Family Support and Coping Mechanisms in Patients with Pulmonary

Tuberculosis

Makhfudli, Alfan Fachrul Rozi, Tintin Sukartini, Candra Panji Asmoro

Faculty of Nursing, Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Keywords: Family Support, Coping Mechanisms, Pulmonary Tuberculosis.

Abstract: Pulmonary tuberculosis is a stressor for patients, which shows coping mechanism that are adaptive or

maladaptive. One of the sources of coping mechanisms is social support, including instrumental,

informational, and emotional support. This study aims to analyze the correlation between family support and

coping mechanisms of patients with pulmonary tuberculosis. This study used a cross-sectional design. The

population comprised of patients with pulmonary tuberculosis in intensive phase treatment and continuous

phase treatment categories one and two at the TB Polyclinic. The sample comprised of 110 respondents based

on the inclusion criteria. The independent variable was family support and the dependent variable was the

coping mechanism. Data were collected through questionnaires and analyzed using the Spearman Rho

statistical test. There is a correlation between family support and pulmonary tuberculosis patients’ coping

mechanisms. The Spearman Rho test results were obtained at p = 0.000 and the correlation coefficient r =

0.377. This means there was positive correlation between family support and coping mechanisms, but the

power of correlation was weak. Patients with pulmonary tuberculosis are dominated by good family support.

The coping mechanisms of respondents is adaptive. Health institutions and health workers should optimize

family support to increase patients’ coping mechanisms.

1 BACKGROUND

Pulmonary tuberculosis is a disease that requires

serious treatment. Tuberculosis is still a health

problem for people in the world, although many

countries have made efforts to overcome this since

1995 (Regulation of the Minister of Health of the

Republic of Indonesia No. 67 of 2016 on

Tuberculosis Control). Pulmonary tuberculosis is a

chronic disease and patients with chronic illnesses

feel a loss of health, independence, productivity, and

self-fulfillment (Yusuf et al., 2015). Patients

diagnosed with pulmonary tuberculosis often

experience stigma from the community, even from

their family who are a source of coping, thus affecting

the patient's coping mechanisms (Azizah et al., 2016).

There is a relationship between family support and

stress (Nursalam, 2009) and poor family support

increases stress. Stigma in patients with pulmonary

tuberculosis is an important social determinant of

health (Craig et al., 2017). In addition to the stigma of

the community, many people with pulmonary

tuberculosis experience stress, depression, and

anxiety problems. This is caused by many factors felt

by people with pulmonary tuberculosis. One of these

is a poor coping mechanism in response to the

stressors they are faced with. Poor coping

mechanisms can be caused by poor family support in

patients with pulmonary tuberculosis.

Coping is a psychological adaptation to stress and

serious life events (Scheenen et al., 2017). The better

the coping strategies that are used to respond to

stressors, the smaller the risk of stress, conversely

when coping mechanisms used are maladaptive, the

risk of stress is higher. Maladaptive coping is

associated with increased stress (Deshmukh et al.,

2017). Psychological disorders of stress, depression,

and anxiety experienced by tuberculosis patients are

a manifestation of the maladaptive coping

mechanisms, impacting on their physical health.

Based on the results of interviews with patients

with pulmonary tuberculosis in the government

pulmonary hospital, it can be concluded that patients

feel burdened and anxious because of pulmonary

tuberculosis. Family support varies; some have good

family support, and some have poor family support.

The patients’ adaptation responses to their

tuberculosis disease varies.

642

Makhfudli, ., Rozi, A., Sukartini, T. and Asmoro, C.

Family Support and Coping Mechanisms in Patients with Pulmonary Tuberculosis.

