The Effectiveness of the Within Our Reach Relationship Education Program for Couples: Findings from a Federal Randomized Trial

Relational concerns and change in relationship satisfaction in a relationship education program

Lower income couples tend to report more difficulty sustaining high-quality intimate relationships. As a result, policy initiatives have been enacted to fund relationship education (RE) programs that aim to increase lower income couples' relationship satisfaction. Generally, these programs demonstrate small, albeit statistically significant improvements in mean levels of relationship functioning. It is critical, however, to understand if RE programming influences the developmental course of intimate relationships, and if this influence depends on couples' initial levels of concerns about their relationships. Using dyadic group-based modeling and three waves of data from 6034 couples in the Supporting Healthy Marriages project, a randomized control trial of RE, we categorized couples into four relationship concern groups (No Relational Concerns, Both Relationally Concerned, Men's Relational Concerns, and Women's Relational Concerns) and explored how these groups moderated the long-term efficacy of RE programming. Results indicated that RE was associated with different developmental trajectories of satisfaction, but RE effects differed for men and women. Specifically, random assignment into RE was associated with men maintaining high levels of relationship satisfaction, whereas women's satisfaction decreased over time. These effects were not moderated by initial relationship concerns. The association between RE and relationship satisfaction trajectories was small in magnitude, suggesting that more comprehensive services are needed to strengthen lower income couples' intimate relationships.

Impact of Prenatal Group Healthy Relationship Education on Postpartum Contraception

Objective

We aimed to evaluate the impact of an antenatal group healthy relationship education program on the postpartum use of long-acting reversible contraception (LARC).

Materials and Methods

This is a planned subgroup analysis of a larger randomized controlled trial. Pregnant and newly parenting women were randomized to either group healthy relationship education, "MotherWise," or no additional services. An evidence-based healthy relationship education program and individual case management sessions were provided. The program did not include any prenatal care or contraception counseling. This subgroup analysis included those participants with a nonanomalous gestation randomized at <40 weeks who received care and delivered at a single safety-net hospital and were discharged home with a live infant(s).

Results

From September 2, 2016 to December 21, 2018, 953 women were randomized in the larger trial; 507 met inclusion criteria for this study; 278 randomized to program and 229 controls. Participants were mostly young, parous, Hispanic, publicly insured women. Participants randomized to program were more likely to take a prescription medicine and be delivered through cesarean; there were not any other significant differences in baseline, antenatal, or perinatal outcomes. Those randomized to program were more likely to be discharged home with immediate postpartum LARC in place (odds ratio [OR] 1.87; confidence interval [CI] 1.17-3.00), and more likely to be using LARC at the postpartum visit (OR 2.19; CI 1.34-3.56).

Conclusion

Antenatal group healthy relationship education provided separately from prenatal care is associated with a twofold increase in the use of postpartum LARC.

Clinical Trial Registration

ClinicalTrials.gov NCT02792309; https://clinicaltrials.gov/ct2/show/NCT02792309?term=NCT02792309&draw=2&rank=1.

Changes in couple, parenting, and individual functioning following Family Expectations program participation

The current study investigated changes in couple, parenting, and individual functioning following participation in Family Expectations, a relationship and parenting education program for new or expectant parents. The sample comprised 339 couples who participated in most sessions of the Family Expectations program and completed assessments at three different time points over a 12-month period. Study analyses examined: (a) change shortly following completion of the program, (b) associations between short-term change and subsequent change in outcomes at 12-month follow-up, and (c) differences in short-term change between married and unmarried couples. Significant improvements were observed in all three domains at short-term follow-up. Short-term changes, particularly for psychological distress, were predictive of long-term change in multiple domains. Few moderation effects by marital status were evident; those that appeared suggested stronger effects for married participants compared to unmarried. Study findings inform ongoing discussions into the utility of federally-funded relationship and parenting programming.

A randomized trial of relationship education using Within Our Reach for economically vulnerable couples

Couples relationship education is grounded in teaching couples' skills and strategies to form and sustain healthy relationships. The purpose of this investigation was to examine the impact of a relationship education intervention on emotion regulation, individual distress, dyadic coping, and relationship adjustment utilizing a randomized control trial for economically vulnerable couples. The analysis sample included 1418 couples (2836 individuals) who were randomly assigned to receive the 12-h Within Our Reach curriculum immediately, or to a wait-list control group. We estimated multilevel growth curve models over time among outcomes between treatment and wait-list control conditions. Treatment group couples demonstrated statistically significant improvements over the 6-month study period on emotional regulation and dyadic coping when compared to their wait-list group counterparts. Although models showed improvements in individual distress and relationship adjustments, these improvements did not amount to statistically significant group differences. Implications and limitations are also noted.

