The Family Journal: Counseling and

Therapy for Couples and Families

The Happy, Healthy, Safe Relationships 1-10
ª The Author(s) 2020
Article reuse guidelines:
Continuum: Conceptualizing a Spectrum sagepub.com/journals-permissions
DOI: 10.1177/1066480720960416
of Relationship Quality to Guide journals.sagepub.com/home/tfj

Community-Based Healthy Relationship

Promotion Programming

Christine E. Murray1 , Ratchneewan Ross1, and Jennifer Cannon1

Abstract
In recent years, the promotion of healthy relationships at the community level has been widely and rapidly increased. However,
the lack of a comprehensive definition of healthy relationships has resulted in potential difficulties in comparing community-based
research findings, thus likely hindering the advancement of science and practice in this area. Defining healthy relationships is
complex due to diverse personal and cultural backgrounds and types of relationships among individuals in diverse communities. In
this article, a definition of healthy relationships and a new research-driven framework, the Happy, Healthy, Safe Relationships
(HHSR) Continuum are presented. This HHSR Continuum is designed to be adaptable to different types of relationships, per-
spectives, and needs of subpopulations within communities. Although additional research is needed to further refine the HHSR
Continuum, this framework potentially holds significant implications for theory and community-based practice in the promotion
of healthy relationships.

Keywords
healthy relationships, conceptual framework, safe relationships, happy, relationships

In recent years, relationship- and family-focused preventive
interventions have been used to reduce harm and increase opti-
mal health outcomes across diverse communities (Halford
et al., 2008, 2018; Tharp et al., 2013). These populations
include those who experienced intimate partner violence
(e.g., Levesque et al., 2016; Schubert, 2015; Tharp et al.,
2011), child maltreatment (e.g., Schramm & Gomez-Scott,
2012), early problematic childhood development (e.g., Guthrie
et al., 2009), and substance abuse (e.g., Bahia, 2018).
In general, relationship- and family-focused interventions
share a core foundation of promoting healthy relationships as
a means of increasing healthy lives and communities. Evidence
shows that healthy relationships not only can buffer between
stress and mental and physical health (Hawkley & Cacioppo,
2013; Lamblin et al., 2017) but also can foster positive social
connections in communities. In contrast, isolation and loneli-
ness are widely recognized as risk factors for a host of chal-
lenges including interpersonal violence (Michalski, 2004),
substance abuse (National Institute on Drug Abuse, 2003), sui-
cide (Centers for Disease Control and Prevention, 2018), and
physical health problems (Xia & Li, 2018).
For community-based healthy relationships interventions to
be impactful, healthy relationships should be comprehensively
defined. However, defining healthy relationships is compli-
cated for at least three reasons. First, healthy relationships are
often defined in various ways in different cultures and contexts.
For example, individuals of particular religious values and cul-
tural norms may view traditional gender roles as healthy while
perceiving egalitarian gender roles as unhealthy. Second, many
different types of relationships exist within communities, such
as couples, families, parent–child, siblings, employers–
employees, coworkers, friends, and neighbors, among others.
Therefore, it is difficult to define healthy relationships in a way
that could apply universally to all. Finally, current research on
healthy relationships and families often narrowly defines
healthy relationships, for example, as safety as compared to
the dynamics of abusive family relationships (e.g., Mumford
et al., 2019), satisfaction within couples (e.g., Yucel, 2018),
and parenting satisfaction (e.g., Amaro & Joseph, 2019).
1
The University of North Carolina, Greensboro, NC, USA
Corresponding Author:
Christine E. Murray, Center for Youth, Family, and Community Partnerships,
UNC Greensboro, Greensboro, NC 27402, USA.
Email: cemurray@uncg.edu
2 The Family Journal: Counseling and Therapy for Couples and Families XX(X)
A consensus of healthy relationships conceptualization can
leverage the promotion of healthy relationships in a compre-
hensive and practical way and facilitate comparisons of future
research results among community-based studies and thus
likely benefiting the advancement of science and practice in
this area.
Therefore, the purpose of this article is to describe the emer-
gence of a universal definition of healthy relationships along
with a new community-based conceptual framework, the
Happy, Healthy, Safe Relationships (HHSR) Continuum,
grounded on our healthy relationships community-based inter-
ventions research process and findings. The HHSR Continuum
provides simple and practical information for professionals and
community members regarding helpful and comprehensive ser-
vices and resources applicable to research, theory, and practice
at different types and levels of relationship quality.
Review of the Literature
Relationship Quality and Healthy Relationships
Definitions
Even though evidence shows that healthy relationships can
optimize health and quality of life, different types of relation-
ships (e.g., couples, families, parent–child) across various
settings (e.g., family, workplace, school, and community)
make healthy relationships difficult to be universally defined.
For example, the Youth.Gov organization (n.d.) includes mul-
tiple characteristics of healthy relationships for teens: mutual
respect, trust, honesty, compromise, individuality, good com-
munication, anger control, fighting fair, problem-solving,
self-confidence, being a role model, and healthy sexual rela-
tionship. As another example, the Human and Health
Services Department (2019) identifies parenting style and
effective communication as key factors of parent–child
healthy relationships. Previous studies defined healthy rela-
tionships based on relationship qualities such as trust, satis-
faction, love, intimacy, commitment, social support, and
boundaries, with positive relationship qualities being associ-
ated with positive overall physical (Barr et al., 2013; Barr &
Simons, 2014; Fletcher et al., 2000; Rauer et al., 2014; Sher-
man et al., 2011; Uchino, 2006) and mental health (Davis
et al., 2016; Falconier et al., 2015; Lamblin et al., 2017:
Thomas, 2016).
