Abstract
Over the past two decades, dyadic health science has grown rapidly to focus on dyads across the lifespan in health and illness contexts. There have been increasing numbers of dyadic theories developed and a wide spectrum of dyadic methods (both quantitative and qualitative) employed to address questions centered on the interpersonal context of health, health behaviors, and wellbeing. Family nurse scholars have unique expertise to contribute to the field of dyadic health science and optimize dyadic health. The purpose of this paper is to provide an overview of theories and methods of dyadic health science and to highlight examples of dyadic health research conducted by family nurse researchers. The paper concludes with a call for family nurse researchers to continue to advance dyadic health science that guides nursing practice in diverse health care settings.
Keywords
Introduction
Family-centered care is a philosophy of care that conceptualizes the patient and family as one unit placed at the center of all health care decisions (Kokorelias et al., 2019). The familial dyad, subsumed within the family, has been a growing research interest among dyadic family scholars for decades. Dyadic health science is a growing multidisciplinary field nested within the broader construct of family health that seeks to understand the role of relational dynamics in health behaviors, health outcomes, and experiences among a pair of individuals (Wilson et al., 2024). Over the past several decades, dyadic family research has spread across the lifespan to center on couples, siblings, parents/children, friends, and other diverse dyadic relationships (Martire & Helgeson, 2017). Moreover, the approaches and concepts in dyadic science have multi-faceted origins in family, marital, relationship, and caregiving research and have more recently been influenced by the areas of health promotion and illness management (Lyons & Lee, 2018).
Foundational sources on dyadic methods and concepts have existed for decades (Bodenmann, 1995; Gonzalez & Griffin, 1997; Kenny, 1996; Kenny et al., 2006; Kiecolt-Glaser & Newton, 2001; Lyons et al., 2002; Raudenbush et al., 1995; Segrin et al., 2005; Thompson & Walker, 1982). Over the last 10–15 years, however, we have seen a rapidly growing body of dyadic theories (Berg & Upchurch, 2007; Lyons & Lee, 2018; Pauly et al., 2021; Trivedi et al., 2016), more sophisticated dyadic methods (Garcia et al., 2015; Laurenceau & Bolger, 2005; Ledermann et al., 2011; Schonbrodt et al., 2018; Solomon et al., 2015), and ever-increasing numbers of dyadic interventions examined within the empirical literature and implemented (Buck et al., 2018; Martire et al., 2004; Shaffer et al., 2020).
Family nurses have been at the forefront of family health practice, research methods, and theory (Feetham, 2018). Their contributions stem from developing middle-range theories to providing a holistic nursing perspective on the family’s experience of health and illness and management of illness, salient ethical issues families face (Buck, Hupcey, et al., 2019; Coyne et al., 2020; J. A. Deatrick et al., 2018; K. A. Knafl et al., 2012; Mooney-Doyle & Ulrich, 2020; Östlund & Persson, 2014; Ryan & Sawin, 2009; Uveges et al., 2019), and methodological challenges (Gray, 2003; Horowitz et al., 2002).
Family nurse researchers view the family system, specifically the dyad in dyadic research, as the unit of care rather than focusing solely on the individual. A growing number of family nurse researchers are contributing to the field of dyadic science, though there remains room for family nurses to more fully engage with this emerging subspecialty. Training in dyadic research methods and theories continues to be a niche or elective specialization within family science, psychology, sociology, and nursing doctoral programs (Lyons et al., 2025; Reed et al., 2013). Thus, family nurse researchers interested in learning more or becoming experts in dyadic research may need to seek training and mentoring experiences at other schools within their universities or at external institutions, creating challenges related to cost, location, and access. Yet, family nurse researchers bring unique expertise that greatly benefits the field of dyadic research and the advancement toward optimizing dyadic health.
This paper serves as both a primer on key dyadic tools and resources and as a launching point for the integration of the diverse dyadic knowledge development within family nursing and related fields. The specific goals of this paper are to: (a) introduce key concepts, theories, and methods that constitute the field of dyadic science; (b) highlight dyadic research conducted by family nurse scholars; and (c) advocate for greater involvement of family nurse researchers in dyadic science to increase its impact in global health research and practice within and beyond family nursing.
