Diabetes-Specific Family Functioning among Adults: Types, Predictors, and Outcomes

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PROJECT SUMMARY Many adults with type 2 diabetes (T2D) have difficulty performing recommended self-care activities and, therefore, achieving optimal glycemic control (A1c). Social and family contexts directly and indirectly impact patients’ motivation and ability to initiate and sustain self-care behaviors via actions that facilitate or impede self-care and via effects on psychological well-being and diabetes distress. Evidence on the importance of family involvement in adults’ management of chronic diseases like diabetes is accumulating, but interventions for adults with T2D have been inconsistent in approach with mixed effects. This may be because little is known about how families communicate about and respond to adults’ efforts to manage T2D effectively, especially among adults who are not married or partnered. A comprehensive framework of diabetes-specific family functioning applicable across family structures is needed to guide intervention development and tailoring, and to improve post-intervention evaluations. Therefore, the goals of this project are to develop a framework of diabetes-specific family functioning among adults with T2D and provide a useful tool for identifying patients likely to benefit from family interventions and for tailoring interventions. Findings will open and guide new lines of inquiry regarding who benefits from certain intervention content and its delivery (family or individual). A typological approach is needed to identify profiles or “types” of diabetes-specific family functioning because families exhibit different patterns of functioning across several interrelated dimensions that cannot be captured by unidimensional analyses. Adults with T2D will complete a survey assessing multiple aspects of diabetes-specific family functioning online, by phone, or in person in English or Spanish. Participants will be recruited using multiple methods to obtain a sample diverse with respect to race/ethnicity, socioeconomic status, geographic region, and family structure. Data will be aggregated to meet two specific aims. Aim 1: (a) identify and validate an empirical typology of diabetes-specific family functioning, and then (b) examine patient and family characteristics predicting type membership (e.g., percent African American patients and percent married patients in each type) and associations between types and patients’ psychological well-being, adherence to self-care, and A1c. This knowledge will guide development of relevant interventions for the most common and most detrimental types. Aim 2: develop a brief assessment which optimizes classification to types identified in aim1 while minimizing the number of items. This brief assessment can be used in future intervention research to tailor and conduct subgroup analyses by type. This project initiates a line of inquiry that will improve family interventions among adults by shifting the focus from family structure to family needs, and by providing a systematic and empirically-driven approach to intervention tailoring.