On the other hand, unhealthy relationship qualities (e.g.,
intimate partner violence, other forms of abuse, infidelity, dis-
honesty, lack of social support, loneliness, isolation, and
impaired boundaries) have been associated with lower levels
of relationship satisfaction (Panuzio & DiLillo, 2010); less
security, trust, and intimacy in relationships (Foshee et al.,
2013); higher levels of mental and physical health issues
(e.g., depression, anxiety, suicide; Centers for Disease Control
and Prevention, 2018; Sherman et al., 2011; Xia & Li, 2018);
and impaired academic performance and feelings of safety for
adolescents while in school (Shipley et al., 2018).
Healthy Relationships and Conceptual Frameworks
Much previous research considers certain aspects of relationship
quality in isolation, without being underpinned by a cohesive and
universal framework applicable to different types of relationships
that people have across areas of their lives. Examples of topics
studied regarding relationship quality are (1) unsafe or unhealthy
relationships (e.g., bullying, intimate partner violence, and child
abuse; Foshee et al., 2013; LoveisRespect.org; Sherman et al.,
2011), (2) relationship satisfaction (Driver & Gottman, 2004;
Hsiao, 2017; Johnson & Anderson, 2013; Yucel, 2018), and (3)
relationship skills (communication, conflict management,
parent–child communication; Fatima & Ajmal, 2012; Frederick-
son, 2009; Gottman, 2007; Kramer et al., 1998; Rehman &
Holtzworth-Monroe, 2007).
Despite the array of topics researched regarding relationship
quality, there remains a need for a cohesive, universal frame-
work to conceptualize the qualities that define healthy relation-
ships in a way that can be applied across diverse types of
relationships, populations, and community settings. Such a
framework would hold practical utility for community mem-
bers as well as professionals. Community members could ben-
efit from a simple way to evaluate the quality of their
relationships in order to identify relationships for which addi-
tional information, support, or services may be needed. Like-
wise, professionals could benefit by having access to a
cohesive framework for conceptualizing the quality of relation-
ships to support their work with individuals and families, such
as by helping to guide appropriate referrals and interventions
that address clients’ needs at different levels of relationship
health. Thus, the current study aimed to build this comprehen-
sive, yet accessible, framework for defining relationship health
in order to enhance both research and practice in the area of
healthy relationship programming.
Development of the HHSR Continuum
In addition to grounding this conceptual framework in the lit-
erature described above, the framework described in this article
was developed through research done as part of an extensive
planning process for a countywide, community-based initiative
to promote healthy relationships in a southeastern state in the
United States. The initiative, the NAME OF INITIATIVE
(Healthy Relationships Initiative) was launched in February
2017 following a nearly 2-year planning process. A full descrip-
tion of (ABBREVIATION OF INITIATIVE) is beyond the
scope of this article, but a brief overview is provided below.
Interested readers may visit the (Healthy Relationships Initia-
tive) website at www.healthyrelationshipsinitiative.org to learn
more about the initiative.
Overview of the NAME OF INITIATIVE (Healthy
Relationships Initiative)
(Healthy Relationships Initiative) was created through a
partnership between the University of North Carolina at
Murray et al.
Greensboro and the Phillips Foundation, a family foundation in
Greensboro, North Carolina. The initiative uses three core
components of interventions (i.e., community mobilization,
social marketing, and relationship education programming) to
achieve its mission of promoting happy, healthy, and safe rela-
tionships in the local community and beyond. The mission’s
description of “happy, healthy, and safe relationships” was
developed after the formulation of the conceptual framework
described in this article, and the original focus of the planning
process was on promoting healthy relationships broadly.
The first component of (Healthy Relationships Initiative)
interventions involves community mobilization, which means
that the initiative is integrated within a large network of part-
nerships with organizations that serve individuals and families
within the local community. A select group of leaders of these
organizations served on an advisory group that steered the
initial planning and implementation of the initiative, and the
vast majority of (Healthy Relationships Initiative)’s resources
and programs are delivered through community partnerships
with these and other organizations. Examples of these
resources and programs include (a) a “Sundays Unplugged”
program with a local children’s museum, in which adults who
turn in their cell phones on Sunday afternoons during the month
of February receive free museum admission, with a goal of
promoting technology-free time for parents and children to
connect; (b) resource fairs at local libraries, through which
parents can meet representatives from approximately 20 local
organizations that serve families with young children, and (c)
the dissemination of parenting tips to families involved in
youth sports programs through branches of a local YMCA.
These examples illustrate how, by mobilizing community part-
nerships, (Healthy Relationships Initiative) aims to reach indi-
viduals and families at various touchpoints in the community
(e.g., museums, libraries, and YMCAs) rather than through
more traditional services such as counseling and parenting
classes.
The second component of (Healthy Relationships Initiative)
involves the use of best practices in social marketing to dis-
seminate information about the importance of healthy relation-
ships, tips for building healthy relationships, and resources for
seeking help to address relationship and family challenges.
Social marketing is widely used in the public health field to
guide community-level initiatives that aim to promote beha-
viors that contribute to healthy, adaptive outcomes (Centers for
Disease Control and Prevention, 2010; Evans, 2006; Grier &
Bryant, 2005; Lefebvre, 2011; Lefebvre & Flora, 1988; Reich-
ert et al., 2013). (Healthy Relationships Initiative)’s social mar-
keting strategies include traditional media outreach, social
media outreach, and face-to-face events.
(Healthy Relationships Initiative)’s third component
involves relationship education programming. This includes
online and face-to-face relationship education programs that
address general relationship topics (e.g., fostering quality time
in relationships) and programming that addresses more specific
populations including single parents, engaged couples, and
teenagers. (Healthy Relationships Initiative)’s online
3
relationship education programs are delivered primarily
through the (Healthy Relationships Initiative) E-Learning Cen-
ter (www.healthyrelationshipsinitiative.org), and they include
live webinars, interactive modules that are completed asyn-
chronously, and a podcast. In addition to programs directed
at community members, (Healthy Relationships Initiative) also
offers professional trainings on a range of relationship and
family issues for local professionals who work with individuals
and families.
