title: Study protocol: Couples Partnering for Lipid Enhancing Strategies (CouPLES) - a randomized, controlled trial.
abstract: BACKGROUND
  Almost 50% of Americans have elevated low-density lipoprotein cholesterol (LDL-C). The behaviors required to lower LDL-C levels may be difficult to adhere to if they are inconsistent with spouses' health practices, and, alternatively, may be enhanced by enlisting support from the spouse. This trial extends previous trials by requiring spouse enrollment, teaching spouses how to provide emotional and instrumental support, allowing patients to decide which component of the intervention they would like to receive, and having patients determine their own goals and action plans.
  
  
  METHODS
  Veteran outpatients with above-goal LDL-C (N = 250) and their spouses are randomized, as a couple, to receive printed education materials only or the materials plus an 11-month, nurse-delivered, telephone-based intervention. The intervention contains four modules: medication adherence, diet, exercise, and patient-physician communication. Patients decide which modules they complete and in which order; modules may be repeated or omitted. Telephone calls are to patients and spouses separately and occur monthly. During each patient telephone call, patients' progress is reviewed, and patients create goals and action plans for the upcoming month. During spouse telephone calls, which occur within one week of patient calls, spouses are informed of patients' goals and action plans and devise strategies to increase emotional and instrumental support.The primary outcome is patients' LDL-C, measured at baseline, 6 months, and 11 months. Linear mixed models will be used to test the primary hypothesis that an 11-month, telephone-based patient-spouse intervention will result in a greater reduction in LDL-C as compared to printed education materials. Various process measures, including social support, self-efficacy, medication adherence, dietary behavior, and exercise, are also assessed to explain any change, or lack thereof, in LDL-C.
  
  
  CONCLUSIONS
  Given the social context in which self-management occurs, interventions that teach spouses to provide instrumental and emotional support may help patients initiate and adhere to behaviors that lower their LDL-C levels. Moreover, allowing patients to retain autonomy by deciding which behaviors they would like to change and how may improve adherence and clinical outcomes.
  
  
  BACKGROUND
  The ClinicalTrials.gov registration number is NCT00321789.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA. voils001@mc.duke.edu
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.forename: Stacey
authors.initials: S
authors.lastname: Kovac
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Amy
authors.initials: A
authors.lastname: Jeffreys
authors.forename: Santanu
authors.initials: S
authors.lastname: Datta
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D008078:Cholesterol, LDL / Q000097:blood*; D002985:Clinical Protocols; D004032:Diet; D050171:Dyslipidemias / Q000097:blood / Q000451:nursing / Q000628:therapy*; D004644:Emotions; D015444:Exercise; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D010045:Outpatients; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D012107:Research Design; D040242:Risk Reduction Behavior; D012648:Self Care; D012944:Social Support; D018454:Spouses; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome; D014728:Veterans
chemical_list: D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents