Let's Enjoy an Evening on the Couch? A Daily Life Investigation of Shared Problematic Behaviors in Three Couple Studies

Symptom-system fit theory proposes that problematic behaviors are maintained by the social system (e.g., the couple relationship) in which they occur because they help promote positive relationship functioning in the short-term. Across three daily life studies, we examined whether mixed-gender couples reported more positive relationship functioning on days in which they engaged in more shared problematic behaviors. In two studies (Study 1: 82 couples who smoke; Study 2: 117 couples who are inactive), days of more shared problematic behavior were accompanied by higher daily closeness and relationship satisfaction. A third study with 79 couples post-stroke investigating unhealthy eating failed to provide evidence for symptom-system fit. In exploratory lagged analyses, we found more support for prior-day problematic behavior being associated with next-day daily relationship functioning than vice-versa. Together, findings point to the importance of a systems perspective when studying interpersonal dynamics that might be involved in the maintenance of problematic behaviors.

How is companionship related to romantic partners' affect, relationship satisfaction, and health behavior? Using a longitudinal dyadic score model to understand daily and couple-level effects of a dyadic predictor

Companionship is related to better affect and relationship satisfaction, but few studies have examined both partners' perspectives over time and the link between companionship and health. In three intensive longitudinal studies (Study 1: 57 community couples; Study 2: 99 smoker-nonsmoker couples; Study 3: 83 dual-smoker couples), both partners reported daily companionship, affect, relationship satisfaction, and a health behavior (smoking in Studies 2 and 3). We proposed a dyadic score model that focuses on the couple level for companionship as a dyadic predictor with considerable shared variance. On days with higher companionship, couples reported better affect and relationship satisfaction. When partners differed in companionship, they also differed in affect and relationship satisfaction. For smoking, a different picture emerged: Whereas smokers with nonsmoking partners smoked less on average with higher companionship, smokers with smoking partners smoked more on days with higher companionship. Findings show companionship as a consequential relationship construct deserving further study. Using the dyadic score model acknowledged both partners' perspectives on companionship. It demonstrated higher precision for detecting effects of partner averages in a dyadic predictor compared with traditional approaches, tests for effects of partner differences in a dyadic predictor and in outcome while maintaining the focus on the dyad.

Mobile Health Self-management Support for Spinal Cord Injury: Systematic Literature Review

BACKGROUND

Self-management plays a critical role in maintaining and improving the health of persons with spinal cord injury (SCI). Despite their potential, existing mobile health (mHealth) self-management support (SMS) tools for SCI have not been comprehensively described in terms of their characteristics and approaches. It is important to have an overview of these tools to know how best to select, further develop, and improve them.

OBJECTIVE

The objective of this systematic literature review was to identify mHealth SMS tools for SCI and summarize their characteristics and approaches to offering SMS.

METHODS

A systematic review of the literature published between January 2010 and March 2022 was conducted across 8 bibliographic databases. The data synthesis was guided by the self-management task taxonomy by Corbin and Strauss, the self-management skill taxonomy by Lorig and Holman, and the Practical Reviews in Self-Management Support taxonomy. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards guided the reporting.

RESULTS

A total of 24 publications reporting on 19 mHealth SMS tools for SCI were included. These tools were introduced from 2015 onward and used various mHealth technologies and multimedia formats to provide SMS using 9 methods identified by the Practical Reviews in Self-Management Support taxonomy (eg, social support and lifestyle advice and support). The identified tools focused on common SCI self-management areas (eg, bowel, bladder, and pain management) and overlooked areas such as sexual dysfunction problems and environmental problems, including barriers in the built environment. Most tools (12/19, 63%) unexpectedly supported a single self-management task instead of all 3 tasks (ie, medical, role, and emotional management), and emotional management tasks had very little support. All self-management skills (eg, problem-solving, decision-making, and action planning) had coverage, but a single tool addressed resource use. The identified mHealth SMS tools were similar in terms of number, introduction period, geographical distribution, and technical sophistication compared with SMS tools for other chronic conditions.

CONCLUSIONS

This systematic literature review provides one of the first descriptions of mHealth SMS tools for SCI in terms of their characteristics and approaches to offering SMS. This study's findings highlight a need for increased coverage of key SMS for SCI components; adopting comparable usability, user experience, and accessibility evaluation methods; and related research to provide more detailed reporting. Future research should consider other data sources such as app stores and technology-centric bibliographic databases to complement this compilation by identifying other possibly overlooked mHealth SMS tools. A consideration of this study's findings is expected to support the selection, development, and improvement of mHealth SMS tools for SCI.

