Spouses' provision of health-related support and control to patients participating in cardiac rehabilitation

Everyday Social Support for Health Behaviours in Older Adults during Times of Challenge: Evidence from Daily Life Assessments

The COVID-19 pandemic challenged older adults' health behaviours, making it even more difficult to engage in healthy diets and physical activity than it had been prepandemic. A resource to promote these could be social support. This study uses data from 136 older adults (Mage = 71.39 years, SD = 5.15, range: 63-87) who reported their daily fruit and vegetable consumption, steps, and health-behaviour-specific support from a close other every evening for up to 10 consecutive days. Findings show that on days when participants reported more emotional support than usual, fruit and vegetable consumption and step counts were higher. Daily instrumental support was positively associated with step counts, only. Participants receiving more overall emotional support across the study period consumed more fruit and vegetables; no parallel person-level association was found for overall steps. There were no significant interactions between dyad type and support links for our outcomes.

Living together-does it help or hinder the pursuit of a healthful diet, physical activity, and weight loss among cancer survivors and their chosen partners?

PURPOSE

Parental or spousal cohabitating relationships are often targeted in behavioral interventions, but the contribution of cohabitation is poorly understood. This study explored whether cohabitation status moderated the impact of social cognitive theory constructs on adiposity, diet, and exercise in a dyadic, web-based weight loss intervention among cancer survivors and their chosen partners.

METHODS

The 24-week weight loss intervention was conducted among 56 dyads, comprised of a cancer survivor and their chosen partner (n = 112). Baseline and 6-month data on social cognitive theory constructs (self-efficacy, social support, and perceived barriers), and study outcomes of adiposity (weight and waist circumference), diet (calories and diet quality), and moderate-to-vigorous physical activity (MVPA) were used to perform moderated-mediation analyses among cohabitating (n = 25) versus non-cohabitating (n = 31) dyads.

RESULTS

The intervention was positively associated with dietary social support (path a1: 0.36, 95% CI [0.083, 0.659]) and inversely associated with perceived dietary barriers (path a1: - 10.57, 95% CI [- 19.109, - 3.091]) and perceived exercise barriers (path a1: - 11.29, 95% CI [- 22.098, - 3.500]) among those who did not cohabitate (effects not observed among cohabitating pairs). The intervention's mediating effects through perceived barriers on weight (indirect effect (ab): - 2.21, 95% CI [- 4.794, - 0.548]), waist circumference (ab: - 1.13, 95% CI [- 2.452, - 0.171]), caloric intake (ab: - 5.09 (2.86), 95% CI [- 12.602, - 0.709]), and self-reported MVPA (ab: 0.29 (0.18), 95% CI [0.019, 0.754]) also were stronger among non-cohabitating pairs.

CONCLUSIONS

These findings suggest that social support partners outside the home substantially enhance intervention impact, though relationship quality and gender dynamics warrant further exploration.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04132219.

Couples-based health behavior change interventions: A relationship science perspective on the unique opportunities and challenges to improve dyadic health

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.

The development and psychometric examination of the partner investment in health scale

OBJECTIVE

Relationship partners' impacts on health are not fully captured by existing measures. A measure that applies to a prevention context and accounts for both partners' perspectives is needed. This work developed and assessed the psychometric properties of the novel Partner Investment in Health scale (PI-H).

DESIGN

A cross-sectional design assessed participants (N = 261) using an online survey. Exploratory factor analyses were used to determine the PI-H factor structure.

MAIN OUTCOME MEASURES

Items assessed the person's investment in their partner's health and their perception of their partner's investment in their health.

RESULTS

A 2 factor structure underlying 24 items on the PI-H scale was supported. Factors represented 1) the respondent's investment and 2) the respondent's perception of their partner's investment. The PI-H significantly correlated with related measures (e.g. relationship satisfaction, dyadic and communal coping; p < .05).

CONCLUSION

A full PI-H scale, two subscales, and a short version of the scale (8 items) are presented. Correlations demonstrated convergent validity and suggested the PI-H is distinct from existing constructs. Theoretical implications and applications are discussed.

From Organizing Medicine to Cooking With More Leafy Greens: A Dyadic, Qualitative Analysis of How Older African American Couples Take Care of Each Other's Health

Guided by the Dyadic Theory of Illness Management, we explored spousal health management behaviors and their congruence within seventeen older African American married couples participating in a dyadic exercise intervention. Both prior to and after the intervention, spouses reported how they took care of their partner's health as well as what their partner did for them. Data were analyzed using theoretical thematic analysis, and five health management behaviors domains were identified (diet, exercise, self-care, medical compliance, relationship maintenance). Both partners were most likely to encourage healthier diets and exercise. Wives tended to report more behaviors compared to husbands. Couples had little congruence in their appraisals of each other's health management behaviors, and patterns were stable over time. Findings suggest incongruence in couples' health management behaviors represented complementary, collaborative efforts to support each other and that husbands may underestimate how much care they both provide to and receive from their wives.

The impact of marital status on tumor aggressiveness, treatment, and screening among black and white men diagnosed with prostate cancer

PURPOSE

To examine the association of marital status with prostate cancer outcomes in a racially-diverse cohort.

METHODS

The study population consisted of men (1010 Black; 1070 White) with incident prostate cancer from the baseline North Carolina-Louisiana Prostate Cancer (PCaP) cohort. Marital status at time of diagnosis and screening history were determined by self-report. The binary measure of marital status was defined as married (including living as married) vs. not married (never married, divorced/separated, or widowed). High-aggressive tumors were defined using a composite measure of PSA, Gleason Score, and stage. Definitive treatment was defined as receipt of radical prostatectomy or radiation. Multivariable logistic regression was used to examine the association of marital status with (1) high-aggressive tumors, (2) receipt of definitive treatment, and (3) screening history among Black and White men with prostate cancer.

RESULTS

Black men were less likely to be married than White men (68.1% vs. 83.6%). Not being married (vs. married) was associated with increased odds of high-aggressive tumors in the overall study population (adjusted Odds Ratio (aOR): 1.56; 95% Confidence Interval (CI): 1.20-2.02) and both Black and White men in race-stratified analyses. Unmarried men were less likely to receive definitive treatment in the overall study population (aOR: 0.68; 95% CI: 0.54-0.85). In race-stratified analyses, unmarried Black men were less likely to receive definitive treatment. Both unmarried Black and White men were less likely to have a history of prostate cancer screening than married men.

CONCLUSION

Lower rates of marriage among Black men might signal decreased support for treatment decision-making, symptom management, and caregiver support which could potentially contribute to prostate cancer disparities.

Recognizing and Appreciating the Partner's Support Protects Relationship Satisfaction during Cardiac Illness

BACKGROUND

This study aimed to examine whether dyadic coping (DC) is associated with relationship satisfaction (RS) among couples facing cardiac diseases. Furthermore, the moderating role of both partners' anxiety and depression was tested.

