Healthy Marriage, Healthy Relationship
Conditions
Brief summary
The Alabama Healthy Marriage and Relationship Education Initiative (AHMREI), a large-scale partnership among Auburn University and 9 additional implementation partners at Family Resource Centers, implements multiple program activities that respond to family needs and integrate comprehensive services to promote healthy marriages and relationships, as authorized by the Claims Resolution Act of 2010 (Pub. L. 111-291). The purpose of this study is to evaluate the efficacy of two selected couples education curricula- Elevate and Couples Connecting Mindfully. The programs are intended to improve the well-being of individuals, couples, and families in domains such as couple well-being, parenting skills, individual skills, and economic stability.
Detailed description
In 2015, Congress provided funding for grants to provide healthy marriage and relationship services to help interested couples enhance or improve adult and family relationships. The Administration for Children and Families (ACF), within the Department of Health and Human Services (HHS), oversees these grants and provides supports to assist grantees in meeting their goals and objectives. To learn about the implementation and effects of these programs, Dr. Francesca Adler-Baeder at Auburn University was awarded a contract to conduct a local impact evaluation study. The evaluation includes impact and process studies for couples education curricula. Couples who are eligible for the programs and agree to be in the study are randomly assigned to either one of two program groups (Elevate or Couples Connecting Mindfully) or a no-program control group. Program group members are offered program services; control group members are not offered those services. The impact study will examine whether the programs improve outcomes for individuals in couples and the children of the participants in the program group compared to outcomes of those in the control group. Members of both program and control groups are surveyed five times over 2 years: before they are randomly assigned, immediately after the curricula have been implemented (approximately 8 weeks later), and 6 months, 1 year, and 2 years after baseline. All surveys are administered via an online survey system, Qualtrics. The survey covers a range of questions related to couple relationships and interactions, individual functioning, parent-child interactions, co-parenting quality, and economic stability. The process aspect of the study will examine multiple aspects of the implementation and operation of the programs. Specifically, program attendance or dose, participant characteristics, facilitator-participant relationship, attitudes towards the program, and mechanisms of change will be considered in the process evaluation. Information for the process evaluation is obtained through the respondents' online surveys and facilitator/educator surveys.
Interventions
BEHAVIORALCouples Connecting Mindfully
BEHAVIORALELEVATE
Sponsors
Mathematica Policy Research, Inc.
Department of Health and Human Services
Auburn University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
19 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
* To be eligible for the AHRMEI Couples Evaluation Project, the applicant must be part of a couple (as defined by the couple) in which both couple members are applying to the program and that: both members of the couple are 19 years of age or older, both members of the couple can attend the majority of the class offerings.
Exclusion criteria
* Does not meet the inclusion criteria.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Couple Satisfaction Index | 6 months | Couple satisfaction was measured using an abbreviated version of the Couple Satisfaction Index utilized in previously published studies. The 3 items (rated from 1 \[Not at all\] to 6 \[Completely\]) are: I have a warm and comfortable relationship with my partner, How rewarding is your relationship with your partner? and In general, how satisfied are you with your relationship? Mean composites were calculated, and the total scale ranges from 1 to 6. Higher scores indicate higher couple satisfaction. |
| The Couple Relationship Skills Inventory | 8 weeks | Couple relationship skills were measured using 32 items from the Couple Relationship Skills Inventory (CRSI). This measure was constructed to match the core relationship skills and predictors of couple quality emphasized in the HMRE programs provided. Items were taken from established and validated social science measures assessing commitment, intimate partner knowledge, friendship, caring behaviors, conflict management, and external support. Example items include, I commit effort every day to making my relationship work, I know my partner's current life stresses, When things 'get heated' I suggest we take a break to calm down, and I initiate physical affection with my partner. Items ranged from 1 (Very strongly disagree) to 7 (Very strongly agree). Composite sum scores were created at the individual level and the total scale ranges from 1-224 (i.e., 32\*7 = 224). Higher scores indicate greater couple relationship skills. |
| Individual Mental Health | 6 months | Individual mental health was measured using the SF-12 Mental Component Summary score assessing anxiety, depression, sense of wellbeing, and social/emotional functioning. Per the measure's design, items were asked on differing scales (e.g., 1 to 3 or 1 to 5) with different anchor responses (e.g., all of the time to none of the time, or not at all to extremely). Example items include, During the past month how much of the time have you accomplished less than you would like or During the past month how often have you felt downhearted and depressed? The SF-12 Mental Component Summary score has shown scale reliability and validity in empirical studies. Scores range from 0 to 100 with a mean of 50 and SD of 10 in the general U.S. population. Higher scores indicate better individual mental health. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Couples Connecting Mindfully Curriculum Receives the Couples Connecting Mindfully curriculum over a 6 week period.