Social support, distress and well-being in individuals experiencing Long-COVID: a cross-sectional survey study

OBJECTIVES

Increasingly attention of the COVID-19 pandemic is directed towards its long-term effects, also known as Long-COVID. So far, Long-COVID was examined mainly from a medical perspective, leaving psychosocial effects of Long-COVID understudied. The present study advances the current literature by examining social support in the context of Long-COVID. The study not only examines received support reported by individuals with Long-COVID, but also provided support reported by relatives of individuals with Long-COVID.

DESIGN

Cross-sectional study.

SETTING

The study was conducted from June to October 2021 in Austria, Germany and the German-speaking part of Switzerland.

PARTICIPANTS

We examined 256 individuals with Long-COVID (M_Age=45.05 years, 90.2% women) and 50 relatives of individuals with Long-COVID (M_Age=48.34 years, 66.1% female) in two separate online surveys, assessing social support, well-being and distress.

PRIMARY OUTCOME MEASURES

Primary outcomes were positive and negative affect, anxiety and depressive symptoms and perceived stress.

RESULTS

For individuals with Long-COVID, receiving emotional support was related to higher well-being (positive affect: b=0.29, p<0.01; negative affect: b=-0.31, p<0.05) and less distress (anxiety: b=-1.45, p<0.01; depressive symptoms: b=-1.04, p<0.05; perceived stress: b=-0.21, p<0.05) but no effects emerged for receiving practical support. For relatives of individuals with Long-COVID, providing emotional support was only related to lower depressive symptoms (b=-2.57, p<0.05). Again, provided practical support was unrelated to the outcomes considered.

CONCLUSIONS

Emotional support is likely to play an important role in well-being and distress of patients and relatives, whereas practical support does not seem to make a difference. Future research should clarify under what conditions different kinds of support unfold their positive effects on well-being and distress in the context of Long-COVID.

Social Stigma, Mental Health, Stress, and Health-Related Quality of Life in People with Long COVID

A considerable amount of people who have been infected with SARS-CoV-2 experience ongoing symptoms, a condition termed long COVID. This study examined nuanced experiences of social stigma in people with long COVID and their associations with perceived stress, depressive symptoms, anxiety, and mental and physical health-related quality of life (hrqol). A total of N = 253 participants with long COVID symptoms (mean age = 45.49, SD = 12.03; n = 224, 88.5% women) completed a cross-sectional online survey on overall social stigma and the subfacets enacted and perceived external stigma, disclosure concerns, and internalized stigma. Data were analysed using multiple regression and controlling for overall burden of consequences of long COVID, overall burden of symptoms of long COVID, and outcome-specific confounders. In line with our preregistered hypotheses, total social stigma was related to more perceived stress, more depressive symptoms, higher anxiety, and lower mental hrqol, but-in contrast to our hypothesis-it was unrelated to physical hrqol after controlling for confounders. The three subscales of social stigma resulted in differential associations with the outcomes. Social stigma experiences go hand in hand with worse mental health in people with long COVID. Future studies should examine potential protective factors to buffer the effects of social stigma on people's well-being.

Having a Good Time Together: The Role of Companionship in Older Couples' Everyday Life

INTRODUCTION

Companionship (i.e., enjoyable shared activities) is associated with higher emotional and relational well-being. However, the role of companionship for emotional well-being and relationship satisfaction in older couples' everyday life is not well understood. This article studies time-varying associations of companionship with emotional and relational well-being as older couples engage in their everyday life.

METHODS

Participants provided three data points a day over 7 days using electronic surveys that were simultaneously completed by both partners. A total of 118 older heterosexual couples reported momentary companionship, positive and negative affect, and closeness. Data were analyzed using an intensive longitudinal dyadic score model.

RESULTS

Couples with higher average companionship showed lower overall negative affect, more overall positive affect, and higher overall closeness. During moments of elevated momentary companionship, partners reported more positive affect, less negative affect, and higher closeness. Regarding between-couple partner differences, i.e., when the female partner's momentary companionship was higher on average than the male partner's momentary companionship, the female partner also showed less negative affect, more positive affect, and higher closeness than the male partner. During moments in which the female partner's momentary companionship was higher than the male partner's momentary companionship, the female partner showed less negative affect, more positive affect, and higher closeness than the male partner.

DISCUSSION

Older couples show a consistent link between companionship and emotional well-being and closeness in everyday life emphasizing the importance of studying companionship in close relationships.

One SMS a day keeps the stress away? A just-in-time planning intervention to reduce occupational stress among apprentices

BACKGROUND

Occupational stress is one of the main sources of stress in apprentices with physical and psychological health consequences. Just-in-time planning interventions (JITPIs) are one opportunity to deliver intervention components at the right times and locations to optimally support apprentices in stressful situations. The aim of this study was to test the proximal effect of a mobile phone-delivered JITPI to reduce occupational stress in 386 apprentices within a planning intervention.