METHODS

One hundred cardiac patients (81.5% men) and their partners (81.5% women) completed a self-report questionnaire during hospitalization. The Actor-Partner Interdependence Model (APIM) and moderation analyses were used to assess the above associations.

RESULTS

Results showed that positive DC was significantly related to higher levels of RS, and negative DC was related to lower levels of RS. Furthermore, patient and partner psychological distress significantly moderated the link between DC and RS: patient-perceived positive DC was associated with higher partner RS when partner depression was high; partner-perceived positive DC was associated with higher patient RS when patient anxiety was low; patient-perceived negative DC has associated with lower patient RS when patient anxiety and depression were high.

CONCLUSION

This study showed that positive DC is associated with a more satisfying relationship and identified under what conditions of cardiac-related distress this can happen. Furthermore, this study underlined the importance of examining DC in addition to the individual coping skills as a process pertaining to personal well-being and couple's outcomes.

The influence of the significant other on treatment adherence in chronic pain management: a qualitative analysis

Objectives. Adherence to treatment recommendations is critical for optimising quality of life for individuals with chronic pain, however adherence rates are low. This study explores the role that significant others are perceived to play in supporting or impeding treatment adherence, as well as examining patient views of the impact of their adherence regimes on their significant others.Design. 25 treatment seeking adults with chronic pain, who were currently living with a romantic partner or adult family member, took part in individual semi-structured interviews.Main outcome measures Interviews were transcribed verbatim and analysed using thematic analysis.Results. Three treatment adherence support themes emerged: social support (emotional, instrumental), positive social control, and supporting autonomy. Participants did not perceive significant others as having any negative influence on their adherence. By contrast, patients perceived that their adherence behaviors had both positive and negative effects on their significant others.Conclusions. These data present an encouraging perspective on the interpersonal context of coping with chronic pain. Significant others facilitated adherence in a range of ways. Future research identifying how best to integrate significant other support into patient self-management programs is needed, in order to lift the poor treatment adherence rates that are noted in the literature.

Examining the link between exercise-specific relational processes and physical activity, psychological distress, and relationship satisfaction among heterosexual and gay male couples

Despite the important role of romantic relationships in physical activity, little research has examined the role of gender and sexual orientation in exercise-specific relational processes. Utilizing cross-sectional, dyadic data from 462 heterosexual and gay couples, the present study examined how exercise encouragement, exercise discouragement, and frequency of exercise disagreements are related to physical activity, psychological distress, and relationship satisfaction. We included important covariates and examined gender and sexual orientation as moderators. Higher exercise encouragement was associated with more frequent physical activity (for gay men only), lower psychological distress (for women only), and higher relationship satisfaction regardless of gender and sexual orientation. Higher exercise discouragement was associated with more physical activity for all participants and higher levels of psychological distress for gay men only. Finally, more frequent exercise disagreements were associated with more psychological distress for all participants. These findings highlight important implications for physical activity promotion, prevention, and intervention.

Capturing the impact employees have on their coworkers and leaders: a holistic approach on health-specific support behavior from employees

Support is a valuable resource for ensuring employee health in the workplace. However, research on health-specific support behavior (i.e., support specifically targeting concrete health aspects) has only concentrated on either leader behavior (e.g., healthy leadership styles) or support provided by employees for specific health issues (e.g., healthy eating or smoking cessation). Although the importance of employee health has been well established, the examination of a wider range of potential health-specific support behaviors from employees provided for their colleagues and leaders has been neglected. To understand employee health-specific support behavior, we adapted an existing health-oriented leadership questionnaire to cover support for colleagues (PeerCare) and their leaders (LeaderCare). Capturing the employee perspective with a sample of 347 employees, the results confirmed a delineation of health-oriented scales (factor, convergent, and discriminant validity). By testing health-specific support behavior processes at work, the positive effects of PeerCare on general health were demonstrated. Contrary to expectations, existing health effects are outweighed when leaders provide health-specific support behavior to their employees (StaffCare). However, the results imply that the health-specific support behavior practices of different actors reinforce each other: the effects of StaffCare and PeerCare enhance each other, and StaffCare has a strong influence on LeaderCare. Remarkably, SelfCare has a key role in this process. The open questions and implications regarding the effects of the different health-specific support behavior measurements are discussed.

Couple-based lifestyle intervention to prevent type 2 diabetes: protocol for a randomised pilot trial

INTRODUCTION

Type 2 diabetes is prevalent among US adults. Lifestyle interventions that modify health behaviours prevent or delay progression to diabetes among individuals at high risk. Despite the well-documented influence of individuals' social context on their health, evidence-based type 2 diabetes prevention interventions do not systematically incorporate participants' romantic partners. Involving partners of individuals at high risk for type 2 diabetes in primary prevention may improve engagement and outcomes of programmes. The randomised pilot trial protocol described in this manuscript will evaluate a couple-based lifestyle intervention to prevent type 2 diabetes. The objective of the trial is to describe the feasibility of the couple-based intervention and the study protocol to guide planning of a definitive randomised clinical trial (RCT).

METHODS AND ANALYSIS

We used community-based participatory research principles to adapt an individual diabetes prevention curriculum for delivery to couples. This parallel two-arm pilot study will include 12 romantic couples in which at least one partner (ie, 'target individual') is at risk for type 2 diabetes. Couples will be randomised to either the 2021 version of the CDC's PreventT2 curriculum designed for delivery to individuals (six couples), or PreventT2 Together, the adapted couple-based curriculum (six couples). Participants and interventionists will be unblinded, but research nurses collecting data will be blinded to treatment allocation. Feasibility of the couple-based intervention and the study protocol will be assessed using both quantitative and qualitative measures.

ETHICS AND DISSEMINATION

This study has been approved by the University of Utah IRB (#143079). Findings will be shared with researchers through publications and presentations. We will collaborate with community partners to determine the optimal strategy for communicating findings to community members. Results will inform a subsequent definitive RCT.

TRIAL REGISTRATION NUMBER

NCT05695170.

Psychological distress, social support, and use of outpatient care among adult men and women with coronary artery disease or other non-cardiovascular chronic disease

OBJECTIVES

Psychological distress, as defined by elevations in symptoms of depression, anxiety, and/or perceived stress, is frequent in patients with chronic diseases, such as coronary artery disease (CAD). While psychological distress is known to impact disease outcomes, less is known about its influence on health care utilization, or on the factors that may modify these relationships. This prospective study examined whether 1) psychological distress predicts greater use of outpatient care services over a period of up to eight years in middle-aged to older individuals with CAD or other non-cardiovascular chronic diseases; 2) this relationship differs according to sex, presence of CAD, and/or social support.

