Family Satisfaction Research Articles

The Effect of Family Characteristics on the Functioning of a Child with an Autistic Spectrum Disorder in Bedouin Society in Israel.

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by difficulties in communication and social-emotional interaction. It is associated with an increase of parental stress and poor family functioning, both of which are harmful for a child's functioning and adaptive behavior. An important source of support to parents are grandparents, especially in traditional populations. One such population is the Bedouin population. The present study tested the association between emotional support from mother and mother-in-law to the adaptive behavior of children with ASD, and whether this relation is serially mediated by family functioning and satisfaction in life as reported by Bedouin mothers of children with ASD. 100 mothers of children with ASD fulfilled a questionnaire about emotional support from their mothers and mother-in-law, family functioning, satisfaction in life and child's adaptive behavior. We found that indeed, family functioning and satisfaction in life serially mediated the relations between emotional support from mother and mother-in-law and child adaptive behavior. These findings indicate that intergenerational solidarity between women can improve not only the functioning of the nuclear family and wife's satisfaction with life, but also, indirectly, the adaptive behavior of a child with ASD. It highlights the importance of women solidarity, especially in traditional society, where women are kept marginal.

Implementation of an Advance Care Planning Intervention in Nursing Homes: An International Multiple Case Study.

The inability of individuals in the advanced stage of dementia to communicate about preferences in care at the end-of-life poses a challenge for healthcare professionals and family carers. The proven effective Family Carer Decision Support intervention has been designed to inform family carers about end-of-life care options available to a person living with advanced dementia. The objectives of the mySupport study were to adapt the application of the intervention for use in different countries, assess impact on family satisfaction and decision-making, and identify costs and supportive conditions for the implementation of the intervention. A multiple-case study design was chosen where the nursing home was the case. Nursing homes were enrolled from six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, and United Kingdom. Seventeen cases (nursing homes) participated, with a total of 296 interviews completed including family carers, nursing home staff, and health providers. Five themes relevant to the implementation of the intervention were identified: supportive relationships; committed staff; perceived value of the intervention; the influence of external factors on the nursing home; and resource impact of delivery. There is a commonality of facilitators and barriers across countries when introducing practice innovation. A key learning point was the importance of implementation being accompanied by committed and supported nursing home leadership. The nursing home context is dynamic and multiple factors influence implementation at different points of time.

Family and friend caregiver satisfaction and utility of passive remote monitoring technology utilized by frail home care clients

Family and friend caregiver satisfaction and utility of passive remote monitoring technology utilized by frail home care clients

Development and initial validation of a family activation measure for acute care.

Activation of a family member refers to their desire, knowledge, confidence, and skills that can inform engagement in healthcare. Family activation combined with opportunity can lead to engagement in care. No tool currently exists to measure family activation in acute care. Therefore, we aimed to develop and validate a tool to measure family activation in acute care. An interdisciplinary team of content experts developed the FAMily Activation Measure (FAM-Activate) through an iterative process. The FAM-Activate tool is a 4-item questionnaire with 5 Likert-type response options (ranging from strongly agree to strongly disagree). Scale scores are converted to a 0-100 point scoring range so that higher FAM-Activate scores indicate increased family activation. An overall FAM-Activate score (range 0-100) is calculated by adding the scores for each item and dividing by 4. We conducted reliability and predictive validity assessments to validate the instrument by administering the FAM-Activate tool to family members of patients in an acute cardiac unit at a tertiary care hospital. We obtained preliminary estimates of family engagement and satisfaction with care. We surveyed 124 family participants (age 54.1±14.4; 73% women; 34% non-white). Participants were predominantly the adult child (38%) or spouse/partner (36%) of patients. The mean FAM-Activate score during hospitalization was 84.1±16.1. FAM-Activate had acceptable internal consistency (Cronbach's a = 0.74) and showed test-retest responsiveness. FAM-Activate was moderately correlated with engagement behavior (Pearson's correlation r = 0.47, P <0.0001). The FAM-Activate score was an independent predictor of family satisfaction, after adjusting for age, gender, relationship, and living status. The FAM-Activate tool was reliable and had predictive validity in the acute cardiac population. Further research is needed to explore whether improving family activation can lead to improved family engagement in care.

