TBM TBM page 95 of 104 Heart disease risk information, encouragement, and physical activity among Mexican-origin couples: Self- or spouse-driven change? Kaley F. Skapinsky, 1 Susan Persky, 1 Megan Lewis, 2 Andrea Goergen, 1 Sato Ashida, 3 Hendrik D. de Heer, 4 Donald Hadley, 5 Anna V. Wilkinson, 6 Laura M. Koehly 1 Abstract Family health history is an accessible, clinically-recommended genomic tool that improves health risk evaluation. It captures both genetic and modifable risk factors that cluster within families. Thus, families represent a salient context for family health history-based interventions that motivate engagement in risk-reducing behaviors. While previous research has explored how individuals respond to their personal risk information, we extend this inquiry to consider how individuals respond to their spouse’s risk information among a sample of Mexican- Americans. One hundred and sixty spouse-dyads within Mexican-heritage households received a pedigree or a pedigree and personalized risk assessments, with or without behavioral recommendations. Analyses of Covariance (ANCOVAs) were conducted to assess the relationship between risk feedback, both personal and spouse, and self-reported physical activity levels at 3-month and 10-month assessments, controlling for baseline levels. The efect of being identifed as an encourager of spouse’s healthy weight was also evaluated. Personal feed- back had no efect on participants’ physical activity at either 3- or 10-month assessments. However, husbands’ risk infor- mation was associated with wives’ physical activity levels at 3-month assessment, with women whose husbands received both increased risk feedback and behavioral recommendations engaging in signifcantly higher physical activity levels than all other women. At 10-month follow-up, physical activity levels for both husbands and wives difered depending on whether they encouraged their spouse’s healthy weight. Spousal risk information may be a stronger source of motivation to improve physical activity patterns than personal risk information, par- ticularly for women. Interventions that activate interpersonal encouragement among spouses may more successfully extend intervention efects. Keywords Family health history, Spouses, Physical activity, Heart disease, Family systems INTRODUCTION Family health history is an accessible, clinically-rec- ommended genomic tool that is well-established in its ability to improve health risk evaluation [1, 2]. In addition, there is a nascent but growing field of inquiry into understanding how family health his- tory-based risk information may influence health behavior change [3–7]. The current study integrates this area of research with substantial evidence demonstrating the positive influence spouses have on one another’s health behaviors [8–10]. While pre- vious research has explored how individuals respond to their own family health risk information [11–13], we extend this inquiry to consider how individu- als respond to risk information about one’s spouse among a sample of Mexican-origin families poten- tially at risk of heart disease. THE IMPORTANCE OF FAMILY HEALTH HISTORY FOR MOTIVATING BEHAVIOR CHANGE Several studies point to the potential for family his- tory-based interventions to motivate individuals and families to initiate screening behaviors and reduce risk behaviors in both clinical and community set- tings [6, 14–16]. For example, using messages tai- lored to individuals’ family health history-based risk and current health behaviors, the Family Healthware Impact Trial demonstrated that patients in primary care were significantly more likely to improve their fruit and vegetable consumption and physical activ- ity levels, compared to patients who received generic health-related messages [17]. However, messages from the Family Healthware Impact Trial included Implications Practice: Including spouses in discussions about family history-based disease risk can motivate improved health behaviors for both partners. Policy: Shifting from patient-centered care to family-centered care affords opportunities for providers to broaden the reach of risk-reducing recommendations from individuals to families. Research: Future research is needed to more fully understand the interpersonal mechanisms among spouses that shift motivations towards en- gagement in healthful behaviors. 1 Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA 2 Patient and Family Engagement Research Program, Center for Communication Science, RTI International, Seattle, WA 98104, USA 3 Community and Behavioral Health, College of Public Health, The University of Iowa, Iowa City, IA 52242, USA 4 Health Sciences Department, College of Health and Human Services, Northern Arizona University, Flagstaf, AZ 86011, USA 5 Ofce of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA 6 Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Austin Regional Campus, University of Texas Health Sciences Center at Houston, Austin, TX 78701, USA ORIGINAL RESEARCH © Society of Behavioral Medicine 2018 Correspondence to: LM Koehly, koehlyl@mail.nih.gov Cite this as:TBM 2018;8:95–104 doi: 10.1093/tbm/ibx012 Downloaded from https://academic.oup.com/tbm/article/8/1/95/4829332 by guest on 30 July 2021