METHODS

Men and women (N = 1236; aged 60.85 ± 6.95 years) with and without CAD completed validated questionnaires on symptoms of depression, anxiety, perceived stress, and social support. Number of medical outpatient visits was obtained from the Régie de l'assurance maladie du Québec. Analyses included bivariate correlations, hierarchical regressions, and moderation analyses, controlling for sociodemographic and lifestyle variables.

RESULTS

Psychological distress, social support, and yearly outpatient visits were significantly correlated (ps < 0.05). In regression analyses, only depressive symptoms were associated with significantly greater use of outpatient care (b = 0.048, p = .004), particularly among CAD patients (b = 0.085, p < .001). Neither sex nor social support moderated this relation.

CONCLUSION

Depression predicted greater outpatient visits in patients with chronic disease, especially CAD patients. More research is needed to determine whether psychosocial interventions may have an impact on health care utilization.

Exploring typologies of appraisals, involvement, and distress in type 2 diabetes family members

The present study conducted a latent profile analysis from a US national sample of 446 family members to identify and predict unique clusters of family members' PWD illness appraisals, involvement, and psychological distress. Time since diagnosis, diabetes adherence, the relationship with the PWD, age, gender, race/ethnicity, income, and economic pressure were included as predictors. Class membership was used to predict the family members' own health behaviors (sleep quality, days of physical activity, and diet quality). Results revealed four distinct classes: Moderately Concerned, Involved, and Distressed (32.51%), Least Concerned, Distressed, and Involved (27.13%), Less Concerned and Distressed, Moderately Involved (23.77%), and Most Concerned, Involved, and Distressed (16.82%). The significant predictors and outcomes of class membership revealed interesting patterns in associations with class membership. Consequently, in addition to involving family members, health promotion and intervention efforts must consider the psychological health and illness appraisals of family members rather than a one-size-fits-all approach.

The emotional well-being of Long COVID patients in relation to their symptoms, social support and stigmatization in social and health services: a qualitative study

BACKGROUND

Long COVID patients have experienced a decline in their quality of life due to, in part but not wholly, its negative emotional impact. Some of the most prevalent mental health symptoms presented by long COVID patients are anxiety, depression, and sleep disorders. As such, the need has arisen to analyze the personal experiences of these patients to understand how they are managing their daily lives while dealing with the condition. The objective of this study is to increase understanding about the emotional well-being of people diagnosed with long COVID.

METHODS

A qualitative design was created and carried out using 35 patients, with 17 participants being interviewed individually and 18 of them taking part in two focus groups. The participating patients were recruited in November and December 2021 from Primary Health Care (PHC) centers in the city of Zaragoza (Northern Spain) and from the Association of Long COVID Patients in Aragon. The study topics were emotional well-being, social support networks, and experience of discrimination. All an inductive thematic content analyses were performed iteratively using NVivo software.

RESULTS

The Long COVID patients identified low levels of self-perceived well-being due to their persistent symptoms, as well as limitations in their daily lives that had been persistent for many months. Suicidal thoughts were also mentioned by several patients. They referred to anguish and anxiety about the future as well as a fear of reinfection or relapse and returning to work. Many of the participants reported that they have sought the help of a mental health professional. Most participants identified discriminatory situations in health care.

CONCLUSIONS

It is necessary to continue researching the impact that Long COVID has had on mental health, as well as to provide Primary Health Care professionals with evidence that can guide the emotional treatment of these patients.

Motives for spousal involvement in a Partner's diabetes management: Considering the role of gender and links to diet-related involvement

Using data from 148 middle-aged and older adult spouses whose partners had type 2 diabetes, we sought to examine spouses' motives for involvement in their partners' diabetes management and whether these motives were related to common types of diabetes-related spousal involvement; we also sought to understand gender differences in these dynamics. Spouses indicated being motivated to be involved in their partners' diabetes management due to altruistic motives to the greatest extent and egoistic motives to the least extent. Results from multivariable regression analyses that controlled for gender, marital quality, and spouses' own conditions requiring dietary changes revealed that all types of motives were related to the frequency of providing diet-related spousal support, whereas only egoistic motives were related to the frequency of exerting diet-related spousal control. We did not find gender differences in any motives nor in associations with spousal involvement. Findings have potential implications for couples-oriented chronic illness interventions.

Rationale and study protocol for We-PAP: a randomized pilot/feasibility trial of a couples-based intervention to promote PAP adherence and sleep health compared to an educational control

BACKGROUND

Obstructive sleep apnea (OSA) is a serious health condition that affects approximately 30-50% of older adults and contributes to risk for cardiometabolic disorders and dementia. Despite the well-documented role of partners in treatment seeking and adherence to positive airway pressure (PAP), treatments for OSA have nearly exclusively focused on the patient and current treatments for OSA do not address co-existing sleep problems such as insomnia that are prevalent in both patients with OSA and their partners. Therefore, the goal of this study is to develop and test a novel couples-based sleep health intervention to promote adherence to PAP and improve sleep health of the couple.

METHODS

We are conducting a two-arm, parallel group, single blind, randomized controlled pilot/feasibility trial to compare our novel couples-based sleep health intervention (We-PAP) to an information control group (IC). We-PAP is based on a transdiagnostic model and uses a dyadic approach including increasing effective partner support, communication skills, and couple-level goal-setting. We-PAP involves 3 sessions and delivered via telehealth in weekly sessions. The IC includes standardized patient educational materials. Both groups receive the usual follow-up with their medical team. The study involves assessments at pre-treatment, post-intervention (approximately 1 month after starting PAP and completing We-PAP sessions or IC) and 3 months after starting PAP. Our main outcomes are feasibility and acceptability ratings. Secondary outcomes include comparing We-PAP to IC for PAP adherence, sleep quality (self-report and objective) and cognitive measures.

DISCUSSION

We-PAP is the first couples-based transdiagnostic sleep health intervention for patients with OSA and their partners. Results of this study will be used to inform the design of a subsequent fully powered clinical trial. If successful, this intervention could significantly advance current clinical practice in the treatment of OSA and sleep health more comprehensively in older adults. Moreover, this intervention may be useful for improving sleep in other aging populations with multiple sleep and other health problems, including patients with chronic illnesses or those at risk for Alzheimer's disease and their caregivers.

TRIAL REGISTRATION

NCT04759157 . Date of registration: February 8, 2021. URL of trial registry record.

