Introduction
Marital satisfaction is one of the factors related to the health of pregnant women and their fetuses. Life skills counseling is a consultation on abilities for adaptive and positive behavior enabling humans to effectively deal with the demands and challenges of life.
Aim
To examine the effects of life skills counseling on marital satisfaction of pregnant women in Asadabad town, Iran.
Materials and Methods
The present study was conducted with a pre-test and post-test design. The participants included 64 pregnant women selected via simple random sampling method. The participants were randomly assigned to two group, experimental and control groups (each with 32 members). The required data were collected through a questionnaire covering demographic characteristics of the participants and the ENRICH Inventory. The pregnant women completed both questionnaires at the pre-test stage. Then, members of the experimental group received eight sessions of life skills training, while members of the control group received no intervention. Members of both groups completed the ENRICH Inventory again immediately after the intervention and again four weeks later. Using the SPSS-16 software, the collected data were analysed through independent t-test and least significant difference test.
Results
Comparison of pre-test scores to post-test scores indicated that life skills training could positively affect marital satisfaction. Results showed that pregnant women in the experimental group obtained higher scores as a result of the intervention, and the difference between their pre-test scores and their post-test scores was statistically significant. Moreover, the difference between the pre and post-test scores for both experimental and control groups was statistically significant (p<0.001).
Conclusion
Life skills counseling positively affects marital satisfaction of people, especially pregnant women.
Introduction
Although, pregnancy and childbirth are natural events in a woman’s life, they are considered stressful experience by many women. Pregnancy is associated with broad mental and physical changes, especially in nulliparous pregnant women [1]. During the pregnancy, women feel uncertain, ambivalent and primarily self-focused, and they become vulnerable and start fantasising [2]. Accordingly, many new parents experience a decline in marital satisfaction during this period [3,4].
Marital satisfaction is defined as couple’s mental attitude and feelings towards their marital relationships. Research has shown that reduced marital satisfaction decreases the quality of parent-child relationship and increases the likelihood of divorce [5].
Following pregnancy, women experience changes in their self-image, beliefs, values, priorities, behavioral patterns, interactions with others and problem-solving skills [6]. Every aspect of marital satisfaction (i.e. sexual relationship, children and parenting, financial management, etc.) is affected by pregnancy that can lead to marital relationship problems so that many new parents experience a decline in their marital satisfaction [7,8].
Couples with relationship problems cannot be good parents [9, 10]. Divorce statistics, as the best indicator of marital dissatisfaction, show that marital satisfaction cannot be achieved easily, and couples need to work hard to achieve it [11]. Research has shown that 68% of women experience impaired marital relationships during their first pregnancy [12].
Pregnant women’s mental health can be improved through consultation and coping strategies training. In fact, women are very willing to learn and change their behaviors during their pregnancy [13]. Education and effective consultation can play crucial roles in solving pregnancy related problems and improving pregnant women’s health status [14, 15].
Life skills enable a person to effectively confront the challenges of life [16]. This is highly dependent on social norms, but life skills are the one considered for welfare and helping individuals to develop communities [17,18].
Counseling is an important component of midwifery services. During these counseling sessions, midwives have the opportunity to help pregnant women to improve their marital lives and enhance their marital satisfaction so that pregnant women can raise their children in a peaceful environment and guarantee the psychological health of the next generation. Studies in this field have already been conducted, but the results have been contradictory. Furthermore, given the fact that learning life skills, according to the WHO recommendation, plays an important role in promoting social well-being, researchers decided to conduct this research in a different environment and in pregnant women.
The present study was conducted to examine the effectiveness of life skills counseling in enhancing pregnant women’s marital satisfaction.
