Quality of Research
Review Date: September 2006
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Markman, H. J., Floyd, F. J., Stanley, S. M., & Storaasli, R. D. (1988). Prevention of marital distress: A longitudinal investigation. Journal of Consulting and Clinical Psychology, 56(2), 210-217.
Markman, H. J., & Hahlweg, K. (1993). The prediction and prevention of marital distress: An international perspective. Clinical Psychology Review, 13, 29-43.
Markman, H. J., Renick, M. J., Floyd, F. J., Stanley, S. M., & Clements, M. (1993). Preventing marital distress through communication and conflict management training: A 4- and 5-year follow-up. Journal of Consulting and Clinical Psychology, 61(1), 70-77. 
Renick, M. J., Blumberg, S. L., & Markman, H. J. (1992). The prevention and relationship program (PREP): An empirically based preventive intervention program for couples. Family Relations, 41, 141-147. Study 2Hahlweg, K., Markman, H. J., Thurmaier, F., Engl, J., & Eckert, V. (1998). Prevention of marital distress: Results of a German prospective longitudinal study. Journal of Family Psychology, 12(4), 543-556. Study 3Halford, W. K., Sanders, M. R., & Behrens, B. C. (2001). Can skills training prevent relationship problems in at-risk couples? Four-year effects of a behavioral relationship education program. Journal of Family Psychology, 15(4), 750-768. Study 4Stanley, S. M., Markman, H. J., Prado, L. M., Olmos-Gallo, A., Tonelli, L., St. Peters, M., et al. (2001). Community-based premarital prevention: Clergy and lay leaders on the front lines. Family Relations, 50(1), 67-76. Study 5Laurenceau, J. P., Stanley, S. M., Olmos-Gallo, A., Baucom, B., & Markman, H. J. (2004). Community-based prevention of marital dysfunction: Multilevel modeling of a randomized effectiveness study. Journal of Consulting and Clinical Psychology, 72(6), 933-943.
Supplementary Materials Halford, W. K., Markman, H. J., Kline, G. H., & Stanley, S. M. (2003). Best practice in couple relationship education. Journal of Marital and Family Therapy, 29(3), 385-406.
Markman, H. J., Stanley, S., & Allen, E. S. (2006). The long-term effects of premarital intervention. Grant application submitted to the National Institute of Child Health and Human Development.
Markman, H. J., Whitton, S. W., Kline, S. M., Thompson, H., St. Peters, M., Leber, D. B., et al. (2004). Use of an empirically based marriage education program by religious organizations: Results of a dissemination trial. Family Relations, 53(5), 504-512.
Stanley, S. M., Allen, E. S., Markman, H. J., Saiz, C. C., Bloomstrom, G., Thomas, R., et al. (2005). Dissemination and evaluation of marriage education in the Army. Family Process, 44(2), 187-201.
Outcomes
| Outcome 1: Relationship satisfaction and stability |
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Description of Measures
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Relationship satisfaction and stability were assessed by self-report measures of (1) marital functioning (Marital Adjustment Test); (2) frequency and quality of sensual or sexual activity (Sexual Dissatisfaction Scale); (3) steps taken toward separation (Relationship Status Inventory); (4) danger signs of interactions (Relationship Dynamic Scale); and (5) couples' confidence with one another (Confidence Scale).
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Key Findings
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In a long-term study, PREP couples showed greater relationship satisfaction at 1 1/2 years and 3 years after the intervention than control couples who received pre- and postassessments only. Husbands participating in PREP reported greater relationship satisfaction than husbands in the control group at 4 and 5 years after the intervention.
In another study, at 3-year follow-up, couples participating in a PREP program modified for German couples (Ein Parschaftliches) had higher relationship satisfaction than control couples who participated in a conventional marital enrichment program (p < .013).
A third study compared a variant of PREP (Self-Regulatory Prevention and Relationship Enhancement Program, or Self-PREP) with a control condition (a relationship education program). The study found that high-risk couples (woman had divorced parents or man's father was violent toward mother) participating in Self-PREP exhibited higher relationship satisfaction at 4-year follow-up than control couples. In low-risk couples, where neither of the high-risk conditions was present, relationship satisfaction was higher in the control condition.
