1
|
Gouin JP, Dymarski M. Couples-based health behavior change interventions: A relationship science perspective on the unique opportunities and challenges to improve dyadic health. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 19:100250. [PMID: 39155951 PMCID: PMC11326928 DOI: 10.1016/j.cpnec.2024.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/05/2024] [Accepted: 07/12/2024] [Indexed: 08/20/2024] Open
Abstract
Epidemiological studies indicate that better marital quality is associated with less morbidity and premature mortality. A number of interpersonal processes related to marital quality are also associated with health-relevant surrogate biomarkers across different physiological systems. Despite these replicated correlational findings, few interventions have harnessed interpersonal processes as potential interventions to enhance health. Building on Dr. Janice Kiecolt-Glaser's model of relationships and health, we propose that couples-based health behavior change interventions may represent an effective way to decrease dysregulation across autonomic, endocrine and immune systems and, ultimately, improve dyadic health. Given that the cohabiting partner is an essential part of the social context in which the behavior change is being pursued, it is important to consider the relational issues triggered by dyadic interventions. Using a relationship science perspective, this article reviews the literature on couples' concordance in health behaviors and health outcomes, the potential pathways underlying this concordance, theories of the couple as a self-sustaining social system, dyadic adaptation of individual self-regulation strategies, effective and ineffective social support and social control in couple relationships, the integration of relationship-building and health behavior change strategies, and the consideration of key moderators related to the nature of the relationship and the context surrounding the relationship. These findings highlight the importance of adopting a relationship science perspective when designing and testing dyadic interventions to improve health outcomes. The data reviewed provide insights on how to optimize couples-based health behavior change interventions to reduce physiological dysregulation and improve dyadic health.
Collapse
Affiliation(s)
| | - Maegan Dymarski
- Department of Psychology, Concordia University, Montreal, Canada
| |
Collapse
|
2
|
Duh-Leong C, Ortiz R, Messito MJ, Katzow MW, Kim CN, Teli R, Gross RS. Household Food Insecurity and Maternal-Toddler Fruit and Vegetable Dietary Concordance. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:100-109. [PMID: 38142387 PMCID: PMC10922249 DOI: 10.1016/j.jneb.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To examine whether prenatal or concurrent household food insecurity influences associations between maternal and toddler fruit and vegetable (FV) intake. DESIGN Application of a life-course framework to an analysis of a longitudinal dataset. SETTING Early childhood obesity prevention program at a New York City public hospital. PARTICIPANTS One-hundred and fifty-six maternal-toddler dyads self-identifying as Hispanic or Latino. VARIABLES MEASURED Maternal and toddler FV intake was measured using Centers for Disease Control and Prevention dietary measures when toddlers were aged 19 months. Household food insecurity (measured prenatally and concurrently at 19 months) was measured using the US Department of Agriculture Food Security Module. ANALYSIS Regression analyses assessed associations between adequate maternal FV intake and toddler FV intake. Interaction terms tested whether prenatal or concurrent household food insecurity moderated this association. RESULTS Adequate maternal FV intake was associated with increased toddler FV intake (B = 6.2 times/wk, 95% confidence interval, 2.0-10.5, P = 0.004). Prenatal household food insecurity was associated with decreased toddler FV intake (B = -6.3 times/wk, 95% confidence interval, -11.67 to -0.9, P = 0.02). There was a significant interaction between the level of maternal-toddler FV association (concordance or similarity in FV intake between mothers and toddlers) and the presence of food insecurity such that maternal-toddler FV association was greater when prenatal household food insecurity was not present (B = -11.6, P = 0.04). CONCLUSIONS AND IMPLICATIONS Strategies to increase FV intake across the life course could examine how the timing of household food insecurity may affect intergenerational maternal-child transmission of dietary practices.
