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The aim of the study was to investigate patterns of self-selection into the Prevention and Relationship Education Program (PREP) as it was offered universally to expectant couples attending maternity services in a Swedish town. The baseline questionnaire was answered by 141 couples, of whom 63% later participated in PREP, and 37% served as a comparison group. The results showed that couples who chose to participate in PREP had a shorter relationship, were more often unmarried firsttime parents, and reported lower levels of relationship adjustment. PREP participants also had higher scores of depressive symptoms and poorer self-rated health. It seems that expectant couples are interested in preventive relationship education and that couples with more risk factors for vulnerable relationships self-selected into PREP when the program was offered universally during pregnancy. The selection pattern into PREP has interesting implications for public health interventions and their dissemination.
Key Words: couple relationship, PREP, preventing marital distress, transition to parenthood.
Introduction
Transition to Parenthood as a 'Window of Opportunity
Transition to parenthood is a sensitive period during which different aspects of couple dynamics are changing, including life values and priorities (Cowan & Cowan, 2000; Shapiro, Gottman, & Carrere, 2000). Despite equal ideals, couples tend to move toward more traditional gender roles after childbirth (Katz-Wise, Priess, & Hyde, 2010), which can be followed by rising conflicts and decreasing relationship satisfaction (Ahlborg, Misvaer, & Möller, 2009; Doss, Rhoades, Stanley, & Markman, 2009). Although many couples resolve their issues successfully, quite a few choose to separate or continue living together in conflict-affected relationships after childbirth (Markman & Hahlweg, 1993). The period when couples become parents is suggested to be an appropriate time to offer couples relationship education to help them adjust to their new roles as parents (Cowan & Cowan, 1995; Halford, 2004). Although there are few interventions for expectant couples, they have shown hopeful results in preventing parentingrelated strain and marital distress among couples (Devaney & Dion, 2010; Schulz, Cowan, & Cowan, 2006). In this study we investigated the self-selection pattern into the Prevention and Relationship Education Program (PREP) when it was offered universally through maternity services to couples in transition to parenthood.
The Evidence Base for the Prevention and Relationship Education Program
Originally designed to educate premarital couples, the Prevention...