A systems theory perspective to understanding marital physical activity.
Abstract: The purpose of this study was to qualitatively examine how cultural, occupational, and familial systems impact physical activity within marriage as well as how the marital system itself affects activity. Employing principles derived from Bertalanffy's Systems Theory, we utilized interviews and photo-elicitation to guide our study of twelve spousal pairs. Findings highlighted cultural expectations to be the primary caregiver as negatively impacting wives while occupational pressures negatively influenced both spouses. This study demonstrated the utility of General Systems Theory to advance our understanding of spousal physical activity and underscored the need for health professionals to consider system influences.
Subject: Marriage
Authors: Michel, Kacy L.
Goodson, Patricia
Pruitt, B.E.
Pub Date: 06/22/2012
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Summer, 2012 Source Volume: 27 Source Issue: 3
Accession Number: 308741523
Full Text: INTRODUCTION

Famous French film actress, Simone Signoret, once remarked, "Chains do not hold a marriage together. It is threads, hundreds of tiny threads, which sew people together." Married couples share a multitude of "threads" such as core values and common life goals, even children for some. It is these threads which serve to unite a couple into a common unit, to "sew" them together. While each partner is an independent person, the marital context uniquely binds two people together, forming an integrated intangible structure, a system.

Psychologists Cox and Paley (1997) support this idea of a marriage being "its own system" and "like any system is dynamic, open to constant revision, and constantly influenced by and influencing other systems" (p. 257). Thus, not only do "tiny threads" sew each marital partner together, but the other structures (i.e. systems) surrounding the pair also connect to the couple. For example, the larger cultural context surrounding a pair may greatly influence everything from what a couple buys for dinner to what television programs they watch to how often they see their extended families. However, unlike the immovable "chains" referenced in the Signoret quote, the threads tying the couple together as a type of system and the threads connecting the couple to the surrounding environmental, organizational, and cultural systems are flexible and constantly forming new connections.

Research indicates one such "thread" connecting the marital unit is physical activity behavior. For example, Falba and Sindelar (2008) used data drawn from the Health and Retirement Study to examine older married couples' influence on each other's health behavior, including physical activity. These researchers documented a health intervention 'spillover effect' (p. 112): when one spouse changed a poor health behavior, this caused a spillover effect in the other. This spillover also served to unite the couples in changing their physical activity habits. At the conclusion of the article, Falba and Sindelar recommended future health education interventions that aim to increase couples' physical activity should provide explicit details of how to assist an individual's spouse in changing his or her health behavior in order for the couple as a whole to be healthier. The researchers emphatically stated, "Although studies have analyzed spousal influence, they have typically evaluated the behavioral change of one spouse and taken the other spouse's behavior as fixed" (p. 96).

In another setting, Homish and Leonard (2008) conducted a longitudinal study in which 634 couples assessed the impact of one partner's health behavior on the other. Scholars in that study found a significant association between wives' and husbands' exercise habits through the first four years of marriage as well as a statistically significant association between husbands' premarital exercise and wives' exercise habits over time. Homish and Leonard suggested, "Understanding how partners influence one another's health behavior is important for health promotion and intervention efforts" (p. 754).

According to these previous studies, partners connect to each other in important ways regarding physical activity. Research also supports the idea that marital systems are threaded to and influenced by the other systems surrounding the marital dyad. Juarbe et al. (2003) conducted a qualitative study with married female Mexican immigrants and highlighted the impact the cultural system had on the sample. Scholars in that study found women associated physical activity with promiscuity, an image incongruent with the cultural expectations of motherhood. Juarbe et al. also identified women's expectation to be the primary caretaker for their husbands and children as another cultural barrier to physical activity.

Along with the cultural system, the occupational system is joined to and exerts influence on the physical activity habits of married individuals. Pettee et al. (2006) conducted a survey with 345 spousal pairs and found married men with higher-paying jobs were more active than men with lower-paying jobs. Authors stated one reason for this disparity could be less access to exercise equipment and facilities. Similarly, Chun & Chelsa (2004) conducted a study with twenty-four married diabetic patients and concluded individuals with jobs involving heavy labor were less likely to engage in formal exercise/physical activity than those working in sedentary jobs.

STATEMENT OF PURPOSE

While the physical activity habits of married individuals may be impacted by the marital system itself and other broader systems, many studies focusing on marriage and physical activity habits are quantitative in nature (Hong et al., 2005; Jenson et al., 2003; Juarbe et al., 2003; Jurj et al., 2006). Quantitative studies, however, do not ask open-ended questions. For example, how do the other systems "threaded" to a marital dyad influence physical activity? What do spouses say or do that impacts behavior within the marital system? What raises or lowers physical activity levels in a marriage? How tightly sewn are these threads that bind these systems together? We wanted to explore these concepts, and therefore we chose a qualitative design. Due to the need for more research in this area, the purpose of this article was to answer the following questions: How does the marital system influence the physical activity habits of each partner? How do the other systems containing the marital union (i.e. cultural, occupational, and familial) influence the physical activity behavior of spouses?