The research-based planning process for (Healthy Relation-
ships Initiative) that Informed the Development of the HHSR
Continuum. An extensive planning process spanning nearly 2
years was conducted to plan for (Healthy Relationships Initia-
tive) before its launch to the community in February 2017. This
planning process included mixed-method research strategies to
inform the development of the initiative’s programming and a
definition of healthy relationships to guide this programming,
which eventually became the HHSR Continuum described later
in this article. This section presents the different research stra-
tegies that were used and the process for developing and refin-
ing the definition.
Research strategies. Several research strategies were used in
addition to grounding the process of developing a definition
of healthy relationships in the review of existing literature
described above. These included community stakeholder inter-
views, a community needs assessment survey, and three focus
groups. A summary of the data gathered through each research
strategy is described below.
Community stakeholder interviews. A series of 10 interviews
with community stakeholders was conducted as part of the
initiative’s planning process. The community leaders to be
interviewed were selected to represent a diversity of organiza-
tions that serve children, adults, and families in the local com-
munity. Most of these organizations were grantees of the
(Healthy Relationships Initiative) funding agency (i.e., the
Phillips Foundation), and all but one of the organizations was
a major nonprofit agency, with the remaining one interview
being done with a representative of the local public school
system. Each interview was based on a semistructured inter-
view guide with seven primary questions, and additional
follow-up questions were asked when appropriate as part of
the interview process. The primary questions addressed such
topics as the biggest relationship challenges that stakeholders
observed among the client populations they served, the impact
of negative relationship outcomes among the client populations
they serve, and questions related to programming that was
needed to promote healthy relationships in the local commu-
nity. All interviews were conducted by a PhD-level university
faculty member. Interviews were not recorded, but detailed
notes were taken during and immediately after the interviews.
The information gained through these stakeholder inter-
views offered insights into common relationship experiences
and challenges within the community. Stakeholders identified
several characteristics of unhealthy and or unsafe relationships,
4 The Family Journal: Counseling and Therapy for Couples and Families XX(X)

which included the following: (1) family estrangement, (2) Table 1. Basic Content Analysis of Participants’ Descriptions of
limited effective communication in parent–child relationships, Characteristics of Healthy Relationships.
(3) inability to manage stress within relationships and families, Times
(4) difficulties balancing the demands of work and family life, Descriptor Noted
and (5) isolation and lack of social support. In contrast, stake-
holders also noted characteristics of healthy relationships, Effective communication 31
including the following: (1) strong communication skills, (2) Respect 21
Trust 18
a sense of connection, (3) respect, (4) appreciation for differ-
Promotes the growth and well-being of individuals in the 14
ences, (5) a focus on strengths, and (6) connection to social relationships
support and community resources. The insights gained through Honesty and openness 14
these stakeholder interviews provided an initial foundation for Encouragement/support 14
the more in-depth research strategies discussed below. Effective conflict management and problem-solving 13
A sense of give and take (i.e., mutual service to one 12
Community needs assessment survey. A community needs another)
assessment survey was conducted to assess community mem- Warmth/caring/comfort 11
bers’ perspectives of healthy relationships, as well as needed Love 9
relationship-supporting resources within the community. This Acceptance 8
Aiming to learn about and understand the other person 6
survey was approved by the researchers’ university institu-
Shared values and life goals 5
tional review board (IRB) prior to data collection. The survey Manage responsibilities together/collaborative 5
was conducted electronically, and participant recruitment pri- Kindness 4
marily was electronic as well, via social media and email, as Free from abuse/control 4
well as through a traditional media press release. The research- Equality 4
ers offered a drawing for one of two US$100 store gift cards as Fun and laughter 4
an incentive for participation in the survey. A total of 88 parti- Safe/peaceful 3
Forgiveness 3
cipants completed the electronic survey.
Gratitude and appreciation 3
The survey instrument was developed by the researchers, Shared interests and time together 2
and one open-ended question on the survey asked participants, Accountability and responsibility for one’s own role in 2
the relationship
How would you define a healthy relationship? What are some Produces joy and happiness 2
words or phrases that come to mind when you think about what Commitment 2
a healthy relationship means to you? You can consider any type of Intimacy 2
relationship or focus on one or more specific types of relationships, Note. Participants could list as many descriptors as they would like to include,
such as couple relationships, parent–child relationships, or and therefore, the number of descriptors noted above is greater than the
friendships. number of participants. The descriptors noted above reflected any terms used
by participants that reflected that theme. For example, the descriptor effective
communication noted above includes such terms as “communication,” “ability to
In Table 1, a basic content analysis of participants’
communicate,” and “sincere and frequent communication.”
responses to that question is presented. As noted in Table 1,
the most frequent characteristics that participants used to
describe healthy relationships were effective communication,
on just two specific populations (i.e., older adults and Christian
respect, and trust. Other frequent descriptors were that they
pastors), they offered insights into how individuals may hold
promote the growth and well-being of individuals in the rela-
unique perspectives toward healthy relationships based on their
tionships, honesty and openness, encouragement and support,
background characteristics, whereas some aspects of healthy
and effective conflict management and problem-solving. Over-
relationships are common across people of different back-
all, some of the descriptors of healthy relationships shared by
grounds. Participants for each focus group were invited by key
survey participants focused on relationship skills (e.g., commu-
contacts at each host agency. For the focus group with Christian
nication and conflict management), whereas other characteris-
pastors, one pastor invited pastors from his own and other area
tics focused on ways those relationships make people feel, such
churches in his professional network to attend. For the focus
as safe, appreciated, and encouraged. Thus, the information
groups with older adults, staff from each agency promoted the
gained through the survey offered valuable insights into the
focus groups to adults using their services. The focus group
multidimensional nature of healthy relationships.
study component was approved by the university IRB prior to
Focus groups. To explore perceptions of healthy relationships data collection, and participants read and signed an informed
within specific populations, three focus groups were con- consent document prior to the focus group starting. Each focus
ducted. Two focus groups were held with senior adults group was based on a structured interview guide, and the focus
(i.e., one through a residential retirement facility and the other groups were audio-recorded and later transcribed. The first
through a senior recreational center), and one was held with a section of questions on the interview guide specifically asked
group of Christian pastors. Although these groups were focused people to define healthy relationships, as well as barriers and
Murray et al.
challenges that may prevent people from having healthy
relationships.
