Couple-based Interventions Research Articles

Mutual Support and Challenges Among Chinese Couples Living With Colorectal Cancer: A Qualitative Study.

A diagnosis of cancer and its treatment affect couples as a unit, and they must cope and give each other mutual support as dyads. Few studies have focused explicitly on understanding mutual support among couples coping with colorectal cancer (CRC). The aim of this study was to explore the mutual support of couples in their journey of coping together with CRC. This is a qualitative descriptive study with purposeful sampling. A total of 11 couples in which 1 partner has been diagnosed with CRC were recruited for in-depth interviews. Three themes and 8 subthemes emerged from a conventional content analysis. The 3 themes were mutual support and reciprocity, challenges confronted in the provision of support, and experiencing adjustments/outcomes. The findings of this study provide insights to healthcare professionals on the process by which couples coping with CRC give each other mutual support and the related challenges. This will aid in the development of an intervention program to support such couples, through enhancing their mutual support, overcoming challenges, and improving their adjustment/outcomes. Healthcare professionals need to (1) include the spouse of the cancer patients in their care and provide them with support, (2) encourage the couples to share their concerns with each other, (3) encourage spousal caregivers to take good care of themselves while providing support to their loved ones with CRC, and (4) develop a couple-based intervention program in providing support to couples coping with cancer as dyads.

Couple identity and well-being in Chinese HIV serodiscordant couples: resilience under the risk of stigma

ABSTRACTResilience literature has suggested the context-specific nature of resilience while such framework has yet to be expanded to health psychology research among HIV serodiscordant couples. Conceptualizing a couple affected by chronic diseases using a “we-ness” framework rather than two separate individuals is important for stress coping of the couple. Considering this social-cognitive context of couple coping would be helpful to facilitate resilience of both the patient and the spouse. It is not clear whether couple identity serves as a protective factor for HIV serodiscordant couples and whether stigma, a prevalent contextual risk in this population, will alter the strength of such a protective effect on well-being. This longitudinal study examined the protective effect of couple identity in predicting the psychological and physical well-being of HIV discordant couples and the moderating role of stigma in such associations. A total of 160 Chinese HIV serodiscordant couples completed the baseline survey and follow-up one year later. Results showed that couple identity predicted fewer depressive symptoms at both the within- and between-couple level and better self-rated physical health at the between-couple level one year later. These protective effects were diminished when HIV stigma was high. This study highlights the importance of examining resources with consideration of contextual factors. It also calls for the sensitivity of stigma in developing a couple-based intervention for HIV serodiscordant couples.

Composite Risk for HIV: A New Approach Towards Integrating Biomedical and Behavioral Strategies in Couples-Based HIV Prevention Research.

A substantial number of new HIV infections among gay, bisexual, and other men who have sex with men and transgender women occurs in the context of primary partnerships. Given the diversity of risk reduction needs and various approaches available for reducing risk within couples, condomless sex is no longer the gold standard HIV outcome. We present a novel, comprehensive, and flexible Composite Risk for HIV (CR-HIV) approach for integrating evolving biomedical and behavioral HIV prevention strategies into couples-based HIV prevention intervention and survey research. We provide illustrative examples of the utility of the CR-HIV approach based on couples' HIV status.

Experiences, Emotions, and Adjustments of HIV-Infected Men in HIV-Concordant Marital Relationship in Cambodia.

Although it has been well documented that the HIV infection experience can be problematic for those affected, the experiences and perceptions of living with HIV among married males in Cambodia have not yet been examined until now. This study’s purpose was to describe the revelations, emotions, reactions, and adjustments to HIV diagnosis among infected Cambodian males in seroconcordant heterosexual relationship. Fifteen qualitative in-depth interviews were conducted with 15 HIV-positive males using unstructured, open-ended questions and in the local Khmer language. Conventional content analysis method was employed for analyzing data. After analysis, four main categories were developed: knowledge of HIV-positive status; realization of self-deeds; discouraging news for both partners; and comparative improvement of life. Participants reported the appearance of physical symptoms as the only reason for pursuing HIV testing. Feelings ranged from sadness and guilt to acceptance of HIV infection in their lives. The participants’ wives expressed anger and worry about being infected by their husbands. However, sufficient inspiration from medical personnel and peer groups, as well as a shared concern for their children, helped couples adjust to their dyadic relationship. The study results highlight the link between individual and couple experiences and emotions post-infection, with implications for designing and implementing coping interventions for this population. The findings of this study have public health implications in the design of couple-based intervention and counseling programs for HIV prevention and treatment with the input of the HIV-positive individuals’ voices.

