RELATIONSHIP-BASED RESEARCH, OUTREACH, AND EDUCATION IN COUPLES WITH CHRONIC ILLNESSES

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: ACTIVE
• Funding Source: HATCH
• Reporting Frequency: Annual
• Accession No.: 1023159
• Project Start Date: May 22, 2020
• Project End Date: May 17, 2025
• Program Code: [(N/A)]- (N/A)

Recipient Organization
AUBURN UNIVERSITY
108 M. WHITE SMITH HALL
AUBURN,AL 36849

Performing Department
Human Development and Family Studies

Non Technical Summary
Among all aims in this proposed Hatch Project, it seeks to (1) identify and address relational dynamics between individuals with a chronic illness and their partners, (2), improve the health literacy and health behaviors of both partners, and (3) better inform the healthcare practices, interventions, and policies of key stakeholders. This project will both collect longitudinal bio-, psycho-, physio-, and sociological data of multiple family members in both real world and intervention conditions and distribute resources and education to families with chronic illnesses and professionals who have a vested interest. Taken together, this project aims to decrease healthcare utilization for families (because intervention will target multiple family members at the same time) which will ultimately reduce taxpayer burden so that resources can be saved, pooled, or better appropriated.

Animal Health Component

50%

Research Effort Categories

Basic

50%

Applied

50%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
802	6099	3070	100%

Knowledge Area
802 - Human Development and Family Well-Being;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3070 - Psychology;

Keywords

chronic illness management

relationships

physical health

social determinants

intervention

translational science

couples

families

diabetes

Goals / Objectives
The work of this Hatch project has two primary goals: Goal 1 will produce basic research on couple dynamics in those with chronic illnesses. Aim 1a seeks understand health congruence and health behavior concordance between partners in order to identify similarities, differences, and reciprocal influences so that the timing and approach of couple-focused intervention efforts can be improved. Aim 1b seeks to Identify key individual, relational, and contextual factors that moderate the nature of partner involvement in the physical and psychological adjustment of the patient with a chronic illness. This aim will help illuminate important ecological considerations that can improve the tailoring of intervention strategies. Aim 1c seeks to examine the non-ill partner's risk of disease and illness in order to focus so that programs can target outcomes for both partners and identify where resources can be saved, pooled, or better appropriated to interventions that target multiple family members at the same time. Goal 2 will produce translational and applied research in couples with chronic illnesses. Aim 2a seeks to establish an online library of couples with chronic illness literature and scholarly work (from already published and emerging research) in collaboration with librarians, information technology (IT) specialists, and software engineers so that families, researchers, and the general public can access the latest information on how couples experience, cope with, and manage illness. Finally, Aim 2b seeks to test the impact of relationship-focused prevention and intervention programs such as relationship education programs and health-behavior specific programs (nutrition, sleep, and exercise) on physical, emotional, and relational health to improve the lives of couples with chronic illnesses. This aim seeks to provide systemic education and intervention to couples regardless of physical location (e.g., rurality) in order to improve the physical health and relationship functioning of both partners.