Introduction to special section: Federally funded, community-based healthy marriage and responsible fatherhood program impact studies

The focus of this special section is impact studies that were conducted as part of the Administration for Children and Families' Healthy Marriage and Responsible Fatherhood initiative. This initiative has led to more than 2 million people receiving relationship education and fatherhood programs across the United States over the last two decades. Community organizations develop these programs, select their curricula and content, and run these programs in their local communities. Many programs funded in the 2015-2020 cohort of grantees included randomized controlled trials of program effectiveness; some of these studies are presented in this issue, with the goal of marrying the field of program evaluation and family science.

Examining quality time as a mediator of dyadic change in a randomized controlled trial of relationship education for low-income couples

Research identifying specific mechanisms of positive change for couples participating in relationship education is scant. Recent studies have identified the potential of communication skills as a likely mechanism, yet more information is needed about the contribution of process factors. Thus, we examined the influence that quality time spent together had on positive post-intervention outcomes based on couples' reports of dyadic coping and dyadic adjustment for 1,367 low-income couples randomly assigned to receive relationship education. Results indicated that treatment couples reported significant gains in quality time spent together, and that those gains fully mediated positive changes in dyadic coping and adjustment. Additionally, actor and partner effects existed such that men's and women's reports of improved quality time influenced their own and their partners dyadic coping and dyadic adjustment. We discuss study implications for practice and future research.

Helping couples achieve relationship success: A decade of progress in couple relationship education research and practice, 2010-2019

This article systematically reviewed 34 rigorous evaluation studies of couple relationship education (CRE) programs from 2010 to 2019 that met the criteria for Level 1 well-established interventions. Significant advances include reaching more diverse and disadvantaged target populations with positive intervention effects on a wider range of outcomes beyond relationship quality, including physical and mental health, coparenting, and even child well-being, and evidence that high-risk couples often benefit the most. In addition, considerable progress has been made delivering effective online CRE, increasing services to individuals rather than to couples, and giving greater attention to youth and young adults to teach them principles and skills that may help them form healthy relationships. Ongoing challenges include expanding our understanding of program moderators and change mechanisms, attending to emerging everyday issues facing couples (e.g., healthy breaking ups, long-distance relationships) and gaining increased institutional support for CRE.

The Relationship Between Social Support and Family Relationships Among Low-Income Couples Attending Relationship Education

Results are mixed for relationship education (RE) interventions with low-income couples. For couples who experienced positive changes, it is not clear what aspects of program models contributed to change. Many low-income couples attend government-funded RE with limited access to social and community resources. Program models often provide related resources complimentary to RE skill-building. We examined the relationship between income, social support, and family functioning for low-income, ethnically diverse couples (N = 856) who attended RE, as well as the mediating effects of social support on family functioning outcomes. Analyses included three separate dyadic models that examined associations among constructs at baseline and immediately following the RE intervention. Results demonstrated relationships between participants' reported social support and family functioning such that (a) social support was associated with baseline family functioning for both men and women; (b) men's baseline social support was influenced by women's baseline family functioning; and (c) men's and women's social support change score had a positive influence on their own family functioning change score. However, social support was not a significant mediator of change in family functioning. Implications for RE practice and research are also discussed.

A Comparison of Low-Income Versus Higher-Income Individuals Seeking an Online Relationship Intervention

Compared to higher-income couples, low-income couples experience higher rates of relationship disruption, including divorce and breakup of cohabiting relationships. In recognition of this disparity in relationship outcomes, relationship interventions have increasingly been targeted at this population. However, these interventions have had limited impacts on the relationships of low-income couples. Developing interventions that are effective and responsive to the needs of low-income couples requires descriptive data on the challenges those couples perceive in their own relationships and an assessment of how their needs compare to the more affluent couples typically served by relationship interventions. The current study sampled over 5,000 individuals at the time they were seeking an online relationship intervention and compared the relationship functioning and life circumstances reported by low-income individuals to that of higher-income individuals. Results indicate that low-income individuals seeking a relationship intervention had higher levels of relationship distress (lower relationship satisfaction, more intense primary relationship problems, and less relationship stability), and had greater levels of contextual stress (more children living at home, less likely to be employed full-time, and lower levels of perceived health). Results suggest that future interventions designed to target low-income couples, as well as practitioners working with low-income couples, should be prepared to handle higher levels of relationship distress and contextual stressors than they may typically see in more affluent couples.