Materials and Methods
The present clinical trial was conducted with a pre-test and post-test design. Out of the clinics in Asadabad, two clinics were randomly selected. Between the two clinics, a clinic was allocated to the intervention group (A) and one to the control group (B). Then, people with the inclusion criteria were given a number. Additionally, in each clinic people were selected using the random number table. Using random sampling method, the volunteer pregnant women meeting the inclusion criteria were selected and entered the study. The error level of the first type and the test power and the maximum error between the mean difference of the samples were considered 0.05, 90% and 15, respectively. Furthermore, based on the following formula, the number of samples was 32 in each group:
The inclusion criteria was that the participant has no history of addiction or underlying diseases, not being diagnosed with gestational diabetes or pre-eclampsia, being pregnant for the first time and at gestational age between 14 and 26 weeks. The exclusion criteria were absent for more than one session, occurrence of stressful events (e.g. someone’s death) during the study, starting to use sedatives during the study, and having a preterm delivery. Moreover, those unable to continue due to pregnancy complications such as preterm rupture of membrane, eclampsia, preeclampsia, and previa were excluded from the study.
The required data were collected through a researcher-made questionnaire covering demographic characteristics of the participants and the ENRICH Inventory. The ENRICH inventory is a 125-item questionnaire assessing 12 subscales of idealistic distortion, marital satisfaction, personality issues, communication, conflict resolution, financial management, leisure activities, sexual relationship, children and parenting, family and friends, equalitarian roles and religious orientation. In the present study, we used the Persian version of the ENRICH questionnaire. This inventory is freely available for use.
In the Persian version of ENRICH Inventory, five options have been designed for every question (‘Very much’, ‘Much’, ‘Moderately’, ‘Few’ and ‘Very few’/ ‘Always’, ‘Frequently’, ‘I don’t know’, ‘seldom’ and ‘never’ for items 95 to 105) [19].
To observe ethical principles, the study objectives were completely explained for the participants. Then, the participants signed the informed consent form and entered the study. The participants were also assured that their information would remain confidential. The experimental and control groups were examined three times (before the intervention, immediately after the intervention and four weeks after the intervention). The counseling program was held for eight consecutive weeks, each week for 60 minutes, conducted based on the GATHER approach (i.e. Greet, Ask, Tell, Help, Explain and Return) [20]. The content of the training program of the meetings are shown in [Table/Fig-1]. The counseling sessions were conducted by a researcher having postgraduate in midwifery counseling. To provide better education, the trainer participated in life skills training courses. Meetings were held once a week. The two groups completed the ENRICH Inventory immediately after completion of the intervention (first follow-up). To evaluate the availability of learned contents over time, the two groups completed the ENRICH Inventory for the third time, four weeks after finishing the intervention (second follow-up).
Contents of the training sessions
| Sessions | Contents | Teaching methods | Duration |
|---|
| First session: Self-awareness | Self-awareness skills/characteristics of self-aware people/ benefits of self-awareness/ physical changes during pregnancy and their impacts of pregnant women/assignments for the next session | Group Discussion/PowerPoint presentation/Assignments | 60 minutes |
| Second session: Empathy | A review of previous session/a review of previous assignments/empathy skills/ effects of empathy on marital relations/ assignments for the next session | Group discussion/PowerPoint presentation/Assignments | 60 minutes |
| Third session: Effective communication | A review of previous session/ a review of previous assignments/effective communication skills/ barriers to effective communication/ assignments for the next session | Group discussion/Assignments | 60 minutes |
| Fourth session: Sexual relationships | A review of previous session/ a review of previous assignments/ sexual response cycle/ common sexual disorders in pregnancy and their causes/ improper sexual thoughts and actions during pregnancy/ feminine and masculine sex roles (pre-sex activities, post-sex activities, erogenous parts of the male/female body) | Group discussion/PowerPoint presentation/Assignments | 60 minutes |
| Fifth session: Decision-making and problem-solving | A review of previous session/ a review of previous assignments/problem-solving and decision-making skills/ problem-solving prerequisites/ problem-solving stages/ decision-making styles | Group discussion/PowerPoint presentation/Assignments | 60 minutes |
| Sixth session: Conflict resolution | A review of previous session/ a review of previous assignments/eight inefficient resolution strategies/ effective resolution strategies/ interrupting skills | Group discussion/PowerPoint presentation/Assignments | 60 minutes |
| Seventh session: Stress/anger management | A review of previous session/ a review of previous assignments/ emotions and their impacts on fetus and marital satisfaction during pregnancy/ factors involved in the establishment of rage/ anger and stress management skills | Group discussion/PowerPoint presentation/Assignments | 60 minutes |
| Eighth session: Review | A review of previous contents | Group discussion/PowerPoint presentation | 60 minutes |
Statistical Analysis
Obtained results were analysed and compared. Using the SPSS-16 software, the collected data through independent t-test and Least Significant Difference (LSD) test (p<0.05).