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Studies Measuring Outcome
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Study 1, Study 2, Study 3, Study 4, Study 5
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Study Designs
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Experimental, Quasi-experimental
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Quality of Research Rating
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2.6
(0.0-4.0 scale)
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| Outcome 2: Communication and conflict management |
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Description of Measures
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Communication and conflict management were assessed by: (1) self-report measures of how couples handle conflict (Conflict Tactics Scale); (2) couple's perception of their communication during interactions (Communication Box); (3) observer ratings of couple's proficiency in communicating with one another (Communication Skills Test); (4) observer's coding of couple's conflict management and intimacy (Interaction Dimensions Coding System); and (5) levels of commitment (Commitment Inventory).
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Key Findings
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In a long-term study, PREP couples showed improved communication 1 1/2 years after the intervention and fewer negative-behavior communications at 3 years after the intervention compared with control couples, who received pre- and postassessments only. At 4 and 5 years after the intervention, husbands participating in PREP reported fewer negative communications than husbands in the control group.
Another study reported that couples participating in a PREP program modified for German families (Ein Parschaftliches) had consistently more positive and less negative communication behavior than control couples who participated in a conventional marital enrichment program.
In a third study using a variant of PREP (Self-PREP), results showed that high-risk couples (woman had divorced parents or man's father was violent toward mother) who participated in Self-PREP had better communication than control couples who participated in a relationship education program.
In a fourth study, couples who had taken PREP delivered by the clergy and lay leaders within a religious organization showed favorable patterns of communication over time when compared with the treatment-as-usual group.
In a multilevel modeling study in three group assignments, negative-behavior trends for wives receiving PREP from clergy showed significantly greater declines when compared with trends for wives receiving treatment as usual. Positive-behavior trends for those receiving treatment as usual or PREP from university clinician partners showed significant declines when compared with trends for wives receiving PREP delivered by clergy.
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Studies Measuring Outcome
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Study 1, Study 2, Study 3, Study 4, Study 5
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Study Designs
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Experimental, Quasi-experimental
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Quality of Research Rating
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2.6
(0.0-4.0 scale)
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| Outcome 3: Problem intensity |
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Description of Measures
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Problem intensity was assessed using: (1) the Relationship Problem Inventory, a self-report scale requiring each partner to rate the perceived intensity of couple's commonly experienced problem areas (e.g., communication, money, sex); and (2) the Marital Agendas Protocol, a scale that assesses intensity in problem areas (e.g., money, sex, children), as well as confidence in being able to solve problems (i.e., relationship efficacy).
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Key Findings
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In a long-term study, PREP couples reported decreased levels of problem intensity from pre- to posttest and at 1 1/2 and 3 years after the intervention when compared with the control couples.
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Studies Measuring Outcome
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Study 1, Study 4, Study 5
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Study Designs
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Experimental
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Quality of Research Rating
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1.8
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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18-25 (Young adult)
26-55 (Adult)
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50% Female
50% Male
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Data not reported/available
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Study 2
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18-25 (Young adult)
26-55 (Adult)
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50% Female
50% Male
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100% Non-U.S. population
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Study 3
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26-55 (Adult)
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50% Female
50% Male
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100% Non-U.S. population
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Study 4
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18-25 (Young adult)
26-55 (Adult)
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50% Female
50% Male
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90.4% White
6.2% Hispanic or Latino
1.8% Race/ethnicity unspecified
0.3% American Indian or Alaska Native
0.3% Asian
0.3% Black or African American
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Study 5
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18-25 (Young adult)
26-55 (Adult)
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50% Female
50% Male
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85.2% White
12.2% Hispanic or Latino
1.8% Black or African American
0.9% American Indian or Alaska Native
0.7% Asian
0.7% Race/ethnicity unspecified
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Relationship satisfaction and stability
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3.0
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3.5
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2.0
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2.5
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2.0
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2.5
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2.6
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2: Communication and conflict management
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3.0
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3.5
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2.0
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2.5
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2.0
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2.5
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2.6
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3: Problem intensity
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2.0
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2.0
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1.5
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2.5
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1.5
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1.5
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1.8
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Study Strengths PREP has been tested using diverse measures, including some measures with strong psychometric properties. There is a clear connection between the need, theory, and intervention. Similar outcomes have been achieved in research conducted by independent investigators.
