Social relationships, stress, and treatment adherence perceptions in type 2 diabetes and hypertension: between-person, within-person, and compositional associations




Rivers, Alannah Shelby
Sanford, Keith

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Taylor & Francis


Objective: Type 2 diabetes and hypertension are “intertwined” conditions with lifestyle treatment plans, but patients often struggle to consistently engage in and follow treatment plans. To identify potential mechanisms for improving patient adherence to lifestyle treatment plans for type 2 diabetes and hypertension, this longitudinal study investigated the extent to which situational changes in patient-practitioner relationships, close relationships, and stress, explain between-person, immediate within-person, and compositional change in patient behavior and attitudes.

Methods and measures: Over one year, 167 participants with type 2 diabetes and/or hypertension completed seven questionnaires assessing adherence perceptions (adherence, benefit, and burden), patient-practitioner experiences (alliance and confusion), close interpersonal interactions (positive and negative), and stress.

Results: Multilevel structural equation modeling analyses revealed that nearly all hypothesized between-person associations were significant. Moreover, all hypothesized predictors explained within-person change in at least one adherence outcome. Predictors also produced compositional effects where outcomes were predicted by scores sustained over time. Most social and stress variables had unique associations with adherence perceptions after controlling for other predictors.

Conclusion: Results highlight the complexity of change processes and importance of social relationships and stress for adherence. Greater understanding of these processes may improve outcomes for individuals with type 2 diabetes and/or hypertension.


Article originally published in Psychology & Health, 1–18. English. Published online 2022.


Diabetes, Adherence, Hypertension, Social support, Stress


This is the post-print of an article that is available at Recommended citation: Rivers, A. S., & Sanford, K. (2022). Social relationships, stress, and treatment adherence perceptions in type 2 diabetes and hypertension: Between-person, within-person, and compositional associations. Psychology & Health, 1–18. This item has been deposited in accordance with publisher copyright and licensing terms and with the author’s permission.