METHODS

An AB/BA crossover design in which participants were randomly allocated to (A) the planning intervention or (B) the assessment only condition was implemented.

RESULTS

The analyses of the study "ready4life", multilevel modeling, revealed no significant effect of the planning intervention on occupational stress reduction.

CONCLUSIONS

Possible reasons for the missing effect might be the low stress level of participants or the type of the intervention delivery. Since apprenticeships in Switzerland differ considerably, future studies should enable more adapted interventions for the apprentices and consider individual circumstances of stress. Further, the intervention should focus on apprentices with high occupational stress levels or a high-risk of stress. Studies should investigate exactly when and why a person needs support regarding her/his occupational stress. Therefore, objective measurements of stress could be helpful.

Dynamic associations between stress and relationship functioning in the wake of COVID-19: Longitudinal data from the German family panel (pairfam)

Individuals all across the world experienced significant disruptions in their personal and family life with the outbreak of the new coronavirus disease 2019 (COVID-19). The current study investigated dynamic associations between stress and relationship functioning over time in the face of the COVID-19 pandemic. Perceived stress, relationship satisfaction, and relationship quality (appreciation, intimacy, conflict) were reported by 1483 young to middle-aged participants who were in a romantic relationship and lived with their partner in 2018/2019 and in May-July 2020 (a few months after the onset of COVID-19). Data were analyzed using bivariate latent change score models. Relationship functioning (satisfaction, appreciation, intimacy) showed small decreases from before to during the pandemic. Contrary to expectations, levels of perceived stress also decreased on average from before to during the pandemic. Changes in relationship functioning were correlated with changes in stress over time, so that participants with greater decreases in relationship satisfaction, appreciation, and intimacy and greater increases in conflict from before to during the pandemic showed lesser decreases/greater increases in stress. Higher pre-pandemic relationship satisfaction was associated with greater decreases/lesser increases in stress from before to during the pandemic. Pre-pandemic levels of other measures of relationship functioning or stress were not associated with changes in outcomes over time. Results add to the literature demonstrating that stress is closely intertwined with the functioning of intimate relationships. Furthermore, they suggest that greater relationship satisfaction may serve as a protective factor for stressful life events.

The impact of adolescent's daily electronic media use on sleep: Insights from adolescent's and their mother's point of view

Several studies demonstrated that electronic media use (EMU) is negatively associated with sleep in adolescents. Most studies however are cross-sectional, self- or parents reports, and not distinguishing between different EMU types. Therefore, this study aimed to examine associations between adolescent's EMU and sleep reported by adolescents and from their mothers' perspective in a dyadic ambulatory assessment design. One hundred and five mother-adolescent dyads reported for 14 consecutive days adolescent's EMU for different EMU types and sleep duration. Mothers reported less EMU in the evening and more sleep of their adolescents than adolescents themselves. Multilevel analyses revealed that at the between- and within-person level, EMU in the evening was negatively associated with sleep. Different EMU types differed in effect sizes of associations with sleep. No effects were found for watching TV/DVD/video, whereas for gaming at the between- and within-person level, negative associations with sleep duration were found. For PC/tablet and smartphone use in the evening significant between-person association with sleep duration for adolescent's self-reports and from mother's point of view was found. It is important to investigate adolescent's EMU on a daily basis, from a dyadic perspective, and for different EMU types separately.

Effectiveness of a Dyadic Buddy App for Smoking Cessation: Randomized Controlled Trial

Background

Tobacco smoking is one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real time. This randomized controlled trial investigated the effectiveness of an app that encourages individuals to quit smoking with the help of a social network member (buddy) in daily life.

Objective

The objective of this study is to test the effectiveness of the SmokeFree buddy app compared with a control group with self-reported smoking abstinence and carbon monoxide (CO)–verified smoking abstinence as primary outcomes and self-reports of smoked cigarettes per day (CPD) as a secondary outcome.

Methods

A total of 162 adults who smoked participated in this single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Around a self-set quit date (ie, 7 days before the self-set quit date and 20 days after) and 6 months later, participants of the intervention and control groups reported on daily smoking abstinence and CPD in end-of-day diaries. Daily smoking abstinence was verified via daily exhaled CO assessments. This assessment was administered via an app displaying results of exhaled CO, thus addressing self-monitoring in both groups. In addition, participants in the intervention group used the SmokeFree buddy app, a multicomponent app that facilitates social support from a buddy of choice.