Ethical consideration: The Vice Chancellor for Research and Technology of Hamadan University of Medical Sciences approved the study (IR.UMSHA.REC.1394.297). It was registered in the Iranian Registry of Clinical Trial (IRCT2015030215341N4). In addition, all participants gave an informed consent before commencing the study.
Results
The results of Kolmogorov-Smirnov test showed that all data were normally distributed (p>0.05). The results of homogeneity test indicated that both experimental and control groups were homogeneous. Based on the results of present study, mean age of the study participants in intervention and control group was 24.09±5.50 and 24.88±4.48 years, respectively. Furthermore, duration of pregnancy was in the intervention group 19.56±3.14 and in the control group 20.81±3.85.
The results presented in [Table/Fig-2] indicate that there was no significant difference between the two groups in terms of mother’s employment status, father’s employment status, father’s job stability, mother’s education and family monthly income (p>0.05). Therefore, the two groups were homogeneous.
Descriptive indicators of demographic characteristics in the two groups.
| Variables | Experimental group n (%) | Control group n (%) | Statistical test results | Significance level (p-value) |
|---|
| Study participant (employment status) | Unemployed | 27 (84.4) | 30 (93.8) | χ2=1.44 Df=1 | 0.23 |
| Employed | 5 (15.6) | 2 (6.2) |
| Participant’s husband (employment status) | Employed | 8 (25.0) | 7 (21.9) | χ2=0.58 Df=2 | 0.74 |
| Self-employed | 15 (46.9) | 18 (56.2) |
| Unemployed | 9 (28.1) | 7 (21.9) |
| Husband’s job stability | Stable | 22 (68.8) | 16 (50.0) | χ2=0.58 Df=1 | 0.12 |
| Unstable | 10 (31.2) | 16 (50.0) |
| Participant’s education level | Unfinished high school | 8 (25.0) | 10 (31.2) | χ2=4.15 Df=3 | 0.24 |
| High school diploma | 11 (34.4) | 14 (43.8) |
| Associate degree | 6 (18.8) | 1 (3.1) |
| Bachelor degree or higher | 7 (21.9) | 7 (21.9) |
| Family monthly income | <125 $ | 11 (34.4) | 11 (34.4) | χ2=2.78 Df=2 | 0.24 |
| 125-250 $ | 12 (37.5) | 17 (57.1) |
| >250 $ | 9 (28.1) | 4 (12.5) |
Significant differences were observed in the subscales of idealistic distortion, marital satisfaction, personality issues, communication, conflict resolution, family and friends, financial management, sexual relationship, equalitarian roles, children and parenting and leisure activities in the experimental group as a result of the intervention, while no significant difference was observed in the control group after the intervention [Table/Fig-3]. The ENRICH Inventory subscale of religious orientation did not change as a result of the intervention.
Comparison of the ENRICH Inventory subscales’ scores between the two groups at different times.