Eight individuals participated across the two focus groups
with older adults, all of whom were female. Some of the defin-
ing characteristics of healthy relationships that were described
by these participants included the following: (1) an ability to
share with one another, (2) effective listening, (3) sharing com-
mon interests, (4) enjoying spending time together, (5) recipro-
city, (6) connection, (7) fun, (8) getting along well, (9) not
holding grudges, (10) having boundaries, (11) providing sup-
port during challenging times, (12) effective communication,
and (13) a team mentality. Some of the barriers and challenges
that impact people’s abilities to build and maintain healthy
relationships that were noted by these focus group participants
included (1) a lack of consideration for others, (2) being in a
rush and busy schedules, (3) demands of work, (4) economic
challenges, (5) a lack of time together, (6) over-reliance on
technology, and (7) loneliness. One unique perspective that
emerged from the focus groups with older adults is that healthy
relationships in older adulthood may involve a level of self-
protection from too much emotional closeness that could result
in grief and loss. A quote from one focus group member that
illustrates this point is as follows:
We don’t want to get too close to somebody, because don’t forget
you’re at the age where death is waiting. That’s a nasty way to put
it, but it’s true. When I moved in, I became very friendly with a
woman, and then she died, so you better not become too friendly
because you’re going to mourn unless you go first. You’re going to
mourn the death again like you did with your husband and you
don’t want that to happen, so you keep a wall.
This perspective was echoed among other focus group
members, although they noted that this perspective reflected
the formation of new relationships and not views toward
existing relationships, such as with long-term friends and
adult children and grandchildren. This perspective illustrates
how, although the older adults in these focus groups defined
healthy relationships in a similar way to others, they may have
a unique filter through which they evaluate relationships
based on their stage of life.
Similarly, the focus group with Christian pastors demon-
strated that their views of healthy relationships held much in
common with views of others, but their views also were influ-
enced by their faith backgrounds. A total of 10 pastors partici-
pated in the focus group. Of these, two group members were
female, and eight were male. The core characteristics of
healthy relationships noted by these focus group members
included (1) good communication, (2) trust, (3) shared goals,
(4) understanding of a shared purpose, (5) whole and secure
individuals, (6) “symbiotic not parasitic,” and (7) “a true heart
connection,” founded in love. Key themes of healthy relation-
ships noted were forgiveness, grace, and unconditional love.
Participants were asked further how their faith and spiritual/
religious views impacted their views about healthy relation-
ships. Participants noted that they believe that healthy
5
relationships with others flow out of a healthy relationship with
God. The pastors who participated in the focus group noted the
following common challenges among the members of their
congregations: (1) lack of good role models in relationships,
(2) a culture of being so busy that people have little time for
important relationships, (3) too many people aren’t intentional
about their relationships and just leave it to chance, (4) social
media and technology, and (5) cultural images of relationships
that paint a picture that they are romantic, easy, positive all the
time, but that set up unrealistic expectations. Throughout this
focus group, the participants offered examples of ways that
their views about relationships were influenced by their faith
and Biblical scripture.
Overall, the focus groups offered insights into how individ-
uals’ views of healthy relationships can be impacted by various
background characteristics. Although only two of these
characteristics—age and religious orientation—were explored
in the focus groups, the information gained through the groups
indicates the need for definitions of healthy relationships that
can be modified and adapted to align with the worldviews of
specific subpopulations.
Process for developing and refining the HHSR Continuum. Once
data from the above sources were gathered, the researchers
worked with the members of the (Healthy Relationships Initia-
tive) advisory committee over a series of meetings to develop
and refine the HHSR Continuum. The original conceptualiza-
tion of the Continuum was drafted by the first author, and the
definitions and overall description of the Continuum were
refined based on feedback from advisory committee members.
In developing the original draft of the conceptualization, the
need for a framework that was broader than simply defining
healthy relationships became clear. Although all aspects of
positive relationship functioning could be described as healthy,
the use of a single term would fail to capture the broad scope of
potential relationship quality. In addition, distinctions were
identified between relational health reflecting the absence of
negative qualities (e.g., abuse, controlling dynamics), generally
positively functioning relationships, and truly optimal relation-
ships. As such, the process of defining healthy relationships
resulted in a conceptualization of positive relationship quality
along a spectrum or continuum of relationship quality rather
than a more categorical definition (i.e., healthy vs. not healthy).
Thus, the resulting HHSR Continuum was formulated and was
further refined through an iterative process of integrating feed-
back provided by the stakeholders represented on the Steering
Committee.
Special efforts were made during the process of developing
the Continuum to provide a universal conceptualization that
could apply broadly to relationships of all kinds and across
different cultural groups but also that retains the ability to be
modified and adapted to reflect the unique values and perspec-
tives of specific subpopulations. In addition, an important aim
was to develop a framework that utilized simple language that
could easily be understood by a wide range of audiences
including researchers, professionals, and members of the
6 The Family Journal: Counseling and Therapy for Couples and Families XX(X)
Figure 1. The Happy, Healthy, Safe Relationships Continuum.
general population. The resulting final version of the HHSR
Continuum is described in the next section.
Description of the HHSR Continuum
The HHSR Continuum is depicted visually in Figure 1. As
shown in Figure 1, the HHSR Continuum is best represented
visually as a pyramid with a dual-sided arrow along one side.