THEORETICAL FRAMEWORK

Given the "threads" connecting a couple to one another, as well as the "threads" connecting a couple to the larger familial, cultural, and occupational systems, it is important not only to focus exclusively on the small parts comprising the various systems, but also consider systems on a broader, more holistic level. To this end, we utilized Bertalanffy's General Systems Theory (GST) to guide this study.

Ludwig von Bertalanffy published his seminal work on GST in 1967. He theorized each individual person is a system living and working within other systems (i.e. the family system, social system, governmental system). For Bertalanffy, to understand any system, one has to look beyond the parts or elements which make up the system. Just as a symphony's collective 'voice' is greater than the individual instruments, so too a system is not simply a multitude of isolated parts tied together, but a new entity entirely.

While Bertalanffy's theory was first applied to biology, the theory has also been used in various other academic fields. For the purpose of this project, we chose McGarry's Family System principles to help ground the theory in this particular context. McGarry (2002) offers four principles derived from Bertalanffy's theory which guided our understanding of the family (or couple) as a system: (a) The Wholeness Principle, (b) The Principle of Levels of Organization, (c) The Principle of Interdependence, and (d) Requisite Variety. The Wholeness Principle states a whole is greater than the sum of its parts. As argued earlier, a marriage isn't just two people living separately, but in tandem; a marriage is a new system which is greater than each individual person. The Levels of Organization Principle encourages the study of a system from higher, holistic levels rather than only examining lower levels such as the individuals composing a system. The Principle of Interdependence works with the notion that no part of a system is independent. This is similar to Cox and Paley's (1997) assertion: "Individual family members are necessarily interdependent, exerting continuous and reciprocal influence on one another" (p. 246). Lastly, Requisite Variety states a system has to be flexible and diverse in order to sustain itself and adapt with environmental changes.

While systems theory doesn't have a consistent language or set of core constructs (Best, Moor, Holmes, & Clark, 2003), thus making operationalization difficult, McGarry's principles are useful for describing and interpreting how the marital system impacts spousal physical activity. For example, if a study participant relies on her husband to watch their newborn son while she swims on a Saturday morning, the Principle of Interdependence gives clues as to how the marital system accommodates physical activity. According to Prest and Protinsky (1993), "Each member of a system exists as an individual, but is integrally connected with the other members of his or her family" (p. 76). A concept map of systems theory in the context of a marriage is presented in Appendix A.

METHODS

SAMPLING

To gain research participants, we employed network purposive sampling. Our criteria were threefold. First, each couple must have been in a heterosexual marriage married. We chose this parameter due to empirical data from a 2004 Centers for Disease Control and Prevention survey highlighting the differing health outcomes of married versus cohabitating as well as heterosexual versus homosexual couples. Second, we chose to interview both partners (male and female) because Fernandez-Ballesteros et al. (2002) indicated there is most likely a gender and age difference regarding physical activity behavior. Third, we included only individuals living in the United States due to limitations in study feasibility.

In order for the sample to be similar in racial makeup to Texas, U. S. Census data guided the purposive sampling. According to the 2010 Census, 70.4 % of Texans are white, 37 % are Hispanic, 11.8% are Black or African American, and 3.8 % are Asian (United States Census, 2010). Thus, we strove to maintain these ratios in our sample.

PROCEDURES

To answer research objectives, we employed a basic qualitative research design using the qualitative techniques of interviewing and photo elicitation. Prior to each interview, we sent photo elicitation instructions to each participant describing the procedures for taking two or three pictures of how his or her marriage may impact exercise or physical activity behavior. We then began each interview asking participants why they chose each photograph. We coded the photos in the same manner as the remainder of the interview.

Next, we conducted hour-long semi-structured interviews in each couple's home or apartment using an interview protocol. In order to reduce spousal bias, couples were interviewed separately. During the interview, we also collected data utilizing field and observational notes.

While interviewing is a well-documented qualitative method (Lincoln & Guba, 1985), photo elicitation is a relatively under-utilized research technique. Collier introduced photo elicitation in 1967 to give an intimate account of family culture (p. 51) and to describe lived experiences (Clark-Ibanez, 2004). Distinct from Wang's photo-voice technique (Wang & Burris, 1994), photo elicitation is meant to elicit deeper responses than mere words alone, not "give voice" to individuals for the purpose of social justice. Harper (2002) stated three ways photo elicitation contribute to the understanding of participants' lives: (a) photographs are visual inventories of objects, people, and environments, (b) photos depict events that are part of collective or institutional paths (i.e. schools, work places), and (c) photos are intimate dimensions of the social. Harper argued that photo elicitation "produces a different kind of information" (p. 13, emphasis ours).