Project Methods
Aims 1a-1c MethodsParticipants will be actively recruited from churches, community centers, hospitals, and agencies around the 5-county spread through social media, posted fliers, and word-of-mouth. Recruitment will occur in two waves, first with participants coming to the Kinesiology building on Auburn University's campus. The Kinesiology building (BUA approved) is outfitted with all necessary equipment for laboratory data collection (anthropometric, biological, physiological and psychophysiological data) and internet-based assessments (see below). Second, depending on the number of participants recruited from the first wave, we will then switch strategies and collect data in collaboration with Auburn University Inter-Professional (nursing, nutrition, social work, and pharmacy) Clinics located at senior centers, low income housing communities, and food banks in Lee and surrounding counties (bringing data collection instruments with). This strategy will help to include more rural couples who may not be able to travel to campus. The Relationships and Health Lab (Novak) coordinator (MS student) will handle contact, scheduling, and communication with participants.Laboratory Assessments. Anthropometric and physiological measurement, biological data via finger); psychophysiological data (Heart Rate variability) will be collectedInternet-based Assessments. Internet-based assessments will be collected via Qualtrics (Qualtrics, Provo, UT) surveys on iPads, including participant demographic information as well as individual (psychological, emotional, and physical health), relational (relationship quality, communication, conflict and coping), and contextual variables (healthcare utilization, rural status, economic pressure, and proximity to healthcare access).Health behavior data collection. Data will be collected on physical activity and sleep assessment via wrist actigraphy for 7 days prior to each visit for both partners, dietary and nutrient intake assessment by collecting two-24 hour dietary recalls prior to each visit for each partner. Finally, the Frugé lab will also oversee the distribution of stool collection kits to each partner at initial visit (to be brought back and collected at second visit) and transportation of frozen samples (BUA approved).Aim 2a MethodsCrucial to this aim is securing funding to help enlist web developers, content creators, and IT experts. The Relationships and Health Lab team has already begun collecting a vast number of peer-reviewed papers (over 500) on chronic illness management in couples within specific illnesses (e.g., type 2 diabetes, cardiovascular disease, cancer). We will create a digital library that has the following functional capabilities:1. Information categorized for easy navigation, including by specific illness (cancer, diabetes, cardiovascular disease, chronic pain, etc.), by relationship dynamic/process (sex, communication, coping, adjustment, conflict, etc.), and by health behavior (diet, sleep, physical activity, medication management, and stress regulation).2. An educational section on how to have difficult discussions around various topics that couples can do together as well as how to make health behavior change efforts as a team.3. Creating both easily digestible graphical representations (pictures and videos) of peer-reviewed research as well as links to open access publications.4. Utilization of search engine optimization (SEO), so that those seeking information on the related topics will readily appear in search results.5. Optimization for multiple viewing formats (computer and phone)Quality assurance, academic rigor, and translation. Each peer-reviewed source will be evaluated against the concepts outlined by Mårtensson and colleagues (2016, 2019), which include four categories of research quality: credible, contributory, communicative, and conforming. Both graduate and undergraduate students will be trained in the framework and evaluate the sources based on the four categories and assign a score between 0 and 10 (scores of 0-3 are poor, 3-5 are satisfactory, 5-7 are credible, 7-10 are excellent). A summary and evaluation of those research articles will be created with links to the original article. These will be reviewed by senior lab members and ultimately the principal investigator.To grow the user base and promote widespread use of its capabilities, it will be shared with several organizations, including through the Alabama Cooperative Extension System (ACES), the Alabama Rural Health Association (ARHA), Chronic Disease Self-Management (CDSM) and Diabetes Self-Management (DSM) program coordinators, and other health and relationship providers throughout the state (mental health providers, therapists, family practitioners, etc.). In addition, it will be promoted online through social media platforms (such as Instagram, Facebook, Twitter, and Reddit) to create awareness of the resources and repository capabilities.Aim 2b MethodsThe Healthy We, Healthy Us: Becoming Partners in Health curricula is currently being developed and includes six modules that target relationship dynamics, individual and couple well-being, joint knowledge and engagement in health behaviors (nutrition, sleep, exercise, and stress management), and utilizing resources (physical, social, community, healthcare).The participant population will be adult couples who volunteer to attend the Healthy We, Healthy Us: Becoming Partners in Health. They will be couples in which either one or both partners have a chronic illness, broadly defined (self-identified), together for a minimum of three years and living together. The minimum age is 19 and there is no maximum age for adult participants.Recruitment. Flyers and advertisements will be placed at various places in the community, including local hospitals and health clinics. After receiving information, the participants will contact the program personnel by phone or email to register for the class. At that time they will each be sent a link for informed consent and the baseline survey. They will also be provided with details for first class (i.e., time/date reminder and location).Procedures. Data collection through online surveys given at three time points: before the first class session, at the third class session (third month), and at the sixth class session (sixth month). The survey will take approximately 15-25 minutes to complete and will include information about their health, their partner's health, communication and relationship functioning. The same process will be conducted for the follow-up data collection after the third and sixth class periods.Measures. For the purposes of this project, we will first collect background information on the participant regarding type of health problem and which is most problematic, their healthcare utilization (3 questions), if they have health insurance, and their satisfaction with their physical health. Following this in the survey will be the International Physical Activity Questionnaire (IPAQ; Craig et al., 2003) and the Pittsburgh Sleep Quality Index Scale (PSQI; Buysse et al., 1989). Social support for diet and exercise will be assessed through 10 diet and 12 exercise questions (Sallis, Grossman, Pinski, Patterson, & Nader, 1987). Depression and anxiety will be measured via the four-item Patient Health Questionnaire (PHQ-4; Kroenke et al., 2009), Stress will be measured via the 10-item Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, 1983). Health support and control will be measured using the 8-item health and support scale (Franks et al., 2006). In addition, anthropometric and physiological measurement will assess height, weight, body composition, waist and hip circumference, and blood pressure (both brachial and ankle BP), and biological data via finger prick will determine lipid, cholesterol, glucose (fasting), and glycemic control (measured via Hemoglobin A1C).

