Skip to main content
. Author manuscript; available in PMC: 2020 Mar 1.
Published in final edited form as: Soc Work Health Care. 2018 Dec 30;58(3):304–323. doi: 10.1080/00981389.2018.1563846

Table 1.

Articles Reviewed

Articles Related to Gender Roles and Spousal Dynamics
Authors Study Type N Demographics Key Social Support Findings Related to Dietary Adherence
August & Sorkin (2010) Survey 1477 Race/Ethnicity: Not reported
Gender: 58.8% male
Mean Age: 66 years old
• Married men are the demographic group in which attempted regulation of health behaviors (such as dietary adherence) by members of one’s social network was received most often
Beverly, Miller, & Wray (2008a) Qualitative (Focus Groups) 60 Race/Ethnicity: Not reported
Gender: 70% male
Mean Age: 66 years old
• In couples, a team-oriented approach to T2D diet management in T2D offers the best chance for dietary adherence
Beverly, Miller, & Wray (2008b) Qualitative (Focus Groups) 60 Race/Ethnicity: Not reported
Gender: 70% male
Mean Age: 66 years old
• Patients feel resentful when spouses attempt to over-control their diet, sometimes hide unhealthy food as a result
• Families of male T2D patients adjust their eating in accordance with patient’s needs
Cornelius et al. (2014) Survey 41, 378 Race/Ethnicity: 94% white
Gender: 100%
Mean Age: 54 years old
• Being unmarried, and particularly becoming a widower, is associated with an increased risk of developing T2D in men, perhaps due to the loss of support for dietary adherence.
Franks et al. (2012) Qualitative (Interviews) 230 Race/Ethnicity: 79% white
Gender: 50% male
Mean Age: 66 years old
• All spouses report providing some sort of dietary support to their spouse with diabetes in the past month
Henry et al. (2013) Combination of Survey and Qualitative(Interviews) 258 Race/Ethnicity: 76% white
Gender: 50% male
Mean Age: 66 years old
• Spouses represent a potential threat to the healthy eating of their partner with diabetes through behaviors which subvert dietary adherence
Koch, Kralik, & Taylor (2000) Qualitative (Focus Groups) 6 Race/Ethnicity: Not reported
Gender: male
Mean Age: Not reported
• Men report: they are not responsible for cooking, spousal support is key in their disease management, and their wives are involved in their care through education and dietary monitoring
Mathew et al. (2012) Qualitative (Combination of Focus Groups and Interviews) 35 Race/Ethnicity: Not reported
Gender: 49% male
Mean Age: 57 years old
• Women report perceiving less social support overall
• Men cite their spouse as a primary source of social support for their T2D management (including dietary adherence), women cite a more diverse mix of family and friends as their primary source of support
Nagelkerk et al. (2006) Qualitative (Focus Groups) 24 Race/Ethnicity: white
Gender: 50% male
Mean Age: 62 years old
• Spouses can be instrumental in diet adherence as they can provide encouragement and facilitate good self-management
Paisley et al. (2008) Qualitative (Interviews) 84 Race/Ethnicity: Not reported
Gender: 50% male
Mean Range*: 23–79 years old
*Mean age not reported
• Spouses and long-term partners report playing a positive role in their partners’ dietary regimen
Piette et al. (2010) Survey 439 Race/Ethnicity: Not reported
Gender: 50% male
Mean Range*: 25–75
*Mean age not reported
• Women report less support from family (including spouses) in their care and report more family-related barriers to their disease management, such as managing their diets
Rook et al. (2011) Survey 191 Race/Ethnicity: 94% white
Gender: 63% male
Mean Age: 67 years old
• Women appear more able to manage their diabetes independently compared to men
• Women react negatively to their spouse’s attempts to exert control over their diabetes management particularly when their husband’s action is unexpected
Savoca & Miller (2001) Qualitative (Interviews) 45 Race/Ethnicity: 64% white
Gender: 42% male
Mean Age: 53 years old
• Over half of the men sampled had food prepared by their wives and considered their wives integral to their diabetes management
• Half of the women sampled reported that they either prepared two meals (one T2D-friendly one for themselves and one non-T2D friendly one for their spouse) or continued to accommodate their spouse preferentially in food preparation
Seidel et al. (2012) Survey 278 Race/Ethnicity: 95% white
Gender: 50% male
Mean Age: 66 years old
• Men expect their spouse to be involved in their diabetes diet management
Stephens et al. (2010) Survey 218 Race/Ethnicity: 94% white
Gender: Not reported
Mean Age: 67 years old
• Spousal issuing of warnings related to food consumption is associated with poorer dietary adherence
• Spousal encouragement to eat well and exercise are associated with increased dietary adherence
Stephens et al. (2013) Survey 252 Race/Ethnicity: 77% white
Gender: 50% male
Mean Age: 66 years old
• Spousal utilization of the tactics of persuasion and applying pressure in an attempt to improve diet adherence are linked to poorer adherence
• When the responsibility for diabetes management is viewed as shared there is a higher level of dietary adherence on average
Stodberg, Sunvisson, & Ahlström (2007) Qualitative (Interviews) 15 Race/Ethnicity: Not reported
Gender: Not reported
Mean Age: Not reported
• Significant others (e.g., spouses or long-term partners) wanted to be involved in their partner’s diabetes management and are concerned for them
Trief et al. (2003) Qualitative (Interviews) 74 Race/Ethnicity: 96% white
Gender: 42% male
Mean Age: 49 years old
• Spousal reminders to eat well appear effective and helpful in encouraging adherence
Weaver et al. (2014) Qualitative (Interviews) 45 Race/Ethnicity: Not reported