The pyramid format represents that relationships must be safe
before they can be healthy, and they must be healthy and safe
before they can become happy. The dual-sided arrow is reflec-
tive of the continuous nature of the framework, such that
although safe, happy, and healthy are depicted as categories,
there are varying degrees of relational quality even within each
category. To further describe the HHSR Continuum, the frame-
work’s definitions of each term are described below:
 Safe relationships are free from all forms of abuse,
neglect, and any other threats to one or more person’s
physical or emotional safety, well-being, and
development.
 Although each individual’s definitions of healthy rela-
tionships may vary, the core of healthy relationships is
built on respect, trust, safety, acceptance, freedom of
choice, positive communication and conflict manage-
ment, and fun. Perfection is not a requirement for
healthy relationships: Even healthy relationships
encounter challenges and conflicts. In healthy relation-
ships, these challenges become opportunities for growth
and learning.
 In addition to being safe and healthy, happy relation-
ships are joy-filled. Happy relationships offer people a
nurturing source of care and support. People in happy
relationships treasure their time together, make each
other a priority, and have a deep understanding of one
another.
The HHSR Continuum also is grounded in the following
assumptions. First, as noted earlier, the framework is designed
to be adapted to apply to specific subpopulations. While the
general definitions of happiness, health, and safety in relation-
ships are designed to be relatively universally applied, they are
intended to be modifiable for use with specific subpopulations
to reflect their viewpoints on healthy relationships that are
reflective of their unique values. As one example, in light of
the input provided in the focus group with Christian pastors
described earlier, members of that subpopulation may add that
healthy relationships are grounded in God’s love, and/or that
safe relationships provide a safe climate for individuals to grow
spiritually within the context of the relationship (i.e., are free
from spiritual abuse). Therefore, this framework is not intended
to be rigidly applied to all populations without allowing for
modifications to reflect the values and belief systems of spe-
cific subpopulations.
A second assumption underlying this HHSR Continuum is
that people can experience varying levels of relationship qual-
ity within different relationships at the same time. As noted
earlier, this framework is intended to apply to a variety of types
of relationships such as couple relationships, parenting and
families, friendships, workplace relationships, and general
community relationships. As an example of this assumption,
consider an individual who has an extremely fulfilling and
happy marriage, experiences bullying in the workplace with
unsafe relationships, and uses effective relationship skills in a
healthy parenting relationship with their teenager. In fact,
because of the diversity of relationships that are part of each
person’s unique life experiences, it is assumed and expected
that each individual could experience vastly different levels of
relationship quality in different contexts of their lives. Thus,
this conceptualization is not designed to reflect an individual’s
personal level of relationship functioning but rather the quality
of relational process between two or more people in a specific
relationship.
Similarly, a third assumption of the HHSR Continuum is
that specific relationships can change over time with respect
to their relationship quality. This assumption is supported by
research findings that have shown how, for example, marital
satisfaction rises and falls across time within the same marital
relationship (e.g., Hsiao, 2017; Johnson & Anderson, 2013).
The quality of a specific relationship may rise or fall over time,
such as in response to family life cycle transitions (Carter &
McGoldrick, 2005), situational conflicts, external pressures
(e.g., work stress), or intentional efforts to change through
seeking counseling.
The fourth and final key assumption of this conceptual
framework is that the HHSR Continuum has implications for
the types of resources, services, and information that may be
needed or beneficial for individuals at different levels of rela-
tionship quality across the spectrum. For example, someone
experiencing unsafe relationships may benefit from resources
provided by a domestic violence agency or through intensive
personal counseling. People aiming to achieve health in their
relationships may benefit from educational programs that train
participants in relationship skills, like communication and con-
flict resolution. Individuals who have generally healthy and
safe relationships may be interested in enrichment programs
Murray et al.
that help them learn to grow deeper connections with them-
selves and the important people in their lives. As such, the
HHSR Continuum is designed to hold practical utility, which
will be described further in the next section, which outlines the
framework’s implications for research, practice, and theory.
Implications for Research, Practice,
and Theory
Overall, the HHSR Continuum was developed to present a
comprehensive framework for describing the potential levels
of quality of various types of relationships. At the most funda-
mental level, safe relationships are free from any form of vio-
lence or abuse. Safety is viewed as foundation for the
establishment of healthy relationships, which are defined by
positive relationship skills (e.g., communication and conflict
management), as well as characteristics like respect, trust, and
acceptance. Within the Continuum framework, happy relation-
ships are those that are at the optimal level of functioning and
are characterized by joy and a deep sense of meaning and
understanding one another.
The HHSR Continuum is intentionally designed to use sim-
ple terminology that can be applied to community-based popu-
lations without extensive training or knowledge of research on
relationship quality. Likewise, it is intended to be modifiable to
be tailored to the unique contextual and cultural perspectives of
subpopulations. The Continuum also was developed to be
applicable to virtually any type of relationship such as couples,
families, parents and children, friendships, workplace relation-
ships, and even acquaintances. With these features of the
HHSR Continuum in mind, the remainder of this section
describes implications of this framework for research, practice,
and theory.
Implications for Research
As a new conceptual framework, there is a need for additional
research to validate the HHSR Continuum and to further refine
the framework’s underlying conceptualization. Future research
can be done to test the cross-cultural application and adaptabil-
ity of the HHSR Continuum in order to identify how various
subpopulations’ viewpoints on healthy relationships vary. The
features of happy, healthy, and safe relationships as defined in
the framework are intended to apply relatively universally.
However, it is important to explore further the extent to which
various personal and cultural background characteristics influ-
ence how people define healthy relationships.
