A Randomized Controlled Trial of a Couple-Based Economic Empowerment Intervention to Improve Relationship Quality and Mental Health in Three States of India
Phase: NA
Conditions: Mental Health, Empathy, Relation, Interpersonal
Sponsor: Technical University of Munich

Official Study Title: 
Strengthening Relationships and Mental Health Through a Couples-Based Economic 
Empowerment Intervention
NCT Number: Pending
Document Type: Study Protocol  
Date: July 25, 2025
Principal Investigator: Anushree Dirangane
Co-Investigator: Prof. Dr. Janina Steinert 
Institution: Technical University of Munich

Strengthening Relationships and Mental Health through a Couples Economic 
Empowerment Intervention
Brief Summary
This sub-study is part of a larger randomized controlled trial (RCT) titled Disentangling and 
Preventing Economic Violence against Women (ECOVI). It is conducted in rural and urban 
communities across Maharashtra, Andhra Pradesh, and Rajasthan, India. The sub-study evaluates 
the impact of a couples-based financial literacy and gender-transformative intervention on 
relationship strength, empathy, and mental health among married couples. Using a two-arm 
cluster RCT design, 150 clusters (villages or community units) are randomized to intervention or 
control,  with  ~15  husband–wife  pairs  per  cluster  (approximately  2,250  couples  in  total). 
Outcomes  are  measured  at  baseline  (pre-intervention)  and  endline  (post-intervention) 
approximately six months after delivery of the intervention to assess changes in perceived 
relationship strength, empathy (using an adapted relationship strengths and empathy scale), and 
mental health (General Health Questionnaire-6, GHQ-6). The study will also explore whether 
improvements in relationship strength and empathy mediate the intervention’s effect on mental 
health outcomes.
Detailed Description
Studies report that couples‐based programs combining financial or economic empowerment 
content  with  gender‐equity  and  relationship‐building  components  often  yield  improved 
relationship quality. For example, Falconier et al. (2022) describe a 20-hour workshop for 
low-income African-American couples that significantly reduced stress and improved conflict 
management and relationship satisfaction at 6 months. Moore et al. (2023) observed improved 

overall relationship quality among low-income couples with children, while studies from Nigeria 
(John et al., 2022) and India (Raj et al., 2022) document enhanced communication, trust, and 
joint decision‐making—with adjusted relative odds for improved communication.
Interventions  that  combine  microfinance  or  business  training  with  participatory  gender  or 
relationship education (e.g., Kim et al., 2007; Ismayilova et al., 2017) report reductions in 
intimate partner violence—one study noted a reduction in risk by more than 50%—and improved 
empowerment through enhanced decision‐making.
Measures of mental health and well-being, such as stress reduction and improved financial 
autonomy, also improved in several evaluations (Falconier et al., 2022; Ismayilova et al., 2017), 
although mental health outcomes appear less consistently reported than relationship outcomes. 
Notably, partner empathy was not an explicitly measured outcome in any study. Programs varied 
in intensity—from 4–8 sessions and multi‐day trainings to interventions extending over 24 
months—and were implemented in diverse contexts spanning low‐income and rural communities 
in the United States, Africa, and South Asia.
This sub-study provides a focused evaluation of psychosocial outcomes within the broader “Let 
us Grow Together: Economic Wellbeing for Families” intervention. The main trial is designed to 
improve families’ economic well-being through financial literacy training, while also integrating 
gender-transformative content to address intra-household dynamics. The sub-study specifically 
evaluates program impacts on marital relationship quality and mental health. It is premised on 
the idea that empowering couples with financial skills and promoting equitable, empathetic 
relationships can strengthen partner bonds and reduce psychological distress.

