The effect of a couple-based posttraumatic growth intervention in supporting couples coping with colorectal cancer: A randomized controlled study.

OBJECTIVES: To promote posttraumatic growth (PTG) in colorectal cancer (CRC) couples, a couple-based PTG intervention was conducted, and the intervention had previously proved be feasible in CRC couples. The current study was conducted to validate the effects of intervention in CRC couples. METHOD: This is a randomized controlled study that included 174 CRC couples. All participants were randomized to either the intervention (usual care plus 5-week PTG intervention, n = 87) or the control group (usual care, n = 87). Data were collected from CRC couple dyads at baseline and immediately post-intervention periods. Primary outcome refers to positive changes, and secondary outcomes include marital satisfaction, quality of life (QOL), and anxiety and depression. Multilevel modeling was applied to analyze the intervention effects. RESULTS: Participants in the program showed increased PTG, marital satisfaction, and QOL both physically and mentally, and decreased levels of anxiety and depression over time. And spousal caregivers showed greater improvement in marital satisfaction and physical QOL compared with patients. In addition, significant intervention effects were shown in the participants' benefit finding, physical health and depressive symptoms. CONCLUSION: The study confirmed the effect of the PTG intervention on CRC couples' benefit finding, physical health and depressive symptoms. However, this study only measured outcome variables at two time-points. Future studies should add follow-up assessments to evaluate long-term effects of the intervention in CRC couples. REGISTRATION NUMBER: ChiCTR2300067809.

Barriers, Facilitators, and Strategies to Improve Participation of a Couple-Based Intervention to Address Women's Antiretroviral Therapy Adherence in KwaZulu-Natal, South Africa.

BACKGROUND: Couple-based interventions (CBIs), despite strong efficacy in improving numerous HIV risk behaviors, are not widely available and have not been tested to improve women's antiretroviral therapy (ART) adherence. We examined barriers and facilitators to participation in a CBI based on cognitive behavioral couple therapy for women's ART adherence in KwaZulu-Natal, South Africa. METHODS: Semi-structured interviews were conducted with women with HIV (n = 15) and men of mixed HIV status (n = 15). Thematic analyses were guided by the Consolidated Framework for Implementation Research. RESULTS: Facilitators mostly related to the couple's relationship, including having an existing healthy relationship, men's desire to support their partners, and a potential opportunity for men's HIV disclosure. Barriers included a lack of understanding of how a CBI approach would be useful for women's ART adherence, sole focus on women if male partners were also living with HIV, and men's lack of prior HIV status disclosure to female partners. CONCLUSION: Findings indicate that relationship context and the male partner's HIV status need to be addressed during recruitment, enrolment, and during the intervention to promote uptake.

Do Couple-Based Interventions Show Larger Effects in Promoting HIV Preventive Behaviors than Individualized Interventions in Couples? A Systematic Review and Meta-analysis of 11 Randomized Controlled Trials.

This systematic review and meta-analysis aims to compare the effects of couple-based prevention interventions against individual-level interventions on HIV prevention in randomized controlled trials (RCTs), identify potential moderators, and assess study quality. Eleven RCTs were included, comprising 3933 couples in the intervention group and 7125 individuals in the individual control group, predominantly in heterosexual couples from the USA and Africa. Couple-based interventions had a more significant effect in promoting condom use and HIV testing. Education levels of high school or above, residence in low- and middle-income countries, and intervention design incorporating HIV counseling and testing were associated with higher odds of condom use. The quality assessment analysis identified methodological and theoretical heterogeneity factors. Evidence of couple-based HIV prevention RCTs among men who have sex with men, injecting drug users, sex workers, and transgender women warrant further investigation. Recommendations are made to improve the quality and replicability of future intervention studies.

