Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works Loma Linda University Electronic Theses, Dissertations & Projects 8-1-2012 Couple's Relationship with Diabetes: Transformation, Partnership, and Management Ruth Houston Barrett Loma Linda University Follow this and additional works at: http://scholarsrepository.llu.edu/etd Part of the Marriage and Family Therapy and Counseling Commons Recommended Citation Barrett, Ruth Houston, "Couple's Relationship with Diabetes: Transformation, Partnership, and Management" (2012). Loma Linda University Electronic Theses, Dissertations & Projects. 73. http://scholarsrepository.llu.edu/etd/73 This Dissertation is brought to you for free and open access by TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. 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LOMA LINDA UNIVERSITY School of Behavioral Health in conjunction with the Faculty of Graduate Studies ____________________ The Couple’s Relationship with Diabetes: Transformation, Partnership, and Management by Ruth Houston Barrett ____________________ A Dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Marital & Family Therapy ____________________ August 2012 © 2012 Ruth Houston Barrett All Rights Reserved Each person whose signature appears below certifies that this dissertation in his/her opinion is adequate, in scope and quality, as a dissertation for the degree Doctor of Philosophy. , Chairperson Colwick Wilson, Professor of Marriage and Family Therapy Curtis A Fox, Professor of Counseling and Family Sciences Carmen Knudson-Martin, Professor of Marriage and Family Therapy Zephon Lister, Assistant Clinical Professor, University of California, San Diego Matt Riggs, Professor of Psychology, California State University, San Bernardino iii ACKNOWLEDGEMENTS I would like to thank my chair, mentor, and guiding light, Dr. Colwick Wilson, for making the journey enlightening, exciting, fun, and worthwhile always, helping me to cross the bridge from being one kind of scientist to another, calling upon me to find my own voice as a researcher and author, and being in all ways an exceptional role model. I also thank my committee members. Dr. Carmen Knudson-Martin provided invaluable care and valuable insights, challenging me to think differently and seek something always a little bit better, deeper, richer, and broader. My thanks go to Dr. Curtis Fox for the engrossing conversations that have energized and inspired and to Dr. Matt Riggs for helping me grasp advanced statistical techniques. I also thank Dr. Zephon Lister for allowing me to collaborate on this ongoing diabetes research project, and I thank both him and Dr. Lucretia Smith for sharing the tremendous job of data collection. To my friends and family, your love and support have meant the world to me. My mother was with me every step of the way, my number one cheerleader, and the person who most believes not only in my dreams, but in the value of pursuing dreams. Both of my parents provided profound instrumental support for which I am deeply and forever grateful. I thank my sister for her many hours spent helping me through one crisis and another, and for always being in my court. My daughters, the brightest and best parts of my life, gave their love, support, encouragement, and amazing maturity when needed, stepping up at those critical moments, reminding me how wonderful they are, and filling my heart with joy always. And simply, I thank my husband from the bottom of my heart for everything he does. iv CONTENT Approval Page .................................................................................................................... iii Acknowledgements ............................................................................................................ iv List of Figures .................................................................................................................... ix List of Tables .......................................................................................................................x Abstract .............................................................................................................................. xi Chapter 1. Introduction ............................................................................................................ 1 Purpose Statement ............................................................................................. 1 Background ....................................................................................................... 3 Diabetes ................................................................................................................ 3 Diabetes Regimen Management ..................................................................5 Rationale ........................................................................................................... 7 Objectives of this Study .................................................................................... 7 Hypotheses ........................................................................................................ 9 2. Theoretical Framework: A Meaning-Oriented, Biopsychosocial Approach ....... 10 The Biopsychosocial Model ........................................................................... 10 A Biopsychosocial Approach to Chronic Illness ............................................ 11 A Biopsychosocial Approach to Diabetes ...................................................... 12 A Meaning-Oriented Biopsychosocial Approach to Diabetes ........................ 14 Empirical Support for Meanings and Narratives about Chronic Illness ......... 15 Empirical Support for Meanings and Narratives about Diabetes ................... 16 Transformational Meanings in Illness Narratives ........................................... 20 The Current Study: Transformation, Partnership, and Management .............. 21 3. Literature Review ................................................................................................. 23 Social Support and Chronic Illness ................................................................. 23 Couples Relationships and Chronic Illness..................................................... 24 Couples Relationships and Diabetes Management ......................................... 27 Associated Psychosocial Problems of Diabetes .............................................. 30 Depression and Diabetes .................................................................................. 33 v Stress, Anxiety and Diabetes ........................................................................... 34 Demographic Factors and Diabetes Management .......................................... 36 Age and Duration of Diabetes ......................................................................... 37 Gender ................................................................................................................ 38 Race/ethnicity ............................................................................................40 SES .............................................................................................................41 Diabetes Psychosocial Instruments and Predictors ......................................... 41 Established Instruments for Diabetes Management and Related Psychosocial Factors ......................................................................................... 41 Predictors of Diabetes Success in Management, Adherence, and Control ................................................................................................................ 42 Established Diabetes Psychosocial Instruments Used in this Study ............... 42 Diabetes Care Profile ........................................................................................ 43 Appraisal of Diabetes Scale ............................................................................. 45 Summary ......................................................................................................... 46 4. Methods................................................................................................................ 48 Research Design .............................................................................................. 48 Sampling ......................................................................................................... 48 Generalizability of Results from Random vs. Convenience Samples ............................................................................................................... 50 Structured Samples of Convenience ............................................................... 53 Alpha Level, Power, Effect Size, Sample Size, and Normality of the Sample .......................................................................................................... 55 Participants ...................................................................................................... 56 Inclusion/Exclusion Criteria ............................................................................ 56 Diversity of Sample .........................................................................................