Marital interactions in the process of dietary change for type 2 diabetes

Participant Insights From a Family-based Meal Kit Delivery Intervention

OBJECTIVE

To explore the lived experiences of prediabetic participants in an in-home, family-based meal kit delivery intervention for 12 weeks. Delivered foods followed a plant-dominant pattern, including small meat portions, to encourage long-term adoption of this pattern.

METHODS

Qualitative in-depth individual interviews (n = 21) were undertaken online with 7 pilot participants, at 3-time points (preintervention, during intervention, and postintervention). Three online focus groups were also undertaken postintervention with 12 participants.

RESULTS

Postintervention, most participants reported positive changes in eating patterns and mindset changes enabling future healthier eating. The deliveries inspired enthusiasm for tastier cooking and family involvement. Although participants indicated they felt well-being improvements, they often became focused on the outcome of their physical test results (eg, weight), leading to some disappointment and feelings of failure.

CONCLUSIONS AND IMPLICATIONS

Participant engagement with the intervention was high, but other underlying emotions, outside diet behavior, can affect long-term adoption outcomes. This has implications for designing future interventions.

Relational climate and openness to plant-forward diets among cohabitating couples

Plant-forward diets offer a potential solution to many of the health and ecological crises that we find ourselves facing today. A key barrier to the adoption and maintenance of plant-forward diets is an anticipated lack of support from family members, friends and romantic partners. The present study examined how relational climate (i.e., the cohesion and flexibility of a partnership) contributes to the tension individuals anticipate in their relationship when a member reduces their animal-product consumption, and their own openness to reducing. Four hundred and ninety-six coupled individuals took part in an online survey. Analyses revealed that couples with more flexible leadership styles anticipated less tension should they or their partner adopt a plant-forward diet. However, dimensions of relational climate were largely unrelated to openness to plant-forward diets. Romantic couples who perceived themselves to be matched in terms of dietary habits were less open to reducing their animal-product consumption than unmatched couples. Politically left-leaning couples and females were more open to plant-forward diets. The meat attachments of male partners were reported as a particular barrier to dietary goals, as were practical concerns about meal coordination, finance, and health. Implications for promoting plant-forward dietary transitions are discussed.

Examining foodwork and eating behaviors among heterosexual and gay male couples

OBJECTIVES

Spouses play an important role in their partner's eating behaviors, including both promoting and impeding healthy eating. The division of foodwork in the relationship (i.e., if there is individual or shared responsibility for food roles) may vary as a function of gender or sexual orientation and may be important in understanding eating behaviors.

METHOD

Using cross-sectional, dyadic data from 462 heterosexual and gay married couples (N = 921 individuals) residing in the United States, we accordingly sought to examine which partner was most responsible for two food roles, food shopping and meal preparation (Aim 1); whether these roles differed by gender (Aim 1a) and sexual orientation (Aim 1b); whether these food roles were related to the frequency of eating healthy and unhealthy foods (Aim 2); and whether these associations differed by gender (Aim 2a) and sexual orientation (Aim 2b).

RESULTS

We found that one individual was responsible for these roles in a majority of couples, although meal preparation was more likely to be shared in gay than in heterosexual couples. We also found that, in general, the person responsible for these food roles ate healthy more frequently compared to when their partner was responsible; findings for shared responsibility were more equivocal. These associations did not differ, however as a function of gender or sexual orientation.

CONCLUSION

Our findings contribute to a further understanding of food dynamics among heterosexual and gay male couples and have important implications for health promotion and intervention efforts.

Effect of Disclosure on Receiving Spousal Support in Korean Immigrants With Type 2 Diabetes

PURPOSE

The purpose of this study was to investigate factors associated with receiving diabetes spousal support in a sample of Korean immigrants with type 2 diabetes (T2DM) and to test whether disclosure (culture-specific factor) is a significant predictor of spousal support receipt in this group.

