THE HEART LAB
HEalth & Adaptation in Relationships Team
Research in the HEART Lab focuses on close relationships. We seek to understand:
- How couples adapt to stressors within & outside their relationship
- How couple adaptation can be improved
- How efficacious interventions are implemented in real-world community and healthcare settings
- How close relationships can facilitate engagement & outcomes in real-world interventions
Most couples face a number of chronic and acute stressors over the course of their relationships. Our work is rooted in the idea that the way a given couple adapts to the stressors that arise is influenced by the nature of the stressor (e.g., chronic, acute), vulnerability factors that partners bring to the relationship (e.g., personality characteristics or family history), and the overall quality of their relationship (Karney & Bradbury, 1995). Over time, their relationship quality will also be affected by how they adapt. Thus, distressed couples (i.e., those with clinically low levels of relationship quality) are less likely to adapt effectively to challenges and, thus, are more likely to experience additional stress; likewise, couples who do not effectively adapt to challenges are more likely to experience additional stressors and to have low levels of relationship quality.
Poor physical health of one or both partners functions as a stressor for many couples and is linked to worse relationship quality through a series of interrelated biopsychosocial processes (Robles et al., 2014). If one partner has (or is at risk for) a chronic disease, there are several lifestyle factors that, if changed, may improve the long-term outcomes for the individual. Yet, individual partners’ adaptation occurs in the context of their relationship – one partner making changes to their physical activity or eating habits is likely to influence the other partner and vice versa. Due at least in part to this mutual influence, partners tend to be similar in a wide range of aspects of health, including lifestyle factors and risk for chronic disease. Although there are many couple- and family-based psychosocial interventions for adults who have developed chronic diseases (Martire & Helgeson, 2017), few programs that aim to prevent chronic diseases systematically include close others.
Much of our current work focuses on primary prevention of type 2 diabetes in a relationship context. An intensive lifestyle intervention was found to be efficacious in preventing or delaying type 2 diabetes in a large randomized controlled trial (The Diabetes Prevention Program Research Group, 2002). However, the CDC’s translation of the lifestyle intervention into real-world community and healthcare settings demonstrates room for significant improvement in participant engagement (i.e., enrollment, attendance, retention), higher levels of which were related to greater lifestyle change (i.e., weight loss, physical activity increase, nutrition improvements) (Ely et al., 2017). In particular, the CDC program did not effectively engage men and participants of color. While our team expected that close relationships could be leveraged to improve engagement in the CDC’s National Diabetes Prevention Program (NDPP), there were no data published on this topic. Together with collaborators, we examined engagement and outcomes among individuals who signed up for the NDPP together with another household member. We found those who signed up for the program together with another household member were more likely to enroll and complete the program, and stayed in the program longer, relative to those who signed up for the program individually (Ritchie, Baucom, & Sauder, 2020). Further, men who signed up with another household member, compared with men who signed up individually, were more likely to meet the CDC goal of at least 5% body weight loss (Ritchie, Baucom, & Sauder, 2020). Although this was not a randomized controlled trial, these results provided preliminary support for the hypothesis that including close others may increase engagement -- and possibly even outcomes -- of primary prevention programs. Of note, relatively more men (versus women) and Hispanic/Latinx participants (versus non-Hispanic participants) signed up for the NDPP together with another household member, suggesting this approach may be particularly relevant for some of the groups that organizations have failed to effectively engage in the NDPP thus far.
In partnership with Dr. Anu Asnaani and her Treatment Mechanisms, Community Empowerment, & Technology Innovations Lab, as well as several colleagues from other institutions (Cassidy Gutner, PhD; Natalie Ritchie, PhD; Megha Shah, MD, MSc), we are in the process of collecting data on current implementation of the NDPP, with a particular focus on delivery to Hispanic/Latinx participants. We recruited 305 Lifestyle Coaches who had delivered the NDPP through CDC-recognized organizations across the country. They each completed a survey on their background, as well as their experiences and perspectives on the NDPP, in May/June 2021. We are in the process of analyzing these data and submitting presentations/papers to disseminate our findings. As a next step, in September 2021 we began recruitment of a subsample of 30 Lifestyle Coaches who work with Hispanic/Latinx participants for a mixed-methods study. Guided by implementation science frameworks, our aim is to better understand delivery to this particular group, including multi-level factors that affect implementation (using Consolidate Framework for Implementation Research; Damschroder et al., 2009) as well as modifications/adaptations made to increase engagement. Our hope is this work will inform strategies to increase access to the NDPP and/or other diabetes prevention packages, thereby reducing health disparities experienced by this particular group.
Finally, with funding from the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK), we are in the process of adapting the NDPP for delivery to couples who want to go through the program together. This adaptation is guided by (1) qualitative data collected from previous NDPP participants to describe partner influences on lifestyle change, (2) feedback from a Community Advisory Board (including 12 members with personal and/or professional experience related to type 2 diabetes prevention across a range of communities) that met from January 2019-December 2020 to ensure the couple-based adaptation of the DPP will be broadly applicable to couples across racial, ethnic, and cultural groups, and (3) mixed-methods data collected from Lifestyle Coaches on the benefits and challenges they have experienced delivering the NDPP to dyads (i.e., friends and/or family members who want to go through the program together). Although currently delayed due to the COVID-19 pandemic, our next step will be to carry out a small pilot trial of the couple-based adaptation (Prevent T2 Together) compared with the CDC’s individual NDPP curriculum (Prevent T2).