DOI: 10.5220/0008330206420647

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 642-647

ISBN: 978-989-758-336-0

Pulmonary tuberculosis sufferers have various

health problems, not only physical but also

psychological. Problems in the psychological aspect

are the emergence of stress, depression, and anxiety

because of poor coping mechanisms in patients with

pulmonary tuberculosis. Based on research conducted

by Muhammad Anugrah and Mokhammad Arifin

(2016), who conducted research on anxiety in patients

with pulmonary tuberculosis in Kedungwuni

Regency Pekalongan, 34 samples were obtained, and

the results indicated that 18 people (52.9%)

experiencing mild anxiety, 11 people (32.4%)

experienced moderate anxiety, and the remaining five

people (14.7%) experienced severe anxiety. The

results of the study by Atif et al. (2014) indicated that

67.1% of 336 respondents were at risk of depression

at the beginning of tuberculosis treatment. The data

of stress, depression, and anxiety events in patients

with pulmonary tuberculosis were also obtained by

stress measurement, depression, and anxiety.

Research intervention by Suryani et al. (2011)

indicated that 64.9% people experienced stress,

anxiety, and mild depression, while 35.1% suffered

from moderate depression.

Increased pulmonary tuberculosis in patients is a

challenge, not only for health workers in health

agencies, but also for the community. Appropriate

management will reduce the risk of the transmission

of pulmonary tuberculosis and will certainly improve

the quality of life for patients with pulmonary

tuberculosis. Having pulmonary tuberculosis causes a

loss of health and as a predisposing factor in the

biology of the emergence of stress in the individual,

will result in the formation of coping mechanisms.

For individuals experiencing stress, coping

mechanisms that emerge can come from various

sources of coping, including social support (Yusuf et

al., 2015). One form of social support is the support

of families. Each family has resources to look after

family members faced with health problems

(Friedman et al., 2010). In addition, family and

community members' support, including peers, is an

important factor influencing treatment compliance

positively, as a form of positive coping mechanisms

in patients with pulmonary tuberculosis (Deshmukh

et al., 2017).

2 METHODS

2.1 Design

This study was conducted using a cross-sectional

approach. The research aimed to analyze the

relationship between independent and dependent

variables. The independent variable in this study is

family support. The dependent variable in this

research is the coping mechanism.

2.2 Sample

The population in this study were pulmonary

tuberculosis patients in the government pulmonary

hospital intensive and advanced treatment phase,

categories 1 and 2. The sampling technique used was

consecutive sampling, which was conducted by

criticizing the sample using inclusion and exclusion

criteria. The sample size in this study comprised of

110 pulmonary tuberculosis patients at the

government pulmonary hospital in the intensive and

advanced treatment phase of category 1 and 2,

according to the inclusion criteria.

2.3 Data Collection

Data were collected using an instrument in the form

of a questionnaire that had been tested for validity and

reliability by previous researchers; hence, it was not

necessary to test validity and reliability in this study.

The questionnaire related to family support and

included emotional, instrumental and informational

supports, measuring respondents’ coping

mechanisms using a Brief Cope scale. Data were

analyzed using the Spearman Rho statistical test to

determine the correlation between variables.

2.4 Ethical Clearance

This study received a certificate of ethical clearance

from the Faculty of Nursing Universitas Airlangga

No. 572/KEPK.

3 RESULTS

Based on Table 1, the number of respondents was 110

people with a majority of 59 (53.6%) females. The

largest number of respondents were aged 21–30

years, comprising of 30 people (27.3%); only one

respondent was aged 71–80 years. The level of the

education of respondents was dominated by

elementary school graduates (SD)/equivalent and

senior high school (SMA)/equivalent with the same

number of 35 people or 31.8% in each group. Most

respondents were married (79 people or 71.8%), 37

respondents (33.6%) were housewives, and just three

respondents worked as Civil Servants (PNS). There

Family Support and Coping Mechanisms in Patients with Pulmonary Tuberculosis

643

were just two religions followed by the respondents,

and Islam is the religion most widely embraced by the

respondents with 107 respondents (97.3%).

Table 2 shows the frequency of respondents in the

treatment phases of pulmonary tuberculosis. Table 2

indicates that the number of respondents who are in

the intensive phase of treatments is lower than those

respondents who are in the phase of follow-up

treatment at 49 respondents or 44.5%.

Table 3 indicates that good family support is

obtained by most research respondents with 109

respondents or 99.1% of the 110. Table 4 indicates

that adaptive coping mechanisms are widely used by

the respondents with 94 respondents or 85.5%.