Progress 10/01/20 to 09/30/21

Outputs
Target Audience:The target audience reached during this reporting period included the readership of academic journals, including Annals of Behavioral Medicine and several other outlets (with manuscripts under review). Changes/Problems:The COVID-19 pandemic has continued to interfere with research activities, however, switching strategies to online data collection has been fruitful. What opportunities for training and professional development has the project provided?The above goals and aims have brought together professionals, faculty, and students from several disciplines and programs across the university (including a new working relationship with professionals in pharmacy (aim 2a)). Additionally, this Hatch project has spurred participation in the Telehealth Network(state-level, collaborative group consisting of faculty and scholars from UAB, Auburn, UA, and ACES) and within that network, the Diabetes and Obesity subgroup. These networks and groups have focused on building relationships, and sharing resources (grant opportunities, etc.).? How have the results been disseminated to communities of interest?Results from the project have been disseminated to several national conferences, including Gerontological Society for America, National Council for Family Relations. There were also several regional presentations Novak, J.R., Ermer, A., & Wilson, S. J. A Dyadic Latent Profile Analysis of Older Couples' Psychological, Relational, and Physical Health. Where you go, I go: Relationship Dynamics and Dyadic Links to Health and Well-being. Symposium Abstract for the Gerontological Society of America (GSA) National Conference. November, 2021. Phoenix, AZ. Novak, J.R., Wei, M., & Seaton, K. Associations between Health Support and Control and Exercising Together on Exercise Self-Efficacy in Heterosexual Married Couples. Poster Abstract for the National Council on Family Relationships. National Conference. November, 2021. Baltimore, MD. Wei, M., Novak, J.R., Miyairi-Steel, M., Peak, T., & Gast, J. Health Support, Health Control, and Intuitive Eating in Gay Married Men. Poster presented at the National Conference for Family Relations. November, 2020. St. Louis, MO. Novak, J. R. Helping, Hurting, or Both?: Exploring Typologies of Type 2 Diabetes Family Members' Distress and Involvement. Poster presented at the 13th Annual Boshell Research Day. Boshell Diabetes Group. September, 2021. Auburn, Alabama. Wood, M., Bostany, E. , & Novak, J. R. Covid-19 Pandemic and Family Systems. Poster presented at the Auburn Research Student Symposium. March, 2021. Seaton, K. M., & Novak, J. R. Parenting Behaviors, Child Physical Activity, and Screen-Time Among Families with ADHD. Poster presented at the Auburn Research Student Symposium. March, 2021. Ryan, K., Thomas, A., Ellis, F., & Novak, J. R. By Chance, with Confidence, or Both?: Testing Important Moderators Between Partner Diet Undermining and Poor Diet in Heterosexual Couples. Poster presented at the Auburn Research Student Symposium. March, 2021. Novak, J. R., Robinson, L., Burke, L., Wei, M., & Adler-Baeder, F. Results from a Pilot Program for Couples with Chronic Illnesses during the COVID-19 Pandemic. Poster presented at the 2021 Faculty Research Symposium at Auburn University, Auburn, Alabama. January, 2021. What do you plan to do during the next reporting period to accomplish the goals?Aim 1a-1c: Finish Data collection and begin analyses Aim2a: Finish manuscripts and begin new manuscripts Aim2b: Pursue Internal and external funding opportunities

Impacts
What was accomplished under these goals? Goal 1 was both accomplished and is still ongoing. Several publications have been accepted, submitted, or in development. Goal 2 was not accomplished, but several related grants were pursued (but not funded).