Nutritional and food education as a complementary treatment approach in severe obese individuals

Background: The treatment for obesity, specifically severe obesity, is a challenge for health professionals and services. It requires a multidisciplinary and holistic approach covering the complexity and difficulties of incorporating healthy habits to prevent associated diseases and mortality. Individual intervention's methods are not enough to change eating habits. Objective: To describe and investigate the contribution of nutritional and food education as a complementary therapeutic approach in the treatment of individuals with severe obesity and their family members. Methods: A multidisciplinary team adopted a group approach. A different topic was addressed at each therapeutic meeting to assist in the nutritional treatment of obesity, such as diet and healthy habits i.e. barriers to lifestyle changes. The topics were developed based on different methodological and teaching approaches to facilitate adherence to non-drug treatment. Results: Overall, there was a greater understanding towards the adoption of healthy eating habits of the whole family, greater motivation to adhere to dietary changes and adoption of a more physical active lifestyle. This interventional educational support methodology had been accepted in such a positive way for patients and their relatives. Family member participation expands the possibilities of establishing necessary and lasting changes in the lifestyle of not only the patients, but their whole families. Conclusion: Health education actions constitute an important complementary therapeutic approach in promoting health and preventing complications in individuals with severe obesity. This article can be useful to enlarge the debate on the subject and face the challenges related to the effective treatment of obesity, notably severe obesity.

Perceptions of partner social control: accuracy, bias, and daily experience

OBJECTIVE

We examined accuracy and bias in people's perceptions of their romantic partner's daily social control attempts of daily health behaviours and how misperceptions of partner daily social control are related to both partners' daily experiences.

DESIGN

106 cohabiting couples from the community reported on their own and their partner's daily social control attempts (i.e., persuasion, pressure) and their daily experiences (i.e., positive and negative affect, autonomy, relationship satisfaction) across 14 consecutive days (N = 2377 reports). Multilevel path models examined tracking accuracy, projection, and mean-level bias in perceptions of partner health social control attempts, and associations between mean-level bias and daily experiences.

RESULTS

Perceptions of provider influence contained significant tracking accuracy, projection, and mean-level accuracy in provider use of social control. Underperceptions of persuasion were associated with negative outcomes for the perceiver and no outcomes for the provider. Overperceptions of persuasion were associated with negative outcomes for providers and marginally higher positive affect for perceivers. Misperceptions of pressure were associated with negative outcomes for both perceivers and providers.

CONCLUSION

Results suggest that social control may have the most benefit and least harm to both partners when people accurately perceive the mean-levels of such influence attempts on their health behaviours.

Role of received social support in the physical activity of coronary heart patients: The Health Action Process Approach

Physical activity (PA) plays a crucial role in the management of coronary artery disease (CAD). The Health Action Process Approach provides a useful framework for understanding and predicting the process of health behaviors. The aim of the current study was to unveil the role of received social support in the HAPA model, concerning the physical activity of CAD patients. A longitudinal sample of 117 CAD patients filled out a questionnaire during three measurement points (baseline, 2 months, and 6 months later). The constructs within the model were measured by the previously validated HAPA scales. PA was assessed with four items, which were also included in the HAPA questionnaire. To test the direct and indirect associations between the variables, structural equation modeling with latent variables was employed. Received social support was proven to have a significant and strong effect on both action planning and action control, suggesting a synergistic effect on the individual factors, as well as increasing the explained variance of PA. Results confirmed the important role of received social support in the PA of CAD patients. It could be presumed that strengthening the social support from family and friends could support the regular physical activity of CAD patients.

Consideration of Future Consequences Influences Involvement in Romantic Partners' Health

This study examined the influence of people's short-term (e.g., convenience) and long-term (e.g., maintain weight) motives toward their romantic partner's health on their provision of health-related social control and autonomy support for their partner's health behaviors, as well as their indifference toward their romantic partner's health. Data from a sample of cohabiting couples (N = 212) were analyzed using multilevel path models. Results showed having more long-term motives for a partner's health lead to increased provisions of autonomy support and social control, and less indifference toward the partner's health, especially when the partner had lower long-term health motives themselves. In contrast, having more short-term motives for a partner's health was associated with providing less social control and autonomy support and showing more indifference toward the partner's health. Thus, people motivated to improve their partner's long-term health engage in more behaviors meant to improve their romantic partner's health choices, particularly when the partner has low motivation to regulate their own health behaviors.

"Do what you can with a happy heart": a longitudinal study of patient and family members' lived experiences of physical activity post-myocardial infarction

PURPOSE

Physical activity (PA) post-myocardial infarction (MI) can reduce risk of reoccurrence and mortality. Yet uptake of PA through cardiac rehabilitation (CR) is poor, and little is known about the long-term PA behaviour of cardiac patients. This study aimed to explore the lived experiences of patients' engagement with PA post-MI, together with the experiences of their family.

METHODS

Longitudinal interviews with six family-dyads were conducted which drew on interpretative phenomenology to understand the lived experiences of PA for post-MI patients and family members.

RESULTS

Participants described a journey that involved leaving "normality" (doing what PA they wanted and when) and transitioning to a new "normality" (being active within post-MI parameters). This journey was expressed through feelings of "I can't do what I was doing before," "finding my way," and "accepting this way".

CONCLUSION

The role of family within the patient's journey was complex, with PA identity, beliefs, and fear of MI re-occurrence influencing PA support both positively and negatively. PA engagement post-MI is a dynamic and interactive process within which the family can have an important influence.IMPLICATIONS FOR REHABILITATIONThe process of (re-)engaging in physical activity post-myocardial infarction involves a complex journey towards acceptance of a new "normality".Family play an important role in regulating and supporting patients' physical activity during the rehabilitation process.Promoting positive health beliefs and helping families understand what, how and when patients should be physically active may optimise the rehabilitation journey for post-myocardial infarction patients.

The Association Between Cardiac Illness-Related Distress and Partner Support: The Moderating Role of Dyadic Coping

Managing cardiac illness is not easy because it dramatically disrupts people's daily life and both the patient and his/her spouse are at risk for experiencing distress, which, in turn, may affect the support provided by the partner as caregiver. The partner, in fact, is the main source of support, but his/her support may sometimes be inadequate. In addition, dyadic coping (i.e., the way partners cope together against stress and support each other in times of difficulty) could likely be a moderating factor. The main aim of the present study was to examine the role that dyadic coping (DC, in terms of positive, negative, and common dyadic coping responses) plays in moderating the link between patient and partner cardiac illness-related distress (in terms of anxiety and depression) and partner support (in terms of overprotection, hostility, and partner support for patient engagement). The study included 100 married couples faced with cardiac illness who completed a self-report questionnaire. We analyzed our data in PROCESS using multiple regressions in order to assess the moderating effects of DC responses in the relationship between the couple's cardiac illness-related distress and partner support. With regard to patient distress, results showed that higher levels of patient anxiety and depression were linked with ineffective partner support (i.e., overprotection and hostility). With regard to partner distress, higher levels of partner depression were linked with hostility; higher levels of partner depression and anxiety were associated with less partner support for patient engagement. Moreover, the association between distress and partner support was moderated by the quality of DC. In particular, low positive DC represented a risk factor for both the patient and the partner during a cardiac illness, as low positive DC exacerbated the link between patient and partner distress and less effective partner support styles. Also, higher levels of negative DC were risky for couples: The association between distress and less adequate partner supportive behaviors was stronger in the case of higher negative DC. These results imply a need for psychosocial interventions for couples in cardiac illness, especially for couples lacking relational competences, such as positive dyadic coping.

