Relationship Help-seeking in a Community Sample: Testing Differences by Geography and Gender
Relationship Help-seeking in a Community Sample: Testing Differences by Geography and Gender
J. Wade Stewart
Kay Bradford
Brian J. Higginbotham
Linda Skogrand
Mark Jackson
Utah State University
Abstract
As Extension faculty members engage in couple relationship education, they may benefit from a clearer understanding of patterns of relationship help-seeking, and the extent to which these patterns vary among geographical settings. In a study conducted in fifteen counties across a western state, we examined ten relationship help-seeking behaviors of 1,986 relationship education participants. We examined differences in help-seeking between women and men and across county type (i.e., rural, micropolitan, and metropolitan) and found that help-seeking behaviors differed somewhat across county types. Compared to men, women reported higher levels of help-seeking especially in micropolitan and metropolitan counties. Insights are discussed.
Keywords: couple relationship education, help-seeking, rural education
Introduction
One purpose of Cooperative Extension is to improve the well-being of American families, especially families living in rural America (Cooperative State Research, Education, and Extension Service 2007). With this goal in mind, Extension faculty are encouraged to perform needs analyses to help determine the services needed, thereby establishing priorities in their assigned areas (McCawley 2009). We believe, however, that even after the needs analysis is complete and programs are being taught, understanding aspects of attendees is an important endeavor especially given that curriculum-based programs usually focus on what to teach and not to whom. An emphasis placed on understanding the audience might help to improve the quality of services. Given that many Extension faculty members facilitate and teach couple relationship education, understanding couple characteristics such as help-seeking could inform future programs by (a) developing the content of the course, (b) presenting the material, (c) advertising, (d) following up with attendees, and (e) making referrals. In the current article, we examined relationship help-seeking of those who attended couple relationship education. We define relationship help-seeking as the performance of a behavior intended to improve an intimate relationship.
Literature review
Several studies document patterns of relational help-seeking behaviors. In one, participants were most likely to seek general relationship help from written materials, friends, counseling, and education groups (Ganong and Cole 1989). In another study, couples anticipating remarriage most frequently sought relational help by talking with family, followed by talking with friends, talking with religious leaders, reading pamphlets, magazines, or news articles, and reading self-help books (Higginbotham, Miller, and Niehuis 2009). Doss and others (2009) investigated the patterns of help-seeking behaviors in 213 newlywed couples during the first five years of marriage. Of these couples, 23 percent sought relationship help by reading books, 19 percent by attending workshops or retreats, and 14 percent by participating in marital therapy. In another study, talking to a friend, reading a magazine article, and talking to a family member were the most sought out relationship helps (Georgia and Doss 2013). Regarding the reasons for seeking professional help, one study showed that women seek professional relationship help for communication issues, feeling distant in the relationship, feeling depressed, and experiencing a lack of quality time with their partner while men only seek professional help when they feel a divorce is eminent (Eubanks-Fleming and Cordova 2009).
Although Extension faculty members do not directly provide all types of help-seeking opportunities studied in the extant literature (e.g., therapy, talking with friends and family, talking with religious leaders, or reading self-help books), gaining insights into where individuals are getting their information and the stepwise progression individuals follow to gather information might help Extension faculty members be more strategic in their efforts. For example, there are many different avenues faculty members might use to reach and attract individuals including web pages, computer applications, classes, workshops, newspapers, brochures, magazines, videos, and word of mouth. Understanding which of these avenues individuals are using to gain information might help faculty members make priority decisions for time and resources. Additionally, because intervention is rarely a one-time endeavor, knowing how to continually reach and help those who have attended courses in their preferred avenue will ensure that attendees will reap benefits after they leave.