Table 5 indicates that one respondent has less

family support and adaptive coping mechanisms and

there are 16 respondents with good family support,

but maladaptive coping mechanisms. Data were

analyzed using the Spearman Rho test, in relation to

family support relationships with coping mechanisms

of pulmonary tuberculosis patients at the Government

Pulmonary Hospital, with the result p = 0.000. The p-

value is below the p-value of 0.05 meaning H0 is

rejected and H1 is accepted; this means there is a

relationship between family support and coping

mechanisms with a weak strength of 0.377.

4 DISCUSSION

Family support is divided into instrumental support,

informational support, and emotional support

(Friedman et al., 2010). The support received by the

study respondents generally indicates good family

support from all three aspects. This is due to the

implementation of family duties in the field of health,

providing care to members of the family who are sick.

Setiadi (2008) suggests that families can take care

measures as well as make efforts to obtain follow-up

actions to prevent worsening health problems. Family

support given directly to the respondents has a

positive impact. This is in line with work by Sabine

Trepte et al. (2015) who state that emotional,

instrumental, and informational support given offline

is better than support given online.

Family support received by respondents comes

from the support of nuclear families who live in one

house, who understand the healthy development of

respondents and generally provide support in the

forms of informational support, instrumental and

emotional support. Informational support from the

family will increase the respondents knowledge of

pulmonary tuberculosis. Good knowledge will

improve the coping mechanisms of respondents. This

is in line with research conducted by Indah Ramadhan

et al. (2013) who suggest that there is a significant

relationship between the level of knowledge and

coping mechanisms.

The emotional support that is part of the support

of the family, includes loving support, understanding,

and attention and will create calm in the

psychological aspect of the respondent directly

related to coping mechanisms. A person who gets

good emotional support will reduce the stigma of self

and increase self-esteem. The research by Peng Wei

et al. (2016) shows that family support has a moderate

effect on the respondents’ self-esteem, while Mega

Arianti et al. (2016) mentions that high self-stigma is

Table 1: Demographic characteristics of respondents.

Characteristic Indicators f

(

)

Age

(years old)

–

20 13 11.8

–

30 30 27.3

–

40 21 19.1

–

50 27 24.5

–

60 13 11.8

–

70 5 4.5

–

80 1 0.1

Total

110 100

Education

Not

asse

6 5.5

Elementary 53 48.2

Junior hi

h 35 31.8

Senior high 16 14.5

Total

110 100

Gender

Male 51 46.4

Female 59 53.6

Total 110 100

Marital status

Marrie

79 71.8

Single 20 18.2

Widow/e

11 10

Total

110 100

Occupation

Gov. staff 3 2.7

Private staff 26 23.6

Housewife 37 33.6

Labore

18 16.4

Unem

ment 18 16.4

Others 8 7.3

Total

110 100

Religion

Moslem 107 97.3

Christian 3 2.7

Total

110 100

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

644

due to a lack of knowledge and support from the

family. Erin K. Truong et al. (2015) mentions that the

quality of life of respondents, who are not stressed by

the stigma, showed better results because the

mechanism of the coping formed is positive.

Increased self-esteem and decreased self-stigma due

to positive family support will make a person feel

confident and able to use adaptive coping

mechanisms, broadly influencing the quality of life.

Family support is very important for supporting

respondents in adapting to stressors, as patients with

pulmonary tuberculosis. Good family support will

elicit a positive response from the responder so they

are calmer and able to adapt well. Eventually, they

will have an impact on improving pulmonary

tuberculosis patients’ quality of life. This is in

accordance with research by Deshmukh et al. 2017

who suggest that family support affects the resilience

of individuals who experience anxiety due to

stressors. Family support also deals with self-esteem

and quality of life. Chia-Chun Li et al. (2015) state

that respondents with low self-esteem and low family

support tend to have a lower quality of life compared

to respondents with low self-esteem but high social

support.

Most respondents use an adaptive coping

mechanism but there are some respondent who have

a maladaptive coping mechanism. The adaptive

coping mechanisms that most respondents use in

facing their stressors are activities such as praying or

meditating when experiencing problems; respondents

take action or steps to try to make the problem better

and are looking for good or wisdom in the problem.