| ENRICH subscales | Experimental groups | Repeated measures analysis | Control groups | Repeated measures analysis | †p-value | Repeated measures analysis |
|---|
| Before intervention | Immediately after intervention | 4 weeks after intervention | Before the intervention | Immediately after the intervention | 4 weeks after the intervention | Before the intervention | Immediately after the intervention | 4 weeks after the intervention |
|---|
| Idealistic distortion | 12.5±3.03 | 14.93±2.46 | 15.68±1.69 | F=53.89 p<0.001 | 13.25±2.34 | 13.15±2.27 | 13.09±2.48 | F=1.19 p=0.31 | 0.27 | 0.004 | <0.001 | F=4.47 p=0.03 |
| Marital satisfaction | 24.50±5.98 | 27.65±4.81 | 29.43±3.44 | F=56.08 p<0.001 | 25.12±3.58 | 25.06±3.47 | 25.21±3.48 | F=1.19 p=0.30 | 0.61 | 0.01 | <0.001 | F=4.06 p=0.04 |
| Personality issues | 20.40±6.33 | 24.00±5.12 | 25.81±4.51 | F=95.01 p<0.001 | 20.28±6.53 | 20.34±6.63 | 20.40±6.42 | F=0.33 p=0.71 | 0.93 | 0.01 | <0.001 | F=4.31 p=0.04 |
| Communication | 20.59±5.64 | 25.25±4.57 | 26.25±5.40 | F=125.4 p<0.001 | 19.84±6.75 | 19.75±6.88 | 19.71±6.72 | F=0.26 p=0.77 | 0.63 | <0.001 | <0.001 | F=8.02 p=0.006 |
| Conflict resolution | 20.68±4.49 | 25.96±3.93 | 26.75±3.91 | F=169.5 p<0.001 | 20.56±5.02 | 20.50±5.06 | 20.40±5.04 | F=0.36 p=1.00 | 0.91 | <0.001 | <0.001 | F=12.36 p=0.001 |
| Financial management | 22.21±6.39 | 26.46±4.21 | 27.78±3.23 | F=61.01 p<0.001 | 22.81±6.12 | 22.75±6.08 | 22.78±6.03 | F=0.24 p=0.78 | 0.70 | 0.006 | <0.001 | F=4.06 p=0.04 |
| Leisure activities | 20.87±5.46 | 24.65±4.81 | 26.18±4.20 | F=87.90 p<0.001 | 21.68±3.50 | 21.50±3.53 | 21.71±3.45 | F=0.91 p=0.04 | 0.48 | 0.004 | <0.001 | F=4.91 p=0.03 |
| Sexual relationship | 23.18±5.93 | 28.09±4.51 | 29.00±3.92 | F=64.94 p<0.001 | 21.90±4.69 | 21.78±4.98 | 21.59±5.16 | F=1.90 p=0.15 | 0.34 | <0.001 | <0.001 | F=18.89 p<0.001 |
| Children and parenting | 24.87±4.76 | 29.00±4.45 | 30.56±4.63 | F=55.00 p<0.001 | 23.56±3.85 | 23.37±3.98 | 23.43±.03 | F=1.79 p=0.17 | 0.23 | <0.001 | <0.001 | F=20.93 p<0.001 |
| Family and friends | 19.87±5.89 | 23.43±5.02 | 25.56±4.02 | F=86.81 p<0.001 | 20.18±5.89 | 20.21±5.92 | 20.12±5.68 | F=0.57 p=0.56 | 0.83 | 0.001 | <0.001 | F=4.31 p=0.04 |
| Equalitarian roles | 13.53±7.27 | 16.43±7.07 | 17.09±6.39 | F=61.25 p<0.001 | 11.75±6.73 | 11.65±6.75 | 11.53±6.61 | F=2.12 p=0.12 | 0.31 | 0.009 | <0.001 | F=5.62 p=0.02 |
| Religious orientation | 23.56±4.27 | 23.56±4.27 | 23.53±4.29 | F=0.22 p=0.79 | 23.90±4.75 | 23.93±4.80 | 23.84±4.84 | F=0.62 p=0.53 | 0.76 | 0.76 | 0.78 | F=0.08 p=0.77 |
| Total scores | 246.81±47.65 | 291.78±39.65 | 306.34±35.29 | F=383.49 p<0.001 | 244.87±36.14 | 244.03±36.03 | 244.00±36.25 | F=1.95 p=0.15 | 0.85 | 0.001 | <0.001 | F=15.88 p<0.001 |
†Independent t-test was used to compare the means.
Discussion
In the experimental group, scores of every subscale of the ENRICH Inventory increased after the intervention, except for the subscale of religious orientation. The results of the study regarding the subscale of marital communication were in line with those of one study conducted by Rogge RD [21]. It can be stated that couples with effective communication and problem-solving skills have higher levels of marital satisfaction.
