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Testing the Reliability and Validity of the Couples Illness Communication Scale: Analysis of the Role of Communication in Relationships

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Currently, one in three adults suffers from one or more chronic conditions (Marengoni et al., 2011). A chronic illness is defined as a disease lasting three months or more that cannot typically be cured by medication or vaccination (Blackwell, Lucas & Clarke, 2014). If a prognosis is perceived as catastrophic it is more likely to result in negative psychological consequences such as depression, a decline in the ability to cope for both the patient and their support network (Taylor., 1983; Affleck & Tennen., 1996). A diagnosis of and consequent adjustment to a chronic condition can have a particularly significant effect on romantic relationships; altering normal communication (Eriksson & Svedlund, 2006). The primary focus of this research is investigating the reliability and validity of the Couples Illness Communication Scale (CICS; Arden‐Close, Moss‐Morris, Dennison, Bayne, & Gidron, 2010) in the chronic headache population.

After a diagnosis of a chronic condition maintaining an open and responsive dialogue encourages effective communication between couples; consequently, increasing relationship satisfaction and decreasing distress (Berg and Upchurch, 2007; Laurenceau, Barrett & Pietromonaco, 1998). However, couples coping with chronic illnesses commonly struggle with this (Martire, & Helgeson, 2017). Conversely, ‘demand withdraw communication’ whereby one partner attempts to discuss a stressor and the other withdraws, and ‘mutual avoidance’ of discussing the illness, increases distress levels and decreases relationship satisfaction (Manne et al, 2006).

Couple communication is always important in romantic relationships however, when one partner suffers from a chronic illness communication becomes essential. This is due to illness-related changes such as diagnosis or treatment which have a direct negative effect on marital satisfaction (Berg & Upchurch, 2007; Bogosian, Moss-Morris, Yardley, & Dennison, 2009).

Badhr, Carmack, Kashy, Cristofanilli & Revenson (2010) demonstrated the benefits of mutually constructive illness communication in the cancer population. Couples who viewed the diagnosis as a couple-related stressor as opposed to an individual stressor, consequently communicated more freely about it and experienced increased relationship satisfaction. Similarly, couples who used more illness-related problem focussed coping strategies and less avoidance displayed better mental health, higher rated relationship satisfaction, and lesser levels of stress (Ptacek, Ptacek & Dodge., 1994; Kayser, Watson & Andrade., 2007). This highlights the importance of monitoring how effectively couples are communicating, as it could provide insight into of how both partners are coping with the adjustment to illness.

Chronic illness should be understood as an intra-dyadic problem as both spouses face with numerous challenges throughout the illness trajectory. Understanding illness-related couple communication from a dyadic perspective requires consideration of the interrelationship between multiple psychosocial illness-related factors and how this will impact both patients and partners (Goldsmith., 2015).

A strong social support network is beneficial when coping with the difficulties that accompany a chronic health condition (Gallant, 2003) with some studies naming a lack of social support as a larger stressor than the health condition itself (Thoman-Touet & Kay, 1992). This emphasizes the importance of interpersonal support in the presence of a chronic health condition. Although social support can come from a variety of sources, a lack of support from a partner cannot be substituted by others (Pistrang and Barker., 1995), demonstrating the importance of extradyadic support in the context of illness.

Perceived stress is defined as the thoughts that one may have about the levels of stress that they are under, the level of stress that is caused when encountering various stressors and how well equipped one feels to deal with the stressors in their lives (Allott et al., 2013). Chronic illness has been shown to increase perceived stress; headache patients reported a higher number of daily stresses and rated those events as more stressful in comparison to general population ratings of the same stressors. (Holoroyd et al., 2000). Studies have shown that the detrimental effects of stress in couples can be mitigated by effectively communicating (Lau, Randall, Duran & Tao., 2019).

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Stress communication is the process by which partners are able to convey and understand each other’s stressful experiences (Bodenmann, 1995; Bodenmann., 1997; Revensen, Kayser & Bodenmann., 2005) however in the context of chronic illness, poorer communication and higher levels of relationship conflict are reported in couples due to increased stress (Bahr, 1979; Lavee, McCubbin & Olsen, 1987; Neff and Karney, 2004). These negative effects were still found to be prominent even in the absence of headaches (Lipton et al, 2003). Additionally, couples reported feelings of obligation to stay in an ‘unhappy’ relationship and endure illness-related stress within their relationship (Parker, 1993).