One important step for future research is to develop an
assessment tool in which the quality of relationships as defined
in the HHSR Continuum could be measured in a single instru-
ment. An assessment tool of this nature could further help to
operationalize the definitions of happy, healthy, and safe rela-
tionships. The process of developing this tool could help fur-
ther refine the overall model through exploratory and
confirmatory factor analysis. Finally, because this conceptual
framework was designed for the purpose of guiding practice in
7
the area of community-based healthy relationship promotion
programming, additional research is needed to examine the
practical utility of the framework in different communities.
This practice-focused research may include testing the frame-
work’s utility as a model for making decisions about which
services are needed at the individual and community levels and
determining whether the constructs of safety, health, and hap-
piness in relationships could be useful outcomes to measure for
relationship-focused community programs.
Implications for Practice
The HHSR Continuum holds many potential applications for
practice with respect to community-based programs and ser-
vices that aim to improve the quality of relationships. The
spectrum of programs and services to which the framework
may apply is as broad as the spectrum of relationship quality
that is addressed within the Continuum. In fact, the HHSR
Continuum can be used to provide a cohesive way to describe
the available programs within a community to community
members and other key stakeholders, such as policy makers.
Community members themselves, and professionals work-
ing with them, can use the HHSR Continuum as an indicator of
the quality of their relationships and then identify potentially
useful resources and services based on the identified quality of
their relationships. For example, if someone is identified as
having an unsafe relationship in any area of life, referrals can
be made to a crisis response agency, victim advocacy services,
and/or trauma-focused therapy. If a person is identified as hav-
ing safe relationships, but as lacking effective relationship
skills that allow for healthy relationships to be formed, that
person could be referred to such services as relationship coun-
seling or a relationship skills training program. Community
members who have generally healthy and safe relationships
can seek resources that help them to further expand the optimal
functioning of their relationships, such as a retreat focused on
relational growth or social media-based messaging that pro-
vides reminders to continue to prioritize the well-being of their
relationships.
For professionals working to affect change at the commu-
nity level, the HHSR Continuum also can offer a framework for
identifying what resources and services may be lacking. For
example, professionals could use the Continuum as a concep-
tual framework to guide a gap analysis process as part of a
community-based needs assessment (Burns et al., 2017).
Finally, another practical application of the HHSR Continuum
is to use the framework to guide the development of relation-
ship education program curricula for specific populations (e.g.,
married couples, parents of children at different ages, single
adults). For example, programs may be targeted to people
experiencing specific levels of relationship quality identified
in the Continuum (e.g., unsafe relationships, safe but unhealthy
relationships). Other programs that are designed for more gen-
eral audiences may incorporate information for people at all
levels of relationship quality to reflect the potential that parti-
cipants may include individuals within each level. This may
8 The Family Journal: Counseling and Therapy for Couples and Families XX(X)
mean including a brief mention of community resources for
people in unsafe relationships (e.g., a domestic violence
agency) as well as more enrichment-focused suggestions for
people with healthy relationships to help them experience
greater joy and optional functioning within their relationships.
Implications for Theory
The HHSR Continuum offers a lens for expanding concepts of
various schools of Family Systems Theory by applying theore-
tical concepts at different levels of relationship quality. Core
theoretical concepts—such as differentiation from Bowen
Family Systems Theory, boundaries and hierarchies from
Structural Family Therapy, and relational ethics from Contex-
tual Family Therapy (Nichols & Davis, 2016)—can be used to
explain how relationships function when they are safe, healthy,
and happy, as well as what factors may drive relational beha-
viors at different levels of relationship quality. The HHSR
Continuum offers a useful framework for training marital/cou-
ple and family counseling and therapy students to help them
understand to understand and apply family systems theoretical
concepts. For example, training in family systems theories
could be organized to answer the following questions: What
does this theory indicate families/relationships look like when
they are safe versus unsafe, healthy versus unhealthy, and
happy versus unhappy? A final implication of the HHSR Con-
tinuum for theory is that the framework calls attention to the
need for greater theoretical focus on happy relationships and
how professionals can help people build and maintain them, in
that more limited theoretical focus to date has been given to
articulating what optimal functioning looks like in relation-
ships, and how this can be achieved.
Conclusion
In recent years, there has been greater attention paid to the need
for the promotion of healthy relationships at the community
level. However, defining healthy relationships is complex,
especially in light of the diversity of types of relationships and
unique cultural and personal backgrounds that exist within
communities. This article described the development and con-
ceptualization of the HHSR Continuum, which is a framework
for understanding the spectrum of relationship quality within
relationships of all kinds. At the foundation of the continuum is
safety within relationships, reflecting the absence of any form
of violence or abuse. Safety is viewed as a precursor to estab-
lishing healthy relationships, which are grounded in positive
relationship skills and such features as respect, trust, and accep-
tance. Happy relationships are those that are at the optimal
level of functioning and are joy-filled. This Continuum is
designed to be adaptable to the perspectives and needs of sub-
populations within communities, as well as to different types of
relationships. Although additional research is needed to further
refine the HHSR Continuum, this framework holds implica-
tions for theory and community-based practice in the promo-
tion of healthy relationships.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: This study
was supported by the Phillips Foundation in Greensboro, North
Carolina.
ORCID iD
Christine E. Murray https://orcid.org/0000-0001-7997-5078
References
Amaro, L. M., & Joseph, N. T. (2019). Relationships of online social
comparison and parenting satisfaction among new mothers: The
mediating roles of belonging and emotion. Journal of Family Com-
munication, 19, 144–156. http://dx.doi.org.libproxy.uncg.edu/10
.1080/15267431.2019.1586711
Bahia, H. K. (2018). Effects of the relationship check up on early
adults’ romantic relationship adjustment and substance abuse: A
pilot study. Dissertation Abstracts International: Section B: The
Sciences and Engineering, 78(7-B)(E). http://gateway.proquest.
com.libproxy.uncg.edu/openurl?url_ver¼Z39.88-2004&rft_val_
fmt¼info:ofi/fmt:kev:mtx:dissertation&res_dat¼xri:pqm&rft_
dat¼xri:pqdiss:10190328
Barr, A. B., Culatta, E., & Simons, R. L. (2013). Romantic relation-
ships and health among African American young adults: Linking
patterns of relationship quality over time to changes in physical
and mental health. Journal of Health and Social Behavior, 54(3),
369–385. doi:10.1177/0022146513486652
Barr, A. B., & Simons, R. L. (2014). A dyadic analysis of relationships
and health: Does couple-level context condition partner effects?