Couples Connecting Mindfully | 626 |
| ELEVATE Curriculum Receives the ELEVATE curriculum over a 6 week period.
ELEVATE | 626 |
| Control No programming is offered. | 606 |
| Total | 1,858 |
Baseline characteristics
| Characteristic | Control | Total | ELEVATE Curriculum | Couples Connecting Mindfully Curriculum |
|---|---|---|---|---|
| Age, Continuous | 36.46 Years STANDARD_DEVIATION 11.19 | 37.30 Years STANDARD_DEVIATION 11.3 | 37.23 Years STANDARD_DEVIATION 11.7 | 38.17 Years STANDARD_DEVIATION 12.85 |
| Education Level Advanced Degree | 106 Participants | 325 Participants | 116 Participants | 103 Participants |
| Education Level Associate's Degree | 49 Participants | 154 Participants | 53 Participants | 52 Participants |
| Education Level Bachelor's Degree | 142 Participants | 397 Participants | 126 Participants | 129 Participants |
| Education Level General Education Development (GED) | 39 Participants | 142 Participants | 55 Participants | 48 Participants |
| Education Level High School Diploma | 83 Participants | 237 Participants | 84 Participants | 70 Participants |
| Education Level No degree or diploma earned | 33 Participants | 102 Participants | 36 Participants | 33 Participants |
| Education Level Not Reported | 23 Participants | 65 Participants | 22 Participants | 20 Participants |
| Education Level Some college but no degree completion | 108 Participants | 367 Participants | 117 Participants | 142 Participants |
| Education Level Vocational/Technical Certification | 23 Participants | 69 Participants | 17 Participants | 29 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 31 Participants | 97 Participants | 36 Participants | 30 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 550 Participants | 1691 Participants | 568 Participants | 573 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 25 Participants | 70 Participants | 22 Participants | 23 Participants |
| Parent Status Not a parent | 140 Participants | 471 Participants | 167 Participants | 164 Participants |
| Parent Status Not reported | 38 Participants | 96 Participants | 27 Participants | 31 Participants |
| Parent Status Parent | 428 Participants | 1291 Participants | 432 Participants | 431 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 8 Participants | 2 Participants | 5 Participants |
| Race (NIH/OMB) Asian | 4 Participants | 17 Participants | 6 Participants | 7 Participants |
| Race (NIH/OMB) Black or African American | 207 Participants | 620 Participants | 201 Participants | 212 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 1 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 42 Participants | 125 Participants | 45 Participants | 38 Participants |
| Race (NIH/OMB) White | 351 Participants | 1087 Participants | 372 Participants | 364 Participants |
| Relationship Status Committed (not engaged/married) | 137 Participants | 387 Participants | 119 Participants | 131 Participants |
| Relationship Status Engaged to be married | 66 Participants | 161 Participants | 45 Participants | 50 Participants |
| Relationship Status Married | 376 Participants | 1213 Participants | 424 Participants | 413 Participants |
| Relationship Status Not Reported | 27 Participants | 86 Participants | 33 Participants | 26 Participants |
| Relationship Status Separated | 0 Participants | 11 Participants | 5 Participants | 6 Participants |
| Sex: Female, Male Female | 308 Participants | 936 Participants | 316 Participants | 312 Participants |
| Sex: Female, Male Male | 298 Participants | 922 Participants | 310 Participants | 314 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Couple Satisfaction Index
Couple satisfaction was measured using an abbreviated version of the Couple Satisfaction Index utilized in previously published studies. The 3 items (rated from 1 \[Not at all\] to 6 \[Completely\]) are: I have a warm and comfortable relationship with my partner, How rewarding is your relationship with your partner? and In general, how satisfied are you with your relationship? Mean composites were calculated, and the total scale ranges from 1 to 6. Higher scores indicate higher couple satisfaction.