Research shows there is often a disparity in how the patient and partner perceive and cope with the adjustments that are necessary to deal with the condition, with both spouses reporting similar feelings but from their own perspectives (Revenson & Majerovitz., 1991). Across a range of chronic health conditions, Health-Related Quality of Life (HRQoL) differed among couples, with some studies finding patients had a worse HRQoL (Kornblith, Herr, Ofman, Scher & Holland, 1994) and other studies finding that spouses reported worse HRQoL (Thommasen & Zhang, 2006). However, enhancing communication has been shown to improve perceived HRQoL (Lim & Shon., 2018).

The research above indicates communication is an important factor in coping with a chronic illness however, investigating illness-related couples communication is vital as even couples who have a good relationship in other respects may not discuss the patient’s illness (Boehmer & Clark, 2001; Holmberg, Scott, Alexy, & Fife, 2001). General couple’s communication is measured on questionnaires such as the Evaluation and Nurturing Relationship Issues, Communication and Happiness couples scale (Fowers and Olsen., 1998). However, the context of illness may have specific dyadic implications, unrelated to general couple’s communication and therefore it is important to develop scales that can assess this such as the CICS (Arden Close et al., 2010).

There is plentiful evidence citing the importance of good illness-related couple communication however, there is a gap in the literature with regard to the type of chronic illness studied. Chronic daily headache (CDH) is a descriptive term that includes all headache disorders that occur for 15 or more days per month. CDHs are estimated to affect around 4% of the population (Olesen, Bousser, Diener, Dodick & First., 2006). Buse et al (2016) reported that around one-third of partners of patients with episodic migraine (EM) and 50% of those with chronic migraine (CM) avoided their spouse because of their illness and its consequences such as arguments. Effects of this avoidance were explored by Smith (1998) who found that 24% of individuals with CM reported an effect on their sexual relationships, 3-6% required relationship counseling and 5% reported separation or divorce due to migraine. Despite this significant negative impact, there is little literature reporting how headache conditions affect illness couple’s communication. More research is needed to understand the extradyadic effects; this would be beneficial to both the patient’s and their partner’s well-being. Difficulties communicating about the illness is not isolated to the patient alone; Hilton & Koop (1994) reported that spouses rarely divulge their feelings about their partner’s illness so as not to burden or concern the patient, further reducing spousal satisfaction. This highlights the importance of measures that provide insight into both couple’s perspectives such as the CICS (Arden Close et al., 2010).

The CICS was developed by Arden Close et al (2010) to provide an insight into couples’ willingness to discuss their illness intradyadically and measure illness-related couple communication. The findings of this study suggested that it was important to understand a couple’s communication when one partner is suffering from a chronic illness related couples in order to improve the couple’s adjustment to the illness.

The CICS specifically measures illness-related couple’s communication and has been tested in life-threatening illnesses (Ovarian cancer) and chronic progressive disease (Multiple Sclerosis; MS) reporting high levels of internal consistency, reliability, and validity within these populations (Arden‐Close et al., 2010). However, it has not been tested within a sample of patients suffering from a chronic stable conditions such as headache disorders. This study aims to build upon the existing literature by testing the reliability and validity of the CICS in the headache population in order to increase the generalisability of the scale.

It is hypothesized that:

  1. Better illness-related couple communication will be associated with better reported social support.
  2. Lower levels of stress will be reported in participants who report more effective illness-related couple communication.
  3. Higher levels of relationship satisfaction will be associated with more effective couple communication.
  4. Lower levels of perceived health-related quality of life (HRQoL) will be associated with poorer illness-related couple communication.
  5. Those who perceive their illness as more threatening are likely to have worse couple communication.

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Testing the Reliability and Validity of the Couples Illness Communication Scale: Analysis of the Role of Communication in Relationships. (2022, September 27). Edubirdie. Retrieved February 5, 2023, from
“Testing the Reliability and Validity of the Couples Illness Communication Scale: Analysis of the Role of Communication in Relationships.” Edubirdie, 27 Sept. 2022,
Testing the Reliability and Validity of the Couples Illness Communication Scale: Analysis of the Role of Communication in Relationships. [online]. Available at: <> [Accessed 5 Feb. 2023].
Testing the Reliability and Validity of the Couples Illness Communication Scale: Analysis of the Role of Communication in Relationships [Internet]. Edubirdie. 2022 Sept 27 [cited 2023 Feb 5]. Available from:
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