Changing sex risk behaviors, gender norms, and relationship dynamics among couples in Cape Town, South Africa: Efficacy of an intervention on the dyad

RationaleSouth Africa continues to experience new HIV infections, with the highest risk among Black Africans living in poor communities. Most HIV prevention interventions target women or men separately and only a small number target couples jointly. ObjectiveThis study examines varying strategies to engage women and men around HIV prevention and improved couple interactions. MethodsThe study comprises three arms: (1) a couple-based intervention delivered to women and men jointly; (2) women and men both offered a gender-focused intervention that is delivered to them separately; and (3) an intervention offered to women only and their male partners receive standard HIV testing and counseling (comparison arm). Between June 2010 and April 2012, men were identified in and around drinking establishments in a large disadvantaged community in Cape Town and asked to participate in the study if they drink regularly, had recent unprotected sex with their partner, and have a female partner who was willing to participate in the study. ResultsA total of 299 couples completed the baseline assessment and 276 were included in the analysis of sexual risk, partner communication, conflict resolution, and gender norm outcomes at baseline and six-month follow-up. Couples that participated in the couple-level intervention and couples where both partners received the intervention separately had better couple-level gender norms than couples in the comparison arm (women only receive intervention). Further, couples in the couple-level intervention and the both partners exposed separately arms were more likely to have the man only report consistent condom use than neither partner report consistent condom use than couples in the comparison arm. ConclusionCommunity-based HIV prevention intervention programs need to consider strategies to engage women and men and, if feasible, reach both partners jointly. Couple-level interventions are promising to improve gender norms and subsequently improve health outcomes, including reduced HIV risk among women, men, and couples.

A Couple-Based Communication Intervention for Hematopoietic Cell Transplantation Survivors and Their Caregiving Partners: Feasibility, Acceptability, and Change in Process Measures

Hematopoietic cell transplantation (HCT) poses significant challenges for recipients and their caregiving partners. Couples may refrain from talking about treatment-related fears and concerns to minimize distress. This single-group, pre–post study examined feasibility and acceptability of an intervention designed to optimize communication between HCT patients and partners; it also assessed change in process measures. Couples met with a therapist 5 times to learn skills for disclosing illness-related thoughts and feelings and responding supportively to one another. The extent to which participants disclosed thoughts, feelings, and information during the session and felt supported was assessed at the close of each session. Forty of 89 eligible couples consented (45%). Thirty couples commenced intervention 1-month post-transplant; 26 of these completed all sessions (87%) and 27 completed follow-up (90%). Ratings of self-disclosure and feeling supported by one's partner increased linearly across intervention sessions among both patients and caregivers (all P ≥ .01). Ratings of satisfaction with the intervention were high. HCT couples can be recruited and retained for this intervention. They found it acceptable and were amenable to skills training. A randomized trial is needed to test efficacy and to identify moderators of treatment response.

Partnership duration and HIV serodisclosure among people living with HIV/AIDS in Lilongwe, Malawi.

HIV serodisclosure to sexual partners is an important aspect of HIV prevention, treatment, and care. We investigated the association between partnership duration and serodisclosure among HIV-infected individuals in Lilongwe, Malawi. We analyzed data from a cross-sectional study of individuals attending one of two antiretroviral therapy (ART) clinics in Lilongwe. Clients aged 18-45 years and sexually active within the past six months were eligible. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between partnership duration ≤1 year and serodisclosure. Five hundred and sixty-two participants completed the survey: 308 (55%) women and 254 (45%) men. Median age was 35 years (IQR 30-40), 90% were married, 88% were on ART, and 95% had serodisclosed to their partner. Marital status, knowledge of partner serostatus, and ART use were significantly associated with serodisclosure. Participants in a relationship for ≤1 year were significantly less likely to disclose their serostatus to their partners compared to those in a relationship for >1 year (OR = 0.18, 95% CI: 0.06, 0.58). Couple-based interventions that encourage serodisclosure among partners within their first year of relationship should be developed to decrease HIV transmission, encourage treatment and support.