DATA ANALYSIS

After transcribing the audio version of interviews verbatim, we utilized the constant comparative method to guide the data analysis (Glaser & Strauss, 1967). We first engaged in a round of open coding to glean potential themes. Next, we conducted a round of axial coding keeping in mind study objectives and the theoretical framework. Axial coding helped create abstractions from the data to ensure that themes were reflexive and interpretive. Finally, we enhanced the credibility of our themes and subthemes using trustworthy documents such as peer debriefing memos, reflective journals, audit trails, and verbatim interview transcripts. According to Erlandson et al., these documents ensured the confirmability, dependability, credibility and transferability of research findings (1993).

FINDINGS

The pictures, words, and ideas from twenty-four diverse individuals (twelve couples) comprised the research data. Couples varied in number of children, ethnicity, background, education, and marital length. We concluded sampling after reaching saturation with one-hundred-fifty pages of interview transcripts and forty-five photographs. Participant data are presented in Table 1.

We presented the main themes and subthemes from our data in vivo (Latin for "within the living") because we felt the comments by participants powerfully encompassed each theme. We organized these themes or categories according to the theoretical framework and McGarry's four systems theory principles: 1) Wholeness Principle (the whole is greater than the sum of its parts), 2) Levels of Organization (nesting of systems within other systems), 3) Interdependence (no part of a system is independent), and 4) Requisite Variety (a system adapts to environmental changes). The themes are presented in Table 2.

"IT ALL COMES FULL CIRCLE"

The first main theme encompassed the idea that the marital systems in this sample are nested within and influenced by larger familial systems such as a couples' extended family (especially the parents of participants). How a participant was raised and the example their parents set both individually and collectively mattered.

Interestingly, many couples with children reported the desire to be a positive influence on them (or future children). Thus, the image of concentric circles beginning with the children of participants, extending to participants, and then expanding to include the larger familial system (parents of participants) captured the first theme: "It all comes full circle."

Three wives and six husbands reported mimicking their own parents' habits. Nicolas related how his father was a professional baseball player, so he himself is active because he was exposed to this model during his youth. Derrick said his father was a professional athlete, and he grew up always throwing footballs and baseballs with his dad. Jude recounted that his father was a "big time weight lifter who was constantly active" and so as an adult he is "just like [his] father."

If both parents of both marital partners in this sample were active, those couples tended to both enjoy and regularly participate in joint activity. Eric remembered both his parents were constantly active and especially "loved dancing together. the salsa, merengue, other Latin dances." His wife, Angel, remarked, "My parents were always pretty active. We grew up thinking exercise was just part of everyday life." Eric and his wife both reported moderate to high activity levels as adult married individuals. Similarly, Jude and Claire said they grew up in active families in which both parents exercised. Therefore, the couple regularly participated in physical activity.

Participants also tended to mimic low parental activity. Molly stated, "My mom wasn't active at all. My mom was sedentary like me." Shannon recounted, "My mom didn't really exercise when we were growing up. We think she is like me." Four women and one man reported similar modeling behavior. Clearly, the parents of the married individuals in this sample greatly influenced both individual and couple physical activity habits.

While the extended family demonstrated great influence on these spouses, participants (especially fathers) voiced a desire to positively impact the physical activity of their children. Nicolas passionately described "wanting to be a good role model" for his son and "wanting to show him how important it is to be healthy." Nicolas said it was one of the biggest priorities for him as a father. Likewise, Jacob said, "We are doing our girls a service to stay healthy. We do want to teach them that." James echoed other fathers by saying, "It is important for a family to be healthy. I want to model that to our son."

The first main theme related to wholeness in that the extended family of a couple (i.e. parents) impacted spousal physical activity. Additionally, the marital systems in this sample exerted influence on their smaller, nuclear family system (i.e. a couple and their children).

"OUR CULTURE HAS CERTAIN EXPECTATIONS"

The second main theme gleaned from participant data related to the larger cultural system. Spouses recounted numerous examples of cultural expectations, obligations, and influences that impact physical activity habits. Keeping with the second GST principle, Levels of Organization, each marital dyad was nested within greater levels of organization. Similar to the concentric circles of a bulls' eye, couples were part of greater familial, then organizational, then cultural systems. This particular theme focused on the cultural system.

We created two subthemes within this main theme: "You are supposed to sacrifice for your husband and kids," and "Skinny models are the standard of beauty." The first subtheme related to female gender roles and expectations, and the latter described the culturally determined "ideal" sense of beauty. While the scope of this paper is limited to physical activity, for participants in this sample (especially women), body image was intrinsically tied to physical activity.

