Annals of Behavioral Medicine

, Volume 43, Issue 3, pp 320–329

Using the Interdependence Model to Understand Spousal Influence on Colorectal Cancer Screening Intentions: A Structural Equation Model

  • Sharon Manne
  • Deborah Kashy
  • David S. Weinberg
  • Joseph A. Boscarino
  • Deborah J. Bowen
Original Article



Although it is widely thought that the marital relationship plays a role in individuals’ decisions to have colorectal cancer screening, few studies have evaluated partner influences.


We evaluated the role of marital relationship factors such as a relational perspective on the frequency of spouse discussions about screening and screening intentions. Individual-level factors were also evaluated.


One hundred sixty-eight couples with both members non-adherent with screening completed measures of perceived risk, screening benefits and barriers, marital quality, relational perspective, discussion frequency, and screening intentions.


Couples’ attitudes about screening were interdependent and one partner’s attitudes and behavior were associated with the other partner’s intention. There was also evidence of joint effects in that intentions were associated with both one’s partner’s attitudes and one’s own attitudes.


Colorectal screening intentions are associated with both partners’ attitudes as well as whether or not couples have discussed screening with one another.


Interdependence model Couples Colorectal cancer screening intentions Actor-partner independence model 


  1. 1.
    American Cancer Society. Cancer Facts and Figures 2011, Atlanta: American Cancer Society. Available at Accessed 12 April 2011.
  2. 2.
    US Dept of Health and Human Services. Healthy People 2010, Washington, DC: US Dept of Health and Human Services, Office of Population Affairs. Available at Accessed 12 April 2011.
  3. 3.
    Beydoun HA., Beydoun MA. Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States. Cancer Causes Contr. 2008; 9: 339-359.Google Scholar
  4. 4.
    McQueen A., Vernon SW, Rothman AJ., Norman GJ, Myers RE, Tilley BC. Examining the role of perceived susceptibility on colorectal cancer screening intention and behavior. Ann Behav Med. 2010; 40: 205–217.PubMedCrossRefGoogle Scholar
  5. 5.
    Madlensky L, Esplen MJ, Gallinger S, McLaughlin JR, Goal V. Relatives of colorectal cancer patients: Factors associated with screening behavior. Am J Prev Med, 2003; 25: 87–94.CrossRefGoogle Scholar
  6. 6.
    Manne S, Markowitz A, Winawer S, Meropol NJ, Haller D, Rakowski W, Babb J, Jandorf L. Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer. Health Psych. 2002; 21: 3–15.CrossRefGoogle Scholar
  7. 7.
    Harris JN, Hay J., Kuniyiki A., Asgari MM, Press N, Bowen DJ. Using a family systems approach to investigate cancer risk communication within melanoma families. Psych Onc. 2010; 19: 1102–1111.CrossRefGoogle Scholar
  8. 8.
    Falba TA, Sindelar JL. Spousal concordance in health behavior change. Health Serv Res. 2008; 43: 96–116.PubMedCrossRefGoogle Scholar
  9. 9.
    Kolonel LN, Lee J. Husband-wife correspondence in smoking, drinking, and dietary habits. Am J Clin Nutr. 1998; 34: 99–104.Google Scholar
  10. 10.
    Wilson SE. The health capital of families: An investigation of the inter-spousal correlation in health status. Soc Sci Med. 2002; 55: 1157–1172.PubMedCrossRefGoogle Scholar
  11. 11.
    Lewis MA, DeVellis BM, Sleath. Social influence and interpersonal communication in health behavior. In: Glanz DK, Rimer BK, Lewis FM, eds. Health behavior and health education: Theory, research, and practice. 3rd edn. San Francisco: Jossey-Bass; 2002: 240–264.Google Scholar
  12. 12.
    Lewis MA, McBride CM, Pollak KI, Puleo E, Butterfield RM, Emmons KM. Understanding health behavior change among couples: An interdependence and communal coping approach. Soc Sci Med. 2006; 62: 1369–1380.PubMedCrossRefGoogle Scholar
  13. 13.