Definition of Dyadic Research
Definitions of dyadic research are somewhat controversial, with some defining it as including two people in the research study regardless of whether the focus of the study is on the dyad, a dyadic process, or more individual experiences. In contrast, others characterize dyadic research as employing specific dyadic analyses, such as Actor–Partner Interdependence Models (APIM), common fate models, dyadic growth curve models, or (in)congruence models. Notably, even creators of some of these traditionally characterized-as-dyadic approaches have questioned whether they are truly capturing aspects of dyads as a unit of analysis or merely describing intertwined behaviors or experiences of individuals (particularly in the case of APIM; Kenny, 2018). There is growing consensus, however, that dyadic research should (a) include both members of the dyad, (b) include a focus on an interpersonal/dyadic process, (c) be driven by a theoretical framework that informs understanding of the interpersonal or interdependent process to be studied, and (d) use methods that support the understanding of the dyadic process (Irani, 2025; Wilson et al., 2024). It is sometimes helpful, however, to conceptualize dyadic research as existing on a spectrum. On one end of this spectrum would exist dyadic research that, at a minimum, includes or attends to both members of the dyad within a single study. On the other end of the spectrum would involve investigations that address all four of these elements and more comprehensively seek to understand the interdependent and reciprocal/transactional nature of health, health care management, and health care experiences within dyads (Lyons, 2021).
Of note, a dyadic approach to health and illness is not appropriate for all families or all cultures; not all families may frame health experiences as a dyadic process and not all family research questions have a dyadic answer (Brewster et al., 2020). Thus, dyadic research is not intended as a replacement for family or individual approaches. However, when a research question involves the interpersonal context of health and illness among two individuals, taking a dyadic approach that is informed by the theory and methods of dyadic research may be beneficial. Although dyadic research can be applied to other dyads such as patient-provider, the main focus of this paper is on dyads consisting of close, pre-existing interpersonal relationships between family members (e.g., couples, parent–child dyads, siblings) or friends.
International Family Nursing Association (IFNA) Family Nurses’ Contributions
To showcase the dyadic work of family nurse scientists, we describe the contributions of family nurses in the literature and of members of the IFNA, an organization instituted in 2009, whose vision is “Nurses transforming health for families worldwide” (IFNA, 2025a). IFNA connects family nurses globally and provides family nursing leadership in research, education, and practice (IFNA, 2025a). To gain insight into the scope and nature of dyadic research occurring among IFNA members, the interdisciplinary IFNA Dyadic Research Subcommittee conducted a survey in 2020 to assess the engagement of members in dyadic science and common theories, methods, and areas of focus. The survey findings were presented at the International Family Nursing Conference in June 2021 (Lyons, Abbott-Anderson, et al., 2021) and supplemented by online searches of other dyadic studies conducted by family nurse scientists. The evidence was selected based on a focus on the dyad and the inclusion of dyadic methods within the studies.
Of the 115 IFNA members that responded to the survey, 54% reported some level of engagement in dyadic science (i.e., including two participants as the subject of research, examining a dyadic interaction or process, or employing dyadic methods) across 15 countries (Australia, Brazil, Canada, Denmark, Japan, Hong Kong, Ireland, Israel, Norway, Portugal, Switzerland, Tasmania, Thailand, the United Kingdom, the United States). Just over half of these researchers (53%) focused on pediatric populations (i.e., parent–child or sibling relationships) rather than on adult-only dyads (i.e., marital/romantic couples or adult care partners and patients). Studies encompassed numerous different health and illness contexts. A variety of qualitative, quantitative, and mixed methods were used, but few studies employed dyadic analyses. The majority of studies were guided by family or individual theories, for example, the Individual Family and Self-Management Theory (IFSMT; Ryan & Sawin, 2009), Family Illness Beliefs (Wright & Bell, 2009), Calgary Model (Wright & Leahey, 1994), Family Management Style Framework (FMSF; K. A. Knafl et al., 2021), Family Systems Theory (Cox & Paley, 1997), and Orem’s Self-Care Model (Orem, 2001). Less than a handful were guided by a dyadic theory (i.e., Systemic Transactional Model [STM], Interdependence Theory, Theory of Dyadic Illness Management; Bodenmann, 1995, 1997; Lyons & Lee, 2018; Thibaut & Kelley, 1959).