Impact of LTCI on Degree of Life Satisfaction and Psychological Blessedness of the Elderly Population: An Empirical Analysis of Psychological Mechanisms and Moderating Effects

Objectives: In order to keep a proactive watch on the economic aspect of old age care, the Chinese government strives not only to build the sense of life satisfaction and blessedness in families, but also ensure social development through social support mechanisms, including the Long-Term Care Insurance (LTCI) plan. This study examines the impact of LTCI on the degree of life satisfaction and psychological blessedness of the old and further investigates the psychological mechanisms and moderating factors involved. Methods: In order to use authentic data related to coping measures for population aging, the CHARLS (China Health and Retirement Longitudinal Study) database was chosen to examine the impact of the LTCI system. Results: The study results found that LTCI significantly improved the degree of life satisfaction of middle-aged and older people. The effect was found to be heterogeneous at the level of gender, marital status, and the number of children through heterogeneity analysis. The results revealed that LTCI had a significant improvement effect on the degree of life satisfaction of middle-aged and older adults, particularly of the male population, in variables such as marital status, having fewer children, increased intergenerational financial support, all of which wove a mechanism showing how LTCI made an improvement effect on the degree of life satisfaction of middle-aged and older people. Conclusion: These results are of great significance in promoting the formulation and implementation of LTCI policies. It provides useful insights to the government, social organizations, and individuals with a scientific basis for the impact of LTCI on the mental health of the old. It also provides a valuable reference for improving the quality of life and blessedness of the elderly population.

Family Caregivers Perceptions of Patient’s Symptom Burden and Satisfaction with Palliative Care Services in a Tertiary Care Center in Saudi Arabia

This study aimed to explore the family caregivers (FCs) perception of patients’ symptom burden as well as their experience and satisfaction with specialized palliative care services (PCS) in a tertiary care center in Kingdom of Saudi Arabia (KSA). Methods: A cross-sectional design assessed patients known to the PCS in a tertiary care center in Saudi Arabic from May 2023 to September 2023. FCs perceptions of patient’s symptom burden and satisfaction with PCS were studied through the Family Satisfaction with End-of-Life Care Scale (FAMCARE-2) and Arabic Questionnaire for Symptom Assessment (AQSA). Results: A convenience sample of 264 FCs agreed to participate (response rate = 94%). Approximately half of the participants were male (n=146; 55.7%). Participants were mostly aged between 30 to 50 years (n =148; 56%). Approximately half were receiving disease-modifying treatments. 101 (38.3%) had a Do-Not-Attempt-Resuscitation (DNAR) order. There was high satisfaction with how the services respected the dignity FCs (M = 4.6; SD=0.6). FCs were less satisfied with ‘the practical assistance provided by the PCS’ (M = 4.1; SD = 0.9). Satisfaction was higher in the outpatient setting (M = 4.3, SD = 0.7). The most severe symptom reported by FCs was ‘tiredness’, followed by ‘pain’. The mildest ones were ‘shortness of breath’, followed by ‘nausea/vomiting’. Conclusion: Overall, FCs have reported a positive experience with inpatient and outpatient PCS. FCs' greater satisfaction was observed in the outpatient setting with the possible rationale that inpatients are often more unstable and symptomatic.

The benefits of a closed ICU: a systematic review

This study compared closed and open intensive care unit (ICU) models in terms of patient outcomes. Closed ICUs had reduced mortality rates, shorter lengths of stay, and lower healthcare-associated infection rates. Intensivists in closed ICUs contributed to better outcomes due to their expertise and competence. Enhanced interdisciplinary collaboration, improved communication, and coordination in closed ICUs led to higher patient and family satisfaction. In addition, closed ICUs were more cost-effective, with better resource use and reduced healthcare costs. Overall, closed ICU models have advantages in patient outcomes, better resource use, cost-effectiveness, and patient satisfaction compared to open ICU models.&#x0D; &#x0D; Key words: Intensive care unit, ICU, patient outcomes, resource utilization, quality of care.