METHODS

A cross-sectional survey was conducted with a convenience sample of 136 US community-dwelling Korean immigrants with T2DM ages 46 to 89 years old. Potential predictors were sociodemographic factors (age, gender, education, years in US), personal characteristics (quality of marriage and depression), diabetes severity (duration of diabetes, A1C, insulin use), diabetes self-management, diabetes worries/concerns (psychological factor), and disclosure of worries (cultural factor). The study used validated survey instruments including Diabetes Care Profile for spousal support received, Summary of Diabetes Self-Care Activities, Problem Area in Diabetes, and Diabetes Distress Disclosure Index. Descriptive statistics, correlations, and hierarchical multivariable linear regression models were conducted.

RESULTS

Six predictors (education level, years spent in the US, glucose control status, diabetes self-management level, diabetes worries/concerns, and disclosure of diabetes worries) were significantly related to receiving spousal support. At least some college education, less time in the US, better glucose control (lower A1C), poor self-management, more diabetes worries, and more disclosure of diabetes worries/distress were associated with receiving higher level of spousal support. Disclosure was the strongest predictor.

CONCLUSION

Receiving spousal support for diabetes self-management among Korean immigrants is influenced by 6 factors identified in this study. Disclosing diabetes worries (cultural factor) is most impactful.

Social Support and Common Dyadic Coping in Couples' Dyadic Management of Type II Diabetes: Protocol for an Ambulatory Assessment Application

Background

Type II diabetes mellitus (T2DM) is a common chronic disease. To manage blood glucose levels, patients need to follow medical recommendations for healthy eating, physical activity, and medication adherence in their everyday life. Illness management is mainly shared with partners and involves social support and common dyadic coping (CDC). Social support and CDC have been identified as having implications for people’s health behavior and well-being. Visible support, however, may also be negatively related to people’s well-being. Thus, the concept of invisible support was introduced. It is unknown which of these concepts (ie, visible support, invisible support, and CDC) displays the most beneficial associations with health behavior and well-being when considered together in the context of illness management in couple’s everyday life. Therefore, a novel ambulatory assessment application for the open-source behavioral intervention platform MobileCoach (AAMC) was developed. It uses objective sensor data in combination with self-reports in couple’s everyday life.

Objective

The aim of this paper is to describe the design of the Dyadic Management of Diabetes (DyMand) study, funded by the Swiss National Science Foundation (CR12I1_166348/1). The study was approved by the cantonal ethics committee of the Canton of Zurich, Switzerland (Req-2017_00430).

Methods

This study follows an intensive longitudinal design with 2 phases of data collection. The first phase is a naturalistic observation phase of couples’ conversations in combination with experience sampling in their daily lives, with plans to follow 180 T2DM patients and their partners using sensor data from smartwatches, mobile phones, and accelerometers for 7 consecutive days. The second phase is an observational study in the laboratory, where couples discuss topics related to their diabetes management. The second phase complements the first phase by focusing on the assessment of a full discussion about diabetes-related concerns. Participants are heterosexual couples with 1 partner having a diagnosis of T2DM.

Results

The AAMC was designed and built until the end of 2018 and internally tested in March 2019. In May 2019, the enrollment of the pilot phase began. The data collection of the DyMand study will begin in September 2019, and analysis and presentation of results will be available in 2021.

Conclusions

For further research and practice, it is crucial to identify the impact of social support and CDC on couples’ dyadic management of T2DM and their well-being in daily life. Using AAMC will make a key contribution with regard to objective operationalizations of visible and invisible support, CDC, physical activity, and well-being. Findings will provide a sound basis for theory- and evidence-based development of dyadic interventions to change health behavior in the context of couple’s dyadic illness management. Challenges to this multimodal sensor approach and its feasibility aspects are discussed.

