Diabetes is the 7th leading cause of death in the United States and is associated with health complications that pose serious threats to quality and quantity of life. Preventing complications involves adhering to a labor- intensive self-care regimen, involving changes in diet, exercise, glucose monitoring, and taking medications to control blood glucose levels and associated conditions (e.g., blood pressure). Previous research in the area of diabetes emphasizes how person factors contribute to outcomes, but diabetes is a chronic illness that takes place in an interpersonal context that extends beyond the person with diabetes. Over the past 5 years, we adopted a communal coping framework to understand the role of the spouse/partner in patient adjustment to newly diagnosed type 2 diabetes (R01 DK095780). Communal coping represents a joint appraisal of the problem (i.e., ?our? problem instead of ?his/her? problem) and couple collaboration to manage the problem. To date, we have recruited 191 (goal 220) couples from the community in which the patient was diagnosed with type 2 diabetes in the past 3 years. Patients are diverse in terms of race (56% white, 44% black), income, and sex (56% male). We have examined communal coping with multiple methods (self-report, language, behavior) and report promising results. With this competing continuation, we have a rare opportunity to collect 5-year longitudinal data on a large sample of Whites and African Americans with type 2 diabetes to examine changes in psychological and physical health with a rich set of psychosocial predictor variables. Primary Aim 1 is to examine how communal coping changes over 5 years and determine if initial communal coping and changes in communal coping predict changes in psychological well-being, self-care behavior, and glycemic control. Primary Aim 2 is to examine sex and race as moderators of the relation of communal coping to health. A secondary exploratory aim is to recruit a comparison group of people without romantic partners to determine if communal coping and the relation of communal coping to outcomes extends to family and friends. Because African Americans are less likely than Whites to be married and are more likely than Whites to have significant non-spousal sources of support, this aim is directed at African Americans. We plan to re-recruit 220 current study couples 5 years after the initial interview and recruit 50 new non-romantic partnered African American dyads. Study methods include: (1) survey instruments to assess communal coping, patient/partner behavior, patient self-care, self-efficacy, and mental health; (2) interview measure of communal coping; (3) evaluation of videotaped couple conversations about diabetes-related problems to assess communal coping, supportive and unsupportive behavior, and affect; (4) in person assessments of physical health parameters, including HbA1c; and (5) 14-day ecological momentary assessment that consists of patients/partners completing brief surveys about their interactions and diabetes care at the end of each day. The results of this study can be used to design dyadic interventions aimed at fostering self-care behavior among persons with type 2 diabetes. 1
Type 2 diabetes is epidemic in our country, and good self-care behavior is critical to both quantity and quality of life. The present application recognizes that self-care takes place in a social context and focuses on the role that the social environment plays in helping patients to enact better self-care without undermining self-efficacy and while maximizing mental health. We have a unique opportunity to collect 5-year longitudinal data on a large sample of both White and African American persons with newly diagnosed type 2 diabetes to examine changes in psychological and physical health with a rich set of psychosocial predictor variables collected at baseline. The present application recognizes that type 2 diabetes is over-represented in the African American community and examines race differences in the role of social environmental factors in health.
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