Do Communication Patterns Affect the Association between Cognitive Impairment and Hearing Loss among Older Adults in Vietnam?

This study examined the prevalence of cognitive impairment among older adults in central Vietnam and the roles of communication (with or without communication devices) in the association between cognitive impairment and hearing loss. This cross-sectional study was performed on 725 randomly selected community-dwelling older adults aged ≥60 years from Thua Thien Hue province, Vietnam. Participants attended a face-to-face survey. Sociodemographic characteristics, social interaction with or without communication devices, health status and cognitive function using the Mini-Mental State Examination were reported. Ordinal logistic regression analysis was performed to quantify the association between hearing loss and cognitive function by frequency of communication with and without devices. Mild and severe cognitive impairment had prevalence rates of 23.6% and 19.3%, respectively. Cognitive impairment was more prevalent among older adults with hearing-loss, vision loss and difficulties with instrumental activities of daily living (IADL). The association between hearing loss and cognitive impairment was not significant when older adults had frequent communication with others using devices. This study presented the relatively high prevalence of cognitive impairment in community-dwelling older adults in Vietnam. Frequent communication using devices attenuated the association between hearing loss and cognitive impairment.

Family composition and living arrangements-Cross-sectional study on family involvement to self-managed rehabilitation of people with coronary artery disease

Aim

To describe the family composition and living arrangements of persons diagnosed with coronary artery disease and those relationships to family involvement in self‐managed rehabilitation.

Design

A cross‐sectional study.

Methods

Data were collected with postal questionnaire from persons diagnosed with coronary artery disease (CAD) by using the Family Involvement in Rehabilitation (FIRE) scale. It measures family members' promotion of patients' rehabilitation and issues encumbering rehabilitation in family. Statistical methods were used to analyse the data.

Results

Patients' gender and having children in the family were predictors of issues encumbering rehabilitation in the family. But when examining living arrangements, patients who lived with a spouse or underage children had a better environment for recovery than those who lived alone or with adult children. More attention should be paid to targeting appropriate support for persons with coronary artery disease and their family members during the rehabilitation phase.

Older adults' physical activity-related social control and social support in the context of personal norms

This study investigated whether perceived physical activity norms moderated the effects of physical activity-related social interactions on intentions to engage in physical activity among community-residing older adults (N = 217). Structural equation modeling tested whether two types of social support and social control interacted with personal norms in predicting intentions to be active. Emotional and informational support were associated with higher intentions, and negative social control was associated with lower intentions to engage in activity. Each of these effects was more prominent in the context of weak personal norms, suggesting future research and interventions should consider joint effects of support and norms.

Associations of family and social contact with health among Italian grandparents

Past research has documented the positive influence of frequent interactions with social networks on several health outcomes in later life, with different patterns by gender. In this study, we explore the association of frequent contact with different members of the social network (namely partner, grandchildren, siblings, friends and neighbours) on self-perceived health status and the limitation of illnesses among older grandparents in Italy, using a large national representative survey. Our results confirm the positive association between good health indicators and frequent contact with members of the “horizontal” network (partner, siblings and friends), while a more ambiguous association has been found with frequent face-to-face contact with children and grandchildren. The results hold for both male and female grandparents. The Mediterranean family-focused culture may possibly explain the distinctly Italian results.

[Effects of Spouse-Participated Health Coaching for Male Office Workers with Cardiocerebrovascular Risk Factors]

PURPOSE

This study aimed to examine the effect of spouses participating in health coaching on stage of the change, health behaviors, and physiological indicators among male office workers with cardiocerebrovascular disease (CVD) risk factors and compare the findings with trainers who provided health coaching only to workers.

METHODS

A quasi-experimental pretest-posttest design was used. Convenience sampling was used to recruit participants from a manufacturing research and development company in the city of Gyeonggi province. The health coaching program for the experimental group (n=26) included individual counseling sessions according to workers' stage of change, and provision of customized health information materials on CVD prevention to workers and their spouses for 12 weeks through mobile phone and email.

RESULTS

After 12 weeks of intervention, the total score for health behavior, and scores on the sub-areas of exercise and health checkups significantly improved in the experimental group, but there were no significant differences in the scores of stage of the change and physical indicators. The results of a paired t-test showed a significant decrease in the body mass index, abdominal circumference, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride values, and a significant increase in the high-density lipoprotein cholesterol value in the experimental group after the intervention.

CONCLUSION

To improve the health of male workers with CVD risk factors in the workplace, sharing health information with their spouses has proven to be more effective than health coaching for only workers. Therefore, it is important to develop strategies to encourage spousal participation when planning workplace health education for changing health-related behaviors.

Experiences of informal caregivers after cardiac surgery: a systematic integrated review of qualitative and quantitative studies

OBJECTIVES

To provide a comprehensive synthesis of informal caregivers' experiences of caring for a significant other following discharge from cardiac surgery.

DESIGN

Systematic integrated review without meta-analysis.

DATA SOURCES

A bibliographic search for publications indexed in six databases (Cochrane Library, CINAHL, MEDLINE, EMBASE, AMED and PsycINFO), including a scan of grey literature sources (GreyNet International, Google Scholar, Web of Science, WorldCat and the Clinical Trials Registry) was conducted in October 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they described views and perspectives of informal caregivers of cardiac surgery patients (non-intervention studies (qualitative and quantitative)), and the effectiveness of interventions to evaluate support programme for informal caregivers of cardiac surgery patients (intervention studies).

RESULTS

Of the 4912 articles identified in searches, 42 primary research studies were included in a narrative synthesis with 5292 participants, including 3231 (62%) caregivers of whom 2557 (79%) were women. The median sample size across studies was 96 (range 6-734). Three major themes emerged from the qualitative study data: (1) caregiver information needs; (2) caregiver work challenges and (3) caregivers adaption to recovery. Across the observational studies (n=22), similar themes were found. The trend across seven intervention studies focused on caregiver information needs related to patient disease management and symptom monitoring, and support for caregivers to reduce symptoms of emotional distress.

CONCLUSION

Informal caregivers want to assist in the care of their significant others after hospital discharge postcardiac surgery. However, caregivers feel insecure and overwhelmed and they lack clear/concise discharge information and follow-up support during the early at-home recovery period. The burden of caregiving has been recognised and reported since the early 1990s, but there remains a limited number of studies that assesses the effectiveness of caregiver interventions.

PROSPERO REGISTRATION NUMBER

CRD42018096590.

