Communication Patterns and Related Factors among Iranian Couples: A Cross-sectional Study

Background: Given the effect of various factors on the use of communication patterns by couples, this study aimed to determine the most common communication pattern among couples and related factors in Sari, northern Iran. Methods: This cross-sectional study was performed on 520 people (260 couples) in Sari. Data were collected using a demographic–fertility factors questionnaire, Enrich couple scale, communication patterns questionnaire, general health questionnaire (GHQ-28), and NEO personality inventory. Data analysis was performed in SPSS version 25 using descriptive and inferential statistics (multiple regression model). Results: While the mean (standard deviation) age of women included in the study was 34.08 (7.71) years, the mean age of men was 39.13 (9.18) years. The most common communication patterns in both women and men was the mutual constructive communication, whereas the lowest frequent communication pattern was the demand/withdraw communication in both men and women. Marital satisfaction had a significant positive correlation with mutual constructive communication pattern in women and men (P = 0.001). In addition, a significant inverse correlation was observed between the number of marriage to date, women’s age, and spouses’ demand/withdraw communication pattern with mutual constructive communication pattern in women. Also, a significant inverse correlation was observed between flexibility (P = 0.047), number of marriages (P = 0.013), and the wives’ age (P = 0.005) with mutual constructive communication pattern in men. Conclusion: According to the results of the study, it is necessary to recognize the factors related to couples’ communication patterns in order to improve the communication patterns so that marital conflicts could be avoided while a more effective communication is established.

Moreover, most studies have focused on the evaluation of patterns of family communication [23]. Considering the aforementioned issue, this study aimed to determine the most common couples' communication pattern and related factors in Sari, Iran. It is hoped that effective steps could be taken toward solving couples' marital conflicts by recognizing these patterns.

Materials and Methods
This cross-sectional research was performed on couples in Sari, north of Iran in 2018.
The inclusion criteria of the study were being a couple residing in Sari, educational level of elementary fifth and above, living with the spouse, and being married for a minimum of one year. The exclusion criterion was the unwillingness of one or both spouses to participate in the study. In total, 27 households were randomly determined as cluster heads by the health center statistics unit using the random number table. The sample size was determined by selecting 10 samples for each factor, which led to the selection of 350 people (175 couples). Since subjects were selected by cluster sampling and the impact factor was 1.5, a total of 524 people (262 couples) were selected.
However, two couples were removed from the research due to incomplete questionnaires, which led to the entrance of 10 families in each cluster (260 couples). Notably, 27 students were trained in a 3-hr educational session to conduct the research inquiry.
The inquiry sessions took 30-45 min. After receiving the address of cluster heads, the interviewers referred to the addresses as two-member teams every day. In case of the absence of households or their unwillingness to participate in the study, inquiries were conducted with other households. Interviews were conducted in an apartment.
Of note, interviewers verbally explained the questionnaire to each couple. In addition, research objectives were explained prior to the study and the subjects were ensured of the confidentiality terms regarding their personal information. In addition, they were allowed to withdraw from the research at any time. Data were collected using the following tools:

Demographic-fertility factors questionnaire
This questionnaire comprised of two sections of demographic characteristics and fertility-related information such as type of contraceptive method; history, type, and cause of infertility; children from a previous marriage; menstrual cycle regularity; duration of menstrual cycle; current pregnancy; number of children; currently living with the spouse; and children's gender.

Enrich couple scale (ECS)
The 35-item version of the ECS scale was used. The validity and reliability of this questionnaire have previously been confirmed in Iran [24,25].

The communication patterns questionnaire (Christensen and Salavi)
This was a 35-item questionnaire, validity and reliability of which have been confirmed in Iran [26].

General health questionnaire (GHQ-28)
The GHQ-28 is a 28-item questionnaire, the validity and reliability of which have previously been confirmed in Iran [27].

NEO personality inventory
This was a 60-item questionnaire. The validity and reliability of this questionnaire have been confirmed in Iran [28].

Statistical analysis
Data were analyzed by SPSS version 25 using a skewness-kurtosis test (to assess the normal distribution of the data), as well as descriptive (frequency, mean, and standard deviation [SD]) and inferential (linear and multiple regressions) statistics. First, the relationship between factors related to the communication patterns was evaluated applying the univariate regression. Ultimately, the significant factors that had linear relations were entered into the multiple regression model to determine the predictive variables of couples' communication patterns. Moreover, the cutoff point of the patterns was obtained based on the estimation of half the difference between maximum and minimum scores in order to determine the frequency of couples' communication patterns, followed by developing a dichotomous variable. In this context, the scores obtained from the minimum possible score of the questionnaire to the cut-off point were coded 0 while the scores above that level were scored 1. In the end, the frequency and related factors of these dichotomous variables were estimated.

