Contributor: Karen S. Lyons, PhD, FGSA
Growing up in Ireland gave me a great love for the art of story-telling and shared narratives, especially in times of stress and grief. But I also realized that there could be many sides to the same story and that it was far less important to determine if there was a “right” side as opposed to actively hearing and giving voice to all versions of the story.
During my time as a psychology student, I was able to delve deeper into the concept of appraisal and how it can shape our behaviors and health outcomes and I also became very interested in how much we are influenced by the contexts and relationships we are situated in. I did a mixed-methods study of older adults living in different contexts for my master’s degree and was struck by how much family and relationships played a role in the outcomes of older adults. Even the absence of family or challenging interpersonal relationships were incredibly important to well-being. In 1995 I moved to the United States for my PhD in Human Development and Family Studies and became very interested in family caregivers, particularly for persons with dementia. Although the majority of research at the time was focused on either the patient or the caregiver, I could not separate those two sides of the story from one another. So, I took advantage of being in the right place at the right time and having very supportive mentors and did my dissertation on frail older adults and their family caregivers using a dyadic approach.
Over my career, I have continued to advocate for a dyadic lens in caregiving and chronic illness and firmly believe in the advantage of including both sides of the family care experience (Lyons, Rauer, et al., 2025; Lyons & Sayer, 2005; Lyons et al., 2002). Dyadic health science, as it is known, has foundations in social psychology, but has also been strongly influenced by nursing and health psychology. Indeed, nurse researcher, Laurel Northouse, PhD, RN, FAAN, coined the term “dyad as unit of care.” My team has consistently shown the importance of having both the patient and care partner on the same page about symptoms, illness progression, care values and preferences (i.e., dyadic appraisal) to optimize health outcomes of both members of the care dyad. When care dyads are on the same page and have more shared appraisals, they are much more likely to engage in dyadic illness management behaviors (e.g., collaborative symptom management, support behaviors, open communication about the illness and symptoms, shared health behaviors). More shared appraisals and collaborative behaviors are associated with better health outcomes for both the patient and their care partner (i.e., dyadic health). I have been lucky enough to examine these concepts across illness contexts with wonderful colleagues, including cancer, Parkinson’s disease, chronic pain, and heart failure to name a few (e.g., Lee & Lyons, 2019; Lyons et al., 2014; Lyons et al., 2018; Lyons et al., 2022; Lyons et al., 2013; Lyons, Whitlatch, et al., 2025; Lyons et al., 2021).
My career and research have been made all the richer by my intentional decision to spend my academic career as a faculty member in Schools of Nursing, 19 years at Oregon Health & Science University before moving to Boston College in 2018. Collaborating with nurses (faculty and students) has enhanced my thinking and always keeps my work relevant and clinically meaningful. Moreover, the importance I place on theory and conceptual foundations for knowledge development are strongly matched with the values embedded in the discipline of nursing. It will come as no surprise then that a collaboration with my colleague, Christopher S. Lee, PhD, RN, FAHA, FAAN, FHFSA (the Barry Family/Goldman Sachs Endowed Professor in nursing at Boston College), a well-known expert in symptom science and illness management, led to the development of the theory of dyadic illness management (Lyons & Lee, 2018). I had been doing dyadic health research for 15 years when we started to work together on heart failure research. I had blended several dyadic and individual frameworks to guide my work, but I had never found one that encompassed the phenomena I saw in my studies. Taking the time to look across the body of work my team had done, the other relevant and novel dyadic health research being done by nurses, social psychologists, and gerontologists, and also examining the existing theories and frameworks related to dyadic coping, caregiving, and illness management, Chris and I proposed and published the theory of dyadic illness management in the Journal of Family Nursing (2018).
At its core, the theory purports that when care dyads share similar illness appraisals (e.g., symptoms, care values) they are more likely to engage in dyadic illness management behaviors (e.g., collaborative symptom management, supportive behaviors, shared decision-making, shared physical activity), and both of these concepts are associated with the health of the patient and the person providing care and support to them (i.e., dyadic health). Over time, dyadic health feeds back to influence how the dyad appraises and manages the illness. The theory assumes that illness is a dyadic phenomenon, that health within the care dyad is interdependent, that there is heterogeneity across dyads in how they experience and respond to illness with multilevel contextual factors explaining this variability, and finally that the health of one member of the dyad is not more important than another. It is this last assumption that led to an emphasis in the theory on reciprocity and balance within the dyad, and the recognition that the care partner in one study is often the patient in another. This becomes particularly true in older adults but also care partners in midlife.
Since its development in 2018, the theory has been cited more than 400 times, primarily by nurse researchers both nationally and internationally. We continue to test the theory and most recently I drew upon the theory to design a dyadic intervention known as Taking Care of Us© that was recently pilot-tested (Lyons, Whitlatch, et al., 2025). The theory has also been included in middle-range nursing theory courses at Boston College and University of North Carolina at Chapel Hill. As someone who has been lucky enough to teach a middle-range nursing theory course for over 10 years, I am very excited that our theory will also be in the upcoming 6th edition of Middle Range Theory for Nursing (Smith et al., forthcoming) and has also recently been included here on the Nursology website.