Results

A significant reduction in CPD from baseline to the 6-month follow-up was observed among participants in both groups. Multilevel analyses revealed no significant intervention effect on self-reported and CO-verified daily smoking abstinence at the quit date and 3 weeks later. However, CPD was lower at the quit date and 3 weeks later in the intervention group than in the control group. No significant differences between groups were found for any outcome measures 6 months after the quit date. Overall, low app engagement and low perceived usefulness were observed.

Conclusions

Despite some encouraging short-term findings on the amount of smoking, the SmokeFree buddy app did not have beneficial effects on smoking abstinence over and above the self-monitoring control condition. Future studies should examine whether and what support processes can be effectively stimulated and how app use can be improved to better achieve this goal.

Trial Registration

ISRCTN Registry 11154315; https://www.isrctn.com/ISRCTN11154315

International Registered Report Identifier (IRRID)

RR2-10.1186/s12889-019-7723-z

Cultivation or enabling? Day-to-day associations between self-efficacy and received support in couples

OBJECTIVE

Theories and empirical findings identify social support and self-efficacy as important variables for behavior change. Two competing hypotheses describe the bidirectional relationship of these two constructs: The cultivation hypothesis assumes that self-efficacy facilitates social support, whereas the enabling hypothesis assumes that social support fosters self-efficacy. To shed more light on the interplay of interpersonal and intrapersonal factors in the behavior change context in daily life, the present study aims to investigate these hypotheses at the within-person level.

METHODS

In total, 99 overweight heterosexual couples intending to increase their physical activity participated in this dyadic intensive longitudinal study. Both partners independently reported on their self-efficacy and their support receipt from their partner in smartphone-based end-of-day diaries across 14 days. To investigate the competing hypotheses prospective lagged multilevel models were applied.

RESULTS

For both partners, higher-than-average levels of self-efficacy on a given day predicted higher support receipt the next day, confirming the cultivation hypothesis. We found no effect of higher-than-average levels of support receipt on a given day on self-efficacy the next day, disconfirming the enabling hypothesis. Same-day support receipt and previous day self-efficacy were positively related to daily physical activity.

CONCLUSIONS

This is the first study investigating the cultivation and the enabling hypothesis on a day-to-day basis using a dyadic intensive longitudinal approach. Findings support the cultivation hypothesis at the within-person level, suggesting that self-efficacy may help to facilitate support receipt close in time. Future studies should use within-person experimental designs and ecological momentary assessments within days to increase our understanding of the temporal dynamics of the cultivation and enabling effect.

Daily support seeking as coping strategy in dual-smoker couples attempting to quit

OBJECTIVE

Smoking cessation is a stressful event and lapses are frequent. The dynamic model of relapse has been criticized for not integrating interpersonal factors as phasic influences. Seeking social support, as a coping strategy to deal with cravings, may help to refrain from smoking.

DESIGN

Overall, 83 heterosexual dual-smoker couples reported on their craving, the extent of seeking social support from one's partner regarding smoking cessation, and their number of cigarettes smoked in smartphone-based end-of-day diaries, from a joint self-set quit date on across 22 consecutive days.

MAIN OUTCOME MEASURE

Number of cigarettes smoked.

RESULTS

Multilevel analyses indicated that on days with higher-than-average levels of craving, male and female smokers reported more cigarettes smoked. Higher-than-usual support seeking was related to fewer cigarettes smoked that same day. For women only, we found a within-person interaction between craving and support seeking on smoking. On days with higher-than-average support-seeking, the effect of craving on smoking was attenuated.

CONCLUSION

Findings confirm the relevance of interpersonal processes in the relapse process, such as support seeking as coping behavior. Further, as a 'first act' in initiating supportive interactions, support seeking is an important piece in the social support process and a promising target for interventions.

From a mother's point of view: Psycho-social predictors of maternal monitoring strategy and adolescents' electronic media use

INTRODUCTION

As early adolescents have limited capacities for self-regulating electronic media use (EMU), parental monitoring is needed. However, research has shown that parents do not exert much monitoring over their children's EMU. A theory-based approach may help to identify key predictors of parental monitoring and its effects on adolescents' EMU. Applying the Health Action Process Approach (HAPA), this study examined maternal psycho-social predictors of maternal monitoring of EMU and, subsequently, children's EMU.

METHODS

In Switzerland, 105 mother-adolescent dyads participated in an observational study with two time points (baseline, T1, and follow-up, T2) two weeks apart. Mothers (M_age = 43.83 years, SD = 4.45) reported on their HAPA variables and their children's EMU. Adolescents (M_age = 12.13 years, SD = 0.99; 60 girls and 45 boys) also reported their EMU.