Collapse
Affiliation(s)
- Carol Duh-Leong
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY.
| | - Robin Ortiz
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY; Institute for Excellence in Health Equity, New York University Langone Health, New York, NY
| | - Mary Jo Messito
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
| | - Michelle W Katzow
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Christina N Kim
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Radhika Teli
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Rachel S Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| |
Collapse
|
3
|
Zhang J, Yang C, Liu Y, Wu D, Liu L, Zheng H, Xu DR, Liao J. Conditions for successful implementation of couple-based collaborative management model of diabetes among community-dwelling older Chinese: a qualitative comparative analysis. BMC Geriatr 2023; 23:832. [PMID: 38082267 PMCID: PMC10712117 DOI: 10.1186/s12877-023-04565-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a prevalent and potentially devastating chronic illness affecting many older adults. Given spousal involvement in many aspects of diabetes management, coping with their partners is increasingly seen as a potential solution to make up for limited resources. This study aimed to identify the key conditions for optimal implementation of couple-based collaborative management model (CCMM) among Chinese older couples with type 2 diabetes mellitus. METHODS Older couples and community healthcare practitioners were selected according to couples' joint intervention attendance rate and community's average attendance rate. This mixed methods research consisted of a qualitative phase and a quantitative phase. In the qualitative phase, in-depth interviews were conducted among 12 pairs of couples in the intervention group and 4 corresponding practitioners, in the follow-up period of the multicentered RCT from January to April 2022. Qualitative comparative analysis (QCA) in the quantitative phase to identify conditions influencing CCMM's implementation and to explore necessary and sufficient combinations of conditions (i.e., solutions) for improving patients' glycated hemoglobin (HbA1c) control (outcome). RESULTS Key conditions included implementation process, couple's role in diabetes management, their belief and perception of CCMM, as well as objective obstacles and subjective initiative for behavior change. Accordingly, major barriers in CCMM's implementation were patients' strong autonomy (particularly among husbands), misbelief and misperception about diabetes management as a result of low literacy, and mistrust of the practitioners. QCA further revealed that no single condition was necessary for effective HbA1c control, while three types of their combinations would be sufficient. Solution 1 and 2 both comprised the presence of spousal willingness to help, plus correct belief and perception of diabetes management, well embodying the utility of couple collaborative management in supporting patients' HbA1c control. On the other hand, solution 3 indicated that high-quality implementation even without spousal support, can promote the patient's subjective initiative to overcome objective obstacles, suggesting enhanced self-management for HbA1c control. CONCLUSIONS Tailored CCMM should be implemented in reference to older couple's preferences and literacy levels, to ensure intervention fidelity, and establish correct understanding of collaborative management among them.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China
| | - Conghui Yang
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yixuan Liu
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China
| | - Dadong Wu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, P.R. China
| | - Lingrui Liu
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, United States
| | - Huiqiong Zheng
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China
| | - Dong Roman Xu
- Center for World Health Organization Studies, Department of Health Management, School of Health Management, Southern Medical University, Shenzhen, P.R. China
- ACACIA Lab for Implementation Research, SMU Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, P.R. China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China.
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China.
| |
Collapse
|
4
|
Yuan X, Liu W, Ni W, Sun Y, Zhang H, Zhang Y, Yin P, Xu J. Concordance of Non-Alcoholic Fatty Liver Disease and Associated Factors among Older Married Couples in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1426. [PMID: 36674180 PMCID: PMC9859299 DOI: 10.3390/ijerph20021426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases which affects mainly middle-aged and older adults, resulting in a considerable disease burden. Evidence of concordance on NAFLD and lifestyle factors within older married couples in China is limited. This study aimed to evaluate spousal concordance regarding lifestyle factors and NAFLD among older Chinese couples. Methods: We conducted a cross-sectional study using data from 58,122 married couples aged 65 years and over recruited from Shenzhen, China during 2018−2020. Logistic regression analyses were used to estimate the reciprocal associations in NAFLD within couples after incremental adjustment for potential confounders. Results: There was a marked concordance regarding NAFLD among older married couples in our study. After adjustment for confounders, the odds of having NAFLD were significantly related to the person’s spouse also having NAFLD (1.84 times higher in husbands and 1.79 times higher in wives). The spousal concordance of NAFLD was similar, irrespective of gender. Couples with both a higher educational level and abdominal obesity were more likely to have a concordance of NAFLD compared to couples with both a lower educational level and no abdominal obesity, respectively (p < 0.05). Conclusion: Our results indicated that health care professionals should bear in mind the marked spousal concordance with respect to risk factors and NAFLD for the prevention and early detection of the highly prevalent disease in older Chinese adults.