Understanding marital violence: a study in grounded theory

Objective:

to understand the phenomenon of marital violence based on the experience of women in judicial process and network professionals.

Method:

a qualitative study, with theoretical-methodological support in grounded theory. Data collection took place in two regional Courts for Peace in the Home in a municipality of the Brazilian Northeast. Interviews were conducted with 38 participants, who composed two sample groups: women in situations of violence and network professionals.

Results:

the understanding of marital violence emerged for the phenomenon “Experiencing marital violence as a progressive and cyclical process, with repercussions for health and implications for social relations”.

Conclusion:

in recognizing marital violence as a recurring problem in the life of women, with implications for their own health and that of their children, the study points to the relevance of coping strategies based on institutional and social support.

The Protecting Strong African American Families Program: a Randomized Controlled Trial with Rural African American Couples

This study presents results from a randomized controlled trial of the Protecting Strong African American Families (ProSAAF) program, a family-centered intervention designed to promote strong couple, coparenting, and parent-child relationships in two-parent African American families. A total of 346 African American couples with an early adolescent child participated; all families lived in rural, low-income communities in the southern USA. Intent-to-treat growth curve analyses involving three waves and spanning 17 months indicated that ProSAAF participants, compared with control participants, reported greater improvements in relationship communication, confidence, satisfaction, partner support, coparenting, and parenting. More than 80% of the couples attended all six of the in-home, facilitator-led sessions; costs to implement the program averaged $1739 per family. The findings inform the ongoing debate surrounding prevention programs for low-income and ethnic minority couples.

Primary Prevention of Intimate Partner Violence Among Recently Married Dyads Residing in the Slums of Pune, India: Development and Rationale for a Dyadic Intervention

BACKGROUND

Intimate partner violence (IPV) is frequently experienced by women of low socioeconomic status in India. It is a human rights violation and associated with negative effects on physical and mental well-being, underscoring the need for effective prevention strategies.

OBJECTIVE

This study aimed to develop a dyadic intervention for the primary prevention of IPV among newly married couples residing in slum communities in India.

METHODS

The intervention was developed using a community-based, mixed-methods design rooted in couple-interdependence theory and guided by the intervention mapping (IM) framework. It used the six critical IM steps to inform the content and delivery of the intervention: (1) needs assessment, (2) preparation of matrices of change objectives, (3) selection of theory-based methods and practical applications, (4) production of intervention components and materials, (5) intervention adoption and implementation, and (6) evaluation planning.

RESULTS

The resulting Ghya Bharari Ekatra (Take a Flight Together) intervention is intended to be delivered in 6 weekly sessions by a trained pair of male and female lay community educators to groups of 3 to 5 newly married couples in the community in which they reside. It uses games, discussions, self-reflections, and skill-building exercises to cover the following topics: enhancing relationship quality time, self-esteem and resilience, communication and conflict management, goal setting and implementation, sexual communication and sexual health and reproductive health knowledge, and redefining and challenging norms surrounding IPV occurrence. The formative work guided the protocol, including module duration and timing (2-hour sessions of convenience to participants), ordering of modules (based on potential level of interest and sensitivity of the topics), content (ie, informed scripts of role plays and films), intervention delivery methods (ie, interactive activities), and selection of the interventionists (based on capacity to connect with participants) and venue (community-based, convenient, and safe spaces). Ghya Bharari Ekatra was piloted between January and May 2018, and evaluation is presently underway.

CONCLUSIONS

Ghya Bharari Ekatra is evidence-based, grounded in intervention-mapping, and developed and iteratively refined using a community-based participatory research approach, suggesting it has great potential to be an acceptable and effective solution to preventing IPV among newly married couples.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134.

Intervenções Preventivas com Casais: O que Podemos Aprender com a Experiência Internacional?

Resumo A dissolução da unidade conjugal é um desafio familiar e para os diversos sistemas sociais a esta relacionados. O objetivo deste artigo é revisar a literatura sobre programas preventivos com casais, visando a identificar os formatos de sucesso, as lacunas existentes no que é oferecido no Brasil e o que podemos aprender com a experiência internacional. Os dados são apresentados e discutidos privilegiando os estudos que se mostraram teórica e empiricamente relevantes para o desenvolvimento de um programa adaptado à realidade brasileira. Os estudos encontrados apontam para a eficácia das intervenções preventivas na promoção de habilidades relacionadas à resiliência conjugal. Entretanto, os mecanismos de mudança implicados nesse processo e sua repercussão na qualidade conjugal ainda não foram esclarecidos.