This approach is supported by Bronfenbrenner’s Ecological Model. Individuals are affected by their environments and the sub-cultures to which they belong (Bronfenbrenner 1994). These environments go beyond broad categories or classifications, but affect the “conditions and processes” of everyday life (Bronfenbrenner 1994, 40). Microsystems (i.e., school, family, friends, and church group) and mesosystems (i.e., the interaction of two microsystems such as school and home) combine to form macrosystems or “the belief systems, bodies of knowledge, material resources, customs, life-styles, and life course options” (Bronfenbrenner 1994, 40) of the culture. Several key differences in the macrosystem exist between rural and urban communities that might affect the daily experiences of individuals. Understanding these conditions and processes might help interventionists more effectively reach those they serve.
Rural versus metropolitan communities
Several noteworthy differences between rural and metropolitan areas could potentially contribute to differences in daily processes and conditions of those in rural America and, therefore, affect where they seek help. For example, non-metropolitan women are more likely to marry and to do so at younger ages compared to their metropolitan counterparts (Snyder, Brown, and Condo 2004). In addition, individuals in rural communities report having poorer health, lower socioeconomic status, and increased drug use (see Gray 2011 for a review). Suicide rates of individuals in rural locations are higher than their counterparts in metropolitan settings (Singh and Siahpush 2002). Taken together, these trends suggest that rural Americans experience more risk factors in their daily lives than individuals in urbanized areas. Conversely, a review of rural and metropolitan mental health research found no significant differences in mental health diagnoses between these two settings (Judd et al. 2002). This lack of discrepancy may be due to individuals in rural communities having a higher “need-for-care threshold” when compared with those in metropolitan communities (Rost et al. 2002, 234). In other words, individuals with problems in rural communities may wait longer before seeking help.
Professional help-seeking behaviors for mental health in rural America
Researchers have also highlighted several rural and metropolitan differences in tendencies to seek and access professional help. For example, Mohatt and others (2005) observed that three major barriers that might prevent mental health help-seeking behaviors in rural communities were acceptability, availability (i.e., limited providers), and accessibility (i.e., lack of knowledge, transportation, financing). As of 1999, 87 percent of the 1,669 designated Mental Health Professional Shortage Areas were located in non-metropolitan settings (Bird, Dempsey and Hartley 2001). In addition, individuals in rural communities may not perceive their own mental health needs and therefore fail to seek help when they need it (see Mohatt et al. 2005). Differences in cultural values, lack of anonymity, and stigmatization might also contribute to the decision not to seek help (Rost et al. 2002).
Informal help-seeking
Individuals generally seek help from those who are closest to them such as friends, family, and spouses regardless of location (Goldsmith and Fitch 1997; Griffith 1985; Mac George et al. 2004; Young, Giles, and Plantz 1982). For personal problems, Griffith (1985) reported that after friends, family, and relatives, individuals sought help from clergy, church members, and roommates; professional therapists were consulted least of all. Furthermore, research supports the claim that women seek help more frequently than men for issues such as depression, drug abuse, stress, and health challenges (see Galdas, Cheater and Marshall 2005). Although one study showed newlywed couples sought marriage advice from friends, parents, religious leaders, and siblings (Sullivan 2008), most extant research has focused on individual help-seeking, not couple help-seeking.
Extension faculty
Extension faculty members provide mental health services to communities (Molgaard 1997) in the form of education. Some have argued that Extension “would be among the most natural, obvious, and successful at provision of couples educational materials” (Stanley in Futris et al. 2005). Indeed, many leading Extension faculty members have formed a nationwide outreach to “provide research-based resources and promote partnerships to advance the knowledge and practice in relationship and marriage education” (National Extension Relationship and Marriage Education Network [NERMEN] 2013). Although NERMEN may act as a resource for Extension faculty currently involved in couple relationship education (CRE), many faculty members are not currently involved in CRE. As such, the insights from this study are meant to help faculty members who are interested in starting CRE programming as well as those that already have couple relationships as a programming priority.
Purpose of the study
The purpose of this study is to examine relational help-seeking patterns of individuals who attended Extension-sponsored couple relationship education. Additionally, we test the extent to which these patterns vary according to a location’s population density (i.e. rural, micropolitan, and metropolitan) and by gender.
Methods
County classification
According to the 2010 United States Census, urbanized areas have populations greater than 50,000, micropolitan or urban clusters have at least 2,500 and 50,000 inhabitants, and rural areas are all other counties. More specifically, we used a coding system based on a map of our state from the 2010 United States Census.
