Type 2 diabetes is a public health problem of great significance. The key determinant of whether health complications ensue is patient self-management. However, the self-care regimen for diabetes is complex and the health care system has limited resources to assist patients. Thus, it is not a surprise that self-care is poor. The present application recognizes that patient self-care takes place in a social context and aims to explore the impact of partner behaviors on patient self-care, self-efficacy, and mental and physical health. We propose to enroll 220 persons who have been diagnosed with type 2 diabetes in the past 2 years and their partners. Half of the couples will be African-American, and half will be Caucasian. Within these two groups, half will consist of female patients and half will consist of male patients. We hypothesize that communal coping in couples will lead to better patient self-care, while maintaining high levels of patient self-efficacy and good mental health. We hypothesize that partner supportive behaviors will mediate these relations. We will explore racial and gender differences in communal coping and supportive behavior as well as whether relations of communal coping and partner behavior are differentially related to outcomes due to race and gender. We propose to use multiple methods to assess independent and dependent variables. Methods include: (1) survey instruments that assess communal coping, patient and partner behavior, patient self-care, self- efficacy, and mental health;(2) a dyadic interview measure of communal coping;(3) a laboratory observational study in which couples discuss the way patients manage their disease so that raters can code the videotaped interactions for communal coping, supportive and unsupportive behavior, and affect;(4) an extension of the laboratory study in which patients view the videotapes, recall thoughts and feelings at key points, and raters code the behavior that precipitated the reactions;(5) in person assessments of physical health parameters;and (6) a 14-day ecological momentary assessment (EMA) study that consists of patients/partners completing a brief survey about patient-partner interactions at the end of each day. During the EMA study, three 24-hour dietary recall interviews will be performed, and patients/partners will wear accelerometers to capture activity and energy expenditure. Couples will be contacted six months later to repeat the survey, physical health assessment, and 24-hour recall interviews. The results of this study can be used to design a couples'intervention aimed at maximizing behaviors that help and minimizing behaviors that hinder self-care.
The epidemic increase in type II diabetes in our nation is associated with astounding economic costs as well as enormous costs to quality and quantity of life. The key to preventing the myriad health complications that are associated with type 2 diabetes is good self-care behavior. However, the self-care behavior regimen is complex, and health care resources to assist patients are limited. The present application recognizes that self-care takes place in a social context and focuses on the role that the partner plays in helping patients to enact better self-care without undermining self-efficacy and while maximizing mental health. The present application also recognizes that type II diabetes is over-represented in the African American community and attempts to examine race differences in the role of the partner in self-care.