A genetically informative analysis of the association between dyadic adjustment, depressive symptoms, and anxiety symptoms

BackgroundPrior research has found a reliable and robust association between poor dyadic (e.g., marital) adjustment and depression and anxiety. However, it is possible that this association may be due, at least in part, to confounding variables (i.e., variables that are causally associated both with marital adjustment and psychopathology and could account for their covariation). The present study was conducted using a genetically informative sample of twins to examine the association between dyadic adjustment and symptoms of depression and anxiety, accounting for unmeasured genetic and shared environmental confounds. MethodsA Swedish sample of monozygotic and dizygotic twins (218 female twin pairs and 321 male twin pairs) and their spouse or long-term partner completed self-report measures of dyadic adjustment, depressive symptoms, and anxiety symptoms. ResultsResults suggest that dyadic adjustment was significantly and negatively associated with depressive symptoms and anxiety symptoms in twins, and nonshared environmental influences largely accounted for this association. Furthermore, results obtained from partners’ reports of dyadic adjustment were largely consistent with those obtained from twins’ reports, suggesting that results were not a function of shared method variance. LimitationsLongitudinal research in genetically informative samples would provide a stronger test of the causal association between dyadic adjustment and psychopathology. ConclusionsThe pattern of findings suggest that common nonshared environmental influences, such as partners’ characteristics, may lead to poorer dyadic adjustment and depression and anxiety. Therefore, couple-based interventions that improve dyadic adjustment may be effective in preventing and treating psychopathology in relationship partners.

A couple-based HIV prevention intervention for Latino men who have sex with men: study protocol for a randomized controlled trial

BackgroundLatino men who have sex with men (MSM) experienced a 13% increase in HIV diagnoses from 2010 to 2014, more than any other racial/ethnic subgroup of MSM in the United States. If current HIV diagnoses rates persist, about one in four Latino MSM in the United States will be diagnosed with HIV during their lifetime. Although some efficacious HIV prevention interventions for Latino MSM exist, none have focused on couples. This paper describes the protocol of a randomized controlled trial (RCT) to test the preliminary efficacy of a couple-based HIV prevention intervention that is culturally tailored for Latino men and their same-sex partners.MethodsThe RCT will determine the preliminary efficacy of Connecting Latinos en Pareja (CLP) to increase the proportion of anal sex acts that are HIV protected (i.e., anal sex acts in which condoms, pre-exposure prophylaxis (PrEP), treatment as prevention (TasP), or a combination thereof, are used to reduce risk of HIV transmission). CLP builds upon previous couple-based interventions with white and black MSM by incorporating biomedical prevention techniques, such as PrEP and TasP, implementing a framework responsive to the couple’s serostatus, and addressing the socio-cultural factors that influence HIV risk among Latino MSM. We also include input from community stakeholders, members of the target population, and a community advisory board as part of intervention development. Assessments will be conducted at baseline, and 3- and 6-months post-intervention to examine the intervention effects on outcomes (HIV-protected sex acts), and factors potentially mediating or moderating intervention effects.DiscussionThis paper describes an innovative RCT that incorporates multiple HIV prevention techniques for Latino MSM in couples, regardless of serostatus. The ongoing involvement of community stakeholders, members of the target population, and a community advisory board is emphasized, and plans for widespread dissemination and application of findings into practice are discussed.Trial registrationTrial registration: NCT03048838. Registered on 3 February 2017.