Gender: 42% male
Mean Age: 60 years old
• Most men sampled relied on the support of others, such as their spouse, to manage their diet
• For women, as meal providers to their families, in low family support scenarios the food preferences of other family members can gain preference over their dietary needs
• Social influence for health behaviors can vary by amount of access to economic wealth
Wong et al. (2005) Qualitative (Interviews) 19 Race/Ethnicity: Not reported
Gender: 59% male
Mean Age: Not reported
• Women are more frequently responsible for food shopping and cooking
• Women are much more likely to be passively supported by their husbands with respect to diet while men are generally more actively supported by their wives
Articles Related to The Impact of Race and Ethnicity
Cherrington et al. (2011) Qualitative (Focus Groups) 45 Race/Ethnicity: Latino
Gender: 47% male
Mean Age: 40 years old
• Latina women are responsible for providing support to the rest of the family often to the detriment of their own dietary self-care
• Employment-related logistic factors get in the way of dietary adherence for Latino men
Chesla & Chung (2005) Qualitative (Group Interview) 16 families Race/Ethnicity: Chinese American
Gender: 69% male
Mean Age: 60 years old
• family dynamics was particularly important in the management of diabetes in the context of a Chinese American family.
• An important response to the diagnosis of T2D for this group involved accommodation of disease management (particularly as it relates to eating) on the part of all nuclear family members.
Choi (2009) Survey 143 Race/Ethnicity: Korean
Gender: 48% male
Mean Age: 62 years old
• The positive effect of family support for diabetes management, including dietary adherence, is stronger for men than women
• Women mentioned not getting support even when it was requested
Choi et al. (2014) Qualitative (Focus Groups) 33 Race/Ethnicity: Korean
Gender: 50% male
Mean Age: 68 years old
• ,Diet was found to be the primary area of diabetes management for which spousal support was relevant, and women reported not getting support even when they asked for it.
• Diet changes (such as reducing white rice intake) were cited as a source of spousal tension when recommendations conflicted with cultural eating habits.
Fisher et al. (2004) Survey 158 Race/Ethnicity: Chinese-American
Gender: 59% male
Age Range*: 25–70 years old
*Mean not reported
• For Chinese Americans, the perception of emotional impact in couples is significant in the context of the performance of key health behaviors (such as adhering to a diet)
Liburd, Namageyo-Funa, & Jack Jr, (2007) Qualitative (Interview) 16 Race/Ethnicity: African-American
Gender: 100% male
Mean Age: 50 years old
• For African American men, gender identity has been found to be of key importance, as cultural expectations regarding masculinity could cause African-American men to behave in ways that may not result in effective management of their T2D (e.g. Alcohol consumption).
Samuel-Hodge et al., 2005 Survey 345 Race/Ethnicity: African-American
Gender: 0% male
Mean Age: 60 years old
• African American women found that filling multiple caregiving roles in a household was associated with putting the family’s needs first and having difficulty saying ‘no’ to family members, which can be detrimental to self-care.
• It may not be accurate to simply assume that taking on more caregiving roles impedes self-care, as elements such as the quality of the relationship between the woman and the receivers of care, as well as the satisfaction and social interaction that caretaking provides, can influence the degree to which caretaking serves as a self-care barrier.
Song et al. (2012) Survey 83 Race/Ethnicity: Korean American
Gender: 58% male
Mean Age: 57 years old
• 83% of men sampled sought support from their wives for their diabetes, while only 60% of women sought support from their husbands
• Women tended to endorse a greater unmet need for support, this is understandable given that women are the primary caretakers in a Korean American family model
Tang et al. (2008) Survey 89 Race/Ethnicity: African American
Gender: 33% male
Mean Age: 60 years old
• One’s spouse was the most-frequently reported source of social support
• Married participants reported more positive support and more satisfaction with their support
• Spousal support is a predictor of healthy eating
• Women endorsed a greater responsibility for caretaking and a perception of less support compared to men
Wen, Shepard, & Parchman, (2004) Survey 138 Race/Ethnicity: Mexican Americans
Gender: 33% male
Mean Age: Not reported
• Greater perceived family support and living with family members (including a spouse) are associated with higher reported levels of dietary adherence
Interventions Targeting Spousal Support for Dietary Adherence
Trief et al. (2011) Intervention 44 Race/Ethnicity: Not reported
Gender: 36% male
Mean Age: 61 years old
• Compared to a diabetes self-care intervention targeting individuals, a couples-focused intervention involving dietary goal-setting and collaborative communication between the members of the couple was associated with lesser improvements in hemoglobin A1C, cholesterol levels, and waist circumference
Wing et al. (1991) Intervention 98 Race/Ethnicity: Note reported
Gender: 41% male
Mean Age: 53 years old
• When randomized to either an individual or couples intervention for weight loss, women were more successful in losing weight in the couples condition and men were more successful when treated individually
*

unless otherwise stated, the social support examined is that of married cohabitating spouses or unmarried longterm partners