The Effects of Mother Participation in Relationship Education on Coparenting, Parenting, and Child Social Competence: Modeling Spillover Effects for Low-Income Minority Preschool Children

Although suggestions are that benefits of relationship and marriage education (RME) participation extend from the interparental relationship with parenting and child outcomes, few evaluation studies of RME test these assumptions and the relationship among changes in these areas. This quasi-experimental study focuses on a parallel process growth model that tests a spillover hypothesis of program effects and finds, in a sample of low-income minority mothers with a child attending a Head Start program, that increases in mother reports of coparenting agreement for RME participants predict decreases in their reports of punitive parenting behaviors. Although improvements in parenting behaviors did not predict increases in teacher reports of children's social competence, improvements in coparenting agreement were associated with increases in children's social competence over time. In addition, comparative tests of outcomes between parents in the program and parents in a comparison group reveal that RME program participants (n = 171) demonstrate significant improvements compared to nonparticipants (n = 143) on coparenting agreement, parenting practices, and teachers' reports of preschool children's social competence over a 1 year period. The findings are offered as a step forward in better understanding the experiences of low-resource participants in RME. Implications for future research are discussed.

Using technology to enhance and expand interventions for couples and families: Conceptual and methodological considerations

Technological advances provide tremendous opportunities for couple and family interventions to overcome logistical, financial, and stigma-related barriers to treatment access. Given technology's ability to facilitate, augment, or at times even substitute for face-to-face interventions, it is important to consider the appropriate role of different technologies in treatment and how that may vary across specific instances of technology use. To that end, this article reviews the potential contributions of telemental health (aka, telehealth; e.g., videoconferencing to remotely deliver real-time services) and asynchronous behavioral intervention technologies (BITs; e.g., apps, web-based programs) for couple and family interventions. Design considerations-such as software and hardware requirements and recommendations, characteristics of intended users, ways to maximize engagement, and tips for integrating therapists/coaches-are included for both types of technology-based intervention. We also present suggestions for the most effective recruitment and evaluation strategies for technology-based couple and family interventions. Finally, we present legal and ethical issues that are especially pertinent when integrating technology into couple and family interventions. (PsycINFO Database Record

Relationship Education for Military Couples: Recommendations for Best Practice

Military couples have a number of distinctive strengths and challenges that are likely to influence their relationship adjustment. Military couples' strengths include stable employment, financial security, and subsidized health and counseling services. At the same time, military couples often experience long periods of separation and associated difficulties with emotional disconnect, trauma symptoms, and reintegrating the family. This paper describes best practice recommendations for working with military couples, including: addressing the distinctive challenges of the military lifestyle, ensuring program delivery is seen as relevant by military couples, and providing relationship education in formats that enhance the accessibility of programs.

Relationship Education for Incarcerated Adults

As relationship education (RE) programs become more widely implemented, it is important to measure and document the changes associated with RE for diverse audiences. Also, researchers have been challenged to examine the impact of RE with more disadvantaged groups. While we are seeing an increase in this area, only three studies have examined RE with an incarcerated sample. These previous studies examined only those currently in a relationship and focused primarily on couple functioning. The aim of this study was to expand the existing literature by examining RE with a broader sample of incarcerated adults, regardless of current relationship status, and to expand our understanding of its association with outcomes beyond the couple domain by also including measures of individual and parental functioning. In addition, we examined whether change from pre- to posttest was moderated by individual characteristics. Using a sample of incarcerated adults (N = 122), the study found positive change in three domains of functioning (couple, individual, and parental). Specifically, results indicated change on five of the eight outcome variables examined. Overall, we found both similarities and differences among program participants on changes from pre- to posttest. For the majority of outcomes, the positive change from pre- to posttest emerged regardless of individual characteristics.

Partner Violence During Adolescence and Young Adulthood: Individual and Relationship Level Risk Factors

Violence within romantic relationships is a significant public health concern. Previous research largely explores partner violence at one or two time points, and often examines a limited set of risk factors. The present study explored both individual and relationship-level risk factors and their associations with physical victimization and perpetration across more than 10 years using a community sample of 200 participants (50 % female; M age Wave 1 = 15.8). Additionally, we explored the effects of previous partner violence on the likelihood of future partner violence. Survival analysis indicated that externalizing symptoms and negative interactions (e.g., relationship conflict) were associated with both perpetration and victimization. Reporting an experience of partner violence did not significantly alter an individual's risk of future partner violence. Overall, men were significantly more likely to report victimization; perpetration rates did not vary by gender. The results highlight the importance of examining multiple levels of risk.