Links of Communal Coping in Couples with Diabetes to Self-care Behavior

描述(申请人提供)：2型糖尿病是一个具有重要意义的公共卫生问题。是否出现健康并发症的关键决定因素是患者的自我管理。然而，糖尿病的自我护理方案很复杂，医疗保健系统帮助患者的资源有限。因此，自理能力差也就不足为奇了。 本申请承认患者自我护理发生在社会背景下，旨在探索伴侣行为对患者自我护理、自我效能和身心健康的影响。我们建议招募220名在过去两年中被诊断为2型糖尿病的患者及其伴侣。一半的夫妇将是非裔美国人，一半将是高加索人。在这两组中，一半将由女性患者组成，另一半将由女性患者组成 由男性患者组成。我们假设，夫妻之间的共同应对将导致更好的患者自我护理，同时保持高水平的患者自我效能和良好的心理健康。我们假设，伴侣的支持行为将会调节这些关系。我们将探索种族和性别在社区应对和支持行为上的差异，以及社区应对和伴侣行为的关系是否与种族和性别的结果存在差异相关。我们建议使用多种方法来评估自变量和因变量。方法包括：(1)评估共同应对、患者和伴侣行为、患者自我照顾、自我效能感和心理健康的调查工具；(2)共同应对的二元访谈测量；(3)实验室观察性研究，夫妇讨论患者处理疾病的方式，以便评分者可以编码共同应对、支持和不支持行为以及情感的录像互动；(4)实验室研究的扩展，患者观看录像带，回忆关键点的想法和感觉，评分者编码引发反应的行为；(5)亲自评估身体健康参数；以及(6)一项为期14天的生态瞬时评估(EMA)研究，由患者/伴侣在每天结束时完成关于患者与伴侣互动的简短调查。在EMA研究期间，将进行三次24小时饮食回忆访谈，患者/伴侣将佩戴加速计来记录活动和能量消耗。六个月后，夫妇们将被联系，以重复调查、身体健康评估和24小时召回访谈。这项研究的结果可用于设计夫妇干预措施，旨在最大限度地帮助和减少阻碍自我照顾的行为。 公共卫生相关性：我国II型糖尿病的流行增加与惊人的经济成本以及对生活质量和数量的巨大成本有关。预防与2型糖尿病相关的各种健康并发症的关键是良好的自我护理行为。然而，自我保健行为养生方式复杂，用于帮助患者的医疗资源有限。本申请承认自我护理是在社会背景下进行的，并侧重于伴侣在帮助患者在不损害自我效能的情况下更好地进行自我护理并同时最大限度地促进心理健康方面所发挥的作用。本申请还认识到II型糖尿病在非裔美国人社区中的比例过高，并试图检查伴侣在自我护理中所起作用的种族差异。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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.