Life satisfaction components and all-cause and cause-specific mortality: A large prospective cohort study

BackgroundWhich life satisfaction components could be a target of positive psychological interventions for longevity is largely unknown. We aimed to investigate association of the composite measure of life satisfaction and its individual components with mortality. MethodsThis cohort study included UK Biobank participants who responded to questions concerning five components of life satisfaction at baseline. We generated a composite score representing overall life satisfaction, ranging from 0 (lowest) to 5 (highest). The outcomes were all-cause and cause-specific mortality. We used multivariable Cox regression to estimate hazard ratios (HR) for the associations of interest. ResultsAmong 165,842 eligible participants, 12,261 all-cause deaths were observed over a median of 12.9-year follow-up. Overall life satisfaction was inversely associated with all-cause mortality (adjusted HR 0.94 [95% CI: 0.93–0.95] per 1 score increment). Health satisfaction showed the strongest association with all-cause mortality, with a fully adjusted HR of 0.52 (95% CI: 0.49–0.55) for high/extreme satisfaction and 0.63 (95% CI: 0.59–0.66) for moderate satisfaction, compared with unsatisfaction (P-trend<0.001), independent of other satisfaction components, regardless of physical health and sociodemographics. The association for family, friendship, work and financial satisfaction was attenuated when adjusted for other life satisfaction components. Similar findings were observed for cause-specific mortality. LimitationsObservational study with single baseline measurement of life satisfaction precludes the ability to establish causal relationship. ConclusionsHigher overall life satisfaction was associated with lower mortality. As the major contributor to lower mortality regardless of physical health and sociodemographics, health satisfaction could be an important target of positive psychological interventions for longevity.

Investigation of the relationship between spiritual care needs of relatives of patients hospitalized in intensive care unit and intensive care satisfaction in Turkey.

Relatives of patients admitted to the intensive care unit (ICU) play a crucial role in the care of their loved ones. After a patient's admission to the ICU, family members may be vulnerable to conditions such as depression, anxiety or post-traumatic stress disorder, which can lead to moral concerns. The aim of this study was to determine the relationship between the spiritual care needs of family members of patients hospitalized in the ICU and their satisfaction with the ICU. In this study, a cross-sectional and correlational design was used. The study was conducted with 291 patient relatives who could be reached by face-to-face questionnaire. Data were collected using the 'Personal Information Form', 'Family Satisfaction Scale in Intensive Care Unit (FS-ICU-24)' and 'Spiritual Care Needs Inventory'. Spiritual Care Needs Inventory (SCNI) total score was determined as 58.00 ± 15.91. The mean total score of FS-ICU-24 was 86.38 ± 7.12. No significant correlation was found between the mean SCNI total score and the FS-ICU-24 total score (r = .084; p > .05). As a result of this research, it was determined that the spiritual care needs of the patients' relatives were at a medium level and their satisfaction with intensive care was high. Institutions should establish spiritual care support units for individuals with patients in ICUs and examine the effects of this on individuals.

Multidisciplinary atopic dermatitis program: A novel approach to managing difficult-to-control atopic dermatitis patients.

Disease improvement for difficult-to-control pediatric atopic dermatitis may be more challenging to achieve when directed by single specialties due to disjointed and conflicting dialogue with patients. The Multidisciplinary Atopic Dermatitis Program (MADP) was developed through collaborations with the Rady Children's Hospital and UC San Diego Health Divisions of Dermatology, Allergy & Immunology and Clinical Pharmacy, to create team-based evaluation and management of children and adolescents with atopic dermatitis (AD). The MADP allows concurrent, comprehensive evaluations by multiple specialists to develop treatment plans. The program includes extensive patient education to support shared decision making, incorporating patient and family's perspectives along with those of clinical experts into their care. Objective severity measures and patient reported outcome data were collected, along with assessment of patient and family satisfaction with the MADP. Data showed significant improvement in AD severity as assessed by providers, patients and families by the first follow-up visit. BSA mean percentage decreased by up to 56% by the 7th visit, and pruritus (NRS), CLDQI and POEM mean scores decreased by more than 4 points, 12 points, and over 11 points, respectively. After management was initiated in the MADP, 72.73% of patients achieved an EASI 50 and 47.73% achieved an EASI 75 from a baseline mean of 21.7. Patients who continued in clinic beyond the second visit showed further clinically significant decreases in disease measures. The multidisciplinary approach shows success in the treatment of difficult-to-control AD patients with improvements in clinician and patient reported outcome measures.

Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study.

Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana. To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers. The study employed a descriptive qualitative design. The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist. Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes. The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice. Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.

Trauma Team Activation in the Emergency Department: A Literature Review of Criteria, Processes and Outcomes

Multiple traumas require a fast and comprehensive treatment to overcome challenges that emerge from the patient’s condition. The right time for trauma team activation is necessary to treat these multiple trauma patients to improve patient outcomes. This integrative review identifies the criteria used to activate the trauma team, the activation process and the outcome of the activation. The search was conducted from January to March 2023 with two databases, namely MEDLINE and PubMed, and grey literature via Google Scholar. The search was limited to articles written in English, with abstracts and available in full text. There was no year limitation. The review found four criteria that were used for trauma team activation: physiological, anatomical, mechanism of injury and others. The process of trauma team activation begins in the pre-hospital setting. Outcomes used to evaluate the impact of trauma team activation included the level of satisfaction of patients and families, the level of complaints, response time, discharge status, and mortality. The findings of this review recommend that the criteria, process, and outcomes of trauma team activation are tailored, based on the needs and available resources of the institutions. Moreover, standardized trauma team activation may be necessary for future development.

Integration of Psychosocial Theory into Palliative Care: Implications for Care Planning and Early Palliative Care.

Palliative care improves patients' symptoms, quality of life and family satisfaction with caregiving, reduces hospital admissions and promotes alignment of medical care with the patient's needs and goals. This article proposes the utility of integrating three psychosocial theories into standard palliative care with implications for care planning, early palliative care and optimizing quality of life. First, Control Theory focuses on the complex juxtaposition of promoting agency/empowerment in patients and carers and coping with often highly uncertain outcomes. Second, Optimal Matching Theory accounts for the alignment of need and provision of care to potentiate the quality of life effects of supportive care in a complex social process involving health care providers, patients and carers. Third, Hope Theory represents a dynamic process, which is marked by variation in the qualities of hope as the patient and carer confront challenges during palliative care. Future work will be translational in nature to adapt both assessment and interventions based on this theoretically driven augmentation of palliative care as well as to evaluate whether it provides a conceptual framework that has incremental utility in palliative care planning.

Parent-couple satisfaction, parent depression, and child mental health in families with autistic children.

Within two-parent households, the parent-couple subsystem (marital or romantic partner relationship) is posited to shape the mental health of both parents and children. Autistic children and their parents have an elevated-risk for mental health problems. The present study longitudinally examined the mediating role of the quality of the parent-couple relationship in time-ordered pathways between changes in the mental health problems of autistic children and in parent depression symptoms at a within-family level. Using four time points of data collected on 188 families of autistic children (aged 5-12 years) across 3 years, the bidirectional associations between parent-couple relationship satisfaction, parent depressive symptoms, and child internalizing and externalizing mental health problems were investigated. Two multi-group (grouped by parent gender) complete longitudinal mediation models in structural equation modeling using Mplus software were conducted. Parent-couple relationship satisfaction mediated: (1) the association between higher parent depressive symptoms and higher child internalizing mental health problems 12 months later for both mothers and fathers, and (2) the association between higher child externalizing mental health problems and higher father depression symptoms 12 months later. Father depression symptoms mediated a pathway from lower parent-couple satisfaction to higher child internalizing mental health problems 12 months later, and mother depression symptoms mediated the pathway from higher child externalizing mental health problems to lower parent-couple satisfaction 12 months later. Findings highlight the bidirectional and complex ways that parent and child mental health and the quality of the parent-couple relationship are entwined across time in families of autistic children. Family-wide interventions that address the needs of multiple family members and family systems are best suited to improve the mental health of parents and autistic children.

Evidence-Based Implementation of the Family-Centered Model and the Use of Tele-Intervention in Early Childhood Services: A Systematic Review.