Family Nursing Research and Theories
Globally, the focus in health and in nursing practice is shifting from individualized care to family-focused care (Moons et al., 2020). Evidence suggests that family-based interventions and research have higher effectiveness than individual interventions (Chesla, 2010; Coyne et al., 2020; Luttik, 2020; Martire et al., 2004; Moons et al., 2020). Nevertheless, capturing the complexity of families in family nursing practice and research is a challenge for most researchers (Russell, 2020). One of the approaches to address this complexity is utilizing family theories (Ganong, 2011; Whyte & Whyte, 1997).
Family theories provide an understanding of the family structure, function, and dynamic, as well as the influence of the context that surrounds them on these elements, and then serve as a conceptual framework and guidance for researchers interested in familial and interpersonal relationships (Kaakinen et al., 2018; Moons et al., 2020). The importance of family theories in the field of family nursing science—a science that focuses on generating knowledge about nursing care of a family with their own values, beliefs, knowledge and experiences in the context of health, illness and wellbeing—is well documented in the literature (Kaakinen et al., 2018). Examples of family nursing theories included on the IFNA website include practice models such as the Wright and Leahey’s Calgary Family Assessment Model (CFAM) and Calgary Family Intervention Model (CFIM), the Family Empowerment Nursing Model, the Concentric Sphere Family Environment Model, the Family Health Model, Family Health Conversations (FamHC0), the Framework of Systemic Organization and the Friedman Family Assessment Model, the Family Life Skill Index, the Illness Beliefs Model, the McGill Model of Nursing, the Dynamic Model of Family Assessment and Intervention (MDAIF), Strengths-Based Nursing (SBN), the Watanabe & Suzuki Family Assessment Model, and the Trinity Model (IFNA, 2025b). Furthermore, examples of theories that guide family health research, such as the Theory of Family Health (Eustace, 2022) based on Neuman’s (1996) Systems Model, highlight areas of inquiry into multilevel influences on the family as a unit when dealing with chronic health conditions. Roger’s Theory of Unitary Human Beings (Rogers, 1989; Sanchez, 1989) and King’s Goal Attainment Theory (Alligood, 2010) are examples of nursing theories and models that have been used in family nursing practice and research focusing on the interactions within familial dyads as well as within the nurse (provider) and family unit.
Dyadic Theories
Dyadic research that centers on familial relationships is in many ways a special type of family research, with its own theories, concepts, and methods. Specific dyadic theories and frameworks originally emerged in couple and family research, where the concept of interdependence between two family members (e.g., siblings, intimate partners) was the focus. For example, Interdependence Theory (Thibaut & Kelley, 1959), a widely used social behavioral theory that describes how two people in a close relationship influence one another and their relationship, is foundational to much of the dyadic research conducted today. Similarly, the STM theorizes how the couple appraises and copes with stress together (i.e., dyadic coping; Bodenmann, 1995, 1997) and was followed by several equally influential dyadic theories that addressed the concept of dyadic coping within couples (i.e., strategies employed by the couple to cope with stress together, most notably, open communication, shared problem-solving and supporting the person with illness; Regan et al., 2015; Traa et al., 2015), including the Developmental-Contextual Model of Couples Coping with Chronic Illness Across the Lifespan (Berg & Upchurch, 2007).
Over the past decade, as the field of dyadic science has grown and greater attention has been placed on understanding health and health behaviors within dyads, an increasing number of dyadic theories and frameworks have been developed. Examples include the Dyadic Health Behavior Change Model (Trivedi et al., 2016), the Relational Turbulence Model (Solomon, 2016), the Theory of Dyadic Illness Management (Lyons & Lee, 2018), the Developmental-Contextual Model of Couple Synchrony (Pauly et al., 2021), the Dyadic Disruption Theory (Cornelius, 2021), and the Dyadic Health Influence Model (Huelsnitz et al., 2022). At their core, dyadic theories examine the interdependence within dyads and the interactional and reciprocal influences on health or behavior. Although many dyadic theories consider individual characteristics of the dyad members, they often center on interpersonal processes such as support, collaboration, communication, shared appraisals, shared goals, interdependence, and in some cases, relational outcomes (e.g., relationship functioning).
