Theory of Dyadic Illness Management

Authors – Karen S. Lyons, PhD, FGSA and Christopher S. Lee, Ph.D., RN, FAHA, FAAN, FHFSA

First published – 2018

Major concepts in the theory of dyadic illness management (Source: Lyons, 2026)

Major Concepts

  • Dyadic Appraisal
  • Dyadic Management Behaviors
  • Dyadic Health

Typology

MIddle range theory

Brief Description

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.

Primary Sources

Lyons, 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.

Smith, M. J., Liehr, P. R., & Carpenter, R. D. (forthcoming). Middle Range Theory for Nursing (6th ed). Springer Publishing.

Application Sources

Lyons, K. S., & Lee, C. S. (2020). The association of dyadic symptom appraisal with physical and mental health over time in care dyads living with lung cancer. Journal of Family Nursing, 26(1), 15-25. https://doi.org/10.1177/1074840719889967

Lee, C. S., Sethares, K. A., Thompson, J. H., Faulkner, K. M., Aarons, E., & Lyons, K. S. (2020). Patterns of heart failure dyadic illness management: The important role of gender. Journal of Cardiovascular Nursing, 35(5), 416-422. https://doi.org/10.1097/JCN.0000000000000695

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

Berridge, C., Turner, N., Liu, L., Fredriksen-Goldsen, K., Lyons, K. S., Demiris, G., Kaye, J., & Lober, W.B. (2023). Preliminary efficacy of Let’s Talk Tech: Technology use planning for dementia care dyads. Innovation in Aging, 7(3), igad018. https://doi.org/10.1093/geroni/igad018

Rauer, A., Cooke, W. M., Haselschwerdt, M., Winters-Stone, K., & Hornbuckle, L. (2024). From organizing medicine to cooking with more leafy greens: A dyadic, qualitative analysis of how older African American couples take care of each other’s health. Research on Aging, 46(5-6), 302-313. https://doi.org/10.1177/01640275241227557

Chen, Y.-q., Zhong, J.-d., Hong, Y.-t., Yuan, J., & Zhang, J.-e. (2024). Patient-Family Caregiver Concordance of Symptom Assessment for Esophageal Cancer Patients Undergoing Esophagectomy. Cancer Nursing, 47(2), 141-150. https://doi.org/10.1097/ncc.0000000000001191

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

Authors

Karen S. Lyons, PhD, FGSA – 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.

Christopher S. Lee, Ph.D., RN, FAHA, FAAN, FHFSA

is the Barry Family/Goldman Sachs Endowed Professorship in Nursing at the Boston College William F. Connell School of Nursing. Dr. Lee is a cardiovascular nurse scientist who has dedicated his career to better understanding heart disease and improving long term outcomes for patients and their families. He is known for his expertise in heart failure self-care and symptom science and patient and care-partner dyadic research in chronic conditions, as well as the application of advanced statistical methods. Dr. Lee’s research involving older adults with heart failure has been support by grants from the National Institutes of Health, the Office of Research on Women’s Health and the American Heart Association (AHA). Dr. Lee’s research on older adults with heart failure has earned him multiple honors including the 2009 Martha Hill New Investigator Award, the 2013 Marie Cowan Promising New Investigator Award, the 2015 Atherosclerosis/Heart Failure Translational Research Prize, the 2020 Mathy Mezey Excellence in Aging Award, and the 2021 Kathleen Dracup Award for Exemplary Early Career Mentoring from the American Heart Association, as well as the 2014 Heart Failure Society of America Nursing Leadership Award, the 2016 Friends of the National Institute of Nursing Research Protégé Award, a National Institute of Nursing Research Director’s Lecture in 2018, and induction into the Sigma Thea Tau International Nurse Researcher Hall of Fame in 2024. Dr. Lee has published more than 250 papers and his work has been cited more than 20,000 times. Dr. Lee also prides himself on mentoring, and has been successful in helping multiple colleagues secure National Research Service Awards, Careers Development Grants and large Research Project Grants.