Volume 11, Issue 3 (2023)
Health Educ Health Promot 2023, 11(3): 411-417 |
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Saati Asr M, Barati M, Parandeh A, Rahmati F. The Most Important Educational Contents Classified in Communication Skills Interventions; a Systematic Review. Health Educ Health Promot 2023; 11 (3) :411-417
URL: http://hehp.modares.ac.ir/article-5-69816-en.html
URL: http://hehp.modares.ac.ir/article-5-69816-en.html
1- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
2- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
3- “Department of Community Health, Faculty of Nursing” and “Medicine, Quran and Hadith Research Center”, Baqiyatallah University of Medical Sciences, Tehran, Iran
2- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
3- “Department of Community Health, Faculty of Nursing” and “Medicine, Quran and Hadith Research Center”, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Table 2. Categories of educational content
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Introduction
One of the fundamental aspects that contribute to the growth and stability of a family, especially in couples, is the establishment of healthy relationships that are based on mutual understanding and adjustment among family members [1], Healthy family relationships have a significant impact on the community by fostering positive behaviors and interactions [2]. By creating and strengthening trust, support, and friendship among family members, Effective communication is vital in building strong connections between them [3].
One of the most common problems that couples report is communication problems, followed by marital conflict as a discordant relationship. The most common marital conflict is divorce [4]. Marital conflict is an important source of environmental stress for family members that can profoundly affect their minds and thoughts [5].
Identifying the factors affecting couples' communication skills and satisfaction can help psychologists and family counselors solve important marital issues and make the counselors more focused on the subject [6]. There is a high correlation between communication skills, marital adjustment, conflict resolution, and divorce rates [7].
Among the best ways to strengthen your spousal relationship is to learn basic communication skills to help resolve conflict between couples. Various studies have shown that communication skills training reduces marital conflicts and increases marital satisfaction [7]. Interventions for couples can lead to the couples’ happiness, reducing the number of divorces in the community and enhancing the satisfaction of the existing relationships between couples [8, 9].
In conclusion, healthy relationships based on understanding and adjustment are crucial to the growth of families, particularly in couples. By improving communication skills between couples, we can achieve the goal of promoting healthy relationships. Also, various techniques are available to improve communication in personal and intimate relationships.
According to the role of communication skills in enhancing coping power, promoting mental health, preventing marital conflicts, and affecting marital satisfaction, and also, by surveying and classifying the most important educational content used in communication skills training, it is possible to design effective interventions for couples. The extracted most important educational content can be used as a suitable pattern for future interventions in couples' problems. Therefore, seems necessary to design a systematic review study in educational contents of couple’s problems, specifically in nursing and midwifery. Therefore, this study was designed and implemented to the most important educational content classified in communication skills training.
Information and Methods
Based on the York Protocol according to the four steps during 2020 [10], this study was conducted by reviewing articles in the PubMed and Science Direct databases.
The search at PubMed was done in February 2020 for the past ten years of studies with “communication skills”, “life skills”, “marital satisfaction”, “marital conflicts”, “communication skills training,” “marital relationship”, “interpersonal conflict”, “marital interactions”, “marital adjustment”, “marital functioning”, “relationship distress”, “couples”, “couples”, “army couples”, “married couples”, “couples-oriented intervention”, “couples intervention”, “distressed couples”, “couples' interactions”, “couples therapy”, “intervention”, “intervention study” and “clinical trial” keywords.
First, 358 articles were found, of which 121 were full-text articles, and 121 articles were added to the EndNote software. Two separate researchers reviewed the titles and abstracts of these articles, and finally, 15 related articles were selected.
The search on the Science Direct database was done in February 2020 with “Communication skills”, “Marital satisfaction”, “Life skills”, “Communication skills training”, “Marital relationship”, “Couple”, “Couples therapy” and “Army couples”, “Intervention” and “Clinical trial” keywords. The selected articles in the Science Direct database have been from ten years ago. 43 articles were selected by reviewing the titles and abstracts of these articles and then were added to the EndNote software; 33 articles had full text. Two separate researchers reviewed the titles and abstracts of these articles, and finally, four related articles were selected (Figure 1).