International Registered Report Identifier (IRRID)

PRR1-10.2196/13685

Correlates, Facilitators and Barriers of Healthy Eating Among Primary Care Patients with Prediabetes in Singapore-A Mixed Methods Approach

Healthy diet remains the primary means to prevent chronic diseases among those with prediabetes. We conducted a mixed methods study, consisting of a cross-sectional survey and in-depth interviews to assess factors associated with fulfilling the healthy plate recommendation, and to explore reasons for the behaviour among primary care patients with prediabetes in Singapore. The prevalence of meeting the recommendation was 57.3%. This was positively associated with being married and negatively associated with being Malay, frequency of eating out weekly and frequency of deep-fried food consumption weekly. The recurrent themes for not meeting the recommendation included family influence, perception of healthy food being not tasty, lack of skills to prepare or choose healthy food, difficulty in finding healthier options when eating out, and healthy food being costly. The recurrent themes for meeting the recommendation included family influence, self-discipline, fear of disease complications, education by healthcare professionals, mass media influence and health promotion campaigns. Much more remains to be done to promote healthy eating among these patients. There were different levels of facilitators and barriers to healthy eating. Apart from the individual and interpersonal levels, practitioners and policy makers need to work together to address the organisational, community and policy barriers to healthy eating.

Family and Couple Variables Regarding Adherence in Type 2 Diabetes Patients in the Initial Stages of the Disease

This study analyzed which family and couple variables predicted adherence to standard care treatment, in patients recently diagnosed with type 2 diabetes. The sample comprised 224 dyads assessed during the first year of diagnosis (T1) and 4 months later (T2). The results showed that family stress, dyadic adjustment, family coping, and positive support assessed by patients at T1 predicted medication adherence and glucose monitoring at T2. Positive support and dyadic adjustment, assessed by partners at T1, predicted patients' adherence to glucose monitoring and diet at T2. This study highlights the important role of the partner in patient`s adherence. Therefore, standard care in type 2 diabetes should be offered in the context of the dyad.

Type D personality and social relations in adults with diabetes: results from diabetes MILES - The Netherlands

OBJECTIVE

To examine whether individual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes.

DESIGN

In the Diabetes MILES-The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56 ± 14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups.

RESULTS

Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259] = 37.27, p < 0.001), and relationship adjustment (Welch[3,191] = 14.74; p < 0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile; adjusted OR = 8.73; 95%CI = 5.05 ∼ 15.09; p < 0.001) and lower relationship adjustment (lowest quartile; adjusted OR = 3.70; 95%CI = 2.10 ∼ 6.53; p < 0.001). Type D was also associated with increased levels of loneliness.

CONCLUSION

Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.

Explicating the Appraisal Dimension of the Communal Coping Model

The communal coping model argues that people cope with stress in the context of their relationships and that coping responses are both cognitive and behavioral in nature. However, the cognitive dimension of the model (appraisal) has not been explicated in extant research. The purpose of this study is to fill that gap by conceptualizing the appraisal dimension of communal coping in the context of families managing one member's type 2 diabetes. Analysis of interviews with individuals with type 2 diabetes and their family members (N = 28) revealed that appraisal consists of problem ownership and perceived problem influence and that appraisals are influenced by knowledge of the disease and changing health status. Theoretical and practical implications are discussed.

Gendered accounts of managing diabetes in same-sex relationships: A discursive analysis of partner support

The gendered dimensions of partner support in relationships where one partner has a chronic condition has been a recurring focus within the literature on gender and health. Such literature however typically focuses exclusively on heterosexual couples while same-sex relationships are rendered invisible, leading to the discourse around partner support being heteronormative. This article examines gendered dimensions within accounts of lesbian, gay and bisexual people with diabetes using a discursive psychological approach. The analysis identifies how participants drew upon a range of interpretative repertoires, including: (1) notions that women are more caring than men; (2) that men can take control in an emergency; (3) that gay men are caring; (4) that grown men can take care of themselves; and (5) that gay men are more independent than heterosexual men. It is argued that rather than simply dismissing heteronormative repertoires of gender and health, non-heterosexuals draw upon them in ways that display ideological tensions.

Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis

Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.

Negotiating Diet in Networks: A Cross-European Study of the Experiences of Managing Type 2 Diabetes

Food and diet are central aspects of diabetes self-management but the relevance of social networks for the way people are supported in their management of type 2 diabetes is often under-acknowledged. In this article, we aimed to explore the coalescences between these two phenomena among people with type 2 diabetes to increase knowledge of interactions within social network related to daily diet. The article is based on 125 qualitative interviews with individuals with type 2 diabetes from five European countries. Based on assumptions that people with chronic illnesses reshape relationships through negotiation, we analyzed negotiations of food at different levels of network. The respondents' reflections indicate that there are complex negotiations that influence self-management and food, including support, knowledge, and relationships within families; attention and openness in social situations; and the premises and norms of society.

Illness perception clusters and relationship quality are associated with diabetes distress in adults with Type 2 diabetes

This report aims to augment what is already known about emotional distress in Type 2 diabetes, by assessing the predictive value of illness perception clusters and relationship quality on four subcategories of Diabetes Distress.162 individuals with Type 2 diabetes responded to a postal questionnaire assessing demographics, depression, diabetes distress, illness perceptions and relationship quality. Long-term blood glucose was retrieved from participants' General Practitioner. Three illness perception clusters emerged from the data, capturing three subgroups of participants sharing similar illness perception schemas. Regression analyses were performed across each diabetes distress subscale, with demographics, illness perception clusters, and relationship variables entered into three blocks. Covariates explained 51.1% of the variance in emotional burden, 41% of the variance in regimen-related distress, 20% of the variance in interpersonal distress, and 8.6% of the variance in physician-related distress. Cluster membership was strongly associated with emotional burden, regimen-related distress, and to a lesser degree interpersonal distress, but was not associated with physician-related distress. Relationship quality most strongly predicted regimen-related distress. Illness perception schemas and interpersonal issues influence emotional adjustment in diabetes. This study provides direction for the content of a novel approach to identifying and reducing diabetes distress in people with Type 2 diabetes.

Emotional reactivity to daily stress, spousal emotional support, and fasting blood glucose among patients with type 2 diabetes

Stress is associated with higher blood glucose in patients with diabetes, but the strength of this association varies considerably across patients. The current daily diary study of 129 patients with type 2 diabetes examined whether individual differences in emotional stress reactivity were associated with fasting blood glucose and whether emotional support provided by spouses moderated this association. Greater stress reactivity was related to greater variability in patients’ fasting glucose readings and, among patients with less support, to higher fasting glucose levels. Investigating individual differences in emotional stress reactivity may help to clarify the role of stress in blood glucose control.

Patients' and Spouses' Contribution Toward Adherence to Self-Care Behaviors in Type 2 Diabetes

This article focuses on patients' and partners' variables regarding adherence to self-care, in recently diagnosed patients with Type 2 diabetes. One hundred four patients and partners were included. Instruments answered were Family Inventory of Life Events and Changes (family stress), Family Crisis Oriented Personal Evaluation Scales (family coping), Revised Dyadic Adjustment Scale (dyadic adjustment), Multidimensional Diabetes Questionnaire (partner support) and Hospital Anxiety and Depression Scale (psychological morbidity). Results showed adherence to diet to be positively predicted by patient dyadic adjustment and patient positive support and negatively by partner depression and partner negative support. Adherence to exercise was predicted by patient's family stress and negatively by partner anxiety. Adherence to glucose monitoring was predicted by partner positive support. Psychological variables were not associated with adherence to foot care. Finally, positive partner support moderated the relationship between family stress and dyadic adjustment in patients. The results emphasize the need to treat the patient in the context of the dyad. Future research should focus on partners' specific instrumental behaviors that promote patients' self-care behaviors.