The results of the study concerning the subscale of conflict resolution were in line with one study conducted by Babaee SN and Ghahari S [22]. To explain these results, it can be mentioned that problem-solving and creativity techniques help groupscouples to solve their marital conflicts and problems effectively [23]. Hasani AM et al., examined the effectiveness of life skills training on marital satisfaction and reported that scores of the idealistic distortion and equalitarian roles increased as a result of intervention. These findings were consistent with the results of this study [24].
The results of the study regarding the subscale of leisure activities were in line with those of the study conducted by Gharibi M [25]. In fact, people can reach agreement on how to spend their leisure time by learning problem-solving techniques. The study findings regarding the subscale of family and friends were consistent with those of another study conducted by Yazdanpanah M et al., [26]. These results can be explained by considering that people’s feelings and attitudes toward their friends and family members can be affected by their life skills, and learning life skills can enhance people’s relationships with their families and friends. The present study findings concerning the subscale of sexual relations were in agreement with study results of previous study [27,28]. To explain these results, it can be mentioned that females’ sexual desire is highly affected by their sexual thoughts and beliefs; therefore, they can be more satisfied with their sexual relationships, if being provided with proper information [29,30]. Regarding the subscale of financial management, results of the present study were in line with results of the study conducted by Tompkins SA et al., [31]. To explain these findings, it can be mentioned that problem-solving training helps couples to reach agreement on how to spend their monthly income.
The study results regarding the subscale of children and parenting were consistent with the study of Tavakolizadeh J et al. [32]. It can be concluded that parents can reach agreement on how to raise their children by learning decision-making and conflict resolution skills. Concerning the subscale of religious orientation, the results of the study were in line with the study results of O’leary S et al., [33]. These findings can be explained by considering that people are normally satisfied with their religious orientations; therefore, interventions such as life skills training cannot significantly change their views towards religion.
The results of the study concerning marital satisfaction were in line with those of Holford WK et al., [34]. It can be concluded that couples who cannot reach agreement on numerous issues are involved in unfinished cycles of repeated problems. On the other hand, couples who can interact effectively can rely on each other as supporters reflecting their problems. Couples who are highly satisfied with their marital relationships attempt to develop their communication skills to be able to deal with their marital problems effectively [35].
Limitation
Small sample size was one of the study limitations. In addition, the ability to generalise the results to the whole community should be made with a larger number of samples.
Conclusion
Based on the results of the present study, life skills counseling is needed to improve marital relationships. When marriage-related needs and expectations of both husband and wife are met, particularly during pregnancy, they will experience higher levels of marital satisfaction.
†Independent t-test was used to compare the means.
[1]. Karamoozian M, Askarizadeh G, Impact of prenatal cognitive-behavioral stress management intervention on maternal anxiety and depression and newborns’ apgar score Iranian Journal of Neonatology 2015 6(2):14-22. [Google Scholar]
[2]. Motavalli R, Ozgoli G, Bakhtiari M, Alavi Majd H, Marital satisfaction and marital intimacy in employed and unemployed pregnant women of Ardebil city J Ardabil Univ Med Sci 2009 9(4):315-324. [Google Scholar]
