Followup: Links of Communal Coping in Couples with Diabetes to Diabetes Outcomes

糖尿病是美国第七大死亡原因，与健康并发症有关 对生活质量和数量构成严重威胁。预防并发症需要坚持分娩- 强化自我护理养生法，包括改变饮食、锻炼、血糖监测和服药以 控制血糖水平和相关条件(例如，血压)。以前在这一领域的研究 糖尿病强调人的因素如何影响结果，但糖尿病是一种慢性病，需要 置身于超越糖尿病患者的人际环境中。在过去的5年里，我们 采用共同应对框架，以了解配偶/伴侣在患者适应中的作用 新诊断的2型糖尿病(R01 DK095780)。社区应对代表着对 问题(即，“我们”的问题而不是“他/她”的问题)和夫妇合作来管理问题。至 到目前为止，我们已经从患者被诊断患有癌症的社区招募了191对夫妇(目标220人) 近3年有2型糖尿病史。患者在种族(56%的白人，44%的黑人)、收入和 性别(56%男性)。我们研究了社区应对的多种方法(自我报告、语言、行为) 并报告有希望的结果。随着竞争的延续，我们有一个难得的机会来收集5年期 对患有2型糖尿病的白人和非裔美国人的大样本进行纵向数据分析 在心理和生理健康方面具有丰富的心理社会预测变量。主要目标1是 研究社区应对在5年内的变化，并确定最初的社区应对和 社区应对预示着心理健康、自我照顾行为和血糖控制的变化。 主要目标2是考察性别和种族作为社区应对与健康关系的调节变量。一个 第二个探索性目标是招募一组没有浪漫伴侣的人来确定 社区应对以及社区应对与结果的关系延伸到家人和朋友。因为 非裔美国人比白人结婚的可能性小，而比白人更有可能有重要的 非配偶支持来源，这一目标是针对非裔美国人的。我们计划重新招募220名 对初次面试5年后的情侣进行研究，招募50名没有恋爱关系的非裔美国人 双子星。研究方法包括：(1)评估社区应对、患者/伴侣行为的调查工具， 患者自我照顾、自我效能感与心理健康；(2)访谈量表；(3)社区应对方式评价 录制夫妇关于糖尿病相关问题的对话，以评估社区应对、支持和 不支持行为和情感；(4)亲自评估身体健康参数，包括糖化血红蛋白； 以及(5)为期14天的生态瞬时评估，由患者/伴侣完成简短调查 关于他们的互动和每天结束时对糖尿病的护理。本研究的结果可用于设计 旨在培养2型糖尿病患者自我护理行为的二元干预措施。 1

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