Health capabilities and diabetes self-management: the impact of economic, social, and cultural resources

While the "social determinants of health" view compels us to explore how social structures shape health outcomes, it often ignores the role individual agency plays. In contrast, approaches that focus on individual choice and personal responsibility for health often overlook the influence of social structures. Amartya Sen's "capabilities" framework and its derivative the "health capabilities" (HC) approach attempts to accommodate both points of view, acknowledging that individuals function under social conditions over which they have little control, while also acting as agents in their own health and well-being. This paper explores how economic, social, and cultural resources shape the health capability of people with diabetes, focusing specifically on dietary practices. Health capability and agency are central to dietary practices, while also being shaped by immediate and broader social conditions that can generate habits and a lifestyle that constrain dietary behaviors. From January 2011 to December 2012, we interviewed 45 people with diabetes from a primary care clinic in Ontario (Canada) to examine how their economic, social, and cultural resources combine to influence dietary practices relative to their condition. We classified respondents into low, medium, and high resource groups based on economic circumstances, and compared how economic resources, social relationships, health-related knowledge and values combine to enhance or weaken health capability and dietary management. Economic, social, and cultural resources conspired to undermine dietary management among most in the low resource group, whereas social influences significantly influenced diet among many in the medium group. High resource respondents appeared most motivated to maintain a healthy diet, and also had the social and cultural resources to enable them to do so. Understanding the influence of all three types of resources is critical for constructing ways to enhance health capability, chronic disease self-management, and health.

Spouses' involvement in their partners' diabetes management: associations with spouse stress and perceived marital quality

Spouses frequently attempt to influence (control) or support their chronically ill partners' adherence behaviors. Studies have documented effects of spousal control and support on chronically ill individuals, but little is known about how these two forms of involvement in a partner's disease management may be associated with spouses' stress or the quality of their interactions with their ill partners. The current study sought to address this gap by examining spouses' day-to-day involvement in their marital partner's management of type 2 diabetes (n = 129). Multilevel analyses of daily diary data revealed that on days when spouses exerted control, they reported more stress and more tense marital interactions, although these associations were more pronounced when patients exhibited poor adherence, had been ill for a longer period of time, and had more comorbid health conditions. On days when spouses provided support, in contrast, they reported less stress and more enjoyable marital interactions. The findings from the current study suggest that spouses' day-to-day stress and quality of interactions with their partners are associated with spouses' involvement in their partners' disease management, with health-related social control and support exhibiting distinctive associations.

Ellen Berscheid, Elaine Hatfield, and the Emergence of Relationship Science

In the past 25 years, relationship science has grown from a nascent research area to a thriving subdiscipline of psychological science. In no small measure, this development reflects the pioneering contributions of Ellen Berscheid and Elaine Hatfield. Beginning at a time when relationships did not appear on the map of psychological science, these two scholars identified relationships as a crucial subject for scientific psychology and began to chart its theoretical and empirical territory. In this article, we review several of their most influential contributions, describing the innovative foundation they built as well as the manner in which this foundation helped set the stage for contemporary advances in knowledge about relationships. We conclude by discussing the broader relevance of this work for psychological science.

Spouse Control and Type 2 Diabetes Management: Moderating Effects of Dyadic Expectations for Spouse Involvement

For married patients, chronic illness management often includes involvement of their spouses. We examined expectations regarding spouse involvement in the health of a partner with type 2 diabetes (N = 139 couples) from the perspectives of the patient and spouse. Partners' dyadic expectations and spouses' gender were posited to moderate spouses' diet-related control and patients' diet adherence. Among male patients, when both partners shared an expectation for spouse involvement greater diet-related spouse control was associated with better diet adherence of patients. In contrast, when expectations for spouse involvement were not shared, greater spouse control by wives was associated with poorer diet adherence. Dyadic expectations for spouse involvement did not moderate the association between spouse control and diet adherence among female patients. Findings suggest that shared expectations for spouse involvement can facilitate spouses' attempts to improve patients' dietary adherence, especially among male patients and their wives.