Social Ambivalence and Disease (SAD): A Theoretical Model Aimed at Understanding the Health Implications of Ambivalent Relationships

The protective influence of social relationships on health is widely documented; however, not all relationships are positive, and negative aspects of relationships may be detrimental. Much less is known about the relationships characterized by both positivity and negativity (i.e., ambivalence). This article provides a theoretical framework for considering the influence of ambivalent relationships on physical health, including reasons why ambivalence should be considered separately from relationships characterized as primarily positive (supportive) or primarily negative (aversive). We introduce the social ambivalence and disease (SAD) model as a guide to understanding the social psychological antecedents, processes, and consequences of ambivalent relationships. We conclude by highlighting gaps in the literature and features of the SAD model that may serve as a guide to future research on potential health-relevant pathways of ambivalent relationships.

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

A Couples-Oriented Intervention for Positive Airway Pressure Therapy Adherence: A Pilot Study of Obstructive Sleep Apnea Patients and Their Partners

Background: Partner involvement can influence positive airway pressure (PAP) therapy use among patients with obstructive sleep apnea (OSA). This study assessed the feasibility, acceptability, and preliminary efficacy of a couples-oriented education and support (CES) intervention for PAP adherence. Participants: Thirty newly diagnosed OSA patients and their partners were randomly assigned to one of three groups: an education and support intervention directed at both patient and partner (CES), an education and support intervention directed only at the patient (PES), or usual care (UC). Methods: Feasibility and acceptability were assessed through enrollment and posttreatment program evaluations, respectively. Assessments of sleep quality, daytime sleepiness, and daytime function were obtained from both patients and partners at baseline and 3 months after PAP initiation. Objective PAP adherence was assessed at 1 week, 1 month, and 3 months. Results: Recruitment and attrition data suggest adequate feasibility. All patients and partners in the CES group reported that the intervention was helpful. Patients in the CES and PES groups increased their PAP adherence over the first month of treatment, whereas PAP adherence decreased over this period in the UC group. For patients, large to medium effects for sleep quality (d = -1.01), daytime sleepiness (d = -0.51), and daytime function (d = 0.51) were found for the CES group. The PES and UC groups effect sizes were large to small for sleep quality (d = -0.94; d = -0.40), daytime sleepiness (d = -0.42; d = -0.82), and daytime function (d = 0.41; d = 0.57), respectively. For partners, large effects for daytime sleepiness (d = -1.31) and daytime function (d = 1.54) and small to medium effect for sleep quality (d = -0.31) were found for the CES group. Worsening of sleep quality (d = 0.65) and no change in daytime sleepiness or daytime function were found for the PES group. For the UC group, medium to large effects were found for sleep quality (d = -0.77), daytime sleepiness (d = -0.77), and daytime function (d = 0.65). Conclusions: The findings of this pilot study provide support for taking a couples intervention approach to improve PAP adherence.

Patterns of Sedentary Behavior in the First Month After Acute Coronary Syndrome

Background Sedentary behavior is a key contributor to cardiovascular disease. Few data exist on the sedentary behavior patterns of patients with acute coronary syndrome. Methods and Results We characterized patterns of sedentary time and their correlates in 149 patients with acute coronary syndrome over the first month postdischarge, a critical period when lifestyle behaviors are formed. Sedentary time was measured by accelerometry for 28 days postdischarge. Group-based modeling at the day level was used to characterize sedentary patterns. Participants spent a mean of 9.7±2.0 hours per day sedentary during the 28 days postdischarge, with significant decreases in sedentary time observed in each consecutive week (P<0.01 for all). Three distinct sedentary patterns were identified: high (20.6% of participants), moderate (47.9%), and low (31.5%). The high and moderate sedentary groups spent a mean of 12.6±0.8 and 10.0±0.7 hours per day sedentary, respectively, and had only minimal decreases in their sedentary time (<3 minutes per day) over the 28 days. The low sedentary group spent a mean of 7.3±0.8 hours per day sedentary, with a rapid decrease in sedentary time (14 minutes per day) observed during the first week postdischarge followed by a relatively smaller decrease (≈5 minutes per day) that persisted until day 21 postdischarge. Non-Hispanic ethnicity, left ventricular ejection fraction <40%, lower physical health-related quality of life, and not having a partner were associated with an increased likelihood of being in the high sedentary group. Conclusions Survivors of acute coronary syndrome accrued high volumes of sedentary time during the first month postdischarge, with most showing little change over time. Interventions targeting reductions in sedentary time among survivors of acute coronary syndrome may be warranted, particularly for those with poor physical health and greater disease severity.

Skin Self-Examination: Partner Comfort and Support During Examinations as Predictors of Self-Efficacy in Patients At Risk for Melanoma Recurrence

BACKGROUND

Skin self-examination (SSE) is an effective method for melanoma survivors to detect potential cancerous growths sooner.

OBJECTIVES

The purpose of this study was to examine whether the SSE self-efficacy of patients with melanoma and their partners is affected by their partners' comfort and support during skin examinations.

METHODS

100 patient-partner dyads completed a 25-item sociodemographic questionnaire. Fifty-two partners attended an education session with the patient on skin examinations and the early detection of melanoma. All patients attended the education session.

FINDINGS

Having their partners attend the education session, as well as being supportive and comfortable with skin examinations, significantly predicted patients' self-efficacy with SSEs. In addition, male patients were found to be significantly more comfortable with partner-assisted skin examinations and reported feeling more supported by their partner than female patients.

Barriers to epilepsy care in Central Uganda, a qualitative interview and focus group study involving PLWE and their caregivers

Background

Epilepsy is a common neurological disease with substantial impact on the subject and their caretakers. This exploratory study identified barriers to care for persons living with epilepsy (PLWE) to develop a culturally acceptable nurse led self-management intervention for PLWE previously developed in the United States.

Methods

The study involving 48 participants (31 PLWE and 17 caregivers) with in depth interviews and focus groups was conducted. We obtained insights into barriers to care in PLWE and their caregivers. Using a thematic analytic procedure emphasizing the dominant themes the qualitative responses were analyzed. Median age of PLWE was 24 years (IQR 19–30), and10 (52.6%) were male. The median age of epilepsy onset was 12 years (IQR 6–18), range of 1–37 years. The median age of caregivers was 50 years (IQR 45–50.5), with a range of 18–78 years. Seventy five percent of caregivers (6/8) were females.

Results

Three major areas of perceived barriers involving individual, family or community and provider and healthcare system barriers to epilepsy care emerged. Individual factors like limited epilepsy knowledge and medication non-adherence were reported to be key barriers to epilepsy care. Caregiver burden and lack of family support as well as poor health care access were identified from the family and health care systems.

Conclusions

The main barrier to epilepsy care is limited epilepsy knowledge in PLWE and their caregivers. Improving epilepsy care awareness and knowledge within communities and appropriate health care provider service for epilepsy would help reduce epilepsy barriers and improve care.