The role of perceptions of partner's alcohol use in heavy alcohol use and alcohol reduction intervention preferences among LGBQ adults in primary, romantic relationships

ABSTRACTCorrelates of heavy episodic alcohol and alcohol reduction intervention preferences were examined among lesbian, gay, bisexual, and queer (LGBQ) adults in romantic relationships. Anonymous data were collected online; analyses included logistic and multinomial regression models. One-fourth of participants reported recent heavy episodic alcohol use. Perceptions of partners' engaging in heavy alcohol use was associated with an increased odds of engaging in heavy alcohol use. Perceptions of partners' heavy alcohol use was associated with an increased odds of preferring a couples-based alcohol intervention compared to preferring no intervention. Findings highlight the need to consider partners in alcohol interventions for LGBQ couples.

Smoking and quitting smoking during pregnancy: A qualitative exploration of the socio-cultural context for the development of a couple-based smoking cessation intervention in Romania.

INTRODUCTIONSmoking during pregnancy has negative effects on the mother and the unborn infant. Barriers to and facilitators of smoking cessation during pregnancy are context-dependent and multifaceted. This qualitative research explored pregnant women’s experiences with smoking and cessation in Romania, and informed the development of a couple-focused smoking cessation intervention.METHODSSemi-structured, in-depth interviews were conducted via telephone, with 15 pregnant women who smoked during pregnancy or had quit smoking upon learning about the pregnancy or shortly before. A hybrid inductive-deductive approach to thematic analysis was used, to identify patterns in the data and explore women’s narratives, in relation to smoking and smoking cessation.RESULTSThree main themes emerged from the data, which shaped the socio-cultural adaptation of the intervention to the local context: 1) Access to and mixed messages from the healthcare system that describe an inconsistent discourse from the healthcare system regarding smoking during pregnancy with some physicians not emphasizing the need for cessation, 2) Cessation as individual or team effort with variations in partner dynamics and difficulty in quitting that have important roles in perceptions about team efforts, and 3) Transition to motherhood and motivation to quit for the health of the pregnancy and infant, although in isolated cases women felt less connected with the pregnancy and such motivators.CONCLUSIONSPregnant women in Romania face systemic, interpersonal, and individual-level barriers that can be responsively integrated in smoking cessation interventions, by culturally adapting them to the local context.

Predictors of enrollment in individual- and couple-based lifestyle intervention trials for cancer survivors.

To utilize data from lifestyle intervention pilot studies for cancer survivors to elucidate demographic, disease-related, and health behavior factors that might predict enrollment in this type of research. Additionally, factors were differentially compared based on intervention design (i.e., individual versus couple-based). Secondary data analysis was conducted regarding predictors of enrollment into lifestyle intervention studies, including Healthy Moves Weight Loss (individual participants, screened n = 89, enrolled n = 30) and Healthy Moves Couples (survivors and their partners, screened n = 197, enrolled n = 23). Due to small sample sizes, common in pilot studies, random forest analyses were used to maximize information yielded by the data. Results identified numerous important predictors of enrollment in individual and couple-based lifestyle interventions. Percent energy from fat and physical activity minutes were identified as important predictors for both recruitment methods. Age, cancer site, and marital status were important predictors of enrollment in the individual-based intervention. Weight, fiber consumption, and disease-related symptom severity and interference were important predictors of enrollment in the couple-based intervention. Although there was some overlap in predictors for enrollment between studies, many differential predictors were identified between individual versus couple-based study designs for lifestyle intervention in cancer survivors. Future lifestyle intervention studies for cancer survivors may benefit from targeting different predictors of enrollment based on study design to optimize recruitment. Additionally, understanding predictors may allow certain barriers to enrollment (i.e., symptom burden) to be directly addressed, making lifestyle intervention research more feasible and acceptable to difficult-to-recruit survivors.

Improving Breast Cancer Survivors' Psychological Outcomes and Quality of Life: Alternatives to Traditional Psychotherapy.

Breast cancer survivors (BCS) often experience psychological problems and lowered quality of life (QOL). While helpful, psychotherapy is often costly and inaccessible. This review aims to provide practitioners with the latest information on empirically tested interventions among BCS that may be used in lieu of, or in addition to, traditional psychotherapy. Recent developments in cancer-related psychological interventions include a focus on facilitating emotional disclosure (e.g., expressive writing), enhancing close relationships (e.g., couples-based interventions), and increasing feasibility and accessibility via online and computer-based intervention programs. These alternatives to psychotherapy offer a number of benefits including cost-effectiveness, personalized adaptability, and ease of implementation. Utilizing these interventions as alternatives or supplements to traditional psychotherapy may offer BCS an opportunity to increase their QOL, improve psychosocial outcomes, and find meaning in their cancer experience. Choosing the appropriate intervention requires understanding the unique circumstances for each survivor and their family.

