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Communication and Diabetes Management Study

Ashley, Kaitlyn and Amanda have been participating in the development of a system for coding relational language in medical encounters (REL-MED). The REL-MED gives detailed descriptions of the treatment talk and strategies of involvement under investigation in a study of patient, spouse, and physician communication.

Chronic illness management for married patients often includes involvement of their spouses both in the medical setting and at home. The research described spouses' role in medical encounters in the context of diabetes management, determining the association between spouse support statements during medical encounters with patient reports of spouse diet-related support at home. Findings support the hypotheses that statements of spousal support during medical encounter dialogue would be positively associated with patient reports of spouse diet-related support at home.

The students prepared and submitted a proposal which was accepted to present at the National Council on Family Relations (NCFR) conference, November 6-9, 2013.

Study Description

In this study of patient, spouse, and physician communication, patients with type 2 diabetes were recruited through collaboration with a local endocrinology clinic. To be eligible, patients had to be at least 50 years of age and dyads had to be married and living together. When participating couples arrived for their scheduled physician visit, both spouses and patients consented to have their medical encounter audio-recorded. The audio-recorded medical visits were then professionally transcribed verbatim. Coding of transcripts took place in three stages. In the first stage, coders were tasked with coding treatment talk and spousal involvement statements within the accompanied medical encounter transcripts. Spousal involvement statements are spousal speaking turns that reveal spouses take an active role in patients' diabetes management outside of the physician's office (e.g., dietary behaviors, symptom monitoring, medication adherence, and/or exercise). Coders identified these statements according to the guidelines of the REL-MED. The second stage consisted of the categorization of the involvement statements into three concepts: statements of spousal support, spousal control, and general spousal involvement. In the third stage, we (i.e., the lead investigators) will look for common themes in patient responses to spousal support, control, and general involvement statements using theoretical comparison.

How this work will help Families

Involvement of spouses in partners' chronic illness management is increasingly recognized as a factor in proper disease management of patients. Interdependence in marital relationships incorporates the interconnections between individuals in close relationships and the salience of one partner's behavior in affecting the other partner's outcomes. Interdependence within diabetes management results in the labeling of health events as meaningful not only for the patient, but also for the marital relationship and the spouse. Behaviors influenced by interdependence include cooperative actions such as support that are meant to address issues regarding health behavior change, health outcomes, and treatment adherence. Although this study is preliminary and does not provide evidence that spouses should be involved in diabetes management, this work may suggest that healthcare professionals including nurses and diabetes educators should be cognizant of the unique needs and concerns of partners who share the disease context with patients. In order to promote illness adjustment, research and practice interventions seeking to promote disease management among patients with diabetes should be designed to educate and provide information relevant to the needs of both patients and their partners.

Project researchers:

Dr. Melissa Franks, Purdue University, HDFS Relationships and Healthcare Lab
Dr. Amber Seidel, Penn State York
Justin Briggs, Purdue University

Funding for the students provided by the Center for Families Research Enhancement Grant with matching funds from the Department of Human Development and Family Studies.