Objective
The goals of the research are to:
1. Refine a communal coping intervention that we have developed via qualitative interviews with 12 couples in which one person has type 1 diabetes
2. Test through random assignment whether the communal coping intervention reduces diabetes distress and improves self-management
3. Obtain feasibility and acceptability data on the intervention via our recruitment rate, our retention rate, and participant ratings of satisfaction with each component of the intervention.
4. To the extent that the intervention is successful, test whether the intervention benefits were due to improved communication, partner responsiveness to needs, social support, and/or self-efficacy.
Background Rationale
The vast majority of research in the area of T1D focuses on children and adolescents. However, children with T1D grow up to be adults, and adults are a neglected area of research. In addition, 1/3 of those diagnosed with T1D are adults. To address disease management among adults with T1D as well as the psychological and physical costs of diabetes, the present application focuses on the person with T1D and their romantic partner. It is well recognized that diabetes and diabetes management takes place in an interpersonal context, and a key figure in that context is the romantic partner. Partners are not only affected by diabetes but affect diabetes. The majority of intervention efforts that target diabetes distress or self-management focus on the patient alone and rarely involve family members, despite the fact that interventions that target couples are more successful than interventions that target patients alone.
Substantial correlational research shows that spouse behavior affects the psychological and physical health of those with diabetes. A large literature shows that spouse social support is related to better disease management. The PI’s program of research shows that couples who engage in “communal coping” have the best health outcomes. Communal coping consists of a shared appraisal of a problem (“our problem” instead of “your problem”) and collaboration with a partner to manage the problem. Thus, this application aims to develop and refine an intervention based in communal coping to reduce patient diabetes distress and enhance patient self-management.
We believe this intervention will be successful for four reasons. First, there is a large literature that has established that communal coping is linked to good psychological and physical health outcomes—much of this work conducted in the area of adults with type 1 and type 2 diabetes. Second, there has been no randomized clinical trial of a communal coping intervention, but there is related intervention research that has included shared appraisal as one component of a broader intervention and there has been intervention research that has focused exclusively on collaboration—all with promising results. Third, intervention research in the area of chronic illness has shown that interventions that target couples are superior to those that target the patient alone. Involving family members in interventions not only helps patients but also may relieve the distress and burden of the family. Our own work with adults with type 1 diabetes has shown that there is a desire for greater partner involvement. Fourth, one limitation of previous intervention research is the lack of theoretical grounding. In fact, many couple interventions are simply revised versions of patient-only interventions delivered to the couple. Here we address this deficit by developing an intervention based in communal coping theory.
In sum, this body of work suggests that an intervention focused on instilling a shared appraisal of diabetes and encouraging collaboration between patients and partners to manage the disease will benefit patients in terms of reduced diabetes distress and enhanced self-care.
Description of Project
Type 1 diabetes is a lifelong chronic disease associated with an intensive daily management regimen. Because this self-care regimen is demanding, adherence is low. The majority of research in the area of type 1 diabetes has focused on children, but these children grow up to become adults. In addition, one-third of people are diagnosed with type 1 diabetes in adulthood. Thus, the present research focuses on helping adults with type 1 diabetes manage their disease and improve their psychological well-being. It is important to recognize that managing diabetes takes place in an interpersonal context—meaning that diabetes affects family members and family members affect diabetes. A key person in the social context of adults with type 1 diabetes is the spouse or romantic partner. The present application harnesses this resource by developing an intervention that targets both the person with type 1 diabetes and their romantic partner. The intervention is based on theoretical and empirical work on the concept of “communal coping.” Communal coping is the idea of appraising a stressor as shared and collaborating with a partner to manage the stressor. A great deal of research has shown that communal coping in couples with diabetes is related to more satisfying relationships, better psychological well-being, and better disease management. Here we conduct an experimental test of this work by developing a communal coping intervention. First, we will obtain feedback from 12 couples, half of whom participated in an earlier version of the intervention, through qualitative interviews. These results will be used to refine the intervention. Next, we will randomly assign 66 couples in which one person has type 1 diabetes to either the intervention or usual care (control group). We will invite couples into the laboratory to complete a set of baseline questionnaires that assess relationship quality, psychological well-being, and diabetes management and download CGM data. Next, we will videotape a discussion of couples discussing the difficulties of managing diabetes. If randomly assigned to the intervention, this initial in-person session will conclude with the communal coping intervention. The intervention consists of recalling ways in which couples managed problems together in the past, education on the concept of communal coping, communication of needs, strategies to think about diabetes as shared, and strategies to collaborate on diabetes management. After the initial session, all couples will complete a brief survey at the end of the day for 14 consecutive days. Couples in the intervention group will receive 7 days of text messages to remind them of the collaborative plans that they developed during the in-person session. Finally, four weeks later, all couples will return to the lab for reassessment: questionnaire completion, videotaped discussion, CGM download. We will obtain data on the feasibility and acceptability of the intervention. We hypothesize that patients randomly assigned to the intervention will have reduced diabetes distress and better self-management 2 weeks and 6 weeks post-intervention compared to those assigned to the control ([standard of care]) group. We also predict that those in the intervention group will have better relationship functioning, psychological well-being, and greater time in range than controls. We will examine whether benefits of the intervention can be explained by increased couple communication, greater perceived responsiveness to needs, enhanced social support, and greater feelings of self-efficacy. This will be the first test of a communal coping intervention that is grounded in theory and extensive prior research. If successful, it will be cost-effective and easily portable to the community. Because health care resources are limited, it is important that clinicians take advantage of existing social resources, such as the family—in this case, the romantic partner.
Anticipated Outcome
1. We hypothesize that couples randomly assigned to the intervention will have reduced diabetes distress and better disease management compared to couples randomly assigned to the control group (usual care).
2. We hypothesize that couples randomly assigned to the intervention will have higher relationship quality, better psychological well-being, and greater time in range (from CGM) compared to couples randomly assigned to the control group (usual care).
3. We hypothesize that couples randomly assigned to the intervention will have increased couple communication, will feel that partners are more responsive to their needs, will have greater support from partners, and will feel a greater sense of self-efficacy compared to couples randomly assigned to the control group (usual care).
4. We hypothesize that the benefits of the intervention as stated in #1 and #2 above will be explained by the increases in communication, partner responsiveness to needs, support, and self-efficacy. In other words, these are the explanations for the benefits of the intervention.
Relevance to T1D
The project centers around the development and test of a communal coping intervention which is aimed at reducing psychological distress and promoting good self-management. Diabetes distress is pervasive. It is not only an important problem in its own right but has been shown to have adverse effects on physical health. Type 1 diabetes is a difficult disease to manage and a burden to manage well. However, self-management is critical to the prevention of diabetes complications. Thus, an intervention that can improve self-management and reduce the burden associated with self-management is extremely important in the context of Type 1 diabetes.