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So-called\n                    <jats:italic>second-order level mechanisms<\/jats:italic>\n                    , underlying family processes such as communication, parenting skills, and organisational abilities are of particular importance for sustaining family-level behavioural changes and improved health outcomes. This systematic review synthesises interventions that integrate such mechanisms and their impact on health- and weight related outcomes. A systematic literature search was conducted in PubMed, PsycInfo, Web of Science, and the Cochrane Library following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The initial search yielded 16,129 records, after a multistep process including two independent reviewers,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200922 studies met the final inclusion criteria. Second-order level mechanisms addressed included parenting skills and practices (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200911), parent\u2013child relationships and communication (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20096), family functioning and dynamics (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20094), home and family environment (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20093), and cultural and family values (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20093), with several interventions addressing multiple mechanism clusters.\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20099 studies reported significant weight-related changes. Psychosocial and behavioral outcomes, when reported, showed improvements in health-related quality of life, family health routines, nutrition knowledge, and self-efficacy. This systematic review provides an integrative overview of family-based interventions utilising second-order level family mechanisms as structural and relational processes that may support the sustainability of change. The results offer a valuable framework for understanding how families regulate and maintain health behaviours beyond isolated behavioural components.\n                  <\/jats:p>","DOI":"10.1007\/s11154-026-10062-5","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T03:48:58Z","timestamp":1783050538000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Family matters? 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