Family nursing dyadic theories have also been used to understand the influence of interpersonal relationships on clinical, familial, and individual outcomes, with emphasis on the role of shared family experiences and perspectives on relational processes and health outcomes. Several examples of dyadic theories were identified in the work of IFNA members and other family nurse researchers in the literature. One example is the well-known dyadic theory of the FMSF (K. A. Knafl et al., 1996, 2021). The FMSF is a middle-range theory that has been utilized to study shared appraisal typologies of weight management strategies in mother–adolescent dyads (Roberts et al., 2022), parental congruence (i.e., how much mothers and fathers agree) with a child with a brain tumor (D. A. Deatrick et al., 2021), and informational management among children with genetic conditions (Gallo et al., 2009). The FMSF has been instrumental in delineating how shared perspectives influence individual and family responses, family systems outcomes, and disease prevention and management within the child or adult interpersonal contexts (K. A. Knafl et al., 2013). Another example is the Interdependence Theory found in the work of Shamali et al. (2019), who studied family functioning in 312 Danish care dyads where one member had heart failure. Guided by Interdependence Theory, they examined the association of perceptions of support with perceptions of family functioning within the care dyads and found that when family care partners rated support from nurses higher, the person with heart failure reported significantly better family functioning (controlling for their own perceptions of support – known as a partner effect). Similarly, Winter and Moriarty (2017) studied 83 U.S. veterans and their family care partners guided by the theory of communal relationships (Clark & Mills, 2012). Although analyzed in separate regressions, their results found important evidence of the influences within care dyads, namely the association of one member’s perceptions of the relationship on the other member and the role of the veteran’s interpersonal competence on how the family member rated their overall relationship with the veteran.
Dyadic Methods
By the 1980s, efforts to statistically model dyadic processes (as distinct from individual processes) began to emerge predominantly among researchers studying siblings and those studying intimate couples (Kenny, 2018; Thompson & Walker, 1982). Over the past 40 years, the prevalence and sophistication of dyadic methods and analyses have grown substantially (Kenny, 2018; Ledermann & Kenny, 2017; Lee et al., 2021). Early analyses often examined dyads by either averaging variables reported by both dyad members, treating discrepancies across dyad members as errors in measurement, or typologizing dyads through cluster or pattern analyses and examining between-group differences (e.g., Mandara, 2003; Thompson & Walker, 1982). Today, these methods have been further refined, and researchers have developed several sophisticated qualitative and quantitative approaches (generally based in multilevel modeling [MLM], structural equation modeling [SEM], or machine learning frameworks; Ledermann & Kenny, 2017) to examine various aspects of dyadic relationships (e.g., interdependence, [in]congruence, mutuality, collaboration) and the progression and interplay of dyadic processes over time (Lyons & Lee, 2020a; Vogl et al., 2019). Below, we provide some brief introductions to a broad selection of these dyadic methods and analyses, as well as exemplars from recent research conducted by family nurse scientists. Details (and further reading) for several common quantitative and qualitative dyadic approaches to data analysis can be found in Table 1.
Suggested Resources for Further Reading on Dyadic Analysis.
Qualitative Dyadic Approaches
Variation exists in qualitative and observational approaches to examining and analyzing dyad-level interactions and concepts. Family nurses have long recognized that intimate partners may possess differing perspectives of the same health care experiences. Dyadic science, however, has helped reveal that how couples jointly appraise, interpret, discuss, and experience their health care journeys holds utility and can provide novel clinical and empirical insights (Francis et al., 2022; Racher et al., 2000; Winter, Moriarty, Piersol, et al., 2016; Winter, Moriarty, Robinson, & Newhart, 2016).
