The Circumplex Dietary Support Assessment diet using Olson's Circumplex Model of Marital and Family Systems and the CDSA's ability to predict dietary adherence in married or cohabiting type 2 diabetics tested. The Circumplex Model, derived from Family Systems Theory, posits that couple interaction is a major influence on behavior and includes three dimensions of family functioning, cohesion, adaptability and communication. Greater cohesion has been associated with greater control of HbA1c in type 2 diabetics. In phase 1, the objective is to draft the initial instrument using qualitative data from previously conducted interviews about dietary adjustment with couples in which one was a type 2 diabetic and to carry out cognitive testing with 16 similar type 2 diabetics. The draft will be revised according to the findings. In phase 2, the objective is to define the factor structure of the final instrument using confirmatory factor analysis. 400 type 2 diabetics will complete the draft CDSA instrument plus several comparison instruments (FACES II, ENRICH communication, Diabetes Family Behavior Checklist & Marlowe-Crowne Social Desirability Scale). After defining the CDSA's factor structure, correlations of the refined CDSA with comparison instruments will be examined to determine both concurrent validity and social desirability bias. In phase 3, the objective is to determine if higher scores on the refined CDSA instrument predict greater dietary compliance. The hypothesis is that male and female diabetics with higher CDSA scores will be significantly more likely to a) meet their calorie intake goal, b) have higher Diet Quality Index scores and/or c) lower HbA1c. Compliance data will be derived from a set of two 24-hour recalls provided by 200 type 2 diabetics who will also complete the refined CDSA and provide current HbA1c measures. Confirmation of the hypotheses will mean the CDSA can be used to assess married or cohabiting type 2 diabetic's degree of success in adjusting to the diabetic diet and identify those needing more couple-based dietary instruction.