Collapse
Affiliation(s)
- Xueli Yuan
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Wei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Wenqing Ni
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Yuanying Sun
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Hongmin Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Yan Zhang
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jian Xu
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen 518020, China
| |
Collapse
|
5
|
Yang C, Xu Y, Zhi J, Zheng H, Sun Z, Wu X, Liao J. Gender-Specific Effect of Couple-Based Intervention on Behavioral and Psychological Outcomes of Older Adults with Type 2 Diabetes during the COVID-19 Partial Lockdown in Guangzhou, China. Healthcare (Basel) 2022; 10:healthcare10112290. [PMID: 36421614 PMCID: PMC9690585 DOI: 10.3390/healthcare10112290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/29/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate the gender-specific effect of a couple-based intervention on the management behaviors and mental well-being of community-dwelling older adults with type 2 diabetes mellitus during the COVID-19 partial lockdown in Guangzhou. Out of 207 participants involved in a prior randomized controlled trial (Trial no. ChiCTR1900027137), 156 (75%) completed the COVID-19 survey. Gendered differences in management behaviors and depressive symptoms between the couple-based intervention group and the patient-only control group were compared by distance to the high-risk areas cross-sectionally and longitudinally using random intercept models. Cross-sectionally, female patients of the intervention group had more positive behavior change scores (β = 1.53, p = 0.002) and fewer depressive symptoms (β = −1.34, p = 0.02) than the control group. Over time, female patients lived closer to the high-risk areas (<5 km) and showed decreasing depressive symptoms (β = −4.48, p = 0.008) in the intervention group vs. the control group. No statistically significant between-group difference was found for males. Females tended to benefit more from the coupled-based intervention than males did, particularly among these closer to the high-risk areas. Chronic disease management can be better sustained with active spousal engagement.
Collapse
Affiliation(s)
- Conghui Yang
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou 510080, China
| | - Yingxin Xu
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou 510080, China
| | - Jingyi Zhi
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou 510080, China
| | - Huiqiong Zheng
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhenhua Sun
- School of Nursing and Health, Guangzhou Nanfang College, Guangzhou 510970, China
| | - Xueji Wu
- Department of Integrated Profession Management, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Jing Liao
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou 510080, China
- Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou 510275, China
- Correspondence: ; Tel.: +86-020-8411-2657
| |
Collapse
|
6
|
Rahmati M, Saei Ghare Naz M, Azizi F, Ramezani Tehrani F. Pregnancy loss and subsequent risk of prediabetes, diabetes and metabolic syndrome in couples: Tehran lipid and glucose study. Lab Invest 2022; 20:372. [PMID: 35982490 PMCID: PMC9389652 DOI: 10.1186/s12967-022-03578-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/07/2022] [Indexed: 12/15/2022]
Abstract
Background There is limited evidence regarding the impact of pregnancy loss on the subsequent risk of metabolic disorders. We aimed to investigate whether history of pregnancy loss is associated with the subsequent risk of prediabetes (pre-DM), diabetes (DM), and metabolic syndrome (METs) among couples. Method In this population-based cohort study, 2765 couples with and without history of pregnancy loss and free of DM, pre-DM, and METs at baseline were included and followed for incidents of DM, pre-DM, and METs by 3-year intervals visits from 1999 to 2018. Detailed data of variables was collected using standard questionnaires, interviews, clinical and laboratory assessments. A modified Poisson regression for binary outcome data with a log link function and robust error variance was used to estimate relative risks (RRs) in couples with and without history of pregnancy loss. Both unadjusted and adjusted models were fitted, and effect measures were calculated. Result During a median follow-up of 15 years, females with history of pregnancy loss were experienced more pre-DM (50% vs. 45.5%), DM (28.9% vs. 21.3%), and METs (70% vs. 60.1%) than females without such history. Moreover, history of pregnancy loss increased the risk of METs by 8% among females. The incidence of DM in males with history of pregnancy loss in their spouses was higher than in males without it (28.8% vs. 23.5%). Among males, having a spouse with history of pregnancy loss was positively associated with the risk of pre-DM (RR = 1.12; 95%CI: 1.02, 1.23, p = 0.02); furthermore, they were more prone to the risk of METs than females with a history of pregnancy loss (RR = 1.13; 95%CI: 1.07, 1.20, p < 0.001). Conclusion Although pregnancy loss is a female-specific factor, may foreshadow the subsequent METs, our study identified a higher risk of subsequent pre-DM and METs in males with history of pregnancy loss in their spouses. Pregnancy loss could be considered a possible future risk factor for metabolic disorders in couples.
Collapse
Affiliation(s)
- Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid, Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Saei Ghare Naz
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid, Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid, Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|