Measuring Relationship Influences on Romantic Couples’ Cancer-Related Behaviors During the COVID-19 Pandemic: Protocol for a Longitudinal Online Study of Dyads and Cancer Survivors (Preprint)

Abstract

BACKGROUND Research has established the effects of romantic relationships on individuals’ morbidity and mortality; however, the interplay between relationship functioning, affective processes, and health behaviors has been relatively understudied. During the COVID-19 pandemic, relational processes may affect novel health behaviors such as social distancing and masking. OBJECTIVE The objective of this manuscript is to contribute to health behavior survey research among couples by describing the design, recruitment, and methods of the Relationships, Risk Perceptions, and Cancer-Related Behaviors during the COVID-19 Pandemic (R2C2) Study. This study was developed to understand how relational and affective processes influence romantic partners’ engagement in cancer prevention behaviors as well as health behaviors introduced or exacerbated by the COVID-19 pandemic. METHODS The R2C2 study used online survey methods to recruit and enroll two cohorts of individuals involved in cohabiting romantic relationships, including one cohort of dyads (n=223 dyads) and one cohort of cancer survivors (n=443). Survey assessments were completed over two timepoints that were 5.57 weeks apart on average (SD=3.14). Health behaviors included COVID-19 vaccination and social distancing, physical activity, diet, sleep, alcohol use, and smoking behavior. We also examined relationship factors, psychological distress, and household chaos. RESULTS From October 2021 to July 2022, we enrolled a total of 926 participants, of which about two-thirds were from the UK (67.76%) and one-third were from the US (32.24%); about two-thirds were married (66.23%) and one-third were members of unmarried couples (32.02%). In Cohort 1 and 2, mean age was about 34 and 50, respectively. In Cohort 1, 3.97% identified as Hispanic/Latino/a, 16.53% Non-Hispanic Asian, 8.53% Non-Hispanic Black or African American, 0.42% Non-Hispanic Middle Eastern or North African, 4.81% Non-Hispanic Multiracial, 1.67% Non-Hispanic Other, and 64.02% Non-Hispanic White; 12.97% identified their sexual orientation as Bisexual or pansexual, 75.10% as heterosexual or straight, 11.09% as homosexual or gay or lesbian, and <1% as something else. In Cohort 2, 2.95% identified as Hispanic/Latino/a, 0.23% Non-Hispanic American Indian and Alaska Native, 1.82% Non-Hispanic Asian, 1.14% Non-Hispanic Black or African American, 0.45% Non-Hispanic Middle Eastern or North African, 2.95% Non-Hispanic Multiracial, and 90.45% Non-Hispanic White; 9.32% identified their sexual orientation as Bisexual or pansexual, 87.27% as heterosexual or straight, 2.95% as homosexual or gay or lesbian, and <1% as something else. The overall enrollment rate for individuals was 66.14% and the overall completion rate was 80.08%. CONCLUSIONS We discuss best practices for collecting online survey data for studies examining relationships and health, challenges related to the COVID-19 pandemic, recruitment of underrepresented groups, and enrollment of dyads; recommendations include conducting pilot studies, allowing for extra time in the data collection timeline for marginalized or underserved populations, surplus screening to account for expected attrition within dyads, as well as planning dyad-specific data quality checks.