Journal of Family Psychology, 28(4), 448–459. https://doi.org/10.
1037/a0037310
Burns, J., Polus, S., Chilcott, J., Ward, S. E., Pfadenhauer, L. M., &
Rehfuess, E. A., (2017). Looking beyond the forest: Using harvest
plots, gap analysis, and expert consultations to assess effective-
ness, engage stakeholders, and inform policy. Research Synthesis
Methods, 9. Retrieved May 24, 2019, from https://doi-org.lib
proxy.uncg.edu/10.1002/jrsm.1284
Carter, B., & McGoldrick, M. (2005). Expanded family life cycle
(3rd ed.). Pearson.
Centers for Disease Control and Prevention. (2010). CDCynergy lite:
Social marketing made simple, A guide for creating effective social
marketing plans. Retrieved August 18, 2015, from http://www.cdc.
gov/healthcommunication/pdf/cdcynergylite.pdf
Centers for Disease Control and Prevention. (2018). Risk factors for
suicide. Retrieved May 24, 2019, from https://www.cdc.gov/violen
ceprevention/suicide/riskprotectivefactors.html
Davis, T. J., Morris, M., & Drake, M. M. (2016). The moderation
effect of mindfulness on the relationship between adult attachment
and wellbeing. Personality and Individual Differences, 96,
115–121.
Murray et al.
Driver, J. L., & Gottman, J. M. (2004). Daily marital interactions and
positive affect during marital conflict among newlywed couples.
Family Process, 43(3), 301–314.
Evans, W. D. (2006). How social marketing works in health care.
British Medical Journal, 332, 1207. Retrieved August 18, 2015,
from http://www.bmj.com/content/332/7551/1207.2.short
Falconier, M. K., Nussbeck, F., Bodenmann, G., Schneider, H., &
Bradbury, T. (2015). Stress from daily hassles in couples: Its
effects on intradyadic stress, relationship satisfaction, and physical
and psychological well-being. Journal of Marital and Family
Therapy, 41(2), 221–235. https://doi.org/10.1111/jmft.12073
Fatima, M., & Ajmal, M. A. (2012). Happy marriage: A qualitative study.
Pakistan Journal of Social and Clinical Psychology, 9(2), 37–42.
Fletcher, G. J. O., Simpson, J. A., & Thomas, G. (2000). Ideals,
perceptions, and evaluations in early relationship development.
Journal of Personality and Social Psychology, 79(6), 933–940.
https://doi.org/10.1037/0022-3514.79.6.933
Foshee, V. A., Benefield, T. S., Reyes, H. L. M., Ennett, S. T., Faris,
R., Chang, L.-yin, . . . Suchindran, C. M. (2013). The peer context
and the development of the perpetration of adolescent dating vio-
lence. Journal of Youth and Adolescence, 42(4), 471–486. https://
doi.org/10.1007/s10964-013-9915-7
Fredrickson, B. (2009). Positivity. Crown Publishers.
Gottman, J. M. (2007). Marital therapy: A research-based approach.
Training manual for the level I professional workshop for clini-
cians. The Gottman Institute.
Grier, S., & Bryant, C. A. (2005). Social marketing in public health.
Annual Review of Public Health, 26, 319–339.
Guthrie, K. F., Gaziano, C., & Gaziano, E. P. (2009). Toward better
beginnings: Enhancing healthy child development and parent-child
relationships in a high-risk population. Home Health Care
Management & Practice, 21, 99–108. http://dx.doi.org.libproxy.
uncg.edu/10.1177/1084822308322650
Halford, W. K., Markman, H. J., & Stanley, S. (2008). Strengthening
couples’ relationships with education: Social policy and public
health perspectives. Journal of Family Psychology, 22, 497–505.
http://dx.doi.org.libproxy.uncg.edu/10.1037/a0012789
Halford, W. K., Pepping, C. A., & Petch, J. (2018). Promoting healthy
relationships. In A. L. Vangelisti & D. Perlman (Eds.), The Cam-
bridge handbook of personal relationships (2nd ed., pp. 579–590).
Cambridge University Press.
Hawkley, L. C., & Cacioppo, J. T. (2013). Social connectedness and
health. In C. Hazan & M. I. Campa (Eds.), Human bonding: The
science of affectional ties (pp. 343–364). Guilford Press.
Healthy and Human Services Department. (2019). Healthy parent-
child relationship. https://www.hhs.gov/ash/oah/adolescent-devel
opment/healthy-relationships/parents-child/index.html
Hsiao, Y.-L. (2017). Longitudinal changes in marital satisfaction dur-
ing middle age in Taiwan. Asian Journal of Social Psychology, 20,
22–32. http://dx.doi.org.libproxy.uncg.edu/10.1111/ajsp.12161
Johnson, M. D., & Anderson, J. R. (2013). The longitudinal associa-
tion of marital confidence, time spent together, and marital satis-
faction. Family Process, 52, 244–256. http://dx.doi.org.libproxy.
uncg.edu/10.1111/j.1545-5300.2012.01417.x
Kramer, K. M., Arbuthnot, J., Gordon, D. A., Rousis, N. J., & Hoza, J.
(1998). Effects of skill-based versus information-based divorce
9
education programs on domestic violence and parental communi-
cation. Family Court Review, 36(1), 9–31. https://doi.org/10.1111/
j.174-1617.1998.tb00491.x
Lamblin, M., Murawski, C., Whittle, S., & Fornito, A. (2017).