Participants in the intervention arm attend six structured community-based sessions for couples. 
These sessions blend financial literacy education (e.g. budgeting, savings, financial planning) 
with content on gender equity, communication, and shared decision-making. The curriculum is 
gender-transformative, meaning it challenges traditional gender roles and encourages empathy 
and cooperation between spouses. Sessions are interactive and participatory, fostering dialogue 
on relationship expectations, emotional support, and joint problem-solving. Between sessions, 
couples receive SMS text message reinforcements to encourage practice of the skills learned and 
to sustain engagement.
The study uses a cluster randomized controlled trial design to avoid contamination between 
participants. Clusters (such as villages or community centers) are randomly assigned to either the 
intervention  or  control  arm  by  an  external  trial  statistician.  All  eligible  couples  within 
intervention clusters receive the couples’ sessions program, whereas couples in control clusters 
do not receive any structured intervention during the study period (they continue with services as 
usual). Both arms undergo identical baseline and endline assessments. The endline survey, 
conducted after completion of the six sessions, collects data on relationship strength, empathy, 
and mental health to measure changes from baseline. By comparing these changes between the 
intervention and control arms, the study will estimate the intervention’s causal effect on the 
targeted outcomes.
In addition to direct outcome evaluation, an exploratory mediation analysis is planned. This 
analysis  will  test  whether  any  improvement  in  mental  health  (GHQ-6  scores)  due  to  the 
intervention occurs indirectly through enhanced relationship strength and empathy. In other 
words, the study will examine if the intervention’s effect on participants’ mental well-being is 
mediated by stronger couple relationships and greater spousal empathy. This will help elucidate 

the mechanism of impact: whether the economic and gender content improves mental health by 
improving how partners relate to and support each other. Findings from this sub-study will 
contribute to understanding the added value of integrating relationship-building and gender 
equity components into economic empowerment programs for families.
Conditions
●
Marital Relationship Quality Improvement
●
Empathy Enhancement
●
Mental Health (Psychological Distress)
Keywords
Couples  Intervention;  Financial  Literacy;  Gender-Transformative;  Relationship  Strength; 
Empathy; Mental Health; GHQ-6; Cluster RCT; India; Family Economic Wellbeing
Study Design
●
Study Type: Interventional two-arm cluster randomized controlled trial
●
Study Model: Parallel assignment by cluster (community-level randomization of couples 
into two groups)
●
Number of Arms: 2 (Intervention vs. Control)
●
Masking: None (Open Label). Due to the nature of the intervention and logistics of the 
trial, participants and facilitators will be aware of group assignment. Blinding of outcome 
assessors will also not be possible since they will be aware of study clusters in which the 
intervention  takes  place  for  logistical  reasons  and  oversight  of  the  intervention 
implementation. 

●
Allocation: Randomized (150 clusters randomly assigned 1:1 to intervention or control)
●
Primary Purpose: Prevention/Supportive Care (to improve psychosocial well-being and 
mental health via a behavioral intervention)
●
Anticipated  Enrollment:  150  clusters,  ~2,250  couples  total  (approximately  4,500 
individuals)
Arms and Interventions
●
Intervention  Arm  (Couples  Training  Intervention):  Married  couples  in  clusters 
assigned  to  the  intervention  receive  a  structured  program  of  six  community-based 
sessions. Each session lasts between 2.5 and 3 hours and includes participatory activities, 
discussions,  and  exercises.  All  six  sessions  would  be  conducted  by  the  same  two 
facilitators - one male and one female. The content integrates financial literacy (e.g., 
household  budgeting,  saving  practices,  joint  financial  planning)  with  gender-
transformative training (e.g., equitable household roles, communication skills, conflict 
resolution, and fostering empathy between spouses). Sessions are delivered by trained 
facilitators in a group setting with fifteen couples, approximately every 2–4 weeks. Some 
sensitive content to address economic violence context would be done in a gender 
segregated  manner  separately  to  encourage  reflections,  ensure  safety  and  reduce 
defensiveness. Between sessions, SMS reminders and tips are sent to participants’ mobile 
phones to reinforce key messages and encourage couples to apply new skills at home. 
The intervention is designed to simultaneously strengthen economic decision-making and 
the emotional/relational bond between partners.
●
Control Arm (No Intervention Control): Married couples in clusters assigned to the 
control arm do not receive the special couples training during the study period. They 

