Diagnosis of chronic conditions among older adults, including hypertension, heart disease, and diabetes, is common and sets in lotion the need for changes in diet, physical activity, and establishing medication regiments. Patients and spouses must engage in these self-management behaviors on a daily basis to stem progression of chronic disease. This study will examine the association between older married couples' social interactions and their success in initiating chronic disease self- management behaviors. This research will address several gaps in the literature regarding older couples' social interaction and the initiation of self-management behaviors. First, most research examining the social interactions that affects these types of behaviors has examined social support, although evidence indicates that social control interactions are also important elements of older adults' close relationships. Second, evidence suggests that marital partners' social support and social control efforts are related to their spouses' behavior change. Most of this research, however, has been conducted with younger couples examining primary prevention of health problems, rather than with older couples examining secondary prevention of disease progression. Third, there has been no systematic study of both social support and social control attempts and their affect on behavior change for both spouses after one spouse has received a chronic disease diagnosis. Hypotheses & Aims: The hypotheses to be tested in the proposed research are: both more social support and more social control between spouses serves to facilitate of self-management behaviors after diagnosis with a chronic health condition for both patient and spouse, and 2) the strength of the association between social support and social control in initiating self- management behaviors will very by the interdependence of the behavior. These associations should be strongest for behaviors that are more interdependent between spouse and patient, such as dietary changes, less strong for physical activity, and weakest for establishing medication adherence. The study aims are to: 1) Determine if both patient and spouse initiate self-management behaviors after a chronic disease diagnosis: 2) Determine the importance of daily social support and social control attempts between spouses as they initiate self-management behaviors; 3) Determine if the association between daily social support and social control attempts between spouses is different for each self-management behavior, including changes in dietary practices, physical activity, and establishing medication regimens. Samples & Methods: 30 couples, in which the husband (aged 55-70) has been diagnosed with cardiovascular disease or Type 2 diabetes will be recruited from a Family Medicine clinic. Both spouse and patient will complete daily diary information that assesses social support, social control and self-management practices. In addition, couples will complete surveys that measure general health, social, and demographic information. Statistical procedures based on hierarchical regression models, which maintain the couple, as the unit of analysis, will be used to test study hypotheses. The long-term goal is to use data collected in this proposal as pilot information that can be used to inform a large study of older couples' initiation and maintenance of self- management strategies.
