Spouses' use of pressure and persuasion to promote osteoarthritis patients' medical adherence after orthopedic surgery.

OBJECTIVE: The authors investigated health-related effects of social control (influence) that spouses exert in relation to osteoarthritis patients' medical adherence after total knee replacement surgery. Patients' behavioral and emotional responses to control were examined as mediators of associations between spouses' use of two control strategies (pressure, persuasion) and patients' physical and psychological recovery. DESIGN: The authors used a three-wave panel design with assessments at one month before surgery, 1 month and 3 months after surgery. Data were collected during in-person interviews with 70 married, older adult patients. MAIN OUTCOME MEASURES: Recovery outcomes were assessed as improvement in knee limitations and depressive symptoms at the 3 month follow-up. RESULTS: Spousal pressure and persuasion at one month postsurgery were indirectly associated with patients' recovery outcomes through patients' positive emotional responses to control. CONCLUSION: Although there are often immediate behavioral benefits in response to partners' use of both pressure and persuasion, the long-term health effects of these strategies seem to be accounted for by their opposing links to positive emotions. Findings further refine theory on health-related social control in marriage.

Affective and behavioural reactions to positive and negative health-related social control in HIV+men.

We examined associations between the receipt of positive and negative health-related social control (i.e. influence) from a primary network member, affective and behavioural reactions (i.e. behaviour change) to social control, and psychosocial well-being in a cross-sectional study of 91 HIV+ men living with HIV (MLWH). Receiving positive control was associated with more self-care behaviours, more active coping efforts, and fewer depressive symptoms. In contrast, receiving negative control was associated with fewer self-care behaviours and more depressive symptoms. Negative affective reactions to control mediated the associations between positive and negative control and depressive symptoms, and between positive control and active coping efforts. Behaviour change only mediated the association between positive control and self-care behaviours. Post-hoc analyses further revealed that men who were not at risk for clinical depression engaged in more behaviour change as a result of receiving negative control. Social control that elicits behaviour change and does not arouse negative affect is effective in promoting better self-care behaviours and psychosocial well-being in MLWH.

Emotional support and affect: associations with health behaviors and active coping efforts in men living with HIV.

The present study represents a cross-sectional examination of the relationship between affect, social support and illness adjustment in men diagnosed with HIV/AIDS. Positive and negative affect were examined as separate mediators of the relationship between emotional support received from a primary support provider and illness adjustment in 105 men living with HIV. Results suggested that depressive symptoms emerged as a mediator between emotional support and engaging in healthy lifestyle behaviors (assessed by summary index). In contrast, positive affect emerged as the primary mediator between emotional support and greater amounts of active coping. Overall, findings suggested that emotional support from close others was indirectly associated with health behaviors and coping through recipients' affective states, and that these positive and negative affective states had differential relationships with multiple aspects of illness adjustment in men living with HIV.

Effects of spousal control and support on older adults' recovery from knee surgery.

The authors investigated associations between spousal control (influence) and support on the recovery outcomes for 70 men and women (mean age = 70) undergoing an increasingly common surgical treatment for osteoarthritis (OA) of the knee. Spouses' positive (motivating) and negative (pressuring) control and spouses' emotional (understanding) and problematic (dismissing) support were examined as predictors of patients' adherence and improvement in well-being. Positive control was associated with better adherence, but only among patients whose spouses provided little problematic support. In contrast, negative control strategies tended to elicit increases in negative affect. Overall, our findings revealed that the effectiveness of spousal control depended largely on the quality of support provided by the spouse.

Older adults' recovery from surgery for osteoarthritis of the knee: psychosocial resources and constraints as predictors of outcomes.

The authors investigated psychosocial resources (positive support, active coping) and psychosocial constraints (negative support, avoidant coping) as predictors of improvement in the health of 63 older adults undergoing surgery for osteoarthritis of the knee. Following surgery, patients and social partners are motivated both to strive for the appetitive goal of recovery (approach), and to protect themselves from pain and impairment (avoidance). The authors assessed resources and constraints 6 weeks after surgery as predictors of outcomes (improvement in knee pain, knee functioning, and psychological well-being) 6 months after surgery. The constraints patients encountered early in recovery were strong predictors of poor recovery. Although resources were associated with some improvement, these effects were largely accounted for by constraints.