"You are supposed to sacrifice for your husband and kids"

Our interview protocol included asking married individuals to describe how culture may influence physical activity habits. Interestingly, each Hispanic woman and one Hispanic man commented on the gender roles and expectations for women as a potential barrier for physical activity.

Maria, mother of a four-year-old son, asserted, "When you get married, you sacrifice for your kids and husband. They are first. Your needs and working out comes second." She also stated, "In the Hispanic culture, the woman is the one who takes care of the kids." Her husband Nicolas echoed her thoughts by saying Hispanic women are generally tasked with taking sole responsibility for the children. He said, "We have a term for it, called marianismo or "being like the Virgin Mary" ... my wife is very marianismo. She is motherly, selfless, submissive, and sacrificial." The concept of marianismo was crucial to understanding the cultural mechanisms influencing the Hispanic men and women in this sample. If a woman was to be sacrificial and the sole caregiver, it would follow that she would have less time for any personal pursuits (such as physical activity or exercise). Although Angel isn't a mother herself, she made this statement:

Liz said many other Hispanic women feel that they can't work out because it is seen as selfish. Her husband, James, stated, "I think in our culture, there is a traditional mind set of gender roles. Maybe some Hispanic men wouldn't like their wives leaving to go work out because they wouldn't be available for the kids." While Hispanic participants had much to say about gender roles and expectations, a few also said that although they understand concepts such as marianismo and machisimo, they don't necessarily subscribe to those cultural principles themselves. For example, James claimed he "wasn't the typical Hispanic guy" and "he definitely encourages his wife to be active."

"Skinny models are the standard of beauty"

Along with the Hispanic culture, participants (especially white females) linked the American cultural ideal of the perfect female form to physical activity habits. While seemingly removed from the idea of physical activity or exercise behavior, seven women named the culturally determined ideal of the perfect female body as a motivator for physical activity.

Brandy highlighted this concept with a picture of her jeans (see Figure 1). She explained the three pairs all represent the various jeans she has worn before, during, and after pregnancy. Brandy described the smallest pair, a size four, as her motivation for increasing her activity. She stated, "I think it is a cultural thing. White women are supposed to be waif thin, and that is hard to live up to ... but I try." Claire, a young white woman, echoed Brandy by admitting, "I always feel pressure to be thin. That is my chief motivation for exercise right now." Shannon said, "I feel the pressure to be thin like my other friends. I am vain, but I want to drop dress sizes. That is why I try to exercise" (see Figure 1).

[FIGURE 1 OMITTED]

In contrast to these white women, Angel, claimed, "I have never wanted to be super skinny and I feel zero pressure to be. In some ways, I am glad I am Hispanic, because I am held to a different standard than white women." While the interview protocol included no questions regarding body image, over half of the female participants commented about physical activity and its relationship to body weight. Especially for white women, the cultural ideal of the "skinny model" was cited as the primary motivator for increased (or wanting to increase) physical activity.

"WE FEEL CONNECTED"

The third main theme described connectedness and highlighted the GST Principle of Interdependence. Since these marriage partners had close, daily contact with one another, it would follow that each part of a dyad was intrinsically linked to the other. Participants stated enjoyment of being active together and mutual verbal encouragement as positive influences on individual and couple exercise. Many couples demonstrated how one spouse was often interdependent with the other.

Marcus and Robin, a couple married only a few years, each spoke to sexual activity as a way to be active and enjoy the other person. In fact, Marcus took a picture of their bed and said, "Sex is a lot of physical activity for us. Honestly, that is the most frequent activity" (see Figure 2). Robin said sex was "a lot of fun" and most of their activity together.

While Marcus and Robin were the only two individuals candid enough to name sex as a primary form of physical activity, six wives and four husbands recorded enjoyment of an activity together as both a cause and outcome of joint exercise. Angel took a picture of a bicycle wheel and told of when her and her husband bought bikes together (see Figure 3). She said, "We would both ride our bikes around town and to the gym. It was really fun to be together and get outside." James stated "being active together takes [our] relationship to another level," and Nicolas asserted "spending time with Maria while being physically active is great."

[FIGURE 2 OMITTED]

[FIGURE 3 OMITTED]

Along with enjoyment of activity, mutual encouragement demonstrated connectedness and interdependence between spouses. Four wives and three husbands commented on the power of verbal encouragement to spur physical activity. Robin said she and Marcus "influence each other" because exercise "is a mutual thing." She stated, "We both have to encourage each other. We both feed off one another." Molly, a reluctant exerciser, commented, "If I didn't have him asking me to walk with him and encouraging me, I probably wouldn't do it." Eric, a personal trainer, asserted, "Physical activity is more successful when we ask each other; I think we motivate and push each other."

