The Family Resilience Assessment Scale (FRAS), developed by Sixbey in 2005 based on Walsh’s family resilience framework, is currently one of the most widely used and well-validated tools for measuring family resilience globally [12]. The commonly used version comprises six dimensions (family communication and problem-solving, utilizing social and economic resources, maintaining a positive outlook, family connectedness, family spirituality, and ability to make meaning of adversity) with a total of 54 items. It uses a 4-point Likert scale, yielding a total score ranging from 54 to 216, where higher scores correspond to higher levels of family resilience. The original scale has an overall Cronbach’s alpha of 0.96, with Cronbach’s alpha values for individual dimensions ranging from 0.70 to 0.96, indicating excellent internal consistency. This scale was subsequently localized and revised by Dong et al. in 2018 with consideration for cultural differences and respondent burden; the Chinese version retains four dimensions and 44 items, demonstrating a Cronbach’s alpha of 0.96 for the total scale and 0.70 to 0.97 for its subscales [13].

The Family Index of Regenerativity and Adaptation-General (FIRA-G), developed by McCubbin et al. [14], consists of seven subscales with a total of 79 items. This scale employs a 4-to-5-point Likert rating system, offering a broad and comprehensive assessment range that enables the measurement of family coping patterns across multiple dimensions. The Cronbach’s alpha coefficients for each subscale range from 0.69 to 0.82. However, due to the tool’s excessive number of items and complex content, respondents may encounter difficulties during completion, potentially compromising the quality of the collected data. Its practical utility thus requires further validation.

The Family Resilience Questionnaire (FRQ) was developed by Faccio et al. in 2019 based on Walsh’s family resilience framework, initially for cancer patients [15]. It includes 4 dimensions (communication and cohesion, perceived social support, family coping, and spirituality), 24 items, and a 7-point Likert scale, with a total score ranging from 24 to 168. Higher scores reflect stronger family resilience. It has good psychometric properties and is suitable for chronic disease families.

The Family Resilience Assessment (FRA), developed by Duncan Lane et al. in 2017 based on Walsh’s family resilience theoretical model, was initially designed for breast cancer patients and their families and has subsequently been widely validated and applied to families affected by a range of other chronic diseases [16]. This scale is structured around three core themes (belief systems, organizational patterns, and communication processes), encompassing nine dimensions and a total of 29 items. It uses a 5-point Likert scale, with responses scored from 1 (“never”) to 5 (“always”), yielding a total score ranging from 29 to 145, where higher scores correspond to higher levels of family resilience.

The original FRA has a Cronbach’s alpha of 0.929, indicating good reliability and validity [16]. To adapt this scale for use in the Chinese population, Zhang et al. conducted localization and cross-cultural adaptation, evaluating its psychometric properties in a sample of Chinese breast cancer patients. The finalized Chinese version of the FRA yielded a Cronbach’s alpha of 0.961 for the total scale, with Cronbach’s alpha values ranging from 0.852 to 0.937 for individual dimensions and a test-retest reliability of 0.86, confirming that the Chinese version of the FRA also possesses satisfactory reliability and validity [17]. This scale features a clear factor structure and concise items, covering all core domains of family resilience; it is therefore suitable for assessing family resilience in AMI patients and provides a sound scientific basis for the development of targeted clinical interventions.

Age and educational level are core demographic factors. Research by Pang et al. demonstrated that the family resilience score in convalescent AMI patients aged ≥55 years (76.91 ± 3.05) was significantly lower than that in patients aged <55 years (77.45 ± 4.61); notably, age ≥ 55 years was identified as an independent risk factor for reduced family resilience (OR = 3.785, 95% CI: 1.451 - 6.119, P < 0.05) [18]. Elderly patients experience progressive decline in physical function and a higher burden of complications, exhibiting a high degree of dependence on family care. Since their primary caregivers are frequently themselves elderly family members, the overall family support capacity is diminished, which in turn compromises family resilience [18].

In terms of educational attainment, the family resilience score was significantly lower in patients with an associate degree or below (73.41 ± 4.57) versus those with a bachelor’s degree or above (76.32 ± 4.25, P < 0.05) [18]. Patients with higher educational levels have greater access to evidence-based rehabilitation knowledge and medical resources, demonstrate stronger communication and collaborative skills, and can effectively mobilize social support to strengthen family resilience [19]; in contrast, patients with lower educational levels exhibit limited disease-related awareness, suboptimal utilization of external support resources, a higher propensity for negative affective states, and greater caregiving burden, which collectively contribute to reduced family resilience [18].

Disease course, disease severity, and complications are key disease-related influencing factors. Research by Pang et al. demonstrated that patients with a disease duration of ≥ 5 months had a significantly lower family resilience score (72.58 ± 6.42) compared to those with a duration < 5 months (76.91 ± 4.56), and a disease duration of ≥5 months was identified as a risk factor for reduced family resilience (OR = 4.059, 95% CI: 2.746 - 5.373, P < 0.05) [18]. A prolonged disease course exerts a sustained drain on the caregiving capacity of family members and increases the financial burden. Additionally, the persistent impairment of patients’ physical and mental functions weakens the family’s collective coping capacity [19][20]. Furthermore, greater disease severity and a higher number of complications translate to higher caregiving difficulty and burden, and consequently lower levels of family resilience [21].