When designing and performing qualitative research involving dyads, it is important to consider the primary research objective and contemplate how participant responses may be shaped by the context in which the interviews are being conducted. For example, participants may alter their responses based on whether they are being interviewed alone or in tandem with the other member of the dyad. Not only is the participant response of potential value in answering the research question but examining the mechanics of influence that exist when the members of the dyad are interviewed together or apart may be of equal or greater value to addressing the primary question being studied. Often different information is gathered from interviews conducted separately, conjointly, or both in variable sequential orders (Racher et al., 2000; Reczek, 2014). In addition, family communication and health scholars have developed a variety of detailed forms of analysis for examining dialogues within couples and attending to the unique challenges of dyadic interviews and observations (Bai et al., 2018; Manning & Kunkel, 2015).
Family nursing scientists have used qualitative interviews to explore the experience of couples with illness. For example, Francis and colleagues explored the experiences of advanced cancer survivors and their intimate partners when communicating about emotionally vulnerable content (e.g., illness appraisals, goals and preferences for care, thoughts about death and dying; Francis et al., 2022). The researchers chose to perform interviews first with both members of the dyad to build rapport before proceeding with individual interviews that explored more sensitive content. This approach also allowed the interviewer to attend to differences in verbal and non-verbal behavior between both modes of interview, which informed the interpretation of findings. Nurse researcher Solomon conducted qualitative interviews of mother–daughter dyads at the end of life and also described an approach to the dyadic analysis of the data (Solomon et al., 2018). A wide range of observational coding systems have been developed for both parent–child and couple dynamics in everyday, stressful, and health care-related contexts (Bai et al., 2018; Kerig & Baucom, 2004). Increasingly similar systems are being developed, standardized, and validated for broader sets of dyadic relationships, such as siblings (Merino & Martínez-Pampliega, 2022) and care partner-patient dyads (Kim et al., 2023). Observational coding can often lend itself to accessing both individual and dyadic-level constructs; ensuring the reliability and validity of observations often requires detailed scoring and coding manuals, with some organizations offering (or requiring) opportunities for training workshops to ensure proper implementation. Some specific nursing-related examples for mother–infant dynamics include the AMBIANCE-brief for assessing disrupted caregiving (Cooke et al., 2020) and the NCAST assessment of mother–child interactions (Horowitz et al., 2005). Furthermore, data management techniques such as family care summaries and computer-generated matrices have been proposed as analytical methods to manage large qualitative data sets in family research (K. A. Knafl & Ayres, 1996).
Quantitative Dyadic Approaches
Contemporary quantitative approaches to analyzing dyadic data are frequently grounded in multilevel modeling, structural equation modeling, and machine learning processes that seek to account for or explicitly examine shared variance and higher-order processes that exist at the level of the dyad as a unit of analysis (Ledermann & Kenny, 2017; Zhao et al., 2022). For example, linear mixed modeling that accounts for intrafamilial correlations has been used for analyzing family dyads (G. J. Knafl et al., 2009). With the increasing popularity of such models, several common statistical research software programs (e.g., SPSS, SAS, STATA, R) have begun to incorporate ways to implement such models, though more specialized software also exists (e.g., Mplus, HLM). Notably, David Kenny has used the freely available (and highly adaptive) R program to create a variety of online tools for automatically restructuring dyadic data and implementing several common dyadic models (see https://davidakenny.net/DyadR/DyadRweb.htm). Moreover, Zhao et al. (2022), in a recent review, provided many practical details and example diagrams of the application of such dyadic methods in nursing research broadly.
Actor–Partner Interdependence Models
APIMs have been widely adopted as a common approach to evaluate data collected from dyadic pairs (Kenny, 2018). The main contribution of these models (and additional extensions such as incorporating longitudinal processes, or mediation/moderation) are their ability to demonstrate how both an individual (actor effects) and their dyadic partners (partner effects) perceptions, behaviors, or experiences are associated with one another (and demonstrate relational interdependence), while simultaneously statistically accounting for shared variance in predictors and outcomes. However, APIMs sometimes receive criticism for focusing on individual outcomes (albeit interdependent) rather than a dyadic outcome, with Kenny himself raising some hesitancy about the APIM dominating dyadic science (Kenny, 2018). However, Kenny has also argued that the insight represented by the patterns of associations within APIMs can help demonstrate or assist in identifying dyadic processes (or the lack thereof) and are thus an important tool to address many dyadic research questions (Kenny, 2018). APIMs have been used by many family nurse researchers (e.g., Shamali et al., 2019; Vellone et al., 2014).