RESUMEN: Esta revista sistemática y metanálisis tiene por objeto comparar los efectos de las intervenciones de prevención basadas en pareja con las a nivel individual en la prevención del VIH en ensayos controlados aleatorios (ECA), identificar posibles moderadores y evaluar la calidad de los estudios. Se incluyeron once ECA, que comprendían 3.933 parejas en el grupo de intervención y 7.125 personas en el grupo de control individual, la mayoría de las cuales eran heterosexuales de EE.UU. y de África. Las intervenciones basadas en pareja son más eficaces para promover el uso de preservativos y pruebas del VIH. Los niveles de educación secundaria o superior, los países de ingresos bajos y medianos, y los diseños de intervención que incluyen pruebas y asesoramiento sobre el VIH se relacionan con más uso de preservativos. El análisis de evaluación de la calidad ha identificado factores de heterogeneidad metodológica y teórica. Las pruebas de ECA basadas en pareja para la prevención del VIH en hombres que tienen sexo con hombres, consumidores de drogas inyectables, trabajadoras sexuales y mujeres transgénero necesitan más investigación. Se hacen recomendaciones para mejorar la calidad y replicabilidad de futuros estudios de intervención.

Feasibility and preliminary effect of a couple-based posttraumatic growth intervention for colorectal cancer couples: A randomized controlled pilot study.

BACKGROUND: Colorectal cancer (CRC) causes severe physical and psychological impacts on the patients as well as their spousal caregivers. To facilitate the psychological adaptation of the CRC suffered couples, a couple-based posttraumatic growth (PTG) intervention was developed based on the PTG affective-cognitive processing model. The feasibility, acceptability and preliminary effect of this intervention were tested. METHODS: A pre-post randomized controlled pilot trail was conducted for Chinese couples coping with CRC. Participants in the intervention group were provided five weekly sessions consecutively, while those in the control group were treated with usual care during the testing period. Outcomes were described as positive changes (PTG, benefit finding [BF]), marital satisfaction, quality of life and anxiety and depression. Qualitative method was also used to evaluate the programme participating sense of the couples. RESULTS: The rate of programme recruitment and programme retention amounts to 78.6% and 87.5%, respectively. The participants have reported overall satisfaction for the programme attendance and have suggested detailed diet guidance. Significant effects were revealed in the outcomes for the CRC couples, including PTG, marital satisfaction, BF, physical and mental health and anxiety and depression. CONCLUSION: The study confirmed the feasibility and preliminary positive effect of the couple-based PTG intervention for the CRC couples. However, in order to extend it in more general applications, large-scale researches are warranted. PRACTICAL IMPLICATION: The couple-based intervention is effective for couples coping with CRC. Clinicians should take the components of the intervention into consideration in their practice work for the CRC couples.

Effect and quality of couple-based interventions of middle-aged and older adults with type 2 diabetes mellitus: a scoping review.

BACKGROUND: Studies have shown the existence of health concordance between patients with type 2 diabetes mellitus (T2DM) and their spouses, and also that spouses could influence the effect of self-management, benefiting patients' health. However, these studies are heterogeneous and the evidence is inconclusive. OBJECTIVE: To synthesize evidence from published randomized controlled trials: the interventional effects and the quality of study performance, also to identify the research gap and the directions for future studies. METHODS: We performed the scoping review by following the PRISMA-ScR guidance. We searched and examined the reports from MEDLINE, EMBASE, PsychInfo, CINAHL Plus by the pre-specified criteria. Key characteristics and information of eligible reports were extracted, analysed and synthesized comprehensively, and the results were presented in the form of words and diagrams. RESULTS: We identified 5 reports from 4 studies out of 3479 records included. Qualified studies indicated a positive effect of couple-based interventions on couples' distress. Insufficient evidence on physiological health or health behaviours was identified owing to the small number of included studies and inconsistent assessment outcomes. The methodological quality across these studies was generally low due to inadequate reporting of study process and substantial biases. CONCLUSIONS: Couple-based interventions for patients with T2DM showed small effects on the couple's distress while the effects of other outcomes were inconclusive. Future studies should strengthen methodologies by using standard measures of core diabetic outcomes, including detailed assessments of implementation process, and taking a dyadic approach to systematically examine the effects.

Couple-based collaborative management model of type 2 diabetes mellitus for community-dwelling older adults in China: protocol for a hybrid type 1 randomized controlled trial.