Results
According to the results of the study, the mean (SD) age of women was 34.08 (7.71) years and that of men was 39.13 (9.18) years. The majority of women were housewives (69.6%) while the majority of men were employees (43.8%). In terms of the level of education, most men and women had a degree between diploma and BSc (68.5% and 72.3%, respectively) (Table 1).     [29,30]. Furthermore, using the demand/withdraw communication pattern by couples could lead to decreased marital satisfaction (especially when there is a demander wife and a withdrawer husband) and might predict divorce. In this respect, the more the use of demand/withdraw communication pattern, the lower the level of marital compatibility [10].
Our findings revealed a significant, negative relationship between women's age and mutual constructive communication pattern (in men and women), which is consistent with the results of Khodakarami et al. [31] and Bakhshi et al. [32]. On the other hand, our findings were inconsistent with the results of Vaijayanthimala et al. [33] and Karny et al. [34]. The results obtained by Bakhshi et al. [32] and Khodakarami et al. [31] demonstrated that the level of marital satisfaction decreased by the increase in women's age. This finding can be justified by the fact that as a woman gets older, she becomes more mature and aware of her marital status, which in turn reduces marital conflicts and problems. In contrast, marriage at a young age can lead to numerous problems and consequently reduced marital satisfaction due to a lack of physical, mental, and emotional preparedness. It may be argued that since individuals have not yet attained the mental, emotional, cultural, social, economic growth, they have not gained many of the skills required to lead a successful life and lack the necessary skills to play the role of spouse, which often leads to many conflicts and incompatibilities. The necessity of achieving economic growth and job stability for men with regard to their responsibilities in providing family finances and housing in marriage and finishing the military service results in the preparedness of men for marriage at an age higher than women, which itself could decrease problems and increase marital satisfaction.
According to the results of the present study, there was an inverse correlation between the number of marriages and mutual constructive communication patterns with family problems [36,37].
Our study indicate an inverse correlation between demand/withdraw communication pattern in men and mutual constructive communication pattern in women. In a research by Gottman et al., it was reported that the demand/withdraw communication pattern (especially when there is a demander wife and a withdrawer husband) led to decreased marital satisfaction and increased possibility of divorce [30]. In a study aimed to evaluate the relationship between the demand/withdraw communication pattern and marital compatibility, it was concluded that the more the use of the demand/withdraw communication pattern by couples, the lower the level of marital compatibility [38]. While previous studies have shown a relationship between this pattern and marital satisfaction and compatibility, most of them have suggested that the nature of this model is complex and how it is affected is not yet fully understood. This complexity and lack of certainty of the type of relationship can be justified by the fact that the association between marital communication patterns and marital satisfaction might depend on the couples' beliefs about marriage. Therefore, given the role of this pattern in the prediction of important marriage consequences (e.g., marital satisfaction and divorce) [30], it is recommended that efforts be dedicated to a better and more accurate understanding of the relationship in future studies.
According to the results of the current study, there was a positive relationship between marital satisfaction and mutual constructive communication pattern in men and women, which is in line with the results of other studies [39,40]. In this regard, it could be pointed out that couples who use mutual constructive communication patterns more in their marital relation avoid destructive behaviors and make efforts to maintain a healthy relationship. In addition, they feel that they understand each other, can properly express their feelings, find solutions for communication problems and negotiate, which ultimately increases their marital satisfaction.
The lack of the presence of men at the time of interviews, which was controlled by visiting the home of the participants by prior appointment is a limitation of our study. All questionnaires were checked for completeness at the time of delivery and the parts left incomplete were explained to the couples again. In case of the presence of spouse, the questionnaires would be completed at the same time; otherwise, interviewers would refer to the participants to complete the questionnaires at another time. Some of the strengths of the present study included cluster sampling, referral of interviewers to the house of the participants in the presence of the man of the house, and the completeness of the questionnaires used.

Conclusion
According to the results of the study, the most common communication pattern in both women and men was the mutual constructive communication pattern. Therefore, it is necessary to recognize the factors related to mutual constructive communication patterns in couples so that marital conflicts could be avoided while a more effective communication is established.