"LIFE CHANGES, AND SO DO WE"

As a final theme, participants identified ways the marital system adapted to various environmental changes such as pets, children, and careers. According to Bertalanffy, a system is flexible, diverse, and capable of adapting to change. Wives and husbands demonstrated numerous ways physical activity habits adapt to shifts in the environment.

Three spousal pairs (n = 6) indicated an increase in joint physical activity after buying a dog. Shannon admonished that after they bought a dog, she and her husband "walk the dog every day" and their dog "keeps [them] walking." Cory also recorded this environmental change with a picture of their dog (see Figure 4) and the comment, "The dog motivates me and her." Derrick said, "We walk the dog nearly every day for forty-five minutes together. In a funny way, the dog kind of brings us together."

While the addition of a pet was unilaterally positive, the marital systems in this sample tended to vary in response to changes in career(s). After Maria's husband took a job in the health and wellness industry, she said, "I learned so much from him. I would even watch his presentations. That really influenced what we eat, how much water we drink, and especially how active we are." Following a change in careers, Noel took a job with a company that reimburses employees for going to the YMCA nine times per month. She commented, "That motivates us both to go. I think we would both slack off if it weren't for that."

[FIGURE 4 OMITTED]

Yet, other couples mentioned the detrimental impact of job changes. After taking a job as an assistant professor, Liz reported feeling guilty for spending so much time working and not with her family. She said she would "probably feel even worse if she took more time to exercise." Liz also stated traveling for work as detrimental because then her husband has the brunt of the childcare, leaving both spouses less time for exercise. Brandy, a mother of two small girls, said her husband's new job requires him to be gone for twelve hours each day. She stated, "He gets home and there is literally thirty minutes before the girls go down. If he got home sooner, I would be more active."

Similar to career changes, how a marital dyad adapted to having a child varied. A few spouses commented on physical activity intensity decreasing after having kids, yet eight spouses described an increase in both exercise frequency and family time devoted to activity. Maria said, "We do things as a family because of our son like walking, skiing, swimming." Julie recalled, "I started biking with my youngest child who was one year old. Shortly after that, we both bought bikes so we could ride." Her husband, Michael, echoed his wife by saying they "tried to kill two birds with one stone" and "family time was also exercise time." Thus, while intensity may have decreased for a few parents, marital systems in the sample also positively adapted to children and thus, spouses reported an increase in frequency of physical activity.

DISCUSSION

The two primary purposes for this study were to examine how the "threads" of the marital system influence physical activity habits and to investigate how the other systems connected to the marital union (i.e. cultural, occupational, and familial) impact spousal physical activity behavior. Regarding the first purpose, the third theme "We feel connected" captured the concept of marital independence and the idea that couples influenced one another by "feeding off each other." Regarding the latter purpose, the first, second, and fourth themes all pointed to other systems influencing the marital dyads in this study.

The third theme, "We feel connected," highlighted the ways spouses positively influence each other within the marital system. Overwhelmingly, partners reported enjoying spending time together while being active and cited this as a chief motivator for activity. One couple even stated the enjoyment of sex as a benefit to being "active" in the bedroom. Along with enjoying each other, spouses were inclined to be physically active if their spouses used positive verbal persuasion. Thus, verbal persuasion was one thread tying the couple together that had a positive impact on activity.

The findings support research by Raglin (2001) and Beverly and Wray (2010). The Raglin study involved thirty married individuals enrolled in an exercise program alone and thirty-two married individuals enrolled with a spouse. Researchers in that study found a positive association between exercising together and adherence to the program. Beverly and Wray used in-depth interviews to investigate the exercise habits of diabetic partners. Qualitative data revealed couples who felt that they were "connected" and "in it together" were more likely to be active individually and as a couple.

In relation to the second purpose, the larger cultural, occupational, and familial systems threaded to these couples greatly impacted these dyads. The first theme, "It all comes full circle," suggested a generational loop in which the parents of these married individuals impacted them and thus participants desired to influence their own children. While not always positive, the parents of those in the sample modeled both exemplary and scant physical activity behavior. Consequently, participants with kids reported the desire to "pass on good habits" or "be a good example" because their parents either did or did not model these things.

Interestingly, the generational influences on physical activity aren't generally the focus of a study. Instead, researchers often investigate the presence or number of children as a demographic factor alone. For instance, Homish and Leonard (2008) found a negative association between having children and female physical activity. Instead of asking binary questions (i.e. Do children raise or lower activity for women?), would a more insightful question be why or how do children impact activity? Future studies should focus on the specific ways children affect parental (and spousal) physical activity.

Along with the larger familial system, the cultural system(s) in which these couples live also affected activity. The Hispanic women in this sample cited the cultural expectation to be the primary care giver as a possible barrier to activity. Juarbe et al. (2003) discovered a similar finding in a qualitative study conducted with Mexican immigrant women. Those researchers reported the cultural obligation to be the primary caretaker as a hindrance to physical activity for women in that sample.