Participants
A total of 1,986 people participated in the study. We chose to include those with missing data (33 percent of the sample) and classified them as non-help seekers to reach a more conservative estimate of the patterns of help-seeking. Participants were recruited through advertising by county Extension faculty in a western state. Sample demographics are reported in Table 1.
Table 1. Participant demographics by county type
[Table 1 Summary: the demographics including sex, age, relationship status, race/ethnicity, and income are described based on three county types: metropolitan, micropolitan, and rural]
| Demographics | Metropolitan | Micropolitan | Rural | |
| Sex | Male | 553 | 200 | 121 |
| Female | 606 | 293 | 189 | |
| Age | Mean age | 39.2 | 38.0 | 44.3 |
| SD | 12.1 | 14.3 | 14.0 | |
| Range | 18-77 | 18-97 | 20-80 | |
| Relationship status | Married | 77.3% | 81.1% | 83.4% |
|
16.6 years | 16.3 years | 21.3 years | |
| Remarried | 15.7% | 14.7% | 12.6% | |
| Single | 11% | 11.3% | 13.1% | |
| Dating | 4.4% | 3.0% | 1.9% | |
| Race/Ethnicity | White | 83.3% | 85.3% | 91.4% |
| Latino American | 6.9% | 8.7% | 1.9% | |
| Asian American | 1.7% | .8% | .6% | |
| Native American | 1.3% | 1.4% | – | |
| Income | Median | $50,500 | $40,000 | $50,000 |
| Range | 0-$250K | 0-$1000K | 0-$275K | |
Procedures
CRE programming was offered by fifteen county Extension offices in a western state. Programming included brief interventions (e.g., educational date nights, one-time classes, and one-time activities) and medium intensity interventions (e.g., multiple-class series). Presenters included county Extension faculty members, therapists, social workers, and educators. At the conclusion of each activity, participants completed a two-page survey that included demographic items and measures of relationship help-seeking, individual functioning, relationship knowledge, intimate partner violence, and relationship satisfaction.
Measures
Participants reported help-seeking behaviors by indicating the number of times they had participated during the past year in any of the following to improve their relationship with their partner: professional counseling; visiting websites; talking to other couples; talking with parents/relatives; talking with religious leaders; reading books; reading pamphlets, magazines, or newspapers; watching videos or movies about marriage; attending classes of two or more sessions; or attending a single-session lecture/workshop (cf., Higginbotham, Miller, and Niehuis 2009). Using these data, we placed participants into a non-seeking group (zero or no data) and a seeking group (any help-seeking within the past year). These results are reported in Tables 2 and 3.
One-third of participants did not complete this measure. Using logistic regression, we tested whether demographic variables differed significantly between those who completed the measure and those who did not for each county type. In all three county types, marital status differed significantly between completers and non-completers: married participants were more likely to complete the survey than those in other relationship statuses. Perhaps singles were less likely to fill out the relationship survey because they perceived it as irrelevant to their current circumstances. In the metropolitan sample, income differed significantly between completers and non-completers.
Results
Geographical differences in help-seeking
Table 2. Percentage of relational help-seeking behaviors for women based on county type
[Table 2 Summary: Percentage of women who sought different types of help-seeking. There are five columns. The first has a list of ten couple help-seeking behaviors, the second gives the overall percentage of the sample who sought the behavior, and the last three give percentages based on county type.]