Psychological resilience, basic psychological need satisfaction, and hope levels are key psychological factors that collectively influence family resilience. Research by Pang et al. demonstrated a positive correlation between psychological resilience and family resilience (r = 0.406, P < 0.05), with psychological resilience serving as an independent protective factor for family resilience (OR = 4.627, 95% CI: 3.647 - 5.608, P < 0.05) [18]. Ding et al. found that basic psychological need satisfaction positively and significantly predicts family resilience (β = 0.489, P < 0.001), and hope levels are also positively correlated with family resilience; notably, these two factors act as chain mediators in the pathway linking basic psychological need satisfaction to family resilience [22]. Patients with a positive psychological state can actively cope with the disease and foster a supportive, collaborative family atmosphere; conversely, negative affective states exacerbate the psychological and caregiving burden on family members and ultimately diminish family resilience [23].

Family communication, family intimacy, social support, and health insurance status are important external influencing factors. Research by Chen et al. demonstrates a positive correlation between family resilience and patients’ quality of life during AMI recovery [19]. A positive family atmosphere and effective family communication can mitigate caregiving conflicts and enhance family resilience [24][25]. Regarding social support, studies by Pang et al. demonstrate a positive correlation between the utilization of social resources and both psychological resilience and quality of life (r = 0.325, 0.368; P < 0.05) [18]. Medical guidance and community-based services provide substantial support to affected families; households with health insurance bear a lighter medical burden, and their family resilience levels are significantly higher than those of self-paid households [18][26].

This psychological intervention mainly targets psychological resilience, basic psychological need satisfaction, hope, anxiety, and depression described in Section 4.3. The supporting evidence is mainly from AMI studies [18][22][23]. With the core objectives of enhancing patients’ psychological resilience and meeting their basic psychological needs, this intervention approach respects patients’ autonomy in treatment, promptly recognizes their rehabilitation progress, and strengthens their sense of self-efficacy [22]. It also guides family members to enhance emotional companionship and effective communication to alleviate patients’ loneliness and anxiety [23]. Additionally, interventions such as mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) may be used to correct patients’ negative cognitions; when these approaches are drawn from broader chronic disease or psychosocial intervention literature, they should be regarded as extrapolated evidence that requires further validation in AMI populations.

This family system intervention mainly targets family communication, family function, caregiver burden, elderly caregivers, and prolonged disease course described in Sections 4.1, 4.2, and 4.4. The supporting evidence includes AMI studies [18]-[21][25] and extrapolated evidence from chronic disease family-resilience research [24]. The family communication climate is optimized by organizing regular family meetings to facilitate open, honest communication between patients and family members about their respective needs, thereby reducing caregiving conflicts [24][25]. Family members are provided with standardized training on AMI rehabilitation knowledge and evidence-based caregiving skills, which clarifies individual caregiving responsibilities, reduces caregiver burnout, and strengthens overall family caregiving capacity [6][24]. For high-risk families characterized by elderly caregivers, prolonged disease course, and substantial financial burdens, individualized one-on-one guidance is provided to help them develop tailored coping strategies, thereby enhancing family stress resistance [18].

This social support intervention mainly targets social resource utilization, community support, and medical burden described in Section 4.4. The supporting evidence includes AMI studies on social resource utilization and medical insurance [18][19][26], while evidence from maintenance hemodialysis and other chronic disease populations should be considered extrapolated evidence [27]. A comprehensive social support network is established and a standardized post-discharge continuous nursing follow-up system is implemented to deliver ongoing evidence-based rehabilitation guidance and health counseling. Families are guided to utilize community-based rehabilitation services and peer support groups, and to access medical insurance reimbursement and healthcare assistance programs, particularly for economically disadvantaged households, thereby alleviating their financial burdens. Resources from healthcare institutions, communities, family and friends, and volunteers are integrated to provide comprehensive support covering professional, emotional, and material dimensions, thereby strengthening the external support system for family resilience.

This hierarchical individualized nursing intervention integrates the demographic, disease-related, psychological, family, and social factors described in Sections 4.1 - 4.4. The supporting evidence is mainly from AMI studies [18]-[21][26], with some intervention logic extrapolated from broader family-resilience research [10]. Stratified interventions are implemented based on patients’ age, disease duration, educational attainment, and financial status: for elderly patients, enhanced family care training is provided and personalized rehabilitation care plans are developed [18]; for patients with prolonged disease courses or more complications, continuous psychological counseling, rehabilitation encouragement, and complication monitoring are provided [20][21]; for patients with low educational attainment, simplified health education approaches are employed to improve their disease self-management capabilities [18]; for patients experiencing financial difficulties, relevant assistance resources are coordinated and enhanced psychological counseling is provided [20][26]. Dynamic adjustment of intervention protocols promotes synchronous physical and psychological recovery in patients, thereby enhancing family resilience [10].