continue with standard activities and resources available in the community but without 
the structured sessions provided to the intervention arm. This control condition represents 
the status quo against which the added effect of the intervention can be measured. After 
the conclusion of the study, control clusters may be offered the intervention materials or 
sessions via our NGO partners in case we find overall positive treatment effects, ensuring 
ethical considerations are met.
Outcome Measures
Primary Outcome Measures
1. Perceived  Relationship  Strength  (PRS):  Change  in  the  composite  Relationship 
Satisfaction Index (Funk & Rogge, 2007) (trust, communication, mutual support, conflict 
resolution).
Hypothesis: Greater  improvement  in  the  intervention  group  than  in  controls.
[Time Frame: T1 = baseline (prior to Session 1); T2 = endline (~14–18 months after 
baseline)]
2. Relational Empathy Scale (RE): Adapted standardized Interpersonal Reactivity Index 
for Couples (emotional support, perspective-taking) (Peloquin & Lafontaine, 2010).
Hypothesis: Larger empathy gains in the intervention group. [Time Frame: T1 = baseline; 
T2 = endline]
3. Mental  Health  (GHQ-6):  Change  in  General  Health  Questionnaire-6  scores 
(psychological distress) (Rao et al, 1992).
Hypothesis: Greater distress reduction (or well-being increase) in the intervention group.
[Time Frame: T1 = baseline; T2 = endline]

Statistical Analysis Plan
Proportion of the mental-health effect that is mediated: Using the mediation framework of Imai, 
Keele & Tingley (2010), we will estimate what percentage of the total treatment effect on GHQ-
6 is carried by (i) changes in empathy and (ii) changes in relationship strength.
[Time Frame: Uses the same T1 and T2 data]
We will examine whether the intervention’s impact on mental health (GHQ-6 at endline) 
operates partly through improvements in partner empathy and relationship strength measured at 
endline. Baseline levels of each construct will be adjusted for to improve precision. Empathy and 
relationship strength will be treated as parallel, potentially correlated mediators; we do not 
assume a temporal order between them because both are only re-measured at endline.
Causal mediation effects will be estimated using the approach of Imai, Keele & Tingley (2010; 
2011). We will report (i) the indirect effect operating through endline empathy, (ii) the indirect 
effect operating through endline relationship strength, (iii) the remaining direct effect, and (iv) 
the percentage of the total treatment effect mediated by each pathway. Cluster-robust inference 
will be used to reflect community-level randomisation. A sensitivity analysis (ρ-based) will 
assess robustness to potential unmeasured confounding of mediator–outcome links.
Moderation (pre-specified)
We  will  explore  whether  programme  impacts  differ  across  the  following  binary  baseline 
moderators:
●
Traditional vs Progressive gender-norm attitude (median split).

●
High vs Low household economic strain (median split).
●
Rural vs Urban residence (cluster classification).
●
Co-residing with in-laws vs not.
●
Children in household (0 vs 1-2 vs ≥3; see note below).
●
Love vs Arranged marriage.
Each moderator will be tested by adding a Treatment × Moderator interaction to the main 
outcome model (ITT). We will report subgroup average treatment effects and apply false-
discovery-rate adjustment across tests.
Children note (future refinement): To probe possible non-linear moderation by family size, we 
will run three binary subgroup models—(i) no children, (ii) 1–2 children, (iii) ≥ 3 children—each 
with its own Treatment × Subgroup interaction. If sample size permits, an additional exploratory 
model in the Statistical Analysis Plan will treat number of children as a three-category factor 
(0, 1–2, 3+) or count term; results will be clearly labelled as exploratory.
Eligibility Criteria
●
Minimum Age: 18 Years
●
Maximum Age:  Women: 18 - 49 years, Men: 18+
●
Sex: Male, Female
●
Gender Based: Couple must comprise one male and one female (heterosexual pair)
●
Accepts Healthy Volunteers: Yes
●
Couples: Married and co-habitating, husband–wife pairs, who regard the selected cluster 
in the  states Maharashtra, Andhra Pradesh, or Rajasthan of India as their primary 
residence for the study period.

●
Consent: Both partners provide written informed consent and agree to six sessions, 
baseline and endline surveys, and SMS follow-ups.
●
Education: Primary schooling (4th grade) complete 
●
Comprehension: Both partners understand the local language used in sessions.
●
Availability: No plans for relocation or prolonged absence before endline.
Exclusion Criteria:
●
Either partner < 18 years.
●
Refusal of consent or unwillingness to participate in sessions or data collection by either 
partner.
●
Serious physical or mental condition that prevents safe, active participation (e.g., severe 
mental illness, debilitating disease).
Data Collection Timeline
●
Baseline  (Month  0):  Comprehensive  survey  (PRS,  RE,  GHQ-6,  demographics) 
administered before the first session in each cluster.
●
Intervention Delivery Period (Months 4–9): Six couples sessions delivered every 2–4 
weeks (total 3–5 months), reinforced by SMS. Attendance and process metrics recorded; 
no midline survey.
●
Endline Assessment (Months 14–18): Post-intervention survey re-administers PRS, RE, 
and GHQ-6 within 3-6 months after interventions Session 6, while matching timing in 
control clusters.
●
Estimated Timeline: The study’s active phase for each cohort of clusters is roughly 14-
18 months  from baseline to endline. For example, if the trial commences enrollment and 