How people interpret healthy eating: contributions of qualitative research

OBJECTIVE

To identify how qualitative research has contributed to understanding the ways people in developed countries interpret healthy eating.

DESIGN

Bibliographic database searches identified reports of qualitative, empirical studies published in English, peer-reviewed journals since 1995.

DATA ANALYSIS

Authors coded, discussed, recoded, and analyzed papers reporting qualitative research studies related to participants' interpretations of healthy eating.

RESULTS

Studies emphasized a social constructionist approach, and most used focus groups and/or individual, in-depth interviews to collect data. Study participants explained healthy eating in terms of food, food components, food production methods, physical outcomes, psychosocial outcomes, standards, personal goals, and as requiring restriction. Researchers described meanings as specific to life stages and different life experiences, such as parenting and disease onset. Identity (self-concept), social settings, resources, food availability, and conflicting considerations were themes in participants' explanations for not eating according to their ideals for healthy eating.

IMPLICATIONS

People interpret healthy eating in complex and diverse ways that reflect their personal, social, and cultural experiences, as well as their environments. Their meanings include but are broader than the food composition and health outcomes considered by scientists. The rich descriptions and concepts generated by qualitative research can help practitioners and researchers think beyond their own experiences and be open to audience members' perspectives as they seek to promote healthy ways of eating.

Marital status and mortality among middle age and elderly men and women in urban Shanghai

BACKGROUND

Previous studies have suggested that marital status is associated with mortality, but few studies have been conducted in China where increasing aging population and divorce rates may have major impact on health and total mortality.

METHODS

We examined the association of marital status with mortality using data from the Shanghai Women's Health Study (1996-2009) and Shanghai Men's Health Study (2002-2009), two population-based cohort studies of 74,942 women aged 40-70 years and 61,500 men aged 40-74 years at the study enrollment. Deaths were identified by biennial home visits and record linkage with the vital statistics registry. Marital status was categorized as married, never married, divorced, widowed, and all unmarried categories combined. Cox regression models were used to derive hazard ratios (HR) and 95% confidence interval (CI).

RESULTS

Unmarried and widowed women had an increased all-cause HR = 1.11, 95% CI: 1.03, 1.21 and HR = 1.10, 95% CI: 1.02, 1.20 respectively) and cancer (HR = 1.17, 95% CI: 1.04, 1.32 and HR = 1.18, 95% CI: 1.04, 1.34 respectively) mortality. Never married women had excess all-cause mortality (HR = 1.46, 95% CI: 1.03, 2.09). Divorce was associated with elevated cardiovascular disease (CVD) mortality in women (HR = 1.47, 95% CI: 1.01, 2.13) and elevated all-cause mortality (HR = 2.45, 95% CI: 1.55, 3.86) in men. Amongst men, not being married was associated with excess all-cause (HR = 1.45, 95% CI: 1.12, 1.88) and CVD (HR = 1.65, 95% CI: 1.07, 2.54) mortality.

CONCLUSIONS

Marriage is associated with decreased all cause mortality and CVD mortality, in particular, among both Chinese men and women.

When does Spousal Social Control Provoke Negative Reactions in the Context of Chronic Illness?: The Pivotal Role of Patients' Expectations

Spouses often monitor and seek to alter each other's health behavior, but such social control attempts can provoke behavioral resistance and emotional distress. Expectations regarding spouses' roles in their partners' health may influence reactions to spousal social control, with resistance and hostility less likely to occur among people who believe spouses should be involved in their partners' health. Evidence consistent with this idea emerged in a study of 191 patients with type 2 diabetes. Patients with greater expectations for spousal involvement (particularly females) generally reacted less negatively to spousal control. The findings help to clarify when people with a chronic illness are likely to resist and resent, rather than appreciate, spousal control.