Common Fate Models
Common fate models use latent variables to model theoretical dyadic concepts constructed from individual reports, thus creating variables more clearly representative of dyadic processes or dynamics (Ledermann & Kenny, 2012). Recently, relational scholars have begun to extend such models into APIM-Hybrid approaches to demonstrate the interplay of both individual and dyadic-level constructs (Ledermann & Kenny, 2012). Donarelli et al. (2019) provide an example of how such models can be utilized in health care contexts. In their study, the authors examined dyadic changes in quality of life, attitudes about parenthood, and marital satisfaction among couples struggling with infertility and utilizing assistive reproductive technology interventions, as well as the extent to which accessing counseling through this process was beneficial to partners both individually and jointly. Their findings thus provided a more robust and sophisticated understanding of both individual and interpersonal impacts of infertility experiences and counseling interventions.
Dyadic Growth Curve Models
Dyadic Growth Curve Models use data collected longitudinally from dyads to examine the pace and direction of changes in dyadic processes over time through the modeling of latent slope and intercept variables. This has most frequently been implemented in nursing research in a manner similar to APIMs, using distinguishable dyads (e.g., husbands/wives, care partner dyads) to model interdependent growth and adjustment (Zhao et al., 2022), such as in investigations of how patients and partners perceive and cope with cancer or chronic illness diagnoses (Badr et al., 2010; Berg & Upchurch, 2007). Ledermann and Macho (2014), however, have also provided demonstrations for the possibility and utility of examining common fate growth models. Such models may also hold promise for use in health care settings and contexts. For example, Canário and Figueiredo (2017) examined how trajectories of anxiety and depression symptoms of women and men changed and were interdependent over the transition to parenthood (e.g., during pregnancy and up to 3 months after the birth of both first children and later children).
Incongruence and Congruence Models
Dyadic models can also be parameterized to examine second-order dyadic variables such as in(congruence) (Lyons & Lee, 2020b; Thompson & Walker, 1982). Data from both members of the dyad are used to create new information at the level of the dyad, for example, incongruent appraisals about the patient’s symptoms or differences in care values within the dyad. Questions can focus on the magnitude of the incongruence (i.e., how large the gap is between the reports of each member of the dyad), direction of the incongruence (i.e., which member of the dyad scores higher on the concept), and the average level of the concept within the dyad. Models can be used to predict incongruence within the dyad over time and the role of incongruence on future dyadic or individual outcomes (Lyons & Lee, 2020a). For example, Polenick et al. (2021) found discordant health conditions to be associated with depressive symptoms 2 years later for husbands, but not wives. Lyons et al. (2018) found incongruence in confidence to be associated with engagement in self-care behaviors in care dyads living with heart failure and symptom incongruence over time to be associated with quality of life of the care dyad (Lyons & Lee, 2020a). Nurse researcher Miller et al. (2022) found that incongruence in physical health within older couples is associated with mental health. An alternative, emerging statistical approach to in(congruence) involves response surface analysis (van Scheppingen et al., 2019). Finally, second-order dyadic variables such as incongruence can also be examined using qualitative data. For example, a team of nurse researchers examined incongruence within heart failure care dyads regarding illness management, end-of-life decisions, and health care issues (Kitko et al., 2015).
Cluster Analyses and Finite Mixture Models
Finally, cluster analyses and finite mixture models (e.g., latent-class, -profile, and -transition analyses) seek to identify patterns or typologies of dyads and examine correlates, antecedents, or consequences of group membership (Asparouhov & Muthén, 2014; Dunn et al., 2018). Unlike variable-centered approaches that more frequently examine average associations among constructs, these person-centered (or dyad/family-centered) approaches can help identify variability within populations and better capture diversity within populations (van Der Gaag, 2023). As an example of this in a nursing context, Wiegelmann et al. (2021) used latent class analyses to identify variable patterns of dementia care dyads and how characteristics of those variable dyads were associated with differences in health care service use, caregiver burden, and the quality of life of patients. In another example, K. A. Knafl et al. (2013) conducted cluster analyses to identify patterns of parents’ and children’s family management practices within the context of caregiving for children with a chronic illness and examined how those patterns were associated with both parent and child functioning.
