Marital interactions in the process of dietary change for type 2 diabetes.

OBJECTIVE To explore how couples adjust to dietary management of type 2 diabetes. DESIGN Couples were interviewed, first together and then separately, during the first year after diagnosis and 1 year later. SETTING Qualitative interviews conducted in hospital classrooms using a semistructured interview guide. PARTICIPANTS Couples (N = 20) with a recently diagnosed spouse who met the study criteria were purposefully selected from volunteers solicited from hospital-based diabetes classes. PHENOMENON OF INTEREST Processes used by the couple to address the prescribed diet. ANALYSIS Thematic analysis of interview transcripts using grounded theory to identify patterns of adaptation processes used over time. RESULTS Three couple categories emerged (cohesive, enmeshed, and disengaged), representing adaptation to the diabetic diet. Initially, 5 couples were cohesive (teamwork approach), 7 were enmeshed (nondiabetic spouse responsible for the diet; spouse was dependent), and 8 were disengaged (spouses functionally separate; spouse was solely responsible for the diet management). A year later, the majority of couples were disengaged (n = 14), 1 couple remained cohesive, and 4 couples remained enmeshed. Themes of flexibility, roles, rules, and communication varied across categories. CONCLUSIONS AND IMPLICATIONS Understanding categories of marital adjustment to the diabetic diet may improve nutrition-based diabetes interventions. Further study is needed to verify these findings in larger and more diverse populations.