RESULTS

Maternal outcome expectancies (T1) for less EMU were positively related (β = 0.25) with their intention to monitor EMU (T1). Further, intention was positively associated (β = 0.45) with planning to monitor EMU (T1) which in turn predicted marginally (β = 0.18) maternal monitoring (T2). No significant associations were found between maternal monitoring (T2) and adolescents' EMU (T2) reported by mothers and adolescents.

CONCLUSIONS

Contrary to hypotheses derived from the HAPA, findings demonstrate that not all the HAPA variables are linked to maternal monitoring of adolescents' EMU. More research is thus needed to identify antecedents and consequences of different strategies of maternal monitoring.

How Do People Experience and Respond to Social Control From Their Partner? Three Daily Diary Studies

Positive and negative forms of social control are commonly used to regulate another person’s health-related behaviors, especially in couples. Social control efforts have been shown to result in desirable, but also undesirable effects on different outcomes. Little is known for which outcomes, when, and under which contextual conditions these different effects unfold in people’s everyday lives. Using the dual-effects model of health-related social control, we predicted that same-day and previous-day positive social control would result in desirable effects on target behavior, and same-day positive control on affect. Same-day and previous-day negative control was assumed to result in undesirable effects on reactant responses (i.e., doing the opposite of what the partner wanted and hiding the unhealthy behavior), and same-day negative control on affect. Further, we explored whether it makes a difference if one or both partners intend to change their health behavior. Three daily diary studies addressed these questions for smoking (Studies 1 and 2), and physical activity (Study 3). Receiving more positive control related to more desirable target behavior, and feeling better; more negative control was associated with more reactant responses and feeling worse. Social control unfolded its effects within 1 day, but hardly across days, indicating that control and its reactions to it are fast-acting processes in daily life. The pattern of results were the same for couples with one and both partners intending to change their behavior. Further, results replicated when using partner-reported provided control. Based on these results, social control cannot be unanimously recommended as a behavior change strategy in couples. Future studies should follow up on dyadic and temporal dynamics of social control in couples’ everyday lives in different contexts.

Invisible Social Support and Invisible Social Control in Dual-smoker Couple's Everyday Life: A Dyadic Perspective

BACKGROUND

Invisible exchange processes (i.e., invisible support, invisible control) are commonly operationalized as support or control provided by a partner, but unnoticed by the recipient, and have been reported to be beneficially related to affect. However, studies have almost exclusively focused on affect as an outcome and rather neglected other outcomes, such as health behavior. One study so far demonstrated a coupling of invisible support and increased unhealthy behavior.

PURPOSE

The present study aimed to investigate differences in invisible exchanges within a dyadic context of heterosexual, romantic dual-smoker couples. We tested whether women's and men's invisible exchanges were associated with negative affect and smoking in everyday life of dual-smoker couples.

METHODS

In a dyadic daily diary study, invisible emotional and instrumental support, invisible positive and negative control, negative affect, and daily smoking were independently assessed in both partners of 83 dual-smoker couples after a joint self-set quit date.

RESULTS

Analyses based on the two-intercept model revealed that at the between-person level invisible support and control were both related to less negative affect, albeit in men only, and were unrelated to smoking behavior. At the within-person level, invisible exchanges were on the whole unrelated to negative affect and smoking.

CONCLUSIONS

Invisible support and invisible control may serve as protective buffers for negative affect in a health-behavior change context for male partners of dual-smoker couples. Future research should clarify under what conditions invisible exchanges unfold positive effects on partners' well-being and health behavior in different health contexts.

Smoking cessation with smartphone applications (SWAPP): study protocol for a randomized controlled trial

Background

Tobacco smoking remains one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real-time. The social context of smokers has, however, been neglected in smartphone apps promoting smoking cessation. This randomized controlled trial investigates the effectiveness of a smartphone app in which smokers quit smoking with the help of a social network member.

Methods

This protocol describes the design of a single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Participants of this study are adult smokers who smoke at least one cigarette per day and intend to quit smoking at a self-set quit date. Blocking as means of group-balanced randomization is used to allocate participants to intervention or control conditions. Both intervention and control group use a smartphone-compatible device for measuring their daily smoking behavior objectively via exhaled carbon monoxide. In addition, the intervention group is instructed to use the SmokeFree Buddy app, a multicomponent app that also facilitates smoking-cessation specific social support from a buddy over a smartphone application. All participants fill out a baseline diary for three consecutive days and are invited to the lab for a background assessment. They subsequently participate in an end-of-day diary phase from 7 days before and until 20 days after a self-set quit date. Six months after the self-set quit date a follow-up diary for three consecutive days takes place. The primary outcome measures are daily self-reported and objectively-assessed smoking abstinence and secondary outcome measures are daily self-reported number of cigarettes smoked.

