Family involvement is helpful and harmful to patients' self-care and glycemic control

Patient Educ Couns. 2014 Dec;97(3):418-25. doi: 10.1016/j.pec.2014.09.011. Epub 2014 Sep 20.


Objective: We assessed the relationships between supportive and obstructive family behaviors and patients' diabetes self-care activities and HbA1C, and potential interaction effects and differences by demographic characteristics.

Methods: In a cross-sectional study, 192 adults with type 2 diabetes completed the Diabetes Family Behavior Checklist-II, the Summary of Diabetes Self-Care Activities, and a glycemic control (HbA1C) test.

Results: Participants reported similar rates of supportive and obstructive behaviors that were positively correlated (rho=0.61, p<0.001). In adjusted analyses, supportive family behaviors were associated with adherence to different self-care behaviors (β=0.20 to 0.50, p<0.05), whereas obstructive family behaviors were associated with less adherence to self-care behaviors (β=-0.28 to -0.39, p<0.01) and worse HbA1C (β=0.18, p<0.05). Supportive behaviors protected against the detrimental effect of obstructive behaviors on HbA1C (interaction β=-0.22, p<0.001). Non-Whites reported more supportive and obstructive behaviors than Whites, but race did not affect the relationships between family behaviors and self-care or HbA1C.

Conclusion: Involving family members in patients' diabetes management may impede patients' self-care and compromise their glycemic control unless family members are taught to avoid obstructive behaviors.

Practice implications: Our findings endorse interventions that help family members develop actionable plans to support patients' self-care and train them to communicate productively about diabetes management.

Keywords: Family; Glycemic control; HbA1C; Self-care; Social support; Type 2 diabetes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / metabolism*
  • Blood Glucose Self-Monitoring
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / psychology*
  • Diabetes Mellitus, Type 2 / therapy*
  • Family / psychology*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Male
  • Medication Adherence / psychology*
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Self Care / psychology*
  • Self Care / statistics & numerical data
  • Social Support
  • Surveys and Questionnaires


  • Blood Glucose
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human