This quasi-experimental study was conducted in 2019 on 88 couples (44 couples) who referred to the premarital counseling center in Felaverjan city among two groups : intervention group (22 couples) and control group (22 couples).
Sampling was done by convenience and simple random sampling. Inclusion criteria included all youth referred a premarital counseling center and were willing to participate in the study, with the condition of having an Android mobile phone and internet access, and exclusion criteria included those who did not want to continue participation in the research and faced with internet disconnection or loss of mobile phones.
The research tool was a researcher-made questionnaire that was designed based on the content of the app and consisted of 4 sections: demographic information, knowledge, attitude and practice questions. The first part included 10 questions about demographic variables of individuals (age, spouse age, gender, occupation, spouse occupation, education, spouse education, occupation of husband and wife, family income status, type of marriage and place of residence) and part two included knowledge questions in the form of 22 three-choice questions (yes, no, I don't know) and 8 multiple-choice questions, and the third part contained attitude questions using 22 Likert-scale attitude questions in the range of 1 to 5 (strongly agree, agree, I don’t have an idea, disagree, strongly disagree), the fourth part of the questionnaire consisted of 8 practice questions for measuring couples' skills. The validity of the questionnaire was confirmed by 12 experts in health education and promotion and 2 experts in clinical psychology and its reliability was obtained 0.75 by Cronbach's alpha test.
After coordinating with Health Deputy of Isfahan, Falavarjan Health Care Network and obtaining the necessary permits and informed consent from both intervention and control groups, the questionnaire was distributed between the couples referred to the premarital counseling center of Falavarjan before education and the questionnaire was collected after completion.
All couples in both intervention and control groups participated in routine face-to-face counseling classes, which consisted of four new topics of marital and reproductive health, family counseling and psychology, couples' mutual rights, and training family ethics and law during two consecutive days.
In the intervention group, pre-marital skills educational and counseling app was installed on their cellphone and they were taught how to use it during one month. The educational and consulting app was designed and produced in two stages. In the first step, after identifying the priorities, needs and ideas of the production of the app, the educational content was prepared in accordance with the authoritative texts related to each topic. Finally, the content was approved by the experts and the manager of the Family and Population Office of Isfahan Health Deputy and 2 experts of health at Isfahan University of Medical Sciences. In order to learn pre-marriage skills more effectively, multimedia educational videos packages (acquaintance-love-marriage) prepared by Isfahan General Welfare Office were used after obtaining the necessary permission.
In the second step, after producing the educational content, the graphic design of the Loading Page, Home Page, and the layout of the page and the creation of the icons associated with the application were done. The design and production phase of the application were conducted by an IT expert introduced by the university's research deputy according to the opinions of consultants and professors of health education and promotion. Software programming was done in two stages. The first step was graphical user interface (GUI) and the second step was programming using Java and android Studio. The final program consists of 5 main application: educational text, communication with counselor, premarital skills, tests, and workshop video. The content of the software includes 9 main parts including marriage preparation, spouse selection criteria, proposal questions, tests, workshop videos, skills, introduction to premarital centers, couples mutual rights, and marriage rules. Skills part includes 9 skills of sexual restraint, decision making in selecting spouse, ethical skills during engagement, effective communication skills, good verbal communication with spouse, empathetic with spouse, good marital relationship, expressing affection to the spouse, problem solving skills, anger management skills, and Skills to correct one's or spouse's behavior. The benefits of this software is not only educational content and videos, but also is the contact counselor icons that by using which, anyone can ask any question or problem online free of charge and receive answer of their questions through email or SMS.
Before collecting data, the youth of both groups were trained by the researcher in terms of instruction about the purpose of the study and how to answer to the questionnaire. All participants in the intervention group became member of a channel (virtual networks) through national messenger entitled Premarital Skills. During the one month intervention, necessary training was provided in the channel by the researcher on how to use the app, and everyone was encouraged to use the app throughout the day. Intervention group subjects were asked to discuss their questions with the app counselor and to answer the questionnaire questions in the app and rate the app through 5 stars rating system. After one month of intervention, they were invited to the premarital center to complete the post-test questionnaire. Finally, data were collected from both groups (intervention and control). Data were entered into SPSS(20). Descriptive statistics indicators (frequency, percentage, mean and standard deviation) and analytical statistics including t-test and paired t-test were used. Significance level was considered less than 0.05.