BACKGROUND: China's limited health care resources cannot meet the needs of chronic disease treatment and management of its rapid growing ageing population. The improvement and maintenance of patient's self-management is essential to disease management. Given disease management mainly occurs in the context of family, this study proposes to validate a Couple-based Collaborative Management Model of chronic diseases that integrates health professionals and family supporters; such as to empower the couples with disease management knowledge and skills, and to improve the couples' health and quality of life. METHODS: The proposed study will validate a couple-based collaborative management model of Type 2 Diabetes Mellitus (T2DM) in a community-based multicenter, two-arm, randomized controlled trial of block design in Guangzhou, China. Specifically, 194 T2DM patients aged ≥55 and their partners recruited from community health care centers will be randomized at the patient level for each center at a 1:1 ratio into the couple-based intervention arm and the individual-based control arm. For the intervention arm, both the patients and their spouses will receive four-weekly structured group education & training sessions and 2 months of weekly tailored behavior change boosters; while these interventions will be only provided to the patients in the control group. Behavior change incentives will be targeted at the couples or only at the patient respectively. Treatment effects on patients' hemoglobin, spouses' quality of life, alongside couples' behavior outcomes will be compared between arms. Study implementation will be evaluated considering its Reach, Effectiveness, Adoption, Implementation and Maintenance following the RE-AIM framework. DISCUSSION: This study will generate a model of effective collaboration between community health professionals and patients' family, which will shield light on chronic disease management strategy for the increasing ageing population. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900027137, Registered 1st Nov. 2019.

A Cross-Section Study of Relationship Characteristics and Smoking Cessation During Pregnancy in a Sample of Romanian Pregnant Women.

INTRODUCTION: Partner support and relationship characteristics may be important factors in effective couple-based pregnancy smoking cessation programs. Research is needed to investigate the links between couple relationship characteristics and maternal smoking cessation to inform the development of such interventions. METHODS: This paper relies on cross-section data collected during the formative phase in the development of an ongoing couple-focused pregnancy tobacco cessation trial. Data (n = 143 pregnant women) were collected from two large public and one private obstetrics and gynecology clinics located in Cluj-Napoca, Romania. Multiple logistic regression was used to identify correlates of smoking cessation during pregnancy. RESULTS: Higher education was a significant correlate of smoking cessation during pregnancy. Women with a college degree or more had higher odds to quit smoking during pregnancy in comparison to their counterparts who graduated high school or less (OR 14.3, 95% CI 2.75-74.28). In addition, women with increased positive partner interactions related to their smoking cessation efforts correlated with higher odds of quitting smoking during pregnancy (OR 1.48, 95% CI 1.15-1.91). DISCUSSION: While pregnancy tobacco cessation interventions with partner support do exist, most were not successful and did not focus on couple-related concepts such as partner interactions, dyadic coping, and dyadic efficacy. The findings of the study are important because they bring new insights regarding the potential role of relationship characteristics to inform future cessation programs focused on pregnant smokers and their life partners.

Self-management intervention for head and neck cancer couples: Results of a randomized pilot trial.

BACKGROUND: Patients with head and neck cancer (HNC) experience significant physical and psychological morbidity during radiotherapy (RT) that contributes to treatment interruptions and a poor quality of life. Although spouses/partners can help by encouraging patient self-management (eg, self-care) during RT, they often experience high psychological distress rates, lack basic health care knowledge and skills, and report increased marital conflict regarding patient self-management. The current pilot study examined the feasibility and acceptability of a 6-session telephone-based intervention called Spouses coping with the Head And neck Radiation Experience (SHARE), which teaches self-management, communication, and coping skills to patients with HNC and their spouses. The treatment effects of SHARE compared with usual medical care (UMC) in controlling patient physical symptoms and improving patient/spouse psychological and marital functioning also were examined. METHODS: Thirty patients who initiated RT and their spouses (60 participants; 40% of whom were racial/ethnic minorities) were randomized to SHARE or UMC, and preintervention and postintervention assessments were completed. RESULTS: Solid recruitment (70%) and low attrition rates (7%) demonstrated feasibility. Strong program evaluations and homework completion rates (72%) supported acceptability. Significant treatment effects (medium in magnitude) were observed for SHARE compared with UMC with regard to HNC-specific physical symptom burden (Cohen's d, -0.89) and symptom interference (Cohen's d, -0.86). Medium to large effects favoring SHARE also were found for patient and spouse depressive symptoms (Cohen's d, -0.84) and cancer-specific distress (Cohen's d, -1.05). CONCLUSIONS: The findings of the current study support the feasibility, acceptability, and preliminary efficacy of SHARE. They also suggest that programs that empower HNC couples with the necessary skills to coordinate care and manage the challenges of RT together hold great promise for controlling a patient's physical symptoms and improving the psychological functioning of both partners.