Time frame: 6 months
Population: 406 ELEVATE respondents, 432 CCM respondents, and 426 Control respondents completed baseline, immediate follow-up, and 6-month follow-up surveys and completed all of the CSI items.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Couples Connecting Mindfully Curriculum | Couple Satisfaction Index | 4.82 score on a scale | Standard Deviation 1.11 |
| ELEVATE Curriculum | Couple Satisfaction Index | 4.90 score on a scale | Standard Deviation 1.17 |
| Control | Couple Satisfaction Index | 4.78 score on a scale | Standard Deviation 1.16 |
p-value: 0.005Mixed Models Analysis
p-value: 0.101Mixed Models Analysis
Primary
Individual Mental Health
Individual mental health was measured using the SF-12 Mental Component Summary score assessing anxiety, depression, sense of wellbeing, and social/emotional functioning. Per the measure's design, items were asked on differing scales (e.g., 1 to 3 or 1 to 5) with different anchor responses (e.g., all of the time to none of the time, or not at all to extremely). Example items include, During the past month how much of the time have you accomplished less than you would like or During the past month how often have you felt downhearted and depressed? The SF-12 Mental Component Summary score has shown scale reliability and validity in empirical studies. Scores range from 0 to 100 with a mean of 50 and SD of 10 in the general U.S. population. Higher scores indicate better individual mental health.
Time frame: 6 months
Population: 389 ELEVATE participants, 423 CCM participants, and 416 control respondents completed baseline, immediate post-program, and 6-month follow-up surveys, as well as 100% of the items of the SF-12 measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Couples Connecting Mindfully Curriculum | Individual Mental Health | 43.63 score on a scale | Standard Deviation 10.16 |
| ELEVATE Curriculum | Individual Mental Health | 43.16 score on a scale | Standard Deviation 10.28 |
| Control | Individual Mental Health | 43.95 score on a scale | Standard Deviation 10.32 |
p-value: 0.003Mixed Models Analysis
p-value: 0.152Mixed Models Analysis
Primary
The Couple Relationship Skills Inventory
Couple relationship skills were measured using 32 items from the Couple Relationship Skills Inventory (CRSI). This measure was constructed to match the core relationship skills and predictors of couple quality emphasized in the HMRE programs provided. Items were taken from established and validated social science measures assessing commitment, intimate partner knowledge, friendship, caring behaviors, conflict management, and external support. Example items include, I commit effort every day to making my relationship work, I know my partner's current life stresses, When things 'get heated' I suggest we take a break to calm down, and I initiate physical affection with my partner. Items ranged from 1 (Very strongly disagree) to 7 (Very strongly agree). Composite sum scores were created at the individual level and the total scale ranges from 1-224 (i.e., 32\*7 = 224). Higher scores indicate greater couple relationship skills.
Time frame: 8 weeks
Population: 497 ELEVATE respondents, 520 CCM respondents, and 521 Control respondents completed both baseline \& immediate follow-up surveys, as well as 80% of the CRSI items.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Couples Connecting Mindfully Curriculum | The Couple Relationship Skills Inventory | 171.14 score on a scale | Standard Deviation 24.23 |
| ELEVATE Curriculum | The Couple Relationship Skills Inventory | 170.73 score on a scale | Standard Deviation 24.33 |
| Control | The Couple Relationship Skills Inventory | 167.64 score on a scale | Standard Deviation 22.85 |
p-value: <0.001Regression, Linear
p-value: <0.001Regression, Linear