A metasynthesis of the self-management of type 2 diabetes

Type 2 diabetes is a metabolic disorder characterized by chronically elevated blood glucose and high risk of comorbidities. In this article we report a metasynthesis of the 21st-Century qualitative research concerning the self-management of type 2 diabetes. We identified 38 relevant articles (sample size range 6 to 175), which were synthesized through a process of iterative reading and theory development. In this literature, authors argued and assumed that diabetes management is influenced by multiple, complex, competing factors, including interpersonal relations, gender, and sociocultural context. Conversely, self-management was sometimes construed as a facet of individual agency and was accepted uncritically, placing accountability for health with patients themselves. We conclude that a satisfactory account of diabetes care would pay attention to the "inner" world, while acknowledging the social and political conditions in which diabetes-related experiences unfold.

Psychological adjustment to Type 2 diabetes and relationship quality

AIMS

  To examine the associations between psychological adjustment to Type 2 diabetes and the reported quality and type of relationships with partners.

METHODS

  All participants (n=88) completed a number of questionnaires, including two measures of relationship quality: the Dyadic Adjustment Scale and the Personal Assessment of Intimacy in Relationships Scale, the Diabetes Quality of Life Scale and the ATT-19 (which assesses personal integration of diabetes). Additionally, HbA(1c) levels were obtained from medical notes.

RESULTS

  Measures of relationship quality significantly contributed to the explanation of two outcomes: personal integration of diabetes and satisfaction with the burden of self-management behaviours. More specifically, the findings demonstrate that a specific aspect of relationship quality--intimacy in recreational activities--is positively associated with the outcomes mentioned above.

CONCLUSIONS

  People with Type 2 diabetes who are not taking insulin, who share engagement in physical activities with their partner are more likely to be psychologically well-adjusted to their diagnosis of diabetes.

Are spouses of chronically ill partners burdened by exerting health-related social control?

Spouses often seek to influence the health behaviors of chronically ill partners, but little research has examined whether spouses find such involvement to be burdensome. The current study examined this question in a sample of 191 nondiabetic spouses whose partners had type 2 diabetes. Results revealed that spouses who attempted to exert more control over their partners' dietary behavior experienced greater burden, particularly when their partners exhibited poor dietary adherence and reacted negatively to spouses' involvement. The findings contribute to a sparse body of knowledge on how spouses are affected by efforts to influence their chronically ill partners' disease management.

Support and influence in the context of diabetes management: do racial/ethnic differences exist?

This study examined the sources and frequency of, and dietary behavioral responses to, health-related social support and control in a racially/ethnically diverse sample of 1,361 adults with type 2 diabetes. Spouses were the most frequently reported sources of support/control for all racial/ethnic groups examined. Mexican Americans and Vietnamese Americans received more support/control compared to non-Hispanic whites. All types of social involvement were associated with good dietary behavior for Mexican Americans, whereas only support was associated with good dietary behavior for non-Hispanic whites. The findings underscore the importance of considering racial/ethnic differences in examining social network members' involvement in chronic disease management.

Promoting and measuring family caregiver self-efficacy in caregiver-physician interactions

This article describes the development of a 5-item scale that assesses family caregivers' self-efficacy in communicating with physicians about ill family members (Perceived Efficacy in Caregiver-Physician Interactions-PECPI) in the context of an evaluation study of an online training in health care communication skills for caregivers. A national sample of 197 self-identified family caregivers participated in an online webinar and completed a brief evaluation instrument before and immediately after the training. Results indicated that the webinar was effective in increasing perceived self-efficacy and self-reported knowledge about and level of preparation for medical visits. Principal component analysis indicates that the PECPI is unidimensional with a Cronbach's alpha of .91.