[3]. Biehle SN, Mickelson KD, Preparing for parenthood: how feelings of responsibility and efficacy impact expectant parents Journal of social and personal relationships 2011 28(5):668-83.10.1177/0265407510385493 [Google Scholar] [CrossRef]
[4]. Soares RM, Nunes MA, Schmidt MI, Giacomello A, Inappropriate eating behaviors during pregnancy: prevalence and associated factors among pregnant women attending primary care in Southern Brazil International Journal of Eating disorders 2009 42(5):387-93.10.1002/eat.2064319115363 [Google Scholar] [CrossRef] [PubMed]
[5]. Funk JL, Rogge RD, Testing the ruler with item response theory: Increasing precision of measurement for relationship satisfaction with the couple’s satisfaction index Journal of Family Psychology 2007 21(4):572-83.10.1037/0893-3200.21.4.57218179329 [Google Scholar] [CrossRef] [PubMed]
[6]. Afshari A, Khalili A, Dehghani M, Beiramijam M, Lotf MD, Noodeh FA, Comparing the frequency of occupational injuries among medical emergency staff and nurses of intensive care units in hamadan Annals of Tropical Medicine and Public Health 2017 10(3):646-150. [Google Scholar]
[7]. Mangeli M, Ramezani T, Mangeli S, The effect of educating about common changes in pregnancy period and the way to cope with them on marital satisfaction of pregnant women Iranian Journal of Medical Education 2009 8(2):305-313. [Google Scholar]
[8]. Kohn JL, Rholes WS, Simpson JA, Martin AMI, Tran S, Wilson CL, Changes in marital satisfaction across the transition to parenthood: the role of adult attachment orientations Personality and social psychology bulletin 2012 38(11):1506-22.10.1177/014616721245454822878461 [Google Scholar] [CrossRef] [PubMed]
[9]. Jenaban Z, Refahei Z, Ghaderi Z, The effectiveness of short-term solution-focused couples therapy in increasing different dimensions of couple’s problem solving ability Journal of Novel Applied Sciences 2014 3(2):209-14. [Google Scholar]
[10]. Miri M, Miri M, Sharifzade G, Miri M, Evaluating the impact of relationship enrichment education on marital satisfaction of primary school female teachers in Birjand, 2012 Mod Care J 2014 11(3):177-185. [Google Scholar]
[11]. Lotfi Kashani F, Vaziri S, The effect of sexual skills training on marital satisfaction Procedia-Social and Behavioral Science 2011 30(2011):2581-85.10.1016/j.sbspro.2011.10.505 [Google Scholar] [CrossRef]
[12]. Pearson R, Lightman S, Evans J, Attentional processing of infant emotion during late pregnancy and mother-infant relations after birth Arch Womens Ment Health 2011 14(1):23-31.10.1007/s00737-010-0180-420859644 [Google Scholar] [CrossRef] [PubMed]
[13]. Toosi M, Akbarzadeh M, Zare N, Sharif F, The role of relaxation training in health index of infants in pregnant mothers J Jahrom Univ Med Sci 2013 11(1):13-9.10.29252/jmj.11.1.3 [Google Scholar] [CrossRef]
[14]. Geller P, Psaros C, Kornfield SL, Satisfaction with pregnancy loss aftercare: are women getting what they want? Arch Womens Ment Health 2010 13(2):11-24.10.1007/s00737-010-0147-520177721 [Google Scholar] [CrossRef] [PubMed]
[15]. Martin L, Hutton EK, Spelten ER, Wal JTG-vd, Dulmen SV, Midwives’ views on appropriate antenatal counselling for congenital anomaly tests: Do they match clients’ preferences? Midwifery 2014 30(2014):600-9.10.1016/j.midw.2013.08.01224100043 [Google Scholar] [CrossRef] [PubMed]
[16]. Shayan A, Jamshidi F, Tahmasebiboldaji V, Khani S, Babaei M, Havasian MR, Impact of a stress management intervention program on sexual functioning and stress reduction in women with breast cancer Asian Pacific Journal of Cancer Prevention 2017 18(10):2787-93. [Google Scholar]
[17]. Khajeddin N, Riahi F, Salehi-Veysi M, Izadi-Mazidi S, Effects of life skills workshops on marital satisfaction Iranian Journal of Psychiatry and Behavioral Sciences 2010 4(2):42-6. [Google Scholar]
[18]. Hosseinkhanzadeh AA, Yeganeh T, The effects of life skills training on marital satisfaction Procedia-Social and Behavioral Sciences 2013 84(2013):769-72.10.1016/j.sbspro.2013.06.643 [Google Scholar] [CrossRef]