The purpose of this review is to explore the evidence and efficacy of two trends in early childhood intervention services: the family-centered model and the use of tele-intervention. A systematic review was carried out following the PRISMA methodology and using three databases: Web of Science, PubMed and Scopus. The studies included were those aimed at children from 0 to 6 years of age, focused on early intervention, and which alluded to the family-centered model and/or tele-intervention. a total of 33 studies were included. Five main themes were identified: (1) The participation of children and family is facilitated and improved by the family-centered model of care; (2) the feeling of competence, self-efficacy, satisfaction and empowerment in professionals and families have a positive impact on quality of life; (3) the use of tele-intervention as a tool for prevention and intervention; (4) preparation for telepractice can improve the development of commitment; (5) tele-intervention as a possible solution to contextual barriers. Tele-intervention in pediatrics is presented as a tool inherent to the family-centered model since its implementation involves several common strategies. Future lines of research should explore the use of this tool as a possible solution to contextual barriers.

Assessment of Satisfaction Levels Among Families of Intensive Care Unit Patients in Saudi Arabia: A Cross-Sectional Study.

Background: Regularly measuring family satisfaction with intensive care unit (ICU) experience is crucial for ensuring high-quality care and identifying areas for improvement. This study aimed to evaluate family satisfaction with the ICU in Saudi Arabia. Methods: A cross-sectional survey was conducted among 248 family members of patients admitted to various ICUs. The survey assessed family satisfaction via a validated questionnaire, the Critical Care Family Satisfaction Survey (CCFSS), which includes five subscales: assurance, information, comfort, proximity, and support. Demographic data were also collected. Descriptive and inferential statistics were calculated. Results: The demographic distribution revealed that a majority of the participants were female (70.97%, n = 176), with the relationships with the patients predominantly being parents (41.94%, n = 104) or offspring (33.87%, n = 84). The overall satisfaction score was 3.79 ± 1.26, with 66.13% of the participants reporting high satisfaction, 20.97% reporting intermediate satisfaction, and 12.90% reporting low satisfaction. The mean subscale scores were as follows: assurance (3.82 ± 1.2), information (3.83 ± 1.25), comfort (3.81 ± 1.27), proximity (3.72 ± 1.28), and support (3.78 ± 1.28). The highest satisfaction scores were observed for sharing in decisions, noise levels, and staff honesty, whereas the lowest scores were for visiting hours flexibility, transfer preparation, and staff responsiveness. Males reported significantly greater satisfaction (4.24 ± 1.20) than females did (3.61 ± 1.11, p = 0.007). Conclusions: This study revealed moderate to high levels of family satisfaction with the ICU, with significant differences based on sex. The findings highlight the importance of effective communication, family involvement in decision-making, and supportive ICU policies. ICUs should regularly assess family satisfaction and use the results to guide quality improvement efforts, with a focus on areas with lower satisfaction scores.

The Impact of Family Communication on Adolescent Satisfaction with Family Life Across Different Family Structures

The Circumplex Model of Marital and Family Systems is one of the most widely used approaches in family studies. This model assumes that family communication is an important element in achieving positive family functioning because it allows family members to alter their levels of flexibility and cohesion. While this theoretical approach has been widely used and tested there are still some gaps in the empirical evidence on the universality of its assumptions. Considering that adolescents today live in a wide variety of families, that are very diverse according to their structures, it is important from an ethical standpoint to test the universality of any theoretical framework that is used in family interventions. This study therefore sought to investigate whether there are differences in satisfaction with family life and family communication in families with different structures and whether family communication is an important correlate of satisfaction with family life in all types of families, using data from a study of adolescents from Zagreb, Croatia (N = 4 821). Linear regression was used to evaluate the association of family satisfaction (dependent variable) with family communication and parental marital status (predictor variables) with the additional inclusion of interaction effects between family communication and parental marital status. The results of this study have shown that adolescents are generally satisfied with their family life and that there are differences in perceived family satisfaction and family communication between adolescents regarding the marital status of their parents. The results presented in this paper support the main hypothesis that in families with adolescents, family communication is strongly associated with family satisfaction, independently of parental marital status. The findings suggest that interventions aimed at improving family communication skills inadolescent families could benefit all families with adolescents.

