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Diabetes-specific family functioning typology associated with intervention engagement and effects: secondary analyses
McKenzie K Roddy1,2, Andrew J Spieker3, Robert A Greevy3
1Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, United States.
Background:
Observationally, family and social support are important for optimal diabetes self-management; however, interventions targeting family/social support have not consistently been effective. A novel, diabetes-specific family functioning typology offers the opportunity to classify types of baseline family functioning to determine for whom family interventions may be effective.
Purpose:
We examined the effects of an intervention by baseline type of family functioning post hoc, to inform differential benefit from interventions.
Methods:
Participants were randomized to enhanced treatment as usual or a 9-month, mobile phone-delivered, family-focused, self-care support intervention. Adults with type 2 diabetes (N = 318) who participated in the randomized clinical trial (RCT) and provided baseline data were included. We determined participants' diabetes-specific family functioning types at baseline using a validated, survey-administered, typology assessment tool. We investigated the associations between type and engagement (eg, attending coaching sessions and responding to text messages) and psychosocial (eg, well-being and diabetes distress) and glycemic outcomes at mid- and post-treatment.
Results:
Despite overall high engagement, there was variability across types in engagement and effects. WantMoreInvolvement benefited the most; Satisfied withLowInvolvement showed early improvements that waned; Collaborative &Helpful were highly engaged but derived minimal benefits from the intervention; and CriticallyInvolved benefitted the least and may have experienced some harm.
Conclusions:
We demonstrated the utility of a novel diabetes-specific family functioning typology to explain variability in response to a family-focused intervention. Findings from this work answer the calls for systems-level consideration in precision behavioral medicine and drive hypothesis generation for future, tailored interventions.
Registration:
The larger RCT is registered with ClinicalTrials.gov (NCT04347291).
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