Discussion

This is the first study examining the effectiveness of a smoking cessation mobile intervention using the SmokeFree Buddy app compared to a control group in a real-life setting around a self-set quit date using a portable objective measure to assess smoking abstinence. Opportunities and challenges with running studies with smoking participants and certain design-related decisions are discussed.

Trial registration

This trial was prospectively registered on 04/04/2018 at ISRCTNregistry: ISRCTN11154315.

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

Couples' daily self-regulation: The Health Action Process Approach at the dyadic level

Objective

Regulating health behavior change often occurs in a dyadic context of romantic relationships. Dyadic approaches to standard health behavior change models are, however, barely considered. We investigated volitional processes of the Health Action Process Approach model for two health behaviors within a dyadic context of romantic couples. Specifically, we tested whether day-to-day volitional self-regulation predicted one’s own and one’s partner’s cigarettes smoked (Study 1) and physical activity (Study 2).

Methods

In two dyadic intensive longitudinal studies (Study 1: 83 dual-smoker couples intending to jointly quit smoking; Study 2: 61 overweight couples intending to become physically active), heterosexual partners independently reported on intention, self-efficacy, action planning, and action control in end-of-day diaries. In Study 1, daily number of cigarettes smoked was assessed via self-report. In Study 2, daily moderate-to-vigorous physical activity (MVPA) was assessed objectively via accelerometers. In both studies, dyadic cross-lagged intensive longitudinal analyses based on the Actor-Partner Interdependence Model were applied.

Results

Across both studies, individual’s own volitional self-regulation positively predicted one’s own health behavior (less cigarettes smoked and more MVPA). One’s partner’s action control and intention also positively predicted one’s own health behavior. A marginal partner effect for self-efficacy was found in the context of smoking only.

Conclusions

Behavioral self-regulation is not only relevant for individuals themselves, but some volitional processes may spill over to their partners. This highlights the need to specify couple-level processes involved in health behavior change, and to consider a social context of self-regulation.

A Daily Diary Study of Joint Quit Attempts by Dual-Smoker Couples: The Role of Received and Provided Social Support

Introduction

Smoking individuals often have a romantic partner who also smokes. Social support from a partner is assumed to be beneficial for successful smoking cessation. To date, no study has examined daily support and smoking in dual-smoker couples jointly attempting to quit. The aim was to test the hypothesis that smokers cut down more on days with higher received and provided emotional and instrumental support. Men are expected to benefit more from support provision of their female partners than vice versa.

Aims and Methods

In this dyadic diary study, 83 dual-smoker couples reported in daily mobile phone diaries number of cigarettes smoked, how much emotional and instrumental support they received from the other partner, and how much they provided to their partners for 22 consecutive days from a joint quit date on applying the Actor-Partner Interdependence Model.

Results

Evidence was found for a support-smoking link for emotional and instrumental support. On days when women and men reported more received and provided support than usual, they smoked fewer cigarettes (actor effects for both). For men only, partner support was related to smoking: On days when women reported providing more support than usual, men smoked fewer cigarettes (partner effect for men).

Conclusions

Social support plays a key role for one's own daily smoking in dual-smoker couples. Support provided by women but not by men was related to less smoking in partners. Findings emphasize the need for dyadic and daily assessments in longitudinal studies and trials to understand the dynamics of support in smoking cessation.

Implications

This study is the first to provide insights into the association between daily smoking and social support after a joint self-set quit attempt of dual-smoker couples using a dyadic intensive longitudinal approach. Received and provided emotional and instrumental support play a key role for one's own daily smoking in dual-smoker couples after a joint self-set quit date. Furthermore, support provided by women was related to less smoking in partners. Because smokers with a romantic partner who also smokes have lower quit success, it is remarkable that this study replicates findings from a prior study with smoker-nonsmoker couples showing the central role of social support after a quit attempt.

Inter-relations among negative social control, self-efficacy, and physical activity in healthy couples

OBJECTIVES

In romantic relationships, partners can influence each other's health-relevant behaviour by exerting negative social control (e.g., pressuring), however, with mixed success. To elucidate this phenomenon, we examined couples motivated to increase their physical activity and investigated the degree to which both partners exerted negative control on each other, their self-efficacy, reciprocal associations among the two behaviour-specific constructs, and their relationship with moderate-to-vigorous physical activity (MVPA).

DESIGN

This was a longitudinal study with three assessment periods (T0, T2, T3) spanning 7 weeks.

METHODS

We performed secondary analyses with data from the control condition (N = 113 heterosexual couples) of a published randomized controlled trial. Dyadic mediator models specified either both partners' self-efficacy as predictors and provided negative partner control to each other as mediators or vice versa. The outcomes comprised both partners' accelerometer-assessed MVPA. Mediators and outcomes were controlled for their T0 values.