    Kelley HH, Berscheid E, Christensen A, Harvey JH, Huston TL, Levinger G, et al. Analyzing close relationships. In Kelley HH, Berscheid E, Christensen A, Harvey J, Huston TL, Levinger G, et al eds. Close relationships. San Francisco, CA: Freeman; 1983; 20–67.Google Scholar
  14. 14.
    Kelley HH, Thibaut TW. Interpersonal relations: A theory of interdependence. New York; Wiley; 1978.Google Scholar
  15. 15.
    Rusbult CE, Van Lange PAM. Interdependence processes. In Higgins ET, Kruglanski AW eds. Social psychology: Handbook of basic principles New York: The Guilford Press; 1996: 564–596.Google Scholar
  16. 16.
    Lewis MA, Butterfield R, Darbes L, Johnston-Brooks CH. The conceptualization and assessment of health-related social control. J Soc Pers Rel. 2004; 21: 669–687.CrossRefGoogle Scholar
  17. 17.
    Franks MM, Rook KS, Keteyian SJ, Stephens MA, Franklin BA, Artinian NT. Spouses' provision of health-related support and control to patients participating in cardiac rehabilitation. J Fam Psychol. 2006; 20: 311–318.PubMedCrossRefGoogle Scholar
  18. 18.
    Butterfield R, Lewis M. Health-related social influence: A social ecological perspective on tactic use. J Soc Pers Rel. 2002; 19: 505–626.CrossRefGoogle Scholar
  19. 19.
    Lewis MA. Butterfield R. Antecedents and reactions to health-related social control. Pers Soc Psych Bull. 2005; 31: 416–427.CrossRefGoogle Scholar
  20. 20.
    Lewis MA, Rook KS. Social control in personal relationships: Impact on health behaviors and psychological distress. Health Psychol. 1991; 18: 63–71.CrossRefGoogle Scholar
  21. 21.
    Rakowski W, Ehrich B, Dube CE. Screening mammography and constructs from the transtheoretical model: Associations using two definitions of stage of adoption. Ann Behav Med. 1996; 18: 91–100.CrossRefGoogle Scholar
  22. 22.
    Sharpley CE., Rogers HJ. Preliminary validation of the Abbreviated Spanier Dyadic Adjustment scale: Some psychometric data regarding a screening test of marital adjustment. Educ Psych Meas. 1984; 44: 1045–1050.CrossRefGoogle Scholar
  23. 23.
    Kenny DA, Kashy DA, Cook WL. Dyadic data analysis. New York: Guilford Press: 2006.Google Scholar
  24. 24.
    Miller GR, Bostner F. Persuasion in personal relationships. In: S. Duck, ed. A handbook of personal relationships New York: Wiley; 1988: 275–288.Google Scholar
  25. 25.
    Cutrona C. Social support in couples. Thousand Oaks, CA: Sage Publications; 1996.Google Scholar
  26. 26.
    Gregory TA, Wilson C, Duncan A, Turnbull D, Cole SR, Young G. Demographic, social cognitive and social ecological predictors of intention and participation in screening for colorectal cancer. BMC Pub Health. 2011; 11: 38.CrossRefGoogle Scholar
  27. 27.
    Power E, Van Jaarsveld C, McCaffery K, Miles A, Atkin W, Wardle J. Understanding intentions and action in colorectal cancer screening. Ann Beh Med. 2008; 35: 285–294.CrossRefGoogle Scholar
  28. 28.
    Ajzen I., Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall; 1980.Google Scholar
  29. 29.
    Fishbein M, Ajzen I. Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley; 1975.Google Scholar
  30. 30.
    Krosnick, J, Chang, L. A comparison of the random digit dialing telephone survey methodology with internet survey methodology as implemented by Knowledge Networks and Harris Interactive. In: Conference of the American Association for Public Opinion Research. 2001: Montreal, Canada.Google Scholar
  31. 31.
    Dennis, M. Are internet panels creating professional respondents? The benefits of online panels far outweigh the potential for panel effects. Marketing Research. 2001; 13(Summer): 34–38.Google Scholar

Copyright information

© The Society of Behavioral Medicine 2012

Authors and Affiliations

  • Sharon Manne
    • 1
  • Deborah Kashy
    • 2
  • David S. Weinberg
    • 3
  • Joseph A. Boscarino
    • 4
  • Deborah J. Bowen
    • 5
  1. 1.UMDNJ/Cancer Institute of New JerseyNew BrunswickUSA
  2. 2.Michigan State UniversityEast LansingUSA
  3. 3.Fox Chase Cancer CenterPhiladelphiaUSA
  4. 4.Geisinger Health SystemsDanvilleUSA
  5. 5.Boston UniversityBostonUSA

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