.JPG)
Figure 1. The PRISMA flowchart
The authors' names, year of publication, country, quality of study, educational intervention, subjects, educational methods, and evaluation results were reviewed and compared [11]. The CONSORT (Consolidated Standards of Reporting Trials) checklist was used to report the clinical trials. Each article gets a specific score from the CONSORT checklist.
The main themes of the selected articles were
extracted and coded, and similar codes were merged and reduced with the help of a statistical expert. More exact categories of the main classes were identified, named, and reported. Study biases were evaluated by two PhD reviewers in health education and the CONSORT checklist.
Findings
19 articles were included in this study (Table 1).
Table 1. Evaluation and report of the articles’ information
One of the fundamental aspects that contribute to the growth and stability of a family, especially in couples, is the establishment of healthy relationships that are based on mutual understanding and adjustment among family members [1], Healthy family relationships have a significant impact on the community by fostering positive behaviors and interactions [2]. By creating and strengthening trust, support, and friendship among family members, Effective communication is vital in building strong connections between them [3].
One of the most common problems that couples report is communication problems, followed by marital conflict as a discordant relationship. The most common marital conflict is divorce [4]. Marital conflict is an important source of environmental stress for family members that can profoundly affect their minds and thoughts [5].
Identifying the factors affecting couples' communication skills and satisfaction can help psychologists and family counselors solve important marital issues and make the counselors more focused on the subject [6]. There is a high correlation between communication skills, marital adjustment, conflict resolution, and divorce rates [7].
Among the best ways to strengthen your spousal relationship is to learn basic communication skills to help resolve conflict between couples. Various studies have shown that communication skills training reduces marital conflicts and increases marital satisfaction [7]. Interventions for couples can lead to the couples’ happiness, reducing the number of divorces in the community and enhancing the satisfaction of the existing relationships between couples [8, 9].
In conclusion, healthy relationships based on understanding and adjustment are crucial to the growth of families, particularly in couples. By improving communication skills between couples, we can achieve the goal of promoting healthy relationships. Also, various techniques are available to improve communication in personal and intimate relationships.
According to the role of communication skills in enhancing coping power, promoting mental health, preventing marital conflicts, and affecting marital satisfaction, and also, by surveying and classifying the most important educational content used in communication skills training, it is possible to design effective interventions for couples. The extracted most important educational content can be used as a suitable pattern for future interventions in couples' problems. Therefore, seems necessary to design a systematic review study in educational contents of couple’s problems, specifically in nursing and midwifery. Therefore, this study was designed and implemented to the most important educational content classified in communication skills training.
Information and Methods
Based on the York Protocol according to the four steps during 2020 [10], this study was conducted by reviewing articles in the PubMed and Science Direct databases.
The search at PubMed was done in February 2020 for the past ten years of studies with “communication skills”, “life skills”, “marital satisfaction”, “marital conflicts”, “communication skills training,” “marital relationship”, “interpersonal conflict”, “marital interactions”, “marital adjustment”, “marital functioning”, “relationship distress”, “couples”, “couples”, “army couples”, “married couples”, “couples-oriented intervention”, “couples intervention”, “distressed couples”, “couples' interactions”, “couples therapy”, “intervention”, “intervention study” and “clinical trial” keywords.
First, 358 articles were found, of which 121 were full-text articles, and 121 articles were added to the EndNote software. Two separate researchers reviewed the titles and abstracts of these articles, and finally, 15 related articles were selected.
The search on the Science Direct database was done in February 2020 with “Communication skills”, “Marital satisfaction”, “Life skills”, “Communication skills training”, “Marital relationship”, “Couple”, “Couples therapy” and “Army couples”, “Intervention” and “Clinical trial” keywords. The selected articles in the Science Direct database have been from ten years ago. 43 articles were selected by reviewing the titles and abstracts of these articles and then were added to the EndNote software; 33 articles had full text. Two separate researchers reviewed the titles and abstracts of these articles, and finally, four related articles were selected (Figure 1).
Figure 1. The PRISMA flowchart
The authors' names, year of publication, country, quality of study, educational intervention, subjects, educational methods, and evaluation results were reviewed and compared [11]. The CONSORT (Consolidated Standards of Reporting Trials) checklist was used to report the clinical trials. Each article gets a specific score from the CONSORT checklist.