Lastly, the final theme, "Life changes and so do we" highlighted the other environmental influences which played on these marital systems. Connected with the principle of Requisite Variety, changes in the environment such as the addition of children or pets or a change in jobs demanded the marital dyad adapt to these changes. While participants cited gaining a pet as a positive influence on joint and individual marital physical activity, children tended to raise exercise frequency yet lower intensity. Careers changes or work demands for one or both parts of a dyad also impacted the marital system. For example, participants cited long work hours and work travel as lowering physical activity.

These findings lend support to Bertalanffy's General Systems Theory (1967) and McGarry's family system principles. The Principle of Levels of Organization helped define the cultural, occupational, and familial systems that influenced the marital systems in this sample. Similarly, findings supported the Principle of Interdependence in that these marital dyads exerted great influence on one another. This was seen in couples speaking to the enjoyment of exercising together and lending positive verbal support to one another. Lastly, how these couples responded to changes in the environment such as pets, children, and career changes demonstrated the Principle of Requisite Variety. The threads connecting these marital systems to the greater environmental systems most definitely adapted to change and showed great flexibility.

However, the first principle, the Wholeness Principle, was somewhat vague. Though simple and obvious (i.e. a whole is greater than the sum of its parts), the principle is so general it was difficult to fully conceptualize this in relation to the data.

As the name suggests, the theory is general, but is it a bit too general? Would it be more advantageous to isolate specific types of systems and narrow down constructs within particular systems? For example, McGarry's GST principles regarding families helped guide our inquiry. Yet, there are no set of GST principles or constructs to assist the understanding of health behavior, specifically physical activity. System principles for understanding health care systems and organizations are in place, but the field lacks systems principles for health behavior.

IMPLICATIONS FOR PRACTICE

While the findings of this study are not generalizable, the findings do indicate a strong parental influence on the physical activity of this sample. For example, if a wife hadn't observed her mother regularly engaging in activity, she was unlikely to be an active person herself. Similarly, if a husband's father valued exercise, the husband generally did as well. Therefore, one possible implication for practice could be that health professionals encourage couples to discuss their family backgrounds with one another. In so doing, health professionals may assist couples in merging two invariably different familial backgrounds. Additionally, if a couple did decide to have children, this kind of intervention may help start a new tradition of wellness for future generations.

LIMITATIONS

We strove to maintain diversity in terms of age and ethnicity, yet this sample included only one couple with children aged 7-13. While the focus of the study was on marriage not parenthood, future studies need to include children within these middle years. Unlike much younger or older children, parents with kids these ages often face the challenge of their children being in numerous extra-curricular activities. Parents, then, must juggle their own schedule with transporting their kids to these events. It is uncertain how parents in this life-stage find time for physical activity.

Another limitation of these findings was the assumption of the value of exercise. According to the Centers for Disease Control and Prevention (2007), 37.7% of Americans get insufficient amounts of physical activity and 24.1% engage in no physical activity. Our participants represented a variety of physical activity levels, but unlike the national average, most were at least low to moderately active. In order to elicit responses concerning physical activity, it was necessary to sample individuals who had some interest in or knowledge of exercise. By interviewing participants who regularly participated in some form of physical activity, an inherent assumption of the value of exercise was present in this sample.

This study set to understand the marital units as systems operating within other larger systems. It is obviously difficult to fully understand any system (couple in this case) after only one interview. Perhaps future qualitative studies may employ ethnographic methods to study how familial systems influence physical activity.

Lastly, this sample included only heterosexual, married couples. We chose our criteria due to a 2004 survey by the Centers for Disease Control and Prevention which showed different health outcomes for married vs. cohabitating adults as well as heterosexual vs. homosexual adults. By excluding cohabitating couples as well as couples from various sexual orientations, we didn't sample individuals involved in every aspect of the spectrum of intimate relationships.

While we note several limitations, this study fulfills a distinct gap in literature. According to Falba and Sindelar (2008), there exists a significant deficit in the amount of studies investigating the impact of spouses on health behavior. This study examined how the threads within marital systems influence the physical activity habits of each partner. Additionally, this study demonstrated how the marital system(s) in this sample were tied to (and influenced by) familial, occupational, and organizational systems.

Appendix A: Systems concept map

[ILLUSTRATION OMITTED]

REFERENCES

Bertalanffy, L. (1967). Robots, men and minds. New York, NY: G. Braziller.

Best, A., Moor, G., Holmes, B., & Clark, P. I. (2003). Health promotion dissemination and systems thinking: Towards an integrative model. American Journal of Health Behavior, S206.

Beverly, E., & Wray, L. (2010). The role of collective efficacy in exercise adherence: A qualitative study of spousal support and Type 2 diabetes management. Health Education Research, 25(2), 211-223.