Study Weaknesses The studies did not discuss in detail how attrition was addressed. One study used a self-selection process that makes it difficult to attribute the findings wholly to the intervention. Inadequate information was provided to determine the influence of religion, which is important given that a number of the studies were conducted in faith-based communities. Intervention fidelity measures were weak, and some studies did not mention methods used to control for leaders' effects. Because participants with different ethnicities were grouped together, it is difficult to analyze if the information is appropriate for diverse ethnic groups. Little descriptive and psychometric information was provided for Communication Box, one of the measures used to rate couple's communication skills.
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Readiness for Dissemination
Review Date: September 2006
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Markman, H., Stanley, S., & Blumberg, S. (2001). Fighting for your marriage. San Francisco: John Wiley & Sons, Inc.
PREP Educational Products, Inc. (1996). The PREP approach [DVD].
PREP Educational Products, Inc. (n.d.). The PREP Instructors Kit.
PREP Educational Products, Inc. (2006). PREP Couples' Manual.
PREP Educational Products, Inc. (2006). PREP on PowerPoint [CD-ROM].
Stanley, S., Markman, H., & Blumberg, S. (2005). The PREP couples' notes: Outline for the 12-hour PREP program. Greenwood Village, CO: PREP Educational Products, Inc.
Stanley, S., Markman, H., Blumberg, S., & Jenkins, N. (2006). PREP Leader's Manual. Greenwood Village, CO: PREP Educational Products, Inc.
Stanley, S., Markman, H., Jenkins, N., & Blumberg, S. (2006). Fighting for your marriage: The PREP clips [DVD]. Greenwood Village, CO: PREP Educational Products, Inc.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.5
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2.5
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2.8
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2.9
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Dissemination Strengths Implementation materials are easy to understand, accommodate a wide range of learning styles, and could be adapted by a wide range of providers, including social workers, clergy, counselors, nurses, and lay leaders within religious organizations. Implementation materials are engaging, and their format and print size make them easy to read. Materials also offer various formats for implementing this program. Detailed leader and participant manuals are provided as well as a variety of visual teaching methods. The highly scripted nature of this program contributes to intervention fidelity. Many if not all lectures are directed by the included media. A variety of outcome measures with brief descriptions are provided.
Dissemination Weaknesses The training information does not clearly specify what type of ongoing training, technical assistance, and supervision are available from developers. No specific outcome or process measure is suggested to support quality assurance.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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PREP on PowerPoint
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$75 each
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Yes
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PREP Clips DVD
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$99.95 each
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Yes
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Fighting for Your Marriage (book)
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$19.95 each
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No
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Participant manual
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$11 per participant
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Yes
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Personality tools
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$0.90 each
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Yes
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Speaker/listener floor cards
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$0.10 each
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No
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Calming Skills Audio CD
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$5 each
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No
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2- to 3-day, on-site or off-site training
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$450-$749 per person depending on curriculum selected, location, and number of trainers/trainees
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Yes
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Off-site technical assistance
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$100-150 per hour
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No
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On-site technical assistance
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$1,000-$1,500 per day plus travel expenses
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No
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Audio/video review of workshop leaders
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$100-150 per hour
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No
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Additional Information Quantity discounts are available for some implementation materials.
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
* Halford, W. K., Sanders, M. R., & Behrens, B. C. (2001). Can skills training prevent relationship problems in at-risk couples? Four-year effects of a behavioral relationship education program. Journal of Family Psychology, 15(4), 750-768.
* Hahlweg, K., Markman, H. J., Thurmaier, F., Engl, J., & Eckert, V (1998). Prevention of marital distress: Results of a German prospective longitudinal study. Journal of Family Psychology, 12(4), 543-556.
* Laurenceau, J. P., Stanley, S. M., Olmos-Gallo, A., Baucom, B., & Markman, H. J. (2004). Community-based prevention of marital dysfunction: Multilevel modeling of a randomized effectiveness study. Journal of Consulting and Clinical Psychology, 72(6), 933-943.
Stanley, S. M., Allen, E. S., Markman, H. J., Saiz, C. C., Bloomstrom, G., Thomas, R., et al. (2005). Dissemination and evaluation of marriage education in the Army. Family Process, 44(2), 187-201.
* Stanley, S. M., Markman, H. J., Prado, L. M., Olmos-Gallo, A., Tonelli, L., St. Peters, M., et al. (2001). Community-based premarital prevention: Clergy and lay leaders on the front lines. Family Relations, 50(1), 67-76.
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