Helping Couples Communicate Better: Does This Help Persons With Type 2 Diabetes Respond Better to a Step Count Prescription?

Difference between mean baseline (week 1) and final (week 24) steps/day; daily steps are automatically uploaded to a secure cloud-based server and pulled by our research team for weekly goals and outcome assessment. We require at least 4 days of measurement. If sufficient days are not captured in week 1, we may compute based on the earliest of weeks 2 through 4 that includes sufficient data. If sufficient days are not captured in week 24, we may compute based on the latest of weeks 20 through 24 that includes sufficient data.

We will assess the difference between hemoglobin A1C (measure of glycemic control) between baseline and final assessment.

We will assessed fasting insulin and fasting glucose levels at baseline and following the intervention. We will use these values to compute the Homeostatic Model Assessment-Insulin Resistance [HOMA-IR] measure.

We will evaluate the change in systolic blood pressure between baseline and final assessments. This will be based on the average of 5 sequential automated oscillometric blood pressure monitor-assessed values.

We will sum total steps over the study period.

We assess this through the common dyadic coping subscale (5 questions) of the Dyadic coping inventory (each question with 5 Likert scale options). We will look at the difference in total score between baseline and final assessments.

Reference: Bodenmann G, Arista LJ, Walsh KJ, et al. Dyadic Coping Inventory. In: Lebow J, Chambers A, Breunlin DC, editors. Encyclopedia of Couple and Family Therapy. Cham: Springer International Publishing; 2018. p. 1-5.

We will assess the difference in BMI between baseline and final assessments. We will use measured weight (digital scale) and height (stadiometer) values to compute BMI as weight in kilograms divided by height in meters squared.

In both index participants and their partners, we will assess the difference between questionnaire-assessed marital quality during the first week and the final week of the intervention. We will use the Couples Satisfaction Index (16 item version; score range 0 to 80).

Reference: Funk JL, Rogge RD. Testing the ruler with item response theory: increasing precision of measurement for relationship satisfaction with the Couples Satisfaction Index. J Fam Psychol. 2007;21(4):572-83.

We will evaluate the difference in HDL between baseline and final assessments.

We are using reactions to the following questions to assess physical activity-related self-efficacy (5-point Likert scale- strong disagree, disagree, neutral, agree, strongly agree): I possess the skills to do regular physical activity over the next 6 months if I wanted to. I have the ability to do regular physical activity over the next 6 months if I wanted to. I am confident that I am capable of engaging in regular physical activity if I had to.

We will use similar questions to assess perceptions of the partner's self-efficacy, substituting 'my partner' for 'I' in the above series of questions. Both the index participant and the partner participant will answer both series of questions.

Reference: Burrell AMG, Allan JL, Williams DM, et al. What do self-efficacy items measure? Examining the discriminant content validity of self-efficacy items. British journal of health psychology. 2018;23(3):597-611.

We will assess the difference between LDL values at baseline and final assessments. LDL is calculated from total cholesterol, HDL, and triglyceride values.

We will assess the difference in percent body fat between baseline and final assessments. We will use the Tanita BF-350 Body Composition Analyzer for Bioelectrical Impedance Analysis (BIA).

We will evaluate the change in diastolic blood pressure between baseline and final assessments. This will be based on the average of 5 sequential automated oscillometric blood pressure monitor-assessed values.

We will examine change in intrinsic and integrated motivation using changes in the intrinsic and integrated regulation subscales of the Behavioural Regulations in Exercise Questionnaire (18 questions each with a 0 to 4-point Likert scale).

Reference: Markland D, Tobin V. A modification to the Behavioural Regulation in Exercise Questionnaire to include an assessment of amotivation. Journal of Sport & Exercise Psychology. 2004;26(2):191-6.

We will assess the difference in diabetes distress between baseline and final assessments using the Diabetes Distress Scale. The index participant will complete the version for people living with type 2 diabetes (17 potential problem areas; scored on Likert scale 1 through 6 for related distress). Partners who have type 2 diabetes will also complete this version. All partners will complete the partner version of the Diabetes Distress Scale (2 potential problem areas; Likert scale 1 through 6).

Reference: Polonsky W, Fisher L, Earles J, et al. Assessing psychosocial distress in diabetes: Development of the diabetes distress scale. Diabetes Care. 2005;28(3):626-31.

We will assess the change in depressed mood between baseline and final assessment as captured by the change in score on the Center for Epidemiologic Studies Depression Scale (CES-D).

Reference: Radloff LS. The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement. 1977;1(3):385-401.

We will assess the difference in healthy eating between baseline and final assessments using the total score of the Starting the Conversation on Diet questionnaire (8 items; each with 3 categories related to frequency [first 7] or amount [last item] of intake- fast food, fruit, vegetables, sweetened beverages, beans/chicken/fish, chips/crackers, desserts/sweets, margarine/butter/fat).

Reference: Paxton AE, Strycker LA, Toobert DJ, et al. Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med. 2011;40(1):67-71.