baseline surveys in January of a given year, intervention delivery in those clusters might 
run from May through October, and endline surveys in May. Across all clusters, a 
staggered rollout may occur. The overall trial (all clusters) is expected to launch in July, 
2025 and conclude data collection by March, 2027, assuming a rolling implementation. 
These dates are approximate; the precise timeline will depend on field logistics. The trial 
registration anticipates enrollment and baseline initiation in the coming months, with 
completion of endline assessments approximately 12 months thereafter (accounting for 
all
 
clusters
 
to
 
finish).

References
Falconier, M. K., Kim, J., & Lachowicz, M. J. (2023). Together–A couples’ program integrating 
relationship and financial education: A randomized controlled trial. Journal of Social and 
Personal Relationships, 40(1), 333–359. https://doi.org/10.1177/02654075221118816
Funk, J. L., & Rogge, R. D. (2007). Testing the ruler with item response theory: Increasing precision 
of measurement for relationship satisfaction with the Couples Satisfaction Index. Journal of 
Family Psychology, 21(4), 572–583. https://doi.org/10.1037/0893-3200.21.4.572
Imai, K., Keele, L., & Tingley, D. (2010). A general approach to causal mediation analysis. 
Psychological Methods, 15(4), 309–334. https://doi.org/10.1037/a0020761
Ismayilova, L., Karimli, L., Gaveras, E., Tô-Camier, A., Sanson, J., Chaffin, J., & Nanema, R. (2018). 
An integrated approach to increasing women’s empowerment status and reducing domestic 
violence: Results of a cluster-randomized controlled trial in a West African country. Psychology 
of Violence, 8(4), 448–459. https://doi.org/10.1037/vio0000136
John, N. A., Adebayo, A., Boychuk, N. A., & OlaOlorun, F. (2022). Intimate partner violence (IPV) 
prevention using a cross-sectoral couple-based intervention: Results from a cluster randomised 
control trial in Ibadan, Nigeria. BMJ Global Health, 7(2), e007192. 
https://doi.org/10.1136/bmjgh-2021-007192
Kim, J. C., Watts, C. H., Hargreaves, J. R., Ndhlovu, L. X., Phetla, G., Morison, L. A., Busza, J., 
Porter, J. D. H., & Pronyk, P. (2007). Understanding the Impact of a Microfinance-Based 
Intervention on Women’s Empowerment and the Reduction of Intimate Partner Violence in 
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https://doi.org/10.2105/ajph.2006.095521

Moore, Q., Wood, R. G., & Wu, A. Y. (2023). Impacts of healthy marriage and relationship education 
with integrated economic stability services. Family Relations, 72(4), 1422–1440. 
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Appendix
Global Health Scale - 6 (6 items)
Have you recently:
felt constantly under strain?
felt you couldn't overcome your difficulties
been able to face up to your problems
been feeling unhappy and depressed
been losing confidence in yourself
been feeling reasonably happy
Response: Not at all, No more than usual, Rather more than usual, Much more than usual
Relationship Satisfaction Index Adapted/ Perceived Relationship Scale (3 items)
Please read each statement and indicate how much you agree or disagree:
My husband’s and my marriage is strong.
My relationship with my husband makes me happy.
I really feel like I am part of a team with my husband.
Responses: Strongly Agree, Agree, Neither agree not disagree, Disagree, Strongly Agree
Interpersonal Reactivity Index for Couples Adapted / Relational Empathy Scale (4 items)
Please read each statement and indicate how much you agree or disagree:
I try to look at my husband’s side of a disagreement before I make a decision.

Sometimes I don’t feel very sorry for my husband when he is having problems.
When I see my husband being taken advantage of, I feel kind of protective towards him.
When I’m upset with my husband, I usually try to “put myself in his shoes” for a while.
Responses: Strongly Agree, Agree, Neither agree not disagree, Disagree, Strongly Agree