Factor Structure and Internal Consistency Reliability of the Croatian Version of the Family Adaptability and Cohesion Evaluation Scale (FACES) IV Package : A Preliminary Study

Introduction: A family operates as a dynamic system comprising various subsystems and is continually interacting with its environment. Therefore, it is essential to comprehend the underlying principles of family functioning. One of the most commonly used models for describing family functioning is the Circumplex Model of Marital and Family Systems (Olson &amp; Gorall, 2003). Aims: In this study, we aimed at examining the factor structure and internal consistency reliability in the Croatian version of the Family Adaptability and Cohesion Evaluation Scale IV Package, which measures family functioning through family cohesion and flexibility at the balanced and unbalanced levels, as well as family communication and family satisfaction. Methods: Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed using a convenient sample of 528 participants. Results: CFA revealed that the Croatian version of the FACES IV Package does not fit the theoretical model of the original factor structure in this preliminary study. The exceptions were the Family Communication Scale and Family Satisfaction Scale, which showed satisfactory parameters. The results of the EFA of FACES IV showed a 5-factor model solution. Conclusions: The Croatian version of the FACES IV Package is not completely suitable for use in the national context. Thus, given these preliminary findings, further testing on a more representative or clinical sample is recommended.

Is it early enough? The authentic meaning of the pediatric palliative approach between early and late referral in pediatric oncology: a case study.

The literature widely supports the benefits of early integration of palliative care into pediatric oncological care; however, many barriers to its successful integration remain. Integrating palliative care as early as possible in the oncology pathway is critical, but other criteria are relevant to positive results. This paper aims to contribute to the early/late referral dualism in pediatric palliative care (PPC) and highlight the importance of a collaborative approach between oncologists and palliative care teams. This study investigates the impact of early versus late referral to PPC, intersecting it with the synergy work between services and the related outcomes. The four pediatric cancer cases were selected based on clinical (e.g., disease duration, multiple treatments, and pain management), management (e.g., involvement of multiple services and multiple home-hospital transitions), and relevance of multidisciplinary team (e.g., difficult clinical decisions and ethical discussions) criteria. A mixed-methods approach was employed, combining qualitative case analysis using clinical diaries, literature review, and practice guidelines development. Critical clinical information, time course, clinician-family communication, and patient involvement were analyzed. The outcomes show how simultaneous care creates continuous discussion and dialogue between professionals. The results indicate the importance of better communication and care coordination to improve patient and family satisfaction, highlighting the uniqueness of the pediatric field and the relationship with children and families. Through the discussion of clinical cases and a literature review, we provide practical guidance for clinicians working in oncology and PPC. These findings underscore the crucial need for a multidisciplinary approach in pediatric oncology, advocating policy changes to support early PPC integration and translate it into complementarity best operating practices. In conclusion, besides assessing the timeliness of referral to the PPC service, the synergy, harmony, and choral work of the professionals involved are equally valuable for a quality-of-life-oriented care plan.

Comparative Evaluation of Facial Paradigms for Devanagari Script-based P300 Speller: Preliminary Findings

Display paradigm design is an important stage in the design of any brain-computer interface (BCI) device including the P300 speller system. Conventional grey-to-white intensification limits the usability of the existing Devanagari-script-based P300 speller (DSP3S) as it suffers from reduced visual contrast, diminished user engagement, limited personalization, minimal cognitive stimulation, and the risk of visual fatigue. The use of a facial paradigm can address the above-mentioned limitations through emotionally resonant stimuli, offering diverse cognitive stimulation, and potentially reducing visual fatigue by introducing dynamic and engaging facial stimuli. In this context, this study is the first attempt to investigate the efficacy of facial paradigms in further improving the usability of DSP3S. The authors investigated three facial paradigms based on the smiley face, famous face, and family faces for DSP3S. The three facial paradigms are evaluated based on their effectiveness, efficiency, and satisfaction. Effectiveness was measured using classification performance and amplitude difference waveform. Whereas efficiency and satisfaction were measured using NASA-TLX, VAS-F scale, and SUS respectively. The obtained results showed that using the proposed family face intensification, efficiency, and satisfaction could be improved. However, no significant difference was observed in effectiveness among the three display paradigms. In this study, apart from investigating the usability of three display paradigms, authors also propose brain signal decoding using morphological filtering and extreme gradient boosting (XGBoost). Finally, the study concludes that the design of display paradigms using different intensification patterns affects the usability of the speller system and should be taken into consideration.