Heart-healthy Lifestyle Change and Couple Communication

This research is dedicated to my mom and dad, who gracefully navigated communication about his heart disease for 20-some years.  A heart attack or bypass surgery creates many changes for couples; I explored these with the generous help of research participants in central Illinois and research assistants from the University of Illinois.  In this series of papers, my co-authors and I take up the particular challenges that arise when couples talk about making heart-healthy lifestyle changes, such as diet, exercise, smoking cessation, and stress management.  We propose a model for what couples found challenging, the strategies they employed, and the ways in which these are situated in their interpretive frames and social environment.

Goldsmith, D. J., Bute, J. J., & Lindholm, K. L. (2012).  Patient and partner strategies for talking about lifestyle change following a cardiac event.  Journal of Applied Communication Research, 40, 65-86.

Heart patients are frequently advised to make lifestyle changes and communication with a romantic partner can help or hinder adoption of heart healthy behaviors. However, talking about lifestyle change can have both positive and negative meanings and this can create dilemmas for couples. We engaged in an interpretive analysis of interviews with 25 patients and 16 partners to identify the ways they managed the meanings of lifestyle change talk. Their communicative strategies included rationing talk, saying it nicely and framing it cooperatively. Each strategy had advantages and disadvantages as well as optimal conditions. We also identified interpretive lenses that shaped the meaning of talk, including legitimacy, patience, emphasizing the positive, moderation, benefits for both people, and perceived compliance. Finally, environmental resources (such as household patterns and communication with the social network) contextualized the meaning of talk. We proposed a model of the interrelated influence of communication, interpretation, and environment on the meanings of talking about lifestyle change.

Goldsmith, D. J., Lindholm Gumminger, K., & Bute, J. J. (2006). Communication about lifestyle change between cardiac patients and their partners.  In B. LePoire & R. M. Dailey (Eds.).  Socially meaningful applied research in interpersonal communication (pp. 95-118). New York: Peter Lang.

Although adherence to a heart-healthy lifestyle can improve recovery from a heart attack or bypass surgery, compliance with recommended behavior modifications is generally low. A spouse or partner can influence patient lifestyle change but much remains to be learned about what types of interactions facilitate adherence versus produce overprotection or resistance. We interviewed 25 persons who experienced a cardiac event in the past year and 16 partners. Our goals were to describe how couples talk about adherence and to identify features of communication that were variable, meaningful, and potentially consequential. Couples varied in how often they talked about adherence and those who talked a little, a lot, or occasionally differed not just in quantity of talk but also in the meaning of talk and strategies for regulating its frequency. Adherence talk occurred in various speech events, including praise, problem-solving discussion, acknowledgment, meta-communication, argument, and compliance-gaining. Different types of episodes entailed different roles and relational qualities. When partners engaged in compliancegaining, the style in which they attempted social control (e.g., direct or indirect, humorous or serious, ritualistic or not, verbal or nonverbal) shaped its meaning. Our findings are consistent with Goldsmith’s (2004) theory of social support and have implications for how we conceptualize and measure couple communication about adherence. Our descriptions of behavior may help couples understand why they experience interactions as supportive or not. Describing behaviors can also give validation to couples experiencing communication challenges as well as offer a range of possible alternatives for interacting.

Goldsmith, D. J., Lindholm, K. A., & Bute, J. J. (2006).  Dilemmas of talking about lifestyle changes among couples coping with a cardiac event.  Social Science & Medicine, 63, 2079-2090.

Persons who have experienced a myocardial infarction (MI) and/or coronary artery bypass graft (CABG) surgery may benefit from a low-fat diet, regular exercise, smoking cessation, and stress management. Yet many patients do not make these changes. A spouse or partner’s attempts at support may facilitate or interfere with patient behavior change. The present study explores dilemmas that may arise when couples talk about lifestyle changes following one person’s MI or CABG. In interviews (carried out in Urbana-Champaign, Illinois, and surrounding communities) with 25 patients and 16 partners we found communicating support for lifestyle change may be interpreted as undesired control or criticism. The caring conveyed by talking may be viewed positively but can also threaten patient autonomy and entrap partners in unwanted expectations and obligations. Finally, lifestyle change conversations may reflect empowered patients collaborating with partners to take control of health but can also serve as potent reminders of loss.  These multiple, potentially conflicting meanings give an account for why talking with a partner does not always facilitate patient lifestyle change. Understanding these dilemmas also suggests practical implications for helping patients and partners.

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