A research protocol for a pilot randomized controlled trial designed to examine the feasibility of a couple-based mind-body intervention for patients with metastatic lung cancer and their partners

BackgroundGiven the generally incurable nature of metastatic non-small cell lung cancer (mNSCLC), patients and their romantic partners are at risk for existential/spiritual distress. Although a handful of dyadic psychosocial interventions for lung cancer patients and their caregivers exist, none of them target spiritual well-being. Informed by the mindfulness-based intervention literature and our pilot work in couples affected by lung cancer, we developed a brief couple-based mind-body (CBMB) intervention. The primary aim of this research protocol is to determine the feasibility of implementing the CBMB intervention versus an active control (AC) or wait list control (WLC) group in patients with mNSCLC and their partners using a randomized controlled trial design.MethodsSeventy-five patients with mNSCLC receiving treatment and their partners are randomized to the CBMB intervention, an AC or a WLC group. Those in the CBMB intervention and AC groups receive four intervention sessions of 60 min each over 4 weeks and complete weekly homework assignments. The first session is delivered in person, and the remaining sessions are delivered via videoconference. The dyads in the AC group discuss cancer-related and personal growth concerns with the interventionist but are not taught coping skills. Patients and partners in all groups complete baseline assessments of quality of life (QOL) prior to randomization. Follow-up assessments are performed 4 weeks and then again 3 months later. The primary outcome is feasibility (i.e., ≥ 30% of eligible couples consent, ≥ 70% of enrolled couples are retained, and ≥ 50% of all CBMB and AC sessions are attended). We will also perform primarily descriptive analyses of the self-reported outcomes (e.g., spiritual well-being and psychological distress) and explore potential intervention mediators (i.e., compassion, communication, mindfulness, and closeness) to inform a larger, future trial.DiscussionThis trial will provide important information regarding the feasibility of a behavioral intervention in a vulnerable yet understudied population using videoconferencing and descriptive data regarding spiritual well-being and other indices of QOL in both mNSCLC patients and their partners.Trial registrationClinicalTrials.gov NCT02596490

Together Eating & Activity Matters (TEAM): results of a pilot randomized-clinical trial of a spousal support weight loss intervention for Black men.

SummaryObjectivesThe objective of this study is to evaluate the feasibility, participation, preliminary efficacy and retention in a couples‐based weight loss intervention among Black men.Design, setting, participantsTwo‐arm pilot randomized clinical trial in an academic clinical setting. Forty self‐identified Black men and their female cohabitating partners (n = 80) aged 18 to 65 years with body mass index from 25 to 45 kg/m2 were randomized using computer generated tables to allocate treatments.InterventionParticipants were randomized to a standard behavioural weight loss (Standard) programme or the Standard programme plus partner involvement (Enhanced). Both interventions focused on calorie reduction, physical activity and self‐monitoring to facilitate weight loss. Enhanced included couples skills training and couple's communication components.Main outcome and measuresChanges in weight from baseline to 3 months among men. Partner weight loss (secondary).ResultsForty Black couples (men mean [SD] age, 47.4[11] years; body mass index, 35.0[6.1]), were recruited. Retention was 100% of the men and 98% of female partners. Attendance at group sessions was 63–73%. Between groups, mean (SD) weight changes among men were −3.4[.04] and −4.7[5.9] kg (p = 0.57) and among women −0.23[4.46] and −2.47[3.62] kg (p = 0.09), in the standard and enhanced groups.ConclusionsWeight losses from an intervention enhanced by partner involvement and an intervention with no partner involvement were not different. Treatment choice can be based on preference rather than outcome as both treatments are effective in producing clinically significant percent weight loss.Trial registration Clinical Trials NCT02458053.