The main themes of the selected articles were
extracted and coded, and similar codes were merged and reduced with the help of a statistical expert. More exact categories of the main classes were identified, named, and reported. Study biases were evaluated by two PhD reviewers in health education and the CONSORT checklist.
Findings
19 articles were included in this study (Table 1).
Table 1. Evaluation and report of the articles’ information
The study participants ranged from a minimum of 9 couples to a maximum of 662 couples. The total number of participants in all of the articles was 5061 persons. 13 articles were from the United States, four were from Iran, and Australia and India contributed one article each; also, all of these articles came from the past decade. Among the 19 articles in this study, six had performed the intervention virtually or by phone [12-17], and the remaining 13 had performed direct intervention [18-30]. In 7 studies related to communication skills, the results of the studies showed that using educational content such as summarizing what the speaker said without reassuring, problem-solving, giving advice, nonverbal behaviors, reflective listening, giving feedback about the strengths and weaknesses of their relationship, how natural differences, hidden emotions, external stress, the promotion of emotional acceptance and the resulting behavior change, emotional expressiveness, couples therapy for depression, coping and communication strategies, affect recognition, empathy training, insights into the relationship dynamics, forgiveness, sensuality and sexuality and expectations researchers were able to improve marital satisfaction [12, 16, 17, 24, 25, 27, 29].
The results of two studies related to communication skills showed that by using educational content such as healthy communication skills, assertiveness, anger management, conflict resolution, listening skills, marital attribution, and nonverbal and verbal behaviors, researchers could reduce marital conflicts [18, 30]. In 5 studies related to communication skills, the results of the studies showed that by using educational contents such as relaxation training, behavior change, observing, understanding, and response training, teaching dyadic coping, communication skills training, emotional expressiveness, marital relationship processes, and marital satisfaction, problem-solving, insights into the relationship dynamics, forgiveness, sensuality, and sexuality and expectations” researchers were able to improve marital relationships [17, 20, 24, 26, 29].
By surveying the educational contents mentioned in these studies, this educational content was divided into Individual and interpersonal. Also, the educational contents of the two mentioned categories were divided into the following four classes; rational, practical, emotional, and motivational (Table 2).
The results of two studies related to communication skills showed that by using educational content such as healthy communication skills, assertiveness, anger management, conflict resolution, listening skills, marital attribution, and nonverbal and verbal behaviors, researchers could reduce marital conflicts [18, 30]. In 5 studies related to communication skills, the results of the studies showed that by using educational contents such as relaxation training, behavior change, observing, understanding, and response training, teaching dyadic coping, communication skills training, emotional expressiveness, marital relationship processes, and marital satisfaction, problem-solving, insights into the relationship dynamics, forgiveness, sensuality, and sexuality and expectations” researchers were able to improve marital relationships [17, 20, 24, 26, 29].
By surveying the educational contents mentioned in these studies, this educational content was divided into Individual and interpersonal. Also, the educational contents of the two mentioned categories were divided into the following four classes; rational, practical, emotional, and motivational (Table 2).
Table 2. Categories of educational content
Discussion
This study aimed to survey the educational contents of communication skills of the studies that were used in couples.
Individual educational content means that these contents are related to the individual characteristics of Persons with an individual essence. In 13 studies, individual educational content was used to influence communication skills. Also, in 3 studies, only individual educational content was used to influence couples' communication skills. In explaining the results of the studies that used individual content, this content was based on the characteristics and issues related to the psychological dimension of individuals. Various psychological characteristics such as cognition, feelings, desires, stress, and depression have been considered. These studies show that by influencing the psychological characteristics of individuals, couples' communication skills can be improved. Similar studies have shown that affecting the psychological dimension of persons can improve communication skills. If communication skills are not improved, people are susceptible to complications such as breaking trust, anger, damaged self-esteem, depression, and emotional problems in the future [31-33].
Interpersonal educational content means that these contents have the essence of more than one person, and when the person is in contact with her partner, these contents become meaningful. In 16 studies, interpersonal educational content was used to influence communication skills. Also, in 7 studies, only interpersonal educational content was used to influence couples' communication skills. The large number of studies on interpersonal content indicates that in communication skills interventions, more emphasis should be on the interpersonal dimension than the individual dimension, and educational content should be adjusted more based on interpersonal characteristics. The following Interpersonal components are mostly mentioned in the articles of this study: The types of verbal and non-verbal behaviors, types of listening, resolving marital conflicts, and intimacy.
Interpersonal therapies generally pay attention to the individual's current relationships, and the focus of interpersonal therapies is on improving relationships and communication skills. These interventions aim to change incompatible beliefs that lead to interpersonal differences. As a result, interventions with interpersonal content ultimately affect the individual and psychological dimensions of the person. In interpersonal methods in therapy sessions, interpersonal problems and differences are first evaluated, and the factors that play a role in their strength are identified. Therapeutic techniques such as rational assertion, social problem-solving, role-playing, role modeling, self-learning, positive self-talk, relaxation, increased self-confidence, active listening, and new interpersonal relationships replace past damaged relationships. This process continues in the treatment sessions so that the participants can establish more appropriate interpersonal relationships [33, 34].
The results of studies have shown that interpersonal training reduces the symptoms of depression, increases happiness, life expectancy, and psychological well-being, and reduces feelings of loneliness, anxiety, and sadness [35]. Working on the interpersonal problems of couples has many effects on improving the couple's relationship, increasing respect and support, having a positive outlook on life, and ultimately achieving self-actualization [36].
According to the Ecological Model, six factors affect behavior. 6 factors include the following: intrapersonal, interpersonal, organizational, community, environment, policy [37]. This study found that two individual and interpersonal factors have been used as educational content in promoting communication skills in couples. It is suggested to use another four factors of ecological models (organizational, community, environment, and policy) to provide educational content to more effective couples' communication skills interventions in the future.
- In this study, six articles performed the intervention virtually or by phone. Various studies have mentioned the benefits of virtual learning, including the following: 1) Economic benefits: reduced travel and equipment production costs. 2) Educational benefits: Attention to the audience's needs, ease of access to various resources, the possibility of recording activities, and continuous pursuit of academic achievement 3) Cultural benefits: the universality of virtual learning and the possibility of building groups in cyberspace. Time benefits: Update High-speed information and availability of virtual training 24 hours a day. Considering the mentioned benefits, comprehensive virtual education in most fields of study seems necessary [38].
This article, like any other review article, has its limitations. The full text of some articles was not available. It is recommended that future interventions in couples' communication skills be established using interpersonal educational content. Nurses and midwives should consider the issue of interpersonal communication when educating couples. Most couples' communication skills interventions should be performed virtually or by phone.
Conclusion
Problem-solving, listening skills, emotional skills, behavioral coping skills, and behavior change are the most frequent educational content in communication skills interventions.
Acknowledgments: The authors would like to thank Kowsar Jafari for editing the manuscript. We thank the “Clinical Research Development Center of Baqiyatallah Hospital” for their kind cooperation.
Ethical Permissions: Not needed.
Conflicts of Interests: Nothing to declare
Authors’ Contribution: Saati Asr MH (First Author), Introduction Writer/Methodologist/Original Researcher/Discussion Writer/Statistical Analyst (40%); Barati M (Second Author), Methodologist/Assistant Researcher/Statistical Analyst (10%); Parandeh A (Third Author), Methodologist/Assistant Researcher/Discussion Writer/Statistical Analyst (10%); Rahmati F (Fourth Author), Methodologist/Assistant Researcher/Supervisor/Discussion Writer/Statistical Analyst (40%)
Funding/Support: The authors received no financial support.
This study aimed to survey the educational contents of communication skills of the studies that were used in couples.
Individual educational content means that these contents are related to the individual characteristics of Persons with an individual essence. In 13 studies, individual educational content was used to influence communication skills. Also, in 3 studies, only individual educational content was used to influence couples' communication skills. In explaining the results of the studies that used individual content, this content was based on the characteristics and issues related to the psychological dimension of individuals. Various psychological characteristics such as cognition, feelings, desires, stress, and depression have been considered. These studies show that by influencing the psychological characteristics of individuals, couples' communication skills can be improved. Similar studies have shown that affecting the psychological dimension of persons can improve communication skills. If communication skills are not improved, people are susceptible to complications such as breaking trust, anger, damaged self-esteem, depression, and emotional problems in the future [31-33].