Additional Sources
Lee, C. S., & Lyons, K. S. (2019). Patterns, relevance and predictors of dyadic mental health over time in lung cancer. Psycho-oncology, 28(8), 1721-1727. https://doi.org/10.1002/pon.5153
Lyons, K. S., Bennett, J. A., Nail, L. M., Fromme, E. K., Dieckmann, N., & Sayer, A. G. (2014). The role of patient pain and physical function on depressive symptoms in couples with lung cancer: A longitudinal dyadic analysis. Journal of Family Psychology, 28, 692-700. https://doi.org/10.1037/fam0000017
Lyons, K. S., Gelow, J. M., Hiatt, S., Mudd, J. O., Auld, J., Chien, C. V., & Lee, C. S. (2018). The role of dyadic confidence on engagement in heart failure care behaviors. The Gerontologist, 58, 635-643. https://doi.org/10.1093/geront/gnx030
Lyons, K. S., Gorman, J. R., Larkin, B. S., Duncan, G., & Hayes-Lattin, B. (2022). Active engagement, protective buffering and depressive symptoms in young-midlife couples surviving cancer: The roles of age and sex. Frontiers in Psychology, 13, 816626. https://doi.org/10.3389/fpsyg.2022.816626
Lyons, K. S., Jones, K. D., Bennett, R. M., Hiatt, S. O., & Sayer, A. G. (2013). Couple perceptions of fibromyalgia symptoms: The role of communication. Pain, 154, 2417-2426. https://doi.org/10.1016/j.pain.2013.07.018Lyons, K. S., & Lee, C. S. (2018). The theory of dyadic illness management. Journal of Family Nursing, 24(1), 8-28. https://doi.org/10.1177/1074840717745669
Lyons, K. S., Rauer, A. J., & Proulx, C. M. (2025). Dyadic health science: Theories, methods, and future directions. Cambridge University Press. https://doi.org/10.1017/9781009649735
Lyons, K. S., & Sayer, A. G. (2005). Using multilevel modeling in caregiving research. Aging & Mental Health, 9, 189-195. https://doi.org/10.1080/13607860500089831
Lyons, K. S., Whitlatch, C. J., Vest, A. R., Upshaw, J. N., Hutton Johnson, S., Walters, A., & Lee, C. S. (2025). Feasibility, acceptability, and preliminary efficacy of the taking care of us intervention for couples living with heart failure. Innovation in Aging, 9(1), igae106. https://doi.org/10.1093/geroni/igae106
Lyons, K. S., Zajack, A., Greer, M., Chaimoy, H., Dieckmann, N., & Carter, J. H. (2021). Benefits of a self-management program for the couple living with Parkinson’s Disease: A pilot study. Journal of Applied Gerontology, 40(8), 881-889. https://doi.org/10.1016/j.pain.2013.07.018
Lyons, K. S., Zarit, S. H., Sayer, A. G., & Whitlatch, C. J. (2002). Caregiving as a dyadic process: Perspectives from caregiver and receiver. The Journals of Gerontology: Series B, 57(3), P195-P204. https://doi.org/10.1093/geronb/57.3.P195
Smith, M. J., Liehr, P. R., & Carpenter, R. D. (forthcoming). Middle Range Theory for Nursing. Springer Publishing.
About Karen S. Lyons, PhD, FGSA
Dr. Lyons is a Professor and the Elizabeth Power Keohane Faculty Fellow at the William F. Connell School of Nursing at Boston College. She received her BA and MA in psychology from University College Dublin, Ireland, where she began her program of research on older adults. She went on to receive her PhD in Human Development and Family Studies from The Pennsylvania State University, followed by a postdoctoral experience with Patricia Archbold, DNSc, RN, FAAN and Barbara Stewart, PhD at the Oregon Health & Science University School of Nursing. Her program of research focuses on the interpersonal context of health and illness. She has made numerous innovative conceptual and methodological contributions to dyadic health science for more than two decades and her body of work has been cited in over 100 review articles and textbooks and led to Fellowship in the Gerontological Society of America. Her current work is focused on dyadic interventions to balance the needs of both members of the care dyad across the adult lifespan. She was the founder and inaugural convener of the Dyadic Health Research interest group in the Gerontological Society of America and the founder of the Dyadic Research Sub-Committee in the International Family Nursing Association. She is also lead author of the first book published on dyadic health science, Dyadic Health Science: Theories, Methods, and Future Directions (Lyons et., al 2025). Dr. Lyons also has a strong commitment to and record of mentoring students and early-career faculty nationally and internationally and has received several awards for her teaching and mentoring. She has taught middle-range nursing theory to PhD students for more than 13 years.