Relationship quality and functional limitations among older adults with cardiovascular disease in the United States of America

Substantial research shows that cardiovascular disease is a major cause of disability in the United States of America (USA) and worldwide. Despite the well-documented significance of intimate partnerships for cardiovascular health and disease management, how relationship quality contributes to the functional health of older adults diagnosed with cardiovascular disease is much less understood than mental health and mortality risk. Informed by the disablement process model and the lifecourse perspective, this study examines the association between relationship quality and functional limitations among partnered older adults aged 50 years and older diagnosed with cardiovascular disease in the USA. Data are from the Health and Retirement Study, 2006–2012 (N = 1,355). Multi-level linear regression analyses show that baseline negative relationship quality is significantly associated with increased functional limitations over the two- and four-year follow-ups. Additionally, the link between negative relationship quality and functional limitations is stronger among older adults with lower household income over a two-year span, compared to their higher-income counterparts, suggesting that these older adults are doubly disadvantaged by higher relationship strains and limited economic resources. Our findings demonstrate the significance of relationship quality for the functional health of older adults with cardiovascular disease and shed light on the importance of marriage/partnerships as an important social context for a critical stage in the disablement process (i.e. functional limitations).

Sticking it out in trauma-focused treatment for PTSD: It takes a village

OBJECTIVE

One in 3 veterans will dropout from trauma-focused treatments for posttraumatic stress disorder (PTSD). Social environments may be particularly important to influencing treatment retention. We examined the role of 2 support system factors in predicting treatment dropout: social control (direct efforts by loved ones to encourage veterans to participate in treatment and face distress) and symptom accommodation (changes in loved ones' behavior to reduce veterans' PTSD-related distress).

METHOD

Veterans and a loved one were surveyed across 4 VA hospitals. All veterans were initiating prolonged exposure therapy or cognitive processing therapy (n = 272 dyads). Dropout was coded through review of VA hospital records.

RESULTS

Regression analyses controlled for traditional, individual-focused factors likely to influence treatment dropout. We found that, even after accounting for these factors, veterans who reported their loved ones encouraged them to face distress were twice as likely to remain in PTSD treatment than veterans who denied such encouragement.

CONCLUSIONS

Clinicians initiating trauma-focused treatments with veterans should routinely assess how open veterans' support systems are to encouraging veterans to face their distress. Outreach to support networks is warranted to ensure loved ones back the underlying philosophy of trauma-focused treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Influence of Relationship Partners on Self-Efficacy for Self-Management Behaviors Among Adults With Type 2 Diabetes

Individuals with type 2 diabetes must engage in daily self-management behaviors to prevent complications. Given that management may be shared with a person's romantic partner, we examined both patients' and their partners' perceptions of relationship characteristics that were hypothesized to affect patients' self-efficacy for diabetes management. Adults with type 2 diabetes and their partners (n = 52 couples, 104 individuals) completed measures of three aspects of relationships that are theorized to affect self-efficacy: partner investment, partner support, and relationship satisfaction. Patients reported their self-efficacy for diabetes management and weekly frequency of diabetes self-management behaviors. A common fate modeling approach in which constructs were modeled as agreement between partner reports showed that relationship factors (investment, support, and satisfaction) significantly predicted patient self-efficacy (R ² = 0.49), which in turn predicted patient self-management behaviors. This model fit the data well [χ² (41) = 48.60, P = 0.19; comparative fit index (CFI) = 0.96; root mean square error of approximation = 0.06; and standardized root mean square residual = 0.07]. Interventions designed to support patients in their self-efficacy for self-management behavior may be improved through consideration of patients' romantic relationships.

Socio-demographic factors impact time to discharge following total knee arthroplasty

AIM

To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway (SSP) by following total knee arthroplasty (TKA).

METHODS

The study included primary TKA’s performed in a high-volume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay (LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index (BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies (PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS.

RESULTS

Eight hundred and six consecutive primary SSP TKA’s were included in this study. Patients were discharged at a median of 49 h (post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer (P < 0.001)], female gender [4.3 h longer (P = 0.012)], age [3.5 h longer per ten-year increase in age (P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported (P = 0.005)], later procedure end-times [0.8 h longer per hour increase in end-time (P = 0.004)] and Black or African American patients [6.1 h longer (P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter (P = 0.011)] and TKA’s performed during holiday weeks [9.4 h shorter (P = 0.011)]. Non-significant factors included: BMI, median income, patient’s living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery.

CONCLUSION

The cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.

Marriage, Social Control, and Health Behavior: A Dyadic Analysis of Same-sex and Different-sex Couples

Prior research based on studies of heterosexual populations suggests that men's health benefits more from marriage than women's, in part because women do more than men to influence the health habits of their spouse. We extend this work by using dyadic survey data from 838 spouses in 419 gay, lesbian, and heterosexual marriages to consider differences in social control tactics across same-sex and different-sex couples-that is, how spouses monitor and regulate each other's health habits. Results suggest that although gender differences in social control are common, gendered patterns sometimes differ depending on whether one is in a same-sex or different-sex marriage. Results also point to the importance of health habits as strong drivers of relationship dynamics across gay and lesbian as well as heterosexual marriages.

Characteristics of Cigarette Smoking in Individuals in Smoking Concordant and Smoking Discordant Couples

Introduction

Partner smoking status may impact smoking cessation outcomes. The purpose of this study is to compare smokers in smoking concordant couples (both partners smoke) to smokers in smoking discordant couples (one partner smokes) on variables that have been shown to be important for quitting smoking.

Methods

Participants were 123 cigarette smokers with cohabitating romantic partners (smoking discordant: n=60, smoking concordant: n=63, 63.9% females). We used one-way MANCOVA, controlling for age and number of cigarettes smoked/day, to examine differences between groups on smoking outcome expectancies, motivation to quit smoking, and dyadic efficacy to quit smoking. We examined smoking behavior in a series of exploratory analyses.

Results

We found a significant multivariate difference between individuals in smoking concordant and discordant couples (p < .05) such that 20.3% of the variation in the linear combination of dependent variables was accounted for by group membership. Follow-up univariate ANCOVA analyses indicated that those in smoking discordant couples reported greater positive outcome expectancies for cigarettes with regard to facilitating social situations and reducing boredom than those in the smoking concordant group. Participants in smoking concordant couples smoked more cigarettes when their partners were present, fewer cigarettes without their partners present, and were more likely to prefer that their partner be involved in their smoking cessation treatment than those in smoking discordant couples.

Discussion

The results of this study may guide the development of smoking cessation interventions that attend to the unique needs of smoking concordant and discordant couples.

