Academic journal article Family Relations

Spouse Control and Type 2 Diabetes Management: Moderating Effects of Dyadic Expectations for Spouse Involvement

Academic journal article Family Relations

Spouse Control and Type 2 Diabetes Management: Moderating Effects of Dyadic Expectations for Spouse Involvement

Article excerpt

For married patients, chronic illness management often includes involvement of their spouses. We examined expectations regarding spouse involvement in the health of a partner with type 2 diabetes (N = 139 couples) from the perspectives of the patient and spouse. Partners dyadic expectations and spouses' gender were posited to moderate spouses' diet-related control and patients' diet adherence. Among male patients, when both partners shared an expectation for spouse involvement greater diet-related spouse control was associated with better diet adherence of patients. In contrast, when expectations for spouse involvement were not shared, greater spouse control by wives was associated with poorer diet adherence. Dyadic expectations for spouse involvement did not moderate the association between spouse control and diet adherence among female patients. Findings suggest that shared expectations for spouse involvement can facilitate spouses' attempts to improve patients' dietary adherence, especially among male patients and their wives.

Key Words: aging families, chronic illness, close relationships.

Married patients often manage chronic illness within the context of their relationship with their spouses. Traditionally, research examining patients and spouses influence in chronic illness management have focused on the perspective of the individual rather than considering both partners (Berg & Upchurch, 2007). More recently, a dyadic approach emphasizing the relational context has been advanced that explicitly includes both partners' roles in shaping patients' behaviors and outcomes in the management of chronic illness (Berg & Upchurch, 2007). This dyadic approach is based on accumulating knowledge that many spouses share lifestyle habits, appraise chronic illness stressors as "ours" rather than "mine," and engage in joint management efforts (e.g., Bodenmann, 2005; Hippisley-Cox, Coupland, Pringle, Crown, & Hammersley, 2002; Revenson, Kayser, & Bodenmann, 2005). It has been suggested that one cannot fully understand an individual's chronic illness management without considering the potential effect of the other partner and the marriage (Bodenmann, 2005). In this investigation, we explored spouses' concordance in their expectations for whether spouses should be involved in their ill partners' health (i.e., dyadic expectations regarding spouse involvement). Specifically, we examined whether dyadic expectations for spouse involvement moderated the association between spouses' diet-related control and patients' diet adherence within the context of type 2 diabetes and whether these associations were further moderated by spouses' gender.

Spouse Control and Health

Spouse control occurs when spouses exert social control, seeking to bring about a change in the behavior of their partner. Social control can be exerted directly through interpersonal interactions or indirectly through social norms (Lewis & Rook, 1999). Social control theory posits that relationships with network members can have a regulatory effect on the behavior of individuals, making it less likely for them to engage in risky or deviant behavior (e.g., Rook & Ituarte, 1999; Umberson, 1987).

Social control of health behaviors often has been examined in the context of intimate ties. Spouses most often seek to change behaviors that may place their partners' health at risk (Lewis, Butterfield, Darbes, & Johnston-Brooks, 2004). In couples, social control enacted by a spouse (i.e., spouse control) often has been associated with improvements in targeted health behaviors of partners (e.g., Umberson, 1992; Westmaas, Wild, & Ferrence, 2002). Social control strategies such as being rewarded for engaging in a healthy behavior appear to be effective in bringing about desired behavior change whereas strategies such as being pressured to change a health behavior are associated with persistence of poor health behaviors (Lewis & Rook, 1 999) and with hiding unhealthy behaviors (Okun, Huff, August, & Rook, 2007). …

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