Centers for Disease Control and Prevention (2004). Marital status and health: U.S. 1999-2002. Retrieved from http://www.cdc.gov/nchs/data/ad/ad351.pdf.

Centers for Disease Control and Prevention (2007). U.S. physical activity statistics. Retrieved from http:// apps.nccd.cdc.gov/PASurveillance/StateSumResultV.asp

Chun, K. M., & Chesla, C. A. (2004). Cultural issues in disease management for chinese americans with type 2 diabetes. Psychology & Health, 19(6), 767-785.

Clark-Ibanez, M. (2004). Framing the social world with photo elicitation interviews. American Behavioral Scientist, 47, 1507-1527.

Collier, J., Jr. (1967). Visual anthropology: Photography as a research method. Newbury Park, CA: Sage. Cox, M. J., & Paley, B. (1997). Families as systems. Annual Review of Psychology, 48(1), 243.

Erlandson, D. A., Harris, E. L., Skipper, B. L., & Allen, S. D. (1993). Doing naturalistic inquiry. Thousand Oaks, CA: Sage.

Falba, T., & Sindelar, J. (2008). Spousal concordance in health behavior change. Health Research and Educational Trust, 43(1), 96-115.

Fernandez-Ballesteros, R., Diez-Nicolas, J., Caprara, G. V., Barbaranelli, C., Bandura, A. (2002). Determinants and structural relation of personal efficacy to collective efficacy. Applies Psychology, 51(1), 107-125.

Glaser, B. G., & Strauss, A. (1967). The discovery of grounded theory. Chicago, IL: Aldine.

Harper, D. (2002). Talking about pictures: A case for photo elicitation. Visual Studies, 17(1), 13-26.

Homish, G., & Leonard, K. (2008). Spousal influence on general health behaviors in a community sample. American Journal of Health Behavior, 32(6), 754-763.

Hong, T., Franks, M., Gonzalez, R., Keteyian, S., Franklin, B., & Artinian, N. (2005). A dyadic investigation of exercise support between cardiac patients and their spouses. Health Psychology, 24(4), 430-434.

Jenson, M., Suls, J., & Lemos, K. (2003). A comparison of physical activity in men and women with cardiac disease: Do gender roles complicate recovery? Women & Health, 37(1), 31-48.

Juarbe, T., Lipson, J., & Turok, X. (2003). Physical activity beliefs, behaviors, and cardiovascular fitness of mexican immigrant women. Journal of TransculturalNursing, 14(2), 108-116.

Jurj, A. L., Wen, W., Li, H. L., Zheng, W., Yang, G., & Xiang, Y. B. (2006). Spousal correlations for lifestyle factors and selected diseases in chinese couples. Annals of Epidemiology, 16(4), 285-291.

McGarry, D. D. (2002). Perceiving the pattern of organization in a family system. Systems Research & Behavioral Science, 19(5), 499-506.

Pettee, K., Brach, J., Kriska, A., Boudreau, R., Richardson, C., Colbert, L., & Satterfield, E. (2006). Influence of marital status on physical activity levels among older adults. Medicine & Science in Sport & Exercise, 38(6), 541-546.

Prest, L. A., & Protinsky, H. (1993). Family systems theory: A unifying framework for codependence. American Journal of Family Therapy, 21(4), 352-360.

Raglin, J. S. (2001). Factors in exercise adherence: Influence of spouse participation. Quest (00336297), 53(3), 356-361.

United States Census (2010). 2010 Census Demographic Profiles. Retrieved from http://2010.census. gov/2010census/data/.

Wang, C., & Burris, M. (1994). Empowerment through photo novella: Portraits of participation. Health Education & Behavior, 21, 171-186.

Kacy L. Michel, PhD

Patricia Goodson, PhD

B.E. Pruitt, EdD

Kacy L. Michel, PhD, is affiliated with the Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA. Patricia Goodson, PhD, is affiliated with the Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA. B.E. Pruitt, EdD, is affiliated with the Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA. Corresponding Author: Kacy L. Michel, Email: kacylmichel@hlkn.tamu.edu or kacylmichel@gmail.com. Phone: 214.608.8299, Fax: 979.862.2672, Department of Health and Kinesiology, 199 G. Rollie White, 4243 TAMU, College Station, Texas 77843-4243
I don't think anyone really verbalizes it, but
   I do think there is more pressure regarding
   your social and gender roles...then say,
   what a white woman feels. In the Hispanic
   culture, women are expected to be the primary
   caregiver. My cousin is married to a
   machismo man. She tries to go work out,
   but her husband is annoyed that he has to
   care for their baby. He always asks when
   she is coming back and complains. Not all
   Hispanic men are like that, but I see it.


