Dyadic collaboration in shared health behavior change: The effects of a randomized trial to test a lifestyle intervention for high-risk Latinas.

Abstract

Objective: This study sought to evaluate the feasibility of a pilot, dyad-based lifestyle intervention, the Unidas por la Vida program, for improving weight loss and dietary intake among high-risk Mexican American mothers who have Type 2 diabetes and their overweight/obese adult daughters. Method: Mother-daughter dyads (N ϭ 89) were recruited from two federally qualified health centers and randomly assigned to either the Unidas intervention or to the control condition. The 16-week Unidas intervention consisted of the following: (a) four group meetings, (b) eight home visits, and (c) booster telephone calls by a lifestyle community coach. The control condition consisted of educational materials mailed to participants' homes. Participants completed surveys at T1 (baseline) and T2 (16 weeks) that assessed various demographic, social network involvement, and dietary variables. Results: Unidas participants lost significantly more weight at T2 (p Ͻ .003) compared with the control participants. Furthermore, intervention participants also were more likely to be eating foods with lower glycemic load (p Ͻ .001) and less saturated fat (p ϭ .004) at T2. Unidas participants also reported a significant increase in health-related social support and social control (persuasion control only) and a decrease in undermining. Conclusions: The Unidas program promoted weight loss and improved dietary intake, as well as changes in diet-related involvement of participants' social networks. The results from this study demonstrate that interventions that draw upon multiple people who share a health-risk have the potential to foster significant changes in lifestyle behaviors and in social network members' health-related involvement. Future research that builds on these findings is needed to elucidate the specific dyadic and social network processes that may drive health behavior change.

Facilitating Partner Support for Lifestyle Change Among Adults with Serious Mental Illness: A Feasibility Pilot Study

“…Behavioral techniques, including modeling, behavioral rehearsal, positive reinforcement, and home assignments were used to teach the participant-partner pair more effective ways to express positive feelings (e.g., recognizing success, expressing gratitude), make requests (e.g., going to the gym together, help with transportation), and express negative feelings (e.g., feeling disappointed) as they related to health behavior changes. Partner communication about health behavior changes such as smoking cessation and weight loss has been the focus of prior studies in general population samples (Rohrbaugh et al 2012;Romo and Dailey 2014), and recent intervention studies have attempted to teach partners more effective ways to talk with participants about negative and positive health behaviors (Patten et al 2011;Sorkin et al 2014;McDonnell et al 2015). Equipping support partners and participants with effective communication skills for giving and receiving support for health behavior change may be a key mechanism of successful partner-support lifestyle interventions for obese individuals with SMI.…”

“…Several prior studies targeting partner support for weight loss in general population samples have required that support partners be classified as overweight (BMI ≥ 25) and/or be interested in losing weight (Wing and Jeffery 1999;Gorin et al 2013;Sorkin et al 2014). However, given the high rates of obesity and comorbid medical conditions among individuals with SMI, we hypothesized that many participants would have close friends or family members who would be willing and interested to support the participant's health goals without necessarily having a self-interest in losing weight.…”

“…Persuasive social support (often referred to as positive social support) is a form of health related social control that involves efforts to prompt or persuade another person to improve his or her health behaviors as opposed to using pressure, such as criticizing or expressing doubts about the person's health behavior Sorkin et al 2014). The Fit Together intervention incorporated communication skills training based on principles and techniques of social skills training with families and couples coping with mental illness (Mueser et al 1994;Mueser and Glynn 1999).…”

“…Two types of health-related social control were assessed with a measure used in prior studies of partner support for lifestyle change Sorkin et al 2014). Persuasive social support strategies involving efforts to prompt or persuade another person to improve his or her health behaviors have been found to elicit positive health behavior change (Stephens et al 2009), whereas control strategies that involve the use of pressure, such as criticizing or expressing doubts about the person's health behavior, have been found to undermine behavior change (Martire et al 2013).…”

“…Randomized controlled trials have shown that enrolling family and friends in weight loss programs leads to greater weight loss for participants, with the added benefit of weight loss among partners (Wing and Jeffery 1999;Gorin et al 2014). Support partners have been successfully trained to increase positive forms of social support (e.g., persuasion) while decreasing negative social support (i.e., criticism) toward participants enrolled in a lifestyle intervention (Sorkin et al 2014). However, lifestyle interventions for overweight and obese individuals with SMI have yet to systematically leverage close relationships, such as family members, friends, and significant others, to support healthy eating and exercise behaviors in daily life where these behaviors take place.…”