Predictors of Physical Activity Levels in Community-Dwelling Older Adults: A Multivariate Approach Based on a Socio-Ecological Framework

The purpose of this study was to explore cross-sectional relationships between self-reported physical activity (PA) and personal, social, and environmental factors in community-dwelling adults aged 50 years and older. Accounting for clustering by neighborhood, generalized estimating equations were used to examine associations between selected correlates and the Physical Activity Scale for the Elderly (PASE) score while adjusting for confounders. Data for 601 participants were analyzed: 79% female, 37% married, mean age 76.8 (± 8.7) years, mean PASE score 112.6 (± 64.8). Age, living in seniors' housing, using nursing/home care services, receiving encouragement to be active, and having benches available in the neighborhood were inversely associated with PASE. Self-efficacy, SF-12 score, PA barriers, social support, and the presence of trails showed positive associations. Several personal, social, and environmental factors associated with PA were identified. The inverse association between PA and living in seniors' housing units should be considered when developing PA programs for older adults.

Development of the Social Network-Based Intervention "Powerful Together with Diabetes" Using Intervention Mapping

This article describes the development of the social network-based intervention Powerful Together with Diabetes which aims to improve diabetes self-management (DSM) among patients with type 2 diabetes living in socioeconomically deprived neighborhoods by stimulating social support for DSM and diminishing social influences hindering DSM (e.g., peer pressure and social norms). The intervention was specifically developed for patients with Dutch, Turkish, Moroccan, and Surinamese backgrounds. The intervention was developed according to Intervention Mapping. This article describes the first four steps of Intervention Mapping: (1) the needs assessment; (2) development of performance and change objectives; (3) selection of theory-based methods and strategies; and (4) the translation of these into an organized program. These four steps resulted in Powerful Together with Diabetes, a 10-month group-based intervention consisting of 24 meetings, 6 meetings for significant others, and 2 meetings for participants and their spouses. The IM method resulted in a tailored approach with a specific focus on the social networks of its participants. This article concludes that the IM method helped our planning team to tailor the intervention to the needs of our target population and facilitated our evaluation design. However, in hindsight, the intervention could have been improved by investing more in participatory planning and community involvement.

Perceptions of Health Information Seeking and Partner Advocacy in the Context of a Cardiology Office Visit: Connections with Health Outcomes

This paper explores perceived active health information seeking, informal advocacy by a partner or other, cardiac efficacy, and cardiovascular health indicators for patients surveyed while visiting their cardiologist. Participants include 208 patients with a diagnosed heart condition. Variables include predisposing characteristics (e.g., illness severity, demographics), perceived active health information seeking during an office visit, informal advocacy by partner or other, cardiac efficacy, and cardiovascular health indicators (i.e., basal metabolic index (BMI), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides). Data were analyzed using correlations, t-tests, and structural equation modeling. As hypothesized, perceived active health information seeking during an office visit (positively) and informal advocacy by partner or other (negatively) predicted cardiac efficacy. One path was added from active information seeking to BMI. Cardiac efficacy, in turn, significantly predicted total cholesterol and BMI. The model was also replicated for LDLs but not for HDLs or triglycerides. We discuss implications for cardiac disease management.

Dailey S, Zhu Y. Let’s work out: communication in workplace wellness programs

Purpose

People spend a lot of time communicating with their co-workers each day; however, research has yet to explore how colleagues influence each other’s health behaviors. The purpose of this paper is to examine the association between health-related communication and health behaviors among co-workers in a workplace wellness program.

Design/methodology/approach

Participants (n=169) were recruited from a large south-western university and its local school district through e-mail announcements sent from a wellness administrator. Participants were part of a workplace wellness program that offers several daily group fitness classes, as well as cooking classes, and other educational programs for faculty and staff.

Findings

Structural equation modeling was used to examine the association between people’s perceived social influence and social support from co-workers, organizational socialization and their health behaviors. Results indicated that perceived social influence from co-workers had an indirect effect on people’s health behaviors through their perceived social support from their co-workers, as well as through their organizational socialization.

Research limitations/implications

These variables were examined cross-sectionally, meaning that causal relationships and directionality cannot be determined in this study.

Practical implications

Co-worker communication and socialization appear to be important factors in understanding individuals’ health behaviors; thus, organizations that offer workplace wellness programs should provide opportunities for socialization and co-worker communication to facilitate employees’ healthy behaviors.

Originality/value

Although the authors only looked at one wellness program and did not examine these variables in programs of varying sizes and types, this study uniquely incorporates interpersonal and organizational communication perspectives in order to give new insight into co-workers’ health-related communication.

Impact of Obstructive Sleep Apnea and Its Treatments on Partners: A Literature Review

STUDY OBJECTIVES

Many adults sleep with a significant other; thus, sleep disorder symptoms and treatments of one partner are likely to impact the other partner's health. A literature review was conducted to examine the impact of obstructive sleep apnea (OSA) and OSA treatments on partner-assessed sleep and daytime functioning and partner involvement in OSA treatment.

METHODS

MEDLINE, EMBASE, and CINAHL searches yielded 38 pertinent quantitative and qualitative studies that described sleep and/or daytime functioning assessed in partners of patients with untreated OSA, sleep and/or daytime functioning assessed in partners who were referred for OSA treatment, including continuous positive airway pressure (CPAP) therapy, oral appliance (OA), or surgery, and/or associations between partner involvement and OSA treatment use.

RESULTS

The majority of studies found untreated OSA to have a negative impact on partners' objective and subjective sleep and daytime functioning, in particular mood, quality of life, and relationship quality. Improvements in partner-assessed sleep quality were reported for CPAP, OA, and surgery. Conflicting results were reported for partners' mood, quality of life, daytime sleepiness, and relationship quality. Perceived partner support was associated with greater CPAP use.

CONCLUSIONS

Symptoms associated with OSA can negatively impact partners' sleep and daytime functioning. Treatment of OSA with CPAP, OA, or surgery can have health benefits for not only patients but also partners. Collaborative partner involvement may be a useful strategy for interventions promoting CPAP adherence.

Interactions between patients' experiences in mental health treatment and lay social network attitudes toward doctors in recovery from mental illness

Research in the area of social networks and health has demonstrated that lay social network members play a critical role in the early stages of the illness career, influencing key decisions and pathways to formal care. Here, we revisit and extend this body of work, examining how the lay social network context can moderate the influence of treatment experiences on recovery outcomes as the illness career unfolds. To achieve this goal, we address two research questions, drawing on a longitudinal sample of people making their initial contact with the mental health treatment system: First, we explore how treatment experiences, lay social network characteristics, and recovery outcomes change over 2 years, beginning with the point of entry into treatment. Second, we examine whether the relationship between perceived treatment experiences and recovery outcomes is contingent on characteristics of the lay network context in which clients are socially embedded, focusing on the network's cultural orientation toward medical professionals. We find that positive treatment interactions facilitate improved self-esteem, mastery, role functioning, recovery optimism, and global functioning when the lay network culture is pro-medical, but largely have null effects on the recovery process when the lay network is more hostile to medical professionals.

Adjusting to Chronic Health Conditions

Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.