instrument is used, the resources and strategies
aimed at providing the supported needed by each family
can be identified.
This tool will be able to be used individually or collectively with family members and professionals so that
plans of action can be generated focused on their needs
and, considering their interaction, with other macrocontexts such as the neighborhood, the community and
society in general [5]. In addition, it can be used in its
entirety or by factors, as well as digitally or physically in
accordance with the needs of each program and family.
Subsequently, it is hoped that the FNA will be a free and
easily accessible tool.
In conclusion, the use of the FNA allows the decisionmaking of families with children with disabilities to be
suitable in the assignation and execution of resources of
all types, including physical, economic, emotional and
social, among others. In this way, it can guarantee the efficacy of these decisions and their application in the design
of policies and programs for these families.

Limitations
One of the limitations of this study was that all the participants were principal caregivers for the child with disabilities. Although the principal caregiver best knows the
needs of the child with disabilities, to rely only on this
persons perceptions creates methodological challenges
when establishing a representation of the needs of all
members of the family.
Similarly, in a later study, a confirmatory analysis of
the data must be performed to provide evidence on the
validity of the construct of the FNA. Additionally, future

studies must further explore the needs of family members


according to different sociodemographic variables, such
as sex, age and level of disability, among others.
To conclude, we must continue the efforts to study the
needs of families with persons with disabilities in other
countries to achieve a better understanding on the global
level of the needs of these families.

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