| Preparation form by rank order | Overall
group % |
Ru%
(189) |
Mi%
(293) |
Me%
(605) |
| Read pamphlets, magazines, or news articles | 34.8 | 22.8Me | 36.5 | 37.8Ru |
| Talked with other couples | 34.8 | 29.6 | 40.6 | 33.7 |
| Talked with parents/relatives | 32.7 | 27.5 | 40.6 | 30.5 |
| Read a book on marriage | 31.3 | 20.1 | 33.1 | 34.2 |
| Attended a workshop or lecture (1 session) | 28.0 | 20.6 | 28.3 | 30.2 |
| Visited a website | 25.0 | 12.2 | 22.5 | 30.2 |
| Attended a class (2 or more sessions) | 20.7 | 9.5Mi | 24.6Ru | 22.4 |
| Talked with religious leaders | 19.0 | 12.2 | 23.2 | 19.0 |
| Watched videos or movies on marriage | 16.7 | 13.2 | 16.0 | 18.0 |
| Professional counseling | 8.2 | 4.2Me | 7.8 | 9.6Ru |
Superscripts indicate statistically significant differences (p<.05) in the ANOVAs using Tukey’s HSD. Ru = Rural, Mi = micropolitan, and Me = Metropolitan
Table 3. Percentage of relational help-seeking behaviors among men by county type
[Table 3 Summary: Percentage of men who sought different types of help-seeking. There are five columns. The first has a list of ten couple help-seeking behaviors, the second gives the overall percentage of the sample who sought the behavior, and the last three give percentages based on county type.].
| Preparation form by rank order | Overall
group % |
Ru%
(121) |
Mi%
(199) |
Me%
(553) |
| Talked with other couples | 30.4 | 20.7 | 34.0 | 31.3 |
| Read pamphlets, magazines, or news articles | 29.9 | 19.8 | 28.0 | 32.9 |
| Talked with parents/relatives | 28.7 | 22.3 | 34.0 | 28.2 |
| Attended a workshop or lecture (1 session) | 26.7 | 19.0 | 24.5 | 29.3 |
| Read a book on marriage | 23.8 | 15.7 | 19.5Me | 26.9Mi |
| Talked with religious leaders | 20.7 | 14.9 | 22.5 | 21.3 |
| Attended a class (2 or more sessions) | 20.3 | 9.1 | 23.0 | 21.9 |
| Visited a website | 18.5 | 10.7 | 16.0 | 21.2 |
| Watched videos or movies on marriage | 14.7 | 9.1 | 15.0 | 15.9 |
| Professional counseling | 9.5 | 7.4 | 7.0 | 10.8 |
Superscripts indicate statistically significant differences (p<.05) in the ANOVAs using Tukey’s HSD. Ru = Rural, Mi = micropolitan, and Me = Metropolitan
Gender differences in help-seeking
Chi-square analyses indicated several gender differences in help-seeking for each county type. In the rural sample, women significantly talked with other couples (c2 = 10.02, p < .05) and talked with parents (c2 = 5.30, p < .05) more than the men. In the micropolitan sample, women read self-help books (c2=14.01, p < .001), visited websites (c2=4.89, p < .05), talked with other couples (c2=10.16, p < .01), talked with their parents (c2=12.43, p < .001), read pamphlets, magazines, or news articles (c2=9.72, p < .01), and attended a workshop (c2=4.30, p < .05) more than their male counterparts. Metropolitan women read self-help books (c2 = 9.39, p < .05), talked with other couples (c2=5.71, p < .05), talked with parents (c2=4.84, p < .05), read pamphlets, magazines, or news articles (c2=7.48, p < .05), and visited a relationship website (c2 = 12.09, p < .001) more than metropolitan men.
County differences in help-seeking
We used one-way ANOVA to compare means of summed help-seeking scores by gender and across county type. Across county type, mean differences in help-seeking scores were not significant for women and men. We also calculated one-way ANOVAs to examine mean differences in help-seeking scores on the ten help-seeking behaviors among women and men. For women, these analyses revealed significant differences in the likelihood of reading a self-help book (F = 3.79, p <.05), professional therapy (F=3.43, p<.05), talking with parents and relatives (F = 3.15, p <.05), and attending a class (F = 3.48, p <.05). Tukey’s HSD comparisons showed that metropolitan women were more likely to read a self-help book than rural women; metropolitan women were more likely to seek therapy than rural women; and micropolitan women were more likely to attend classes than rural women. For men, significant differences were found for reading a self-help book (F = 4.81, p <.05). Metropolitan men sought more self-help books than micropolitan men.