Endurance with partnership: a preliminary conceptual framework for couples undergoing in vitro fertilisation treatment

Background/objectives: Infertility affects both women and men in the physical, emotional, existential, and interpersonal realms. When couples seek in vitro fertilisation (IVF) treatment, they further suffer from the difficulties of the treatment and the uncertainty of its outcome. The aim of this study was to develop a preliminary conceptual framework for couples undergoing IVF treatment to give health professionals a better understanding of the experiences of such couples, and to guide the development of an intervention.Methods: The process of identifying frameworks adopted in intervention studies confirmed that there is no established framework for infertile couples undergoing IVF treatment. A skeletal framework identified from previous studies provides an internal structure for the proposed framework for couples undergoing IVF treatment, filled out with concepts drawn from a concept analysis and a qualitative study, knitting the structure together.Results: This preliminary framework is the Endurance with Partnership Conceptual Framework (P-EPCF). It consists of four domains: the impacts of infertility and stressors, dyadic mediators, dyadic moderators and dyadic outcomes. According to the P-EPCF, the impacts of infertility and IVF treatment can be mediated by the couples’ partnership and dyadic coping. Improvements in the psychological well-being and marital functioning of IVF couples can then be expected.Conclusions: The P-EPCF would be potentially valuable in guiding the development of a complex, couple-based intervention, which could focus on enhancing the partnership of couples and their coping strategies.

Supplemental Material for Pilot Randomized Trial of a Couple-Based Physical Activity Videoconference Intervention for Sedentary Cancer Survivors

Supplemental Material for Pilot Randomized Trial of a Couple-Based Physical Activity Videoconference Intervention for Sedentary Cancer Survivors

Concordance in Reported Love, Trust, and Relationship Quality among Same-Sex Male Relationships.

This paper examines concurrence of self-reported love, trust, and dyadic quality experiences between partners in 293 male couples. Significant yet poor concurrence was observed for all three self-reported relationship measures, but varied by relationship characteristics. Using an actor-partner interdependence model (APIM), actor and partner characteristics were shown to be associated with self-reported relationship concerns, such as satisfaction and intimate partner violence. This knowledge is important in the development and delivery of couples-based health interventions, such as couples HIV testing and counseling, for interventions that respect the unique relationship dynamics of each couple are needed to effectively address dyadic health.

A pilot open trial of UNITE-BED: A couple-based intervention for binge-eating disorder

A pilot open trial of UNITE-BED: A couple-based intervention for binge-eating disorder

Pilot Testing of a Brief Couple-Based Mind-Body Intervention for Patients With Metastatic Non-Small Cell Lung Cancer and Their Partners

ContextGiven the generally incurable nature of metastatic lung cancer, patients and their spouses/partners are at risk for psychological and spiritual distress. To address this concern, we developed a couple-based mind-body (CBMB) intervention. ObjectivesThis formative research aimed at examining the intervention's acceptability and initial efficacy in patients with metastatic lung cancer undergoing treatment and their spouses. MethodsIntervention content evaluation sessions and an ensuing single-arm trial were conducted. To evaluate intervention content, participants performed intervention exercises and then participated in semistructured interviews and completed written evaluations. In the single-arm trial, four intervention sessions were delivered over two weeks, focusing on cultivating mindfulness, interpersonal connection, gratitude, and purpose. Newly recruited couples completed measures of depressive symptoms, cancer distress, spiritual well-being, and sleep disturbances before and after the intervention. ResultsContent evaluations by seven dyads of patients and their partners revealed high acceptability ratings for the CBMB intervention (e.g., all participants would recommend the intervention). Consent and adherence rates (54% and 67%, respectively) were acceptable in the single-arm trial. All patients (n = 7 dyads; 67% male; mean age, 55 years) and partners (33% male; mean age, 59 years) rated the intervention as useful. Paired t-test analyses revealed large effect sizes for reduced sleep disturbances (d = 1.83) and medium effect sizes for cancer-specific distress (d = 0.61) for patients and large effect sizes for depressive symptoms (d = 0.90) for partners. ConclusionBased on these results, the CBMB intervention appears to be acceptable and subjectively useful. In addition, we observed preliminary evidence of quality of life gains in both patients and their partners.