Table 1. Participant table

Couple         Length      Education      Children    Ethnicity
               of Time
               Married

Robin (30)     2 yrs     High School     0            African-
Marcus (33)              Undergraduate   0            American
                                                      African-
                                                      American
Angel (29)     Less      Graduate        0            Hispanic
Eric (28)      than 1    Undergraduate   0            Hispanic
               yr

Shannon        23 yrs    Undergraduate   3 (ages      Caucasian
(46)                     Undergraduate   17, 20,      Caucasian
Cory (45)                                22)

Maria (31)     3 yrs     Undergraduate   1 (age 4)    Hispanic
Nicolas (31)             Graduate                     Hispanic

Julie (60)     36 yrs    Graduate        2 (ages      Caucasian
Michael                  Graduate        29, 33)      Native
(63)                                                  American

Brandy (31)    8 yrs     High School     2 (ages      Caucasian
Jacob (32)               High School     1, 3)        Caucasian

Olivia (57)    28 yrs    Undergraduate   3 (ages      Caucasian
Daniel (57)              High School     21, 25,      Caucasian
                                         27)

Liz (38)       5 yrs     Graduate        1 (age 1)    Hispanic
James (37)               Graduate                     Hispanic

Claire (23)    Less      Undergraduate   0            Caucasian
Jude (22)      than 1    High School     0            Hispanic
               yr
Molly (61)     41 yrs    High School     4 (ages      Caucasian
Derrick (60)             Graduate        22, 24,      Hispanic
                                         28, 31)

Noel (28)      10 yrs    Graduate        3 (ages 1,   Caucasian
Josh (33)                Undergraduate   2, 4)        Caucasian

Savannah       17 yrs    Graduate        2 (ages 8,   Caucasian
(48)                     Undergraduate   13)          Caucasian
George (52)

Avg length     15.48     Ethnicity of Sample: Caucasian: 54%
of marriage:             African-American: 8% Other: > 4%

Couple                 Marital Context

Robin (30)      Robin is in retail sales, and
Marcus (33)     Marcus is a football coach at
                     a local high school

Angel (29)       Angel works long hours as a
Eric (28)        graduate student, and Eric
                stays fit due to his job as a
                      personal trainer

Shannon          Cory stays busy running an
(46)            at-home software company, and
Cory (45)         Shannon is an elementary
                           teacher
Maria (31)     Marco and Maria live apart due
Nicolas (31)   to work situations; they value
                spending time with their son
Julie (60)      Julie and Michael are retired
Michael         and very active; they enjoy
(63)                 spending time with
                        grandchildren
Brandy (31)     Brandy and Jacob struggle to
Jacob (32)      make ends meet due to limited
                 vocational opportunities;
                    Brandy stays at home
Olivia (57)      Olivia is hoping to retire
Daniel (57)    from teaching this year, while
                 Daniel loves his job as a
                       sound engineer
Liz (38)        James and Liz have very high
James (37)       powered, stressful careers;
                 theystruggle to find time
                        for exercise
Claire (23)      Claire and Jude met at the
Jude (22)        gym, and they are both very
                       physically fit
Molly (61)       While Derrick is still very
Derrick (60)      active, Molly's arthritis
                   makes it difficult to
                 exercise; they raised four
                      adopted children
Noel (28)         Noel and Josh lead a very
Josh (33)           hectic life trying to
                raise three children under 5;
                  the children take up all
                   the couple's free time
Savannah         Savannah is a tenure-track
(48)             professor, and George is a
George (52)     commercial realtor; they both
                 know they should exercise,
                  but don't know when they
                       would find time

Avg length              Hispanic: 33%
of marriage:

Table 2. Summary of main themes

Theme                           Subtheme

1) "It all comes full
circle"
(Multigenerational
influence)
                          "You are supposed to
2) "Our culture has        sacrifice for your
certain expectations"      husband and kids"
(Cultural influence)         (Gender Roles)
                         "Skinny models are the
                          standard of beauty"
                              (Body Image)
3) "We feel connected"
4) "Life changes and
so do we"

Theme                         Exemplary Quote

1) "It all comes full     "My dad was super active
circle"                   so I am too...I want that
(Multigenerational           for my boy, too"
influence)
2) "Our culture has        "After you marry, your
certain expectations"    needs come second to your
(Cultural influence)         husband and kids"
                          "I feel the pressure to
                                  be thin"

3) "We feel connected"    "We feed off each other"
4) "Life changes and     "Our work, our kids, shoot
so do we"                   even the dog make a
                            difference in terms
                              of our activity"

Theme                       GST Principle

1) "It all comes full         Wholeness
circle"                       Principle
(Multigenerational
influence)

2) "Our culture has
certain expectations"         Levels of
(Cultural influence)        Organisation

3) "We feel connected"     Interdependence
4) "Life changes and      Requisite Variety
so do we"
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.