Interpersonal educational content means that these contents have the essence of more than one person, and when the person is in contact with her partner, these contents become meaningful. In 16 studies, interpersonal educational content was used to influence communication skills. Also, in 7 studies, only interpersonal educational content was used to influence couples' communication skills. The large number of studies on interpersonal content indicates that in communication skills interventions, more emphasis should be on the interpersonal dimension than the individual dimension, and educational content should be adjusted more based on interpersonal characteristics. The following Interpersonal components are mostly mentioned in the articles of this study: The types of verbal and non-verbal behaviors, types of listening, resolving marital conflicts, and intimacy.
Interpersonal therapies generally pay attention to the individual's current relationships, and the focus of interpersonal therapies is on improving relationships and communication skills. These interventions aim to change incompatible beliefs that lead to interpersonal differences. As a result, interventions with interpersonal content ultimately affect the individual and psychological dimensions of the person. In interpersonal methods in therapy sessions, interpersonal problems and differences are first evaluated, and the factors that play a role in their strength are identified. Therapeutic techniques such as rational assertion, social problem-solving, role-playing, role modeling, self-learning, positive self-talk, relaxation, increased self-confidence, active listening, and new interpersonal relationships replace past damaged relationships. This process continues in the treatment sessions so that the participants can establish more appropriate interpersonal relationships [33, 34].
The results of studies have shown that interpersonal training reduces the symptoms of depression, increases happiness, life expectancy, and psychological well-being, and reduces feelings of loneliness, anxiety, and sadness [35]. Working on the interpersonal problems of couples has many effects on improving the couple's relationship, increasing respect and support, having a positive outlook on life, and ultimately achieving self-actualization [36].
According to the Ecological Model, six factors affect behavior. 6 factors include the following: intrapersonal, interpersonal, organizational, community, environment, policy [37]. This study found that two individual and interpersonal factors have been used as educational content in promoting communication skills in couples. It is suggested to use another four factors of ecological models (organizational, community, environment, and policy) to provide educational content to more effective couples' communication skills interventions in the future.
- In this study, six articles performed the intervention virtually or by phone. Various studies have mentioned the benefits of virtual learning, including the following: 1) Economic benefits: reduced travel and equipment production costs. 2) Educational benefits: Attention to the audience's needs, ease of access to various resources, the possibility of recording activities, and continuous pursuit of academic achievement 3) Cultural benefits: the universality of virtual learning and the possibility of building groups in cyberspace. Time benefits: Update High-speed information and availability of virtual training 24 hours a day. Considering the mentioned benefits, comprehensive virtual education in most fields of study seems necessary [38].
This article, like any other review article, has its limitations. The full text of some articles was not available. It is recommended that future interventions in couples' communication skills be established using interpersonal educational content. Nurses and midwives should consider the issue of interpersonal communication when educating couples. Most couples' communication skills interventions should be performed virtually or by phone.
Conclusion
Problem-solving, listening skills, emotional skills, behavioral coping skills, and behavior change are the most frequent educational content in communication skills interventions.
Acknowledgments: The authors would like to thank Kowsar Jafari for editing the manuscript. We thank the “Clinical Research Development Center of Baqiyatallah Hospital” for their kind cooperation.
Ethical Permissions: Not needed.
Conflicts of Interests: Nothing to declare
Authors’ Contribution: Saati Asr MH (First Author), Introduction Writer/Methodologist/Original Researcher/Discussion Writer/Statistical Analyst (40%); Barati M (Second Author), Methodologist/Assistant Researcher/Statistical Analyst (10%); Parandeh A (Third Author), Methodologist/Assistant Researcher/Discussion Writer/Statistical Analyst (10%); Rahmati F (Fourth Author), Methodologist/Assistant Researcher/Supervisor/Discussion Writer/Statistical Analyst (40%)
Funding/Support: The authors received no financial support.
Article Type: Systematic Review |
Subject:
Health Education and Health Behavior
Received: 2023/06/14 | Accepted: 2023/08/27 | Published: 2023/09/20
Received: 2023/06/14 | Accepted: 2023/08/27 | Published: 2023/09/20
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