Publications

• Type: Journal Articles Status: Accepted Year Published: 2021 Citation: Wilson, S. J., & Novak, J. R. (2021). The Implications of Being in it Together: Relationship Satisfaction and Joint Health Behaviors Predict Better Health and Stronger Concordance between Partners. Annals of Behavioral Medicine (40% contribution; ISI impact factor = 4.908; 2020). http://dx.doi.org/10.1093/abm/kaab099
• Type: Journal Articles Status: Under Review Year Published: 2021 Citation: Novak, J. R., Wilson, S. J., Ermer, A. E., & Harper, J. M. Aging Together: Dyadic Profiles of Older Couples Marital Quality, Psychological Well-being, and Physical Health. The Journals of Gerontology: Psychological Sciences
• Type: Journal Articles Status: Under Review Year Published: 2021 Citation: Novak, J. R., Pratt, K., Hernandez, D. C., & Berge, J. M. Family Systems and Obesity: A review of key concepts and influences within and between family subsystems and a Call for Family-Informed Interventions.
• Type: Journal Articles Status: Under Review Year Published: 2021 Citation: August, K., Novak, J. R., Peak, T, Gast, J., & Miyairi, M. Examining Foodwork and Eating Behaviors Between and Among Heterosexual and Gay Couples
• Type: Journal Articles Status: Under Review Year Published: 2021 Citation: Novak, J. R., August, K., Whitely, H., Kavookjian, J., & Burnett, D. O. Exploring Typologies of Type 2 Family Members Illness Appraisals, Involvement, and Psychological Distress. Health Psychology

Progress 05/22/20 to 09/30/20

Outputs
Target Audience:The target audience reached during this reporting period included 3 couples (so far) with type 2 diabetes in the surrounding counties for face-to-face lab visits on campus(aim 1). We have received a planning grant to begin work on aim 2a, by launching a survey for the needs of family members of those with type 2 diabetes. Additionally, we developed and piloted a six-week relationship education programand had 12 coupleswith a chronic illness attend (aim 2b). This program was delivered via Zoom due to the COVID-19 pandemic but also helped those that were economically disadvantaged or physically susceptible to in-class attendance to be able to attend. Finally, we distributed these findings to administrators of the Alabama Healthy Marriage and Relationship Education Initiative as well as the community funding agency (Women's Philanthropy Board). Changes/Problems:Unsurprisingly, the efforts from all aims of this Hatch project have been affected by the COVID-19 pandemic, especially since the data collection is with vulnerable populations who are at more risk for complications from the virus. Although some research activities have pivoted to allow for data collection of psychosocial self-report data online, the objective biophysiological and anthropometric data collection has hadto remain on-site(aims 1a-1c). The PI will coordinate with the funders to request an extension of the research activities if needed. Aim 2a has not been affected by the COVID-19 pandemic, but has further demonstrated theincreased need for online and self-guided programs which will be developed as a result of the research activities. Aim 2b had to pivot and offer theHealthy We, Healthy Uspilot program virtually instead of face-to-face as initially planned. This undoubtedly could have affected participation as well as engagement, but further testing of the program is needed, especially in a face-to-face format. What opportunities for training and professional development has the project provided?Training activities:The above goals and aims have brought together professionals, faculty, and students from several disciplines and programs across the university (including a new working relationship with professionals in pharmacy (aim 2a). Additionally, this Hatch project has spurred participation in the Telehealth Network(state-level, collaborative group consisting of faculty and scholars from UAB, Auburn, UA, and ACES) and within that network, the Diabetes and Obesity subgroup. These networks and groups have focused on building relationships, and sharing of resources (grant opportunities, etc.). Professional Development:The PI was invited for a presentation entitled "Family and Food" for the regional dietetic association (fall 2020) and will also be a panel member in the state-wide Alabama Rare Conference (Virtual)this spring. How have the results been disseminated to communities of interest?Only the pilot results from aim 2b (Healthy We, Healthy Us: Becoming Partners in Health) program have been distributed to community members via the Women's Philanthropy Board (WPB; funding agency) as well as the Alabama Healthy Marriage and Relationship Education Initiative (AHMREI) administrators and staff, which reports to the Administration for Children and Families in the state of Alabama. Other aims (1a-1c and 2a are still under development and initial data collection). Additionally, the pilot results will be presented at the 2020-2021 Faculty Research Symposium at Auburn University. What do you plan to do during the next reporting period to accomplish the goals?Aim 1a-1c: Data collection will continue the calendar year of 2021. Although we anticipate that the COVID-19 pandemic will settle, wemay need to switch/improve our recruitment strategy for couples with type 2 diabetes by building relationships with community partners through churches, agencies, and healthcare clinics in the surrounding counties as well as utilize targeted digital ads and social media. Aim 2a: Data collection will continue until thetarget sample of family members is reached. The data will be analyzed for publication and the findings will be distributed within the community and several organizations through brief reports and presentations at conferences. Following, work on the development of an online program for family members will be developed. 2b:In order to further test and refine the program, the program will be further tweaked and tested, but is first in need of funding. The PI will prepare a grant submission through several foundations.

