Michael Arnold Mages, Maria Fernanda Ramirez Cifuentes, Chenfei Yu, Bonnie Ilene Glanz, and Jonathan D Zurawski
A new diagnosis of Multiple Sclerosis (MS) disrupts not only the life of the patient but also impacts the network of people surrounding them. From a family systems perspective, the diagnosis functions as a stressor that affects interconnected relationships, requiring adaptation not only within the dyad of patient and partner but also affects their broader care network. In this paper, we discuss the application of the Systemic Transaction Model (STM) as a framework for understanding how stress and coping unfold within these interdependent systems, yet existing interventions primarily target the individual patient, overlooking the dynamic interplay of relational and systemic factors. Without structured support during the early-stage adjustment period, couples often experience distress, diminished quality of life, and misaligned coping strategies that could otherwise be addressed through systemic design approaches.
This paper proposes a systemic, relational approach to designing just-in-time interventions for couples facing MS. Conceptualizing MS as a “we-disease,” we shift the focus of care from individual symptom management to shared coping, relational resilience, and communication. Building on prior work developing OurSleepKit, a dyadic mHealth intervention to support adherence to CPAP therapy for obstructive sleep apnea (OSA), we explore how technology can be leveraged and designed to function as an active component within a broader system of care to facilitate the everyday work of relational support, emotional coordination, and shared decision-making in the context of MS. By addressing not only individual behaviours but also the interactions and relationships that shape care experiences, we advocate for a systemic intervention that supports adaptation across multiple layers of the care ecosystem.
Grounded in a multi-framework approach that draws from Design for Care, the Systemic Transaction Model, and Transition Design, this paper offers an integrated lens for addressing the relational complexity and temporal dynamics of chronic illness care. By operationalising and supporting dyadic coping from a systemic design perspective, we aim to showcase its potential to serve as a leverage point for change, not just at the level of the patient–partner dyad, but across interconnected layers of the care system. This paper calls for a reframing of chronic illness interventions through relational and systemic lenses, advocating for design approaches that recognise the evolving interplay between patients, partners, and healthcare providers. Future work will explore the feasibility of this approach in supporting these relational dynamics, with implications for chronic disease management more broadly.
Keywords: systemic design, caregiving system, systems of care, dyadic design, healthcare