It is not only learning and performing self-management skills that is important, but also the context in which the skills are performed. If patients feel they have the support of others, combined with their own self-efficacy, they are apt to perform self-management skills; if they don’t have a supportive context, including self-efficacy, there is less chance that they will perform the skills. Joekea and coworkers used a self-regulatory framework to identify how couples perceive a partner's support style after myocardial infarction (MI), and whether this predicts the patient's health-related quality of life (QL) and self-management 9 months later. The longitudinal dyadic study included 73 couples (86% men), recruited from two cardiac rehabilitation programs in the Netherlands. Mean age of patients was 54.8. Participants were interviewed and completed questionnaires at baseline. Repeat questionnaires were returned by 69 and 67 couples after three and nine months, respectively. Support by partners was conceptualized as ‘active engagement,’ which involves the extent to which a partner engages the patient in conversations that focus on emotional support and problem solving. Levels of active engagement did not change over time, nor did they differ between members of the dyad. Levels of overprotection diminished with time, while patients consistently perceived more engagement than partners report providing. Patients' experience of goal hindrance three months due to the MI was associated with a decreased QL at nine months. The perception of having a supportive partner at baseline contributed to enhanced patient QL at each subsequent time point, although not to physical functioning. Perceiving a partner as overprotective at baseline predicted worsened physical functioning in patients at three months. Patients whose partner displayed active engagement at baseline reported improvements in self-management at nine months.

VALUE OF STUDY TO READER: The study not only showed the importance of self-management, but the significance of partners in helping to manage myocardial infarction. These two factors establish a nourishing context that should contribute the effectiveness and long-term maintenance of self-management skills.

K Joekea, S Maes, M Warrens. Predicting quality of life and self-management from dyadic support and overprotection after myocardial infarction. British Journal of Health Psychology, 2007;12:473-489.