New debate: is it time for infertility weight-loss programmes to be couple-based?

With obesity on the rise in the general population, it has also become more prevalent among people of reproductive age. Weight loss has shown benefits in overweight women and men experiencing fertility problems. However, the existing weight-loss interventions for individuals with infertility are associated with high drop-out rates and limited success. In this article, we argue for the development of weight-loss programmes targeting couples, as couples are routinely seen in fertility clinics, rather than individuals. Couples may have correlated weights, and similar eating and activity patterns. Involving both partners may facilitate mutual support, behaviour change, weight loss and programme continuation, at very little additional cost. A successful couple-based intervention could improve the chances of achieving pregnancy and delivering a healthy baby, with a reduction in pregnancy complications. In the longer run, both partners and their baby could benefit from maintained behaviour change with better health across the lifespan. We conclude that there is a need for research to systematically develop a couple-based weight-loss intervention with state-of-the-art design that is tailored to both partners' needs.

The Partnership and Coping Enhancement Programme for couples undergoing in vitro fertilization treatment: the development of a complex intervention in China.

PURPOSE: Couples as dyads suffer from the diagnosis of infertility and related treatment. These couples commonly experience emotional and physical pain and tension in their marital lives. The purpose of this study is to report on the process of developing a potentially feasible and effective complex intervention for couples undergoing in vitro fertilization treatment in China. METHODS: The Medical Research Council (MRC) framework for developing and evaluating the complex intervention was adopted to guide the development of the Partnership and Coping Enhancement Programme (PCEP). In developing the PCEP, three steps were taken, namely, (1) identifying evidence by conducting literature reviews, a concept analysis and a qualitative study; (2) identifying/developing a theory-in this case, a preliminary Endurance with Partnership Conceptual Framework (P-EPCF) was proposed; and (3) modelling the process and outcomes of the PCEP. RESULTS: The PCEP that was developed is targeted mainly at the domains of the partnership mediators of stress in the P-EPCF. It consists of two sections-partnership and coping-and will be delivered to infertile couples on the day of embryo transfer. The main focuses of the programme are to facilitate mutual sharing and support in infertile couples, and to improve their individual and dyadic coping strategies while undergoing IVF treatment, especially in the period when they are waiting for the results of a pregnancy test and after the disclosure of a negative treatment outcome. The programme is couple-based, consisting of experience sharing, psychoeducation, meditation exercise, skill practise and supplemental written materials. CONCLUSIONS: The Partnership and Coping Enhancement Programme (PCEP) for couples undergoing in vitro fertilization treatment was developed according to the guideline of the MRC framework. It is recommended that a pilot study be conducted to evaluate its feasibility and to model the process and outcomes of the programme.

A systematic review of spousal couple-based intervention studies for couples coping with cancer: direction for the development of interventions.

OBJECTIVE: With the research focus on family caregiving shifting from the individual to the dyadic level, it is suggested that the caregiver-patient dyad as a unit be the focus and direction of caregiving interventions for families coping with cancer. The objectives in conducting this review were to explore the existing interventions for spousal couples coping with cancer in terms of type of intervention, contents, approach, and outcome measurements; and to identify directions for the development of interventions. METHODS: A systematic search of four databases was conducted to identify articles published in English or Chinese from the launch of the databases to March 2013. Studies were located using an electronic search, a manual search, and an author search. RESULTS: A total of 17 articles were identified and included in this review. These interventions focused mainly on patient caregiving and caregiver self care, and usually lasted for 6 weeks using a face-to-face group mode, with follow-up at around 3 months. The outcome measures can be grouped into three main dimensions: dyadic appraisal, dyadic coping, and dyadic adjustments. Positive outcomes were reported for these interventions, including improvements in communication, dyadic coping, the quality of life of both the patients and their partners, psychosocial distress, sexual functioning, and marital satisfaction. CONCLUSIONS: These findings highlighted the positive outcomes of couple-based interventions that focus on couples coping with cancer. Future studies on couple-based interventions should be conducted in different cultures, such as in Asian countries. Collaboration between researchers and clinicians is crucial to ensure the development of effective and accessible supportive interventions targeting couples coping with cancer.