Impacts
What was accomplished under these goals? Project Impact:Among all aims in thisHatch Project, it seeks to (1) identify and address relational dynamics between individuals with a chronic illness and their partners, (2), improve the health literacy and health behaviors of both partners, and (3) better inform the healthcare practices, interventions, and policies of key stakeholders. This project iscollecting longitudinal bio-, psycho-, physio-, and sociological data of multiple family members in both real world and intervention conditions and distributing resources and education to families with chronic illnesses and professionals who have a vested interest. Taken together, this project aims to decrease healthcare utilization for families (because intervention will target multiple family members at the same time) which will ultimately reduce taxpayer burden so that resources can be saved, pooled, or better appropriated. Goal 1 (Aim1a-1c): Data collection has begun with couples with type 2 diabetes in surrounding counties. We have begun collecting data both online (psychosocial and self-reported health behaviors) and face-to-face in the lab (psychophysiological and anthropometric). Thismulti-wave data collection projectwill help to understand the relationship dynamics around the management of type 2 diabetes, including the ways in which the partner without diabetes contributes (for good or ill) or is impacted by the person with diabetes. The data collected will also help identify factors that are accessed and utilized within their community, such as healthcare, health stores, gyms, etc. Although not enough data has yet been collected to report initial statistics and findings, we anticipate this will occur over the next cycle. Finally, we have also realized that this project is occurring during the COVID-19 pandemic, and as such will help to illuminate factors, barriers, and real-world implications for couples during the global pandemic. Goal 2 (Aim 2a): A planning grant was received for assessing the needs of family members with type 2 diabetes and a survey was launched.The survey includes assessing5 domains related to their experience, including, (1) how family members find information and resources related to diabetes, such as dietary restrictions and knowing what foods to limit and the expected course of diabetes and how to manage it long-term; (2) how family members dealwith the emotions and behaviors of the care recipient, such as the individual with diabetes' own depressive symptoms, anger, frustration, guilt, uncertainty etc., (3) how they provide physical care, including assisting with checking blood glucose levels, (4) how family membersproviding instrumental care, such as identifying public health nurses, transportation issues, financial concerns, and respite care; and (5) how family members dealwith one's own personal responses to caregiving, such as dealing with their own emotional well-being--anxiety, stress, depressive symptoms, and loss of a social life from being involved with diabetes management. This needs assessment survey will lay the groundwork for the development of an intervention and education program. Goal 2 (Aim 2b): TheHealthy We, Healthy Us: Becoming Partners in Healthprogram waspiloted and tested with 12 couples in an online format.A six week curricula was developed, including a participant workbook, a facilitators handbook, and instructional activities. This included work from 5 undergraduate students and 3 graduate students across several different disciplines (nutrition/dietetics, human development and family science, psychology). The program was piloted over 12 weeks(1 session every other week) to 12 couples and collected pre, post, and 4 weeks post. Quantitative Results can be seen in the table below: Increased/Improved Decreased Health satisfaction? Doctor Visits* Relationship Satisfaction? Hospital visits? Provision of one's own health support ? Depression ? Perceived partner health support from partner? Anxiety* Nutrition/Diet-related support? Provision of Health control*** Exercise Support ? Perceived Health control? Exercise Encouragement* Diet Quality? Physical Activity* Sleep Quality? ? = mean scores trending in expected direction,*P = ~ .1, ** p <.10, *** p <.05 Related to the qualitative and lived experiences, participants reported that attending virtual was helpful, that their relationship to their chronic illness and their partner improved, that they had incorporated mindfulness activities into their daily lives, and their nutrition, sleep, and physical activity had improved. This can be summed up by one participant who stated, "The balance between body health, mental health, spirituality, community and social relations with family and friends are the key to a good relationship in a couple. There are lots of resources that we can use to help us with chronic diseases and for a good relationship. Mindfulness is a wonderful technique that can help us to manage stress, especially when chronic diseases are present and could affect the relationship between couples. Learning how to include this technique as part of our life is a key to succeed."

Publications