RESULTS

The first model showed that women's and men's provided negative partner control (T0) was positively related to the other partners' self-efficacy (T2). Testing the alternative predictive direction, the second model showed that only women's self-efficacy (T0) was associated with more provided negative partner control (T2) by men. Women and men showed less MVPA (T3) when their partners had provided them with more negative control at T2.

CONCLUSIONS

As negative control provided to partners may be detrimental to their behaviour change, interventionists should advise couples to avoid it. However, active ingredients of negative control that may benefit recipients' self-efficacy beliefs should be investigated in future work. Statement of contribution What is already known on this subject? Couples often try to change each other's health behaviour not just using supportive tactics, but also controlling ones. Negative partner control (e.g., rebuking and nagging) was found to have adverse or no effects on control recipients' health behaviour change. To understand underlying mechanisms of this relationship, reactance and negative affect of recipients have been investigated, but only rarely their self-efficacy, a consistent individual predictor of behaviour change that is likely to share reciprocal relations with social exchange processes, including negative social control. What does this study add? Although harmful for behaviour change, negative partner control may increase control recipients' self-efficacy. Higher self-efficacy of one partner may also increase provided negative partner control by the other.

Health Behavior Change in Older Adults: Testing the Health Action Process Approach at the Inter- and Intraindividual Level

BACKGROUND

Health behavior change theories usually claim to be universally and individually applicable. Most research has tested behavior change theories at the interindividual level and within young-to-middle-aged populations. However, associations at the interindividual level can differ substantially from associations at the intraindividual level. This study examines the applicability of the Health Action Process Approach (HAPA) at the inter- and the intraindividual level among older adults.

METHODS

Two intensive longitudinal studies examined the HAPA model covering two different health behaviors and two different time spans: Study 1 (physical activity, N = 52 × 6 monthly observations) and Study 2 (medication adherence, N = 64 × 30 daily observations). The HAPA constructs (risk awareness, outcome expectancy, self-efficacy, intention, action planning, action control), and self-reported behaviors were assessed.

RESULTS

Overall, at the interindividual level, results of both studies largely confirmed the associations specified by the HAPA. At the intraindividual level, results were less in line with the HAPA. Only action control emerged as consistent predictor of behavior.

CONCLUSIONS

This study emphasises the importance of examining health behavior change theories at both, the inter- and the intraindividual level.

Goal Disengagement, Well-Being, and Goal Achievement in Romantic Couples Pursuing Health Behavior Change: Evidence from Two Daily Diary Studies

BACKGROUND

Withdrawing effort and commitment from important goals (i.e. goal disengagement) has been discussed as an effective aspect of goal adaption. However, studies have focused especially on between-person differences. The present studies aimed to investigate within-person differences in goal disengagement within a dyadic context of romantic couples. Across two different health behaviors, we specifically tested whether goal disengagement would be associated with better well-being, but lower goal achievement in everyday life.

METHODS

In two dyadic daily diary studies (Study 1: 61 overweight couples aiming to become physically active; Study 2: 83 dual-smoker couples aiming to quit smoking), both partners independently reported on goal disengagement, positive and negative affect. Behavioral goal achievement was measured via accelerometer (Study 1) and self-report (Study 2).

RESULTS

Analyses based on the Actor-Partner Interdependence Model revealed that across both studies, one's own goal disengagement was related to lower well-being and a lower likelihood for goal achievement on a daily level (actor effects). Only in Study 1 were partner effects on negative affect and goal achievement found.

CONCLUSIONS

In daily life, goal disengagement may not be as adaptive for well-being and goal achievement in health behavior change. Dyadic associations were not consistent, and might be more context-sensitive.

Assessing adherence to multiple medications and in daily life among patients with multimorbidity

OBJECTIVE

Chronic conditions often require multiple medication intake. However, past research has focused on assessing overall adherence or adherence to a single index medication only. This study explored adherence measures for multiple medication intake, and in daily life, among patients with multiple chronic conditions (i.e. multimorbidity).

DESIGN

Eighty-four patients with multimorbidity and multiple-medication regimens completed three monthly panel questionnaires. A randomly assigned subsample additionally completed a 30-day daily diary.

MAIN OUTCOME MEASURE

The Non-Adherence Report; a brief self-report measure of adherence to each prescribed medication (NAR-M), and in daily life. We further assessed the Medication Adherence Report Scale (MARS), and a subsample of participants were randomised to electronic adherence monitoring.

