The process of dietary change for couples with a diabetic spouse: A family systems perspective.

摘要

Prescribed dietary regimens for type 2 diabetes management require extensive lifestyle changes, which are bound to effect and be influenced by the diabetic's immediate social environment. For those in marital relationships, non-diabetic spouses play an integral role in the diabetic's adjustment to the prescribed diets. The purpose of this study was to use concepts from family systems theory to explore the dynamic marital interactions that accompany adjustment to prescribed diets for type 2 diabetes and to determine whether these interactions (or non-actions) create environments that influence dietary change. Twenty newly diagnosed diabetics were recruited from one of four diabetes outpatient education programs in central PA. In-depth interviews with diabetic volunteers and their spouses were conducted at two time points, one year apart (T0 and T1). Interview T0 took place after the diabetic completed the dietary education portion of the outpatient diabetes class. Nineteen of the original twenty couples participated in interview T1. Analysis of the qualitative data revealed three distinct patterns of marital interaction around the dietary regimens: disengaged (diabetics were solely responsible for the dietary regimens and non-diabetics were either indifferent or sabotaging), enmeshed (non-diabetics assumed full responsibility for the dietary regimens and diabetics were dependent), and cohesive (spouses worked together to support dietary change). At T0, 8 couples were disengaged, 7 were enmeshed, and 4 were cohesive. At T1 we observed significant shifts: 14 couples were disengaged, 4 were enmeshed, and only 1 couple remained cohesive. By T1, diabetics in the disengaged category were unable to sustain dietary changes without spousal involvement or support. Diabetics in enmeshed couples demanded independence and non-diabetics relinquished their diligence in managing diabetic's diets. Accompanying these shifts was a sample-wide reversion to pre-diagnosis eating patterns. While cohesive couples at T0 exhibited the most success with the prescribed diets, more research with larger and diverse samples is needed to determine the longevity of a teamwork approach in diabetic dietary management. Using family systems theory to guide this study was a novel approach compared to patient-only perspectives taken in previous research. Our results provide insight into the dynamic marital patterns that accompany adjustment to and influence success with prescribed diets for diabetes.