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To identify patterns of dyadic engagement in type 2 diabetes care, describe their characteristics, and explore their association with glycated haemoglobin.
In chronic conditions, patient self-care and caregiver contribution should be considered a dyadic phenomenon. However, patterns of dyadic engagement in type 2 diabetes care have not yet been identified.
Multicentre observational cross-sectional study.
Patient self-care and caregiver contribution were assessed using the Self-Care of Diabetes Inventory and the Caregiver Contribution to Self-Care of Diabetes Inventory. Patterns of dyadic engagement in type 2 diabetes care were identified by latent class analysis. Associations between patient-caregiver characteristics and class membership were estimated using multinomial regression. The association between classes and glycated haemoglobin levels was assessed using linear regression.
251 dyads of patients with type 2 diabetes and their primary informal caregivers were enrolled. Patients were mostly male (55%, median age 72) and caregivers mostly female (71%, median age 64). Three patterns of dyadic engagement were identified: ‘equally engaged-low care’ (14%), ‘mostly patient engaged-middling care’ (25%), and ‘equally engaged-high care’ (61%). Patient characteristics (sex, education, self-efficacy) and caregiver characteristics (burden, chronic diseases) were associated with pattern membership. Membership in the ‘mostly patient engaged-middling care’ and ‘equally engaged-high care’ patterns was associated with decreased glycated haemoglobin compared to ‘equally engaged-low care’.
The three identified patterns of dyadic engagement in type 2 diabetes showed differences in patient and caregiver characteristics and were associated with glycated haemoglobin.
The study identified and described patterns of dyadic engagement in type 2 diabetes care. The three identified patterns showed differences in characteristics and in patient glycemic control. Healthcare professionals should consider these patterns for tailoring interventions focused on both dyad members.
STROBE checklist was followed.
Patients and their informal caregivers were recruited to participate in the study.
To explore how older adult-family caregiver dyads jointly manage multiple chronic conditions. Specifically, it investigates how dyads (i) prioritise chronic diseases, (ii) make and negotiate decisions related to self-care and (iii) define and distribute self-care tasks and caregiver contributions.
A qualitative descriptive study using dyadic data collection and analysis.
Semi-structured interviews were conducted separately with chronically ill older adults and their family caregivers between July and December 2024. A hybrid inductive-deductive content analysis was applied. Dyadic analysis compared intra-dyad perspectives to identify patterns of agreement and disagreement.
Thirty-four dyads (n = 68 participants) were interviewed. Older adults had a mean age of 80.09 years (SD = 6.95) and were affected by a median of four chronic conditions. Family caregivers had a mean age of 51.71 years (SD = 14.59), with most being the older adults' children (66.67%) and women (82.35%). Five categories, comprising 25 subcategories, were derived from the data. Disease prioritisation varied within dyads: older adults often focused on conditions with the most disabling symptoms, while caregivers emphasised those with higher risks of complication. Decision-making roles ranged from older adult-led to caregiver-led to shared. Care organisation followed three models: collaborative, older adult-directed, or caregiver-directed. Challenges in managing diseases included treatment adherence, care coordination, emotional burden and addressing multiple symptoms simultaneously. Role distribution in disease management and decision-making was complex and occasionally misaligned, sometimes resulting in conflict. Collaborative dyads reported greater adaptability and balance, while incongruent dyads experienced relational and organisational strain.
Managing multiple chronic conditions in older adults is a relational process shaped by interpersonal dynamics and shared responsibilities with family caregivers. Recognising dyadic relational patterns is essential for designing targeted educational interventions. Nurses should incorporate dyadic assessments into routine care to improve outcomes for older adults and reduce caregiver burden.
This study highlights the importance of viewing chronic disease management as a dyadic process, rather than an individual task, involving both the older adult and the family caregiver. Tailored strategies that account for the relational dynamics within dyads, such as decision-making roles and care task distribution, are essential for effective chronic disease management.
Consolidated criteria for reporting qualitative studies (COREQ).
None.
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