RESULTS

The NAR-M indicated M = 94.7% adherence at Time 1 (SD = 9.3%). The NAR-M was significantly correlated with the MARS (r_t1 = .52, r_t2 = .57, and r_t3 = .65; p < .001), and in tendency with electronically assessed adherence (r_t2 = .45, r_t3 = .46, p < .10). Variance components analysis indicated that between-person differences accounted for 10.2% of the variance in NAR-M adherence rates, whereas 22.9% were attributable to medication by person interactions.

CONCLUSION

This study highlights the importance and feasibility of studying adherence to multiple medications differentially, and in daily life. Future studies may use these measures to investigate within-person and between-medication differences in adherence.

Daily negative affect and smoking after a self-set quit attempt: The role of dyadic invisible social support in a daily diary study

OBJECTIVES

Social support receipt from one's partner is assumed to be beneficial for successful smoking cessation. However, support receipt can have costs. Recent research suggests that the most effective support is unnoticed by the receiver (i.e., invisible). Therefore, this study examined the association between everyday levels of dyadic invisible emotional and instrumental support, daily negative affect, and daily smoking after a self-set quit attempt in smoker-non-smoker couples.

METHODS

Overall, 100 smokers (72.0% men, mean age M = 40.48, SD = 9.82) and their non-smoking partners completed electronic diaries from a self-set quit date on for 22 consecutive days, reporting daily invisible emotional and instrumental social support, daily negative affect, and daily smoking.

RESULTS

Same-day multilevel analyses showed that at the between-person level, higher individual mean levels of invisible emotional and instrumental support were associated with less daily negative affect. In contrast to our assumption, more receipt of invisible emotional and instrumental support was related to more daily cigarettes smoked.

CONCLUSIONS

The findings are in line with previous results, indicating invisible support to have beneficial relations with affect. However, results emphasize the need for further prospective daily diary approaches for understanding the dynamics of invisible support on smoking cessation. Statement of contribution What is already known on this subject? Social support receipt from a close other has proven to have emotional costs. According to current studies, the most effective social support is unnoticed by the receiver (i.e., invisible). There is empirical evidence for beneficial effects of invisible social support on affective well-being. What does this study add? Confirming benefits of invisible social support for negative affect in a health behaviour change setting Providing first evidence for detrimental effects of invisible social support on smoking.

Examining gender differences in received, provided, and invisible social control: an application of the dual-effects model

The dual-effects model of social control not only assumes that social control leads to better health practices but also arouses psychological distress. However, findings are inconsistent. The present study advances the current literature by examining social control from a dyadic perspective in the context of smoking. In addition, the study examines whether control, continuous smoking abstinence, and affect are differentially related for men and women. Before and three weeks after a self-set quit attempt, we examined 106 smokers (77 men, mean age: 40.67, average number of cigarettes smoked per day: 16.59 [SD=8.52, range=1-40] at baseline and 5.27 [SD=6.97, range=0-40] at follow-up) and their nonsmoking heterosexual partners, assessing received and provided control, continuous abstinence, and affect. With regard to smoker's affective reactions, partner's provided control was related to an increase in positive and to a decrease in negative affect, but only for female smokers. Moreover, the greater the discrepancy between smoker received and partner's provided control was the more positive affect increased and the more negative affect decreased, but again only for female smokers. These findings demonstrate that female smokers' well-being was raised over time if they were not aware of the control attempts of their nonsmoking partners, indicating positive effects of invisible social control. This study's results emphasize the importance of applying a dyadic perspective and taking gender differences in the dual-effects model of social control into account.

Social control and smoking: examining the moderating effects of different dimensions of relationship quality

A common form of social regulation of an individual's health behavior is social control. The contextual model of social control assumes that higher relationship quality goes along with more beneficial effects of social control on health behavior. This study examined potential differential moderating effects of different dimensions of relationship quality on the associations between positive and negative social control and smoking behavior and hiding smoking. The sample consisted of 144 smokers (n = 72 women; mean age = 31.78, SD = 10.04) with a nonsmoking partner. Positive and negative social control, dimensions of relationship quality consensus, cohesion and satisfaction, numbers of cigarettes smoked (NCS), hiding smoking (HS), and control variables were assessed at baseline. Four weeks later NCS and HS were assessed again. Only for smokers with high consensus, but not cohesion and satisfaction, a negative association between positive control and NCS emerged. Moreover, smokers with high consensus tended to report more HS when being positively and negatively socially controlled. This also emerged for cohesion and positive control. Satisfaction with the relationship did not display any interaction effects. This study's results emphasize the importance of differentiating not only between positive and negative social control but also between different dimensions of relationship quality in order to gain a comprehensive understanding of the dynamics in romantic dyads with regard to social regulation of behavioral change.