With increasing numbers of publications, workshops, and online (and often freely available) resources, the opportunities to familiarize oneself with the many dyadic methods available is increasing exponentially (see Table 1 for a list of further recommended references). We have outlined here both some common and some cutting-edge methods, though more continue to be developed. Although this is exciting and needed for the advancement of dyadic science and building capacity across disciplines and globally, what is most important for family nurse researchers to keep in mind is to match the research question with the methods and acknowledge that not all questions have a dyadic answer.
Dyadic Interventions
Over the last decade, an increasing number of interventions have been targeted at care dyads and couples (Bakas et al., 2017; Buck et al., 2018; Shaffer et al., 2020), focusing on health behaviors (e.g., physical activity), illness management, health, and relational outcomes (Badr et al., 2019; Gorman et al., 2022; Hornbuckle et al., 2021; Lyons, Zajack, et al., 2021; McCarthy et al., 2020; Orsulic-Jeras et al., 2019; Reese et al., 2020; Sorkin et al., 2014; Trivedi et al., 2016; Winters-Stone et al., 2016). Family nurse researchers and their interdisciplinary teams have also contributed to the growing field of dyadic interventions. Tryphonopoulos and Letourneau (2020) tested a video-feedback intervention to improve mother–infant interactions and cortisol patterns in mothers with postpartum depression and their infants. The intervention group showed significant improvement in mother–infant interactions, particularly maternal responsiveness, and a significant decline in infant diurnal cortisol. Similarly, Anis et al. (2020) developed a parent training program for mothers and children in at-risk family situations such as poverty, addiction, and violence. The program focused on the mothers’ reflective function to regulate feelings and behaviors toward their child. Results showed significant improvements in mother–child interactions in the intervention group. In a randomized controlled trial, Moriarty et al. (2016) evaluated the effect of the Veterans’ In-Home Program (VIP), an in-home rehabilitation intervention targeted to the dyad (the veteran with traumatic brain injury (TBI) and a family member). Veterans in the VIP group showed significantly higher community reintegration and greater ability to manage self-identified TBI-related problems than the control group that received usual clinic care and two phone calls (Winter, Moriarty, Robinson, Piersol, et al., 2016). Family members in the VIP showed significantly lower depressive symptoms and lower caregiver burden, compared to family members in the control condition (Moriarty et al., 2016).
Discussion
The dyadic perspective discussed in this paper is instrumental in understanding intimate interpersonal influences on health and health behaviors, and thus an important type of family research. Although the 2020 survey data of IFNA members reported some level of dyadic research (most with pediatric populations), it also revealed only limited applications of dyadic theory or dyadic analyses. These findings suggest there are numerous opportunities for additional investigation of the interpersonal and interdependent context of health in family nursing research (Wilson et al., 2024). The findings also shed light on several methodological issues in conducting dyadic research.
For instance, given ongoing controversies around the definition of dyadic research and the variability around what elements are included in this research, family nurses conducting dyadic research should explicitly describe the elements in their studies that reflect a dyadic conceptualization: inclusion of both members of the dyad, a focus on a dyadic process, the dyadic theoretical model informing the investigation, and the methods that have been utilized to examine and understand dyadic dynamics (Wilson et al., 2024). Such explicit descriptions will provide clarity around the continuum of dyadic research and the optimal elements in it, thereby advancing dyadic science and methodology. Furthermore, family nurse scientists, whether conducting dyadic research or other types of family research, are encouraged to address the key criteria for research of families that were identified in Feetham’s early seminal work (Feetham, 1984) and later work (Feetham, 2018).
