Challenges and lessons learned in the development and implementation of a couples-focused telephone intervention for adults with type 2 diabetes: the Diabetes Support Project

Type 2 diabetes (T2DM) studies report that marital/family support relates to glycemic control, adherence, and quality of life. Yet, there are few reports on couples-focused interventions. This study aims to describe the challenges faced and lessons learned in the implementation of a theoretically based, couples intervention. Three hundred fifty couples (one partner has T2DM in poor glycemic control) are randomized to a couples intervention, individual intervention, or enhanced usual care. All contacts are by telephone to increase reach. The medical (e.g., glycemic control), psychosocial (e.g., diabetes distress), and behavioral (e.g., regimen adherence) outcomes were measured. Challenges in recruitment, assessment, and intervention with couples are described, with suggestions about how to address them. Findings concerning the efficacy and cost-effectiveness of the couples intervention, its effect on partners, and possible mechanisms of demonstrated changes, are anticipated in 2013. Interventionists need specific skills to work with couples to promote communal coping and increase the likelihood of an efficacious couples intervention.