[19]. Honarian M, Younesi J, Shafiabadi A, Nafissi G, The impact of couple therapy based on attachment” in deterministic thinking and marital satisfaction among couples International Journal of Psychology and Counselling 2010 2(6):91-9. [Google Scholar]
[20]. Rinehart W, Rudy S, Drennan M, New Gather Guide to Counseling. Johns Hopkins University, School of Public Health, Center for Communications Programs, Population Information Program 1998 [Google Scholar]
[21]. Rogge RD, Cobb RJ, Lawrence E, Johnson MD, Bradbury TN, Is skills training necessary for the primary prevention of marital distress and dissolution? A 3-year experimental study of three interventions Journal of Consulting and Clinical Psychology 2013 81:949-961.10.1037/a003420924060193 [Google Scholar] [CrossRef] [PubMed]
[22]. Babaee SN, Ghahari S, Effectiveness of communication skills training on intimacy and marital adjustment among married women International Journal of Medical Research & Health Sciences 2001 190(1):309-16. [Google Scholar]
[23]. Nasiri S, Kordi M, Gharavi MM, A comparative study of the effects of problem-solving skills training and relaxation on the score of self-esteem in women with postpartum depression Iran J Nurs Midwifery Res 2015 20(1):105-12. [Google Scholar]
[24]. Agha Mohammad Hasani P, Mokhtaree M, Sayadi A, Nazer M, Mosavi S, Study of emotional intelligence and marital satisfaction in academic members of Rafsanjan University of Medical Sciences J Psychol Psychother 2012 2(2):100010610.4172/2161-0487.1000106 [Google Scholar] [CrossRef]
[25]. Gharibi M, Sanagouymoharer G, Yaghoubinia F, The relationship between quality of life with marital satisfaction in Nurses in Social Security Hospital in Zahedan Global Journal of Health Science 2016 8(2):178-84. [Google Scholar]
[26]. Yazdanpanah M, Eslami M, Nakhaee N, Effectiveness of the premarital education programme in Iran Hindawi Publishing Corporation 2014 :1-5.10.1155/2014/964087 [Google Scholar] [CrossRef]
[27]. Sasanpour M, The effect of sexual cognitive reconstruction therapy on sexual problems of couples Procedia-Social and Behavioral Sciences 2013 84(2013):1448-1454.10.1016/j.sbspro.2013.06.772 [Google Scholar] [CrossRef]
[28]. Babazadeh R, Mirzaii K, Masomi Z, Changes in sexual desire and activity during pregnancy among women in Shahroud International Journal of Gynecology & Obstetrics 2013 120(1):82-4.10.1016/j.ijgo.2012.07.02123073227 [Google Scholar] [CrossRef] [PubMed]
[29]. Vural BK, Temel AB, Effectiveness of premarital sexual counselling program on sexual satisfaction of recently married couples Sexual Health 2009 6(3):222-32.10.1071/SH0806519653960 [Google Scholar] [CrossRef] [PubMed]
[30]. Masoumi SZ, Garousian M, Khani S, Oliaei SR, Shayan A, Comparison of quality of life, sexual satisfaction and marital satisfaction between fertile and infertile couples International Journal of Fertility & Sterility 2016 10(3):290-6. [Google Scholar]
[31]. Tompkins SA, Roeder JA, Thomas JJ, Koch KK, Effectiveness of a relationship enrichment program for couples living with multiple sclerosiss International Journal of MS Care 2013 15:27-34.10.7224/1537-2073.2012-00224453760 [Google Scholar] [CrossRef] [PubMed]
[32]. Tavakolizadeh J, Nejatian M, Soori A, The effectiveness of communication skills training on marital conflicts and its different aspects in women Procedia-Social and Behavioral Sciences 2015 171:214-21.10.1016/j.sbspro.2015.01.112 [Google Scholar] [CrossRef]
[33]. O’leary S, Vidair B, Marital adjustment child-rearing disagreement and over reactive parenting: predicting child behavior problems Journal of Family Psychology 2005 19(2):205-16.10.1037/0893-3200.19.2.20815982096 [Google Scholar] [CrossRef] [PubMed]
[34]. Halford WK, Bodenmann G, Effects of relationship education on maintenance of couple relationship satisfaction Clinical Psychology Review 2013 33(2013):512-25.10.1016/j.cpr.2013.02.00123500155 [Google Scholar] [CrossRef] [PubMed]
[35]. Masoumi Z, Keramat A, Hajiaghaee R, Systematic review on effect of herbal medicine on pain after perineal episiotomy and cesarean cutting Journal of Medicinal Plants 2011 4(40):1-16. [Google Scholar]