A strength of dyadic research is that it may focus on diverse dyadic relationships, such as couples, siblings, parent–child, and other relationships, such as best friends. Family nurses should be deliberate and thoughtful about which dyads they attend to in future work and consider strategies for effective recruitment. Some studies recruit dyads by asking one participant to identify who is most significant to them and actively involved in their life and/or management of a specific condition. No matter the particular dyad of interest, a description and rationale for the selection process for dyads are essential in a research report. Furthermore, building relationships with partner organizations, community members, and both members of dyads is often critical to both recruitment and retention in dyadic health care research (Whitlach et al., 2019).
In this paper, an overview of varied qualitative and quantitative analytic methods was presented. There is no one analytic method that suits every study. A rationale for the specific method chosen, along with its strengths and limitations, would enhance reports of dyadic studies as well as advance the rigor of dyadic science. Compared to research involving only one individual, dyadic research is more complex given the recruitment and scheduling challenges, increased resources needed for data collection, potential for missing data, and decisions needed around sophisticated data analytic methods (Wilson et al., 2024). Multidisciplinary teams, whether led by family nurse researchers or other disciplines, are optimally equipped to address this complexity and to uncover the biopsychosocial spiritual mechanisms of dyadic processes related to the health and wellbeing of each member and the dyad as a whole (Wilson et al., 2024).
Implications for Nursing Practice and Research
With the increasing number of dyadic theories addressing health conditions, family nurse scientists are well positioned to test these theories in many health care settings—inpatient, outpatient, home, and other community settings. Of note, nurses in all settings, particularly those in inpatient settings with 24/7 care, interact more with patients and their families than any other discipline, and thus dyadic research has much potential to be translated into nursing practice, with the goal to ultimately support the health of dyads and families.
Across the globe, the burden of chronic illness is high as approximately one in three of all adults experience multiple chronic conditions (Hajat & Stein, 2018). Family nurses and nurse scientists often work with families of adults and children with chronic illness, thus affording opportunities to illuminate dyadic processes over the illness trajectory. This work has the potential to inform targeted interventions that support dyads over specific times and transitions over the course of illness. This is particularly important given the growing number of family members who provide care, and often complex care, for family members with chronic conditions and for the increasing number of older adults with multiple co-morbidities (American Association of Retired Persons [AARP] & National Alliance for Caregiving, 2025; Jika et al., 2021; National Academies of Sciences, Engineering, and Medicine, 2016).
Although this paper highlighted the work of IFNA members and other family nurse researchers, there are many other nurses engaged in dyad research globally, whose work was not included. A comprehensive critique and synthesis of all studies published by family nurse researchers pertaining to dyadic health research was beyond the scope of this paper but would be a worthwhile review that contributes to our understanding of the state of the science. Such an article would also be invaluable in identifying gaps in knowledge and future directions for family nurse scientists.
This paper aimed to stimulate continued international dialogue around the role of family nursing research within the dyadic health science field, and it highlighted many contributions of family nurse researchers to the field. Research training programs that further develop expertise within family nursing and other disciplines are needed to strengthen the capacity to conduct dyadic health research from an interdisciplinary perspective. The need is obvious and timely given the ongoing interest among funding agencies (e.g., U.S. National Institutes of Health, Australian Commission on Safety and Quality of Health Care), academic journals, clinical providers, and researchers across multiple disciplines (Buck, Bekelman, et al., 2019; Hornbuckle et al., 2021; Hwang, 2020; Wilson et al., 2024; Wilson et al., 2020). For example, in 2021, the U.S. National Institutes of Health issued funding calls for research specifically focused on the influences of dyadic processes and interdependence on health outcomes for dyads across the lifespan.
Conclusion
The operationalization of how to deliver family-centered care is challenging. A research focus on dyads within the family and how dyadic processes contribute to dyadic and individual health outcomes is essential to the provision of family-centered care and is, therefore, of great relevance to family nursing. It is our hope that this paper provides context and resources for greater numbers of family nurse researchers to engage in dyadic health science to inform their research and practice, but also to contribute their unique and vital expertise into this fast-growing interdisciplinary field of research.
Footnotes
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The authors received no financial support for the research, authorship, and/or publication of this article.
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