The effects of a couple-based gestational diabetes mellitus intervention on self-management and pregnancy outcomes: A randomised controlled trial.

AIMS: To estimate the effectiveness of the Couples Coping with Gestational Diabetes Mellitus (GDM) Programme on GDM self-management and pregnancy outcomes. METHODS: A randomised controlled trial among pregnant women with suboptimal GDM self-management and their partners was undertaken. Couples recruited from three hospitals in China were randomly allocated to either intervention (n = 70) or control (n = 70) conditions. Couples in the intervention group underwent the couple-based intervention (GDM education, shared illness appraisals, initiation of collaborative action and consolidation of collaborative action). Women in the control group received individual GDM education. Data were analysed using the independent samples t-test, chi-square test, and generalised estimating equations. RESULTS: GDM knowledge for the women and their partners and GDM self-management significantly improved in both the intervention and control groups, with stronger improvement in the intervention group. Women in the intervention group gained significantly less weight than those in the control group (11.2 kg ± 2.8 kg vs 13.1 kg ± 2.6 kg, p = 0.008). Infant birth weights were significantly lower in the intervention group (3.2 kg ± 0.3 kg vs 3.4 kg ± 0.4 kg, p = 0.008). There were no significant differences in other pregnancy outcomes. CONCLUSIONS: The Couples Coping with GDM Programme was associated with improvements in GDM knowledge of women and their partners and in women's self-management, and with lower gestational weight gain and infant birth weight.

Gender-Specific Effect of Couple-Based Intervention on Behavioral and Psychological Outcomes of Older Adults with Type 2 Diabetes during the COVID-19 Partial Lockdown in Guangzhou, China.

This study aimed to evaluate the gender-specific effect of a couple-based intervention on the management behaviors and mental well-being of community-dwelling older adults with type 2 diabetes mellitus during the COVID-19 partial lockdown in Guangzhou. Out of 207 participants involved in a prior randomized controlled trial (Trial no. ChiCTR1900027137), 156 (75%) completed the COVID-19 survey. Gendered differences in management behaviors and depressive symptoms between the couple-based intervention group and the patient-only control group were compared by distance to the high-risk areas cross-sectionally and longitudinally using random intercept models. Cross-sectionally, female patients of the intervention group had more positive behavior change scores (ß = 1.53, p = 0.002) and fewer depressive symptoms (ß = −1.34, p = 0.02) than the control group. Over time, female patients lived closer to the high-risk areas (<5 km) and showed decreasing depressive symptoms (ß = −4.48, p = 0.008) in the intervention group vs. the control group. No statistically significant between-group difference was found for males. Females tended to benefit more from the coupled-based intervention than males did, particularly among these closer to the high-risk areas. Chronic disease management can be better sustained with active spousal engagement.

The effectiveness of a couple-based intervention for people living with mild Alzheimer's disease and their spousal caregivers in Korea.

BACKGROUND AND OBJECTIVES: We evaluated the effectiveness of a Korean version of the Couples Life Story Approach (CLSA-K), a structured life-review program originally developed in the U.S. to help older adults with dementia and their spousal caregivers engage with each other and improve their quality of life.Research design and methods: Fifty mild people living with mild Alzheimer's disease and their spouses were recruited and 37 couples completed the five-week CLSA-K program. Data on psychosocial outcomes-i.e., depressive symptoms, talkativeness, mutuality (for both caregivers and care recipients) and burden (for caregivers)-were collected one week prior to (Time 1) and one week after the intervention (Time 2). Using repeated measures generalized linear models, we examined the differences in the amounts and patterns of the changes in outcomes according to age, gender, and the care-recipients' level of cognitive impairment. RESULTS: Some participants benefited from the CLSA-K program, while others did not. For caregivers, mental health, and marital quality remained stable, while caregiver burden increased among those with spouses who had moderate levels of cognitive impairment. For care-recipients, younger and male participants showed increased talkativeness. DISCUSSION AND IMPLICATIONS: CLSA-K appears to be promising for specific subgroups of participants in Korea. Multi-component or other approaches may be more beneficial for other couples. Cultural differences as well as social positions may play a role in the acceptability and efficacy of the couple-based intervention.