Social connectedness, mental health, and the adolescent
brain. Neuroscience and Biobehavioral Reviews, 80, 57–68.
http://dx.doi.org.libproxy.uncg.edu/10.1016/j.neubiorev.2017.05.010
Lefebvre, R. C. (2011). An integrative model for social marketing.
Journal of Social Marketing, 1, 54–72.
Lefebvre, R. C., & Flora, J. A. (1988). Social marketing and public
health intervention. Health Education Quarterly, 15, 299–315.
Levesque, D. A., Johnson, J. L., Welch, C. A., Prochaska, J. M., &
Paiva, A. L. (2016). Teen dating violence prevention: Cluster-
randomized trial of Teen Choices, an online, stage-based program
for healthy, nonviolent relationships. Psychology of Violence, Spe-
cial Issue: Interventions for Violence, 421–432. http://dx.doi.org.
libproxy.uncg.edu/10.1037/vio0000049
Michalski, J. H. (2004). Making sociological sense out of trends in
intimate partner violence: The social structure of violence against
women. Violence Against Women, 10, 652–675. http://dx.doi.org
.libproxy.uncg.edu/10.1177/1077801204265018
Mumford, E. A., Liu, W., & Taylor, B. G. (2019). Youth and young
adult dating relationship dynamics and subsequent abusive out-
comes. Journal of Adolescence, 72, 112–123. http://dx.doi.org.lib
proxy.uncg.edu/10.1016/j.adolescence.2019.02.013
National Institute on Drug Abuse. (2003). Preventing drug use among
children and adolescents. Retrieved May 24, 2019, from https://
www.drugabuse.gov/publications/preventing-drug-abuse-among-
children-adolescents/chapter-1-risk-factors-protective-factors
Nichols, M. P., & Davis, S. (2016). Family therapy: Concepts and
methods (11th ed.). Pearson.
Panuzio, J., & DiLillo, D. (2010). Physical, psychological, and sexual
intimate partner aggression among newlywed couples: Longitudi-
nal prediction of marital satisfaction. Journal of Family Violence,
25(7), 689–699. https://doi.org/10.1007/s10896-010-9328-2
Rauer, A. J., Sabey, A., & Jensen, J. F. (2013). Growing old together:
Compassionate love and health in older adulthood. Journal of
Social and Personal Relationships, 31(5), 677–696. doi:10.1177/
0265407513503596
Rehman, U. S., & Holtzworth-Munroe, A. (2007). A cross-cultural
examination of the relation of marital communication behavior
to marital satisfaction. Journal of Family Psychology, 21(4),
759–763. https://doi.org/10.1037/0893-3200.21.4.759
Reichert, T., Heckler, S. E., & Jackson, S. (2013). The effects of
sexual social marketing appeals on cognitive processing and per-
suasion. Journal of Advertising, 30, 13–27.
Schramm, D. G., & Gomez-Scott, J. (2012). Merging relationship
education and child abuse prevention knowledge: An evaluation
of effectiveness with adolescents. Marriage & Family Review, 48,
792–808. http://dx.doi.org.libproxy.uncg.edu/10.1080/01494929.
2012.714722
Schubert, K. (2015). Building a culture of health: Promoting healthy
relationships and reducing teen dating violence. Journal of Ado-
lescent Health, 56, S3–S4. http://dx.doi.org.libproxy.uncg.edu/10.
1016/j.jadohealth.2014.11.015
10 The Family Journal: Counseling and Therapy for Couples and Families XX(X)
Shipley, M., Holden, C., McNeill, E. B., Fehr, S., & Wilson, K.
(2018). Piecing together behaviors of healthy relationships. Health
Educator, 50(1), 24–29.
Tharp, A. T., Burton, T., Freire, K., Hall, D. M., Harrier, S., Latzman,
N. E., Lou, F., Niolon, P. H., Ramirez, M., & Vagi, K. J. (2011).
Dating matters: Strategies to promote healthy teen relationships.
Journal of Women’s Health, 20, 1761–1765. http://dx.doi.org.lib
proxy.uncg.edu/10.1089/jwh.2011.3177
Tharp, A. T., Carter, M., Fasula, A. M., Hatfield-Timajchy, K., Jayne,
P. E., Latzman, N. E., & Kinsey, J. (2013). Advancing adolescent
sexual and reproductive health by promoting healthy relationships.
Journal of Women’s Health, 22, 911–914. http://dx.doi.org.lib
proxy.uncg.edu/10.1089/jwh.2013.4534
Thomas, S., Jenkins, R., Burch, T., Calamos, N. L., Fisher, B., Giotaki,
G., Gnani, S., Hertel, L., Marks, M., Mathers, N., Millington-San-
ders, C., Morris, D., Ruprah-Shah, B., Stange, K., Thomas, P.,
White, R., & Wright, F. (2016). Promoting mental health and
preventing mental illness in general practice. London Journal of
Primary Care, 8(1), 3–9. https://doi.org/10.1080/17571472.2015.
1135659
Uchino, B. N. (2006). Social support and health: A review of physio-
logical processes potentially underlying links to disease outcomes.
Journal of Behavioral Medicine, 29(4), 377–387. https://doi.org/
10.1007/s10865-006-9056-5
Xia, N., & Li, H. (2018). Loneliness, social isolation, and cardiovas-
cular health. Antioxidants & Redox Signaling, 28, 837–851. https://
doi.org/10.1089/ars.2017.7312
Youth.Gov. (n.d.). Characteristics of healthy & unhealthy relationships.
https://youth.gov/youth-topics/teen-dating-violence/characteristics
Yucel, D. (2018). The dyadic nature of relationships: Relationship
satisfaction among married and cohabiting couples. Applied
Research in Quality of Life, 13, 37–58. http://dx.doi.org.libproxy.
uncg.edu/10.1007/s11482-017-9505-z