Marital status and gender differences in managing a chronic illness: the function of health-related social control

The attempts of social network members to regulate individuals' health behaviors, or health-related social control, is one mechanism by which social relationships influence health. Little is known, however, about whether this process varies in married versus unmarried individuals managing a chronic illness in which health behaviors are a key component. Researchers have proposed that social control attempts may have dual effects on recipients' well-being, such that improved health behaviors may occur at the cost of increased emotional distress. The current study accordingly sought to examine marital status differences in the sources, frequency, and responses to health-related social control in an ethnically diverse sample of 1477 patients with type 2 diabetes from southern California, USA. Results from two-way ANCOVAs revealed that married individuals reported their spouses most frequently as sources of social control, with unmarried women naming children and unmarried men naming friends/neighbors most frequently as sources of social control. Married men reported receiving social control most often, whereas unmarried men reported receiving social control least often. Regression analyses that examined behavioral and emotional responses to social control revealed that social control using persuasion was associated with better dietary behavior among married patients. Results also revealed a complex pattern of emotional responses, such that social control was associated with both appreciation and hostility, with the effect for appreciation most pronounced among women. Findings from this study highlight the importance of marital status and gender differences in social network members' involvement in the management of a chronic illness.

When the going gets tough, does support get going? Determinants of spousal support provision to type 2 diabetic patients

Although spousal support has been linked to positive outcomes in various health-related contexts, some research has found that the amount of social support provided to those who are chronically ill deteriorates over time. The current study refines the literature by considering multiple factors associated with spouses' provision of emotional support to partners with Type 2 diabetes. This diary study (N = 126 couples) examined the roles that stressor (disease severity and diabetes-specific anxiety), recipient (negative and positive affect), provider (negative and positive affect), and relationship (tension and enjoyment) factors play in spouses' provision of emotional support. Daily disease severity, patients' and spouses' daily negative affect, and spouses' daily relationship enjoyment were predictors of support provision. Wives, but not husbands, provided more support on days when patients experienced diabetes-specific anxiety. Results advance understanding of support provision in the context of a chronic stressor.

The illness demands of diabetes on couples in Botswana

This report is part of a larger study that investigated the relationships between illness demands, marital support, and psychological adjustment in the context of diabetes mellitus in rural and urban middle-aged marital couples in Botswana. Ninety-six persons experiencing diabetes and 87 of their spouses participated in the study. This report is based on data from 87 diabetic patients and their spouses. Data were collected through face-to-face interviews. Patients and their spouses were interviewed separately. Three open-ended questions elicited participants' personal experiences of illness demands. The couple participants reported many challenging illness experiences associated with the illness and contextual factors that influenced their perception about the burden of illness and reported that the illness experienced was often a growth-enhancing and maturing process.

Dietary change: what are the responses and roles of significant others?

OBJECTIVE

This study examined the impact of one person's dietary change on the experiences of a significant other with whom they regularly shared meals.

DESIGN

Qualitative constant comparison approach using semistructured interviews.

SETTING

Community-based.

PARTICIPANTS

Forty-two participants were recruited using a stratified purposive sampling strategy.

ANALYSIS

Verbatim transcripts were analyzed using NUD*IST, version 4.0 software (Qualitative Solutions and Research, Melbourne, Australia, 1997) and manual coding.

RESULTS

Most dietary changers had modified their diets in response to a disease diagnosis (eg, cardiovascular disease, diabetes, cancer, hypoglycemia, acquired immunodeficiency syndrome (AIDS), ulcer, allergies). Others had changed their diets for personal reasons (eg, weight loss, vegetarian diets). The dietary changes included dietary fat reduction, conversion to vegetarian or vegan diets, restriction of total kilocalorie intake, and elimination or reduction of specific food items. Significant others described a range of emotional responses to the dietary change, including cooperation, encouragement, skepticism, and anger. Significant others' descriptions of the roles that they played in the dietary change were positive (enabling), neutral (neither enabling nor inhibiting), or negative (inhibiting). Most significant others played positive roles; few played neutral or negative roles.

CONCLUSIONS AND IMPLICATIONS

Understanding dietary change from the perspective of significant others can enable nutrition professionals to develop strategies to promote dietary modifications as a shared activity.