Discussion
Differences in help-seeking tendencies among rural, micropolitan, and metropolitan counties were typically not significant in our sample. Perhaps differences in relational help-seeking behaviors with differing geographical areas have begun to fade. We predicted that individuals in metropolitan areas would seek relationship help more readily than those in rural counties because of the historical difference in availability of relationship resources. However, common barriers to help-seeking (e.g., acceptability, availability, and accessibility; Mohatt et al. 2005) pertain almost exclusively to seeking professional help, and most of the relational help-seeking behaviors (e.g., talking with other couples, talking with parents, talking with clergy, visiting a website, and watching a video) in the current study are inherently acceptable, readily available, and accessible. That said, among rural women we did find relatively lower levels of reading relationship-related material, as well as attending classes and seeking therapy; and among rural men, relatively lower levels of reading relationship-related books. Another explanation into the lack of differences between counties might be with how the counties were classified.
One might expect differences in patterns of seeking professional help across county type and, indeed, metropolitan women sought out therapy more than their rural counterparts. Lichter and Brown (2011) concluded, “The social and spatial boundaries that have divided rural from urban America historically are rapidly shifting, blurring, and being crossed” (584). Perhaps our nonsignificant findings among county types are the result of these increasingly imprecise “social and spatial boundaries” between rural and metropolitan communities.
The current findings largely support previous literature that indicates women are more likely than men to engage in help-seeking behaviors (Galdas, Cheater, and Marshall 2005). Indeed, women and men in our sample differed significantly in their ratings for two behaviors in rural counties, six in micropolitan counties, and five in metropolitan counties. Differentials between genders based on county type may be due to location and or the differences in sample size. Measures of relational help-seeking behaviors in this community sample were consistent with past research in that individuals sought help from those nearest them (Georgia and Doss 2013; Griffith 1985; Young, Giles, and Plantz 1982). For women, talking with other couples and reading pamphlets were tied for first, and talking with parents/relatives was ranked third. For men, talking with other couples, reading pamphlets, and talking with parents/relatives were ranked first, second, and third respectively. Furthermore, professional help-seeking was among the least likely help-seeking behaviors regardless of county type, a finding consistent with past research (Griffith 1985).
Limitations
This study has several limitations and therefore only tentative conclusions may be drawn from this study. The measure we used did not define some of the help-seeking behaviors and asked for couples to report a whole year of behaviors, which may have resulted in inaccurate reporting. Furthermore, 33 percent of possible data were missing. Another limitation is that county classifications may lack precision. For example, some counties (especially geographically large counties) consist of both rural and metropolitan citizens, but are classified into a single county; therefore, residents of the same county likely experience differing levels of resources and perhaps different macrosystems. Isserman (2005) recommended using nine different county classifications including three classifications for metropolitan areas, four for micropolitan settings, and two for rural settings. Given the number of individuals in the current sample and preliminary nature of the research, only three county classifications were used. Future research might include finer geographic classifications to facilitate greater precision in analyses of relational help-seeking. Another limitation includes a lack of understanding into the motivations of those seeking help which undoubtedly would help Extension faculty members when serving couples.
Conclusion
Keeping Bronfenbrenner’s Ecological Model in mind, it is important for Extension faculty members to consider how sub-cultures affect those they teach. Understanding the macrosystem (i.e., needs, resources, families, organizations, partners, interactions, and life-styles) will help Extension faculty members to more effectively reach and change those they are hired to serve. This study might be seen as a tentative guide to Extension faculty — offering insights faculty might use when performing a needs analysis, teaching a course, or marketing. Individual circumstances of Extension faculty members differ drastically; consequently, these findings and conclusions may not hold true in each unique situation. Yet, we believe that considering more fully the help-seeking behaviors of those with whom we interact will ultimately improve the quality of the services offered by Extension faculty members.
Funding for this manuscript was provided, in part, by the Utah Department of Workforce Services and the Utah Marriage Commission. The authors thank the Cooperative Extension faculty members for their work, as well as the attendees who participated in the research.
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