Measuring couple relationship quality in a rural African population: Validation of a Couple Functionality Assessment Tool in Malawi.

Allison Ruark,Dorothy Brewster-Lee,Paul Clayton Perrin,John Hembling,Rachel Chase,Valerie Rhoe Davis,Takeru Abe

doi:10.1371/journal.pone.0188561

Allison Ruark, Dorothy Brewster-Lee + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0188561

Copy DOI

Abstract

Available data suggest that individual and family well-being are linked to the quality of women’s and men’s couple relationships, but few tools exist to assess couple relationship functioning in low- and middle-income countries. In response to this gap, Catholic Relief Services has developed a Couple Functionality Assessment Tool (CFAT) to capture valid and reliable data on various domains of relationship quality. This tool is designed to be used by interventions which aim to improve couple and family well-being as a means of measuring the effectiveness of these interventions, particularly related to couple relationship quality. We carried out a validation study of the CFAT among 401 married and cohabiting adults (203 women and 198 men) in rural Chikhwawa District, Malawi. Using psychometric scales, the CFAT addressed six domains of couple relationship quality (intimacy, partner support, sexual satisfaction, gender roles, decision-making, and communication and conflict management), and included questions on intimate partner violence. We used exploratory factor analysis to assess scale performance of each domain and produce a shortened Relationship Quality Index (RQI) composed of items from five relationship quality domains. This article reports the performance of the RQI. Internal reliability and validity of the RQI were found to be good. Regression analyses examined the relationship of the RQI to outcomes important to health and development: intra-household cooperation, positive health behaviors, intimate partner violence, and gender-equitable norms. We found many significant correlations between RQI scores and these couple- and family-level development issues. There is a need to further validate the tool with use in other populations as well as to continue to explore whether the observed linkages between couple functionality and development outcomes are causal relationships.

Highlights

The quality of women’s and men’s couple relationships has implications for their health and well-being as well as the health and well-being of their families
Based on factor loadings and predictive ability, we reduced the total number of items in the Relationship Quality Index (RQI) from 56 to 22 and dropped the gender roles scale entirely due to poor performance of the scale
This study provided a wealth of data about couple functionality in a rural Malawian population and regarding the impact of various aspects of couple relationships on behaviors and attitudes which support key health and development goals

Summary

Introduction

The quality of women’s and men’s couple relationships has implications for their health and well-being as well as the health and well-being of their families. Whereas decades of research in high-income countries have shown that marital quality impacts physical and emotional health [1] and child well-being [2], research has only recently begun to investigate associations between health and the quality of couple relationships in low- and middle-income countries (LMIC). All research reviewed by Lawrence and colleagues appears to be from the United States, and we could not identify in the literature a definition of relationship quality based on research from LMIC. In South Africa, three innovative interventions have attempted to enhance couple relationship quality in order to reduce HIV risk [10,11,12], and have documented linkages between relationship quality and outcomes such as shared power [10] and decreased intimate partner violence (IPV) [11]. IPV, a sign of poor relationship quality, carries with it many risks, including increased risk of HIV infection [13,14]

Methods

Results

Conclusion