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Effects of ePREP and OurRelationship on Low-Income Couples’ Mental Health and Health Behaviors: a Randomized Controlled Trial


Relationship distress is a pervasive problem in the USA that disproportionally impacts couples with low-income levels. The goal of the present study was to evaluate the effectiveness of two online relationship interventions, OurRelationship and ePREP, both of which were supported by a paraprofessional coach, in improving mental health and physical health behaviors with low-income couples. Couples (N = 742) were randomized to either intervention or a 6-month waitlist control group and assessed pre-, mid-, and post-intervention as well at 4 and 6 months after randomization. Results from multilevel models indicated that during treatment, compared to couples in the waitlist group, couples in the intervention groups reported significantly greater improvements in mental health that were small to moderate in magnitude (psychological distress, anger, problematic alcohol use, and perceived stress) as well as improvements in physical health/health behaviors (perceived health, insomnia, and exercise) that were small in magnitude. Furthermore, the differences between intervention and waitlist groups were maintained over follow-up. Treatment gains in both mental health and physical health behaviors were generally stronger for those who began treatment with greater difficulties in those areas. Implications of these findings with regard to intervention and policy are discussed.

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Fig. 1


  1. According to one partner’s reports of annual household income, all couples were within 200% of the federal poverty line. However, when annual household income was extrapolated from each individual’s reports of individual income in the last 30 days, 85% of couples fell within that range. It is unclear which method of reporting is more accurate, so we include both here.

  2. In addition to testing initial levels of individual mental and physical health as moderators of outcomes, initial levels of relationship distress using the Couple Satisfaction Index (CSI-4; Funk and Rogge 2007) were tested as a moderator of mental health and physical health/health behaviors in separate analyses. No significant moderation effects were observed for initial gains during the intervention or for maintenance of those gains over follow-up by initial relationship distress with the exception of perceived health maintenance from post to follow-up such that those with distress reported greater gains over follow-up (see Supplementary Table 5).


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We would like to thank Sean Aaron, Zach Blackhurst, Tommy Chou, Krista Dowdle, Meghan Maddock, Ana Martinez de Andino, Hannah Mitchell, Kathryn Nowlan, Lane Richie, Karen Rothman, Alyssa Vazquez, and Sara Wigderson who served as coaches and Scott R. Braithwaite who served as a supervisor as well as Clark Brinson and Samantha Joseph who served as Project Coordinators for this study.


This research was supported by the U.S. Department of Health and Human Services, Administration for Children and Families, Grant Number 90FM0063. This project was also made possible by Grant Number 90PR0008 from the Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Planning, Research and Evaluation, the Administration for Children and Families, or the U.S. Department of Health and Human Services.

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Correspondence to McKenzie K. Roddy.

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Dr. Brian Doss is a co-inventor of the intellectual property used in this study and an equity owner in OurRelationship LCC.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Miami IRB and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Roddy, M.K., Rhoades, G.K. & Doss, B.D. Effects of ePREP and OurRelationship on Low-Income Couples’ Mental Health and Health Behaviors: a Randomized Controlled Trial. Prev Sci 21, 861–871 (2020).

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