The respondents with adaptive coping mechanisms

are natural and learn to live with problems they are

experiencing as well as accepting the problem they

face.

The coping mechanism used by the research

respondents showed different results; most

respondents used adaptive coping mechanisms and a

small percentage of respondents used maladaptive

coping mechanisms. Different coping responses in

each individual are influenced by how individuals

perceive stressful events; coping does not necessarily

lead to solving problems faced by individuals

(Azizah, et al., 2016). Coping mechanisms are

dynamic, so, according to various factors influencing

the selected coping mechanisms, human behavior is

always dynamic (Yusuf et al., 2015).

Pulmonary tuberculosis and its impact on life

aspects is a stressor that affects respondents’, their

family, and other aspects of their lives. The coping

mechanism used by respondents clearly differs

because it depends on how individuals perceive the

stressors they are facing; they are influenced by

various factors, so even if the same stressors and its

impact on the aspects of life apply, the perceptions

and the supporting factors of the emergence of coping

mechanisms on each respondent vary, which means

that the coping mechanisms used in adapting to

stressors also vary.

A coping mechanism that is widely used by the

respondents in this study is the adaptive coping

mechanism. The results of this study indicates that

most research respondents can adapt to the stressors

they face. Good adaptation to stressors will affect the

respondents’ psychological responses as well as

emotional disturbances; individuals with good coping

mechanisms will calmly respond to stressors and

improve their resilience. This is in line with research

by Okafor et al. (2016) who suggest that active coping

behavior is associated with increased resilience.

The results of the data analysis indicate that there

is a relationship between family support and coping

mechanisms in patients with pulmonary tuberculosis.

Some respondents have less family support but have

Table 2: Frequency of respondents in the phase of

treatment of pulmonary tuberculosis.

Phase f %

Intensive 49 44.5

Continue

61 55.5

Total 110 100

Table 3: Family support and coping mechanisms of

patients with pulmonary tuberculosis.

Family support f %

High 109 99.1

Less 1 0.9

Total 110 100

Table 4. Coping mechanisms of patients with

pulmonary tuberculosis.

mechanism f %

Ada

tive 94 85.5

Maladaptive 16 14.5

Total 110 100

Table 5. The relationship of family support with the

coping mechanisms of patients with pulmonary

tuberculosis.

Variable Famil

ort Total

Less Hi

Coping Mec f % f % f %

Maladaptive 0 0 16 14.5 16 16.5

Adaptive 1 0.9 93 84.5 94 85.5

Total 1 0.9 109 99.1 110 100

(p)

0.000

(

)

0.377

Family Support and Coping Mechanisms in Patients with Pulmonary Tuberculosis

645

adaptive coping mechanisms. Some respondents have

good family support but use a maladaptive coping

mechanism. Facing stressors, such as suffering from

pulmonary tuberculosis and its effects, will certainly

cause psychological disturbances, especially for the

sufferer. Individuals who deal with stressors are

perceived to suppress their desire to seek the

resources they need, such as economy, time, family

social support, and other resources to help them deal

with it (Azizah et al., 2016).

Family support is required by the patient to help

them deal with problems well. Family support is a

social support experienced by family members who

are ready to provide help and assistance whenever it

is needed (Friedman et al., 2010). Family support is

comprised of three forms of support, helping the

patient with pulmonary tuberculosis in adapting to the

problem. This appropriates facilities, information,

and attention of the family, to elicit good coping

mechanisms or adaptive coping mechanisms in

response to the stressors.

Family support is a resource that can generate

physical and psychological comfort for an individual.

Family support provides a positive aspect for family

members who receive support (Azizah et al., 2016).

Family is a source of coping mechanism for

individuals in the face of stressors or problems they

face (Azizah et al., 2016). Good family support to

family members who are experiencing health

problems in this study has a positive impact in the

form of positive or adaptive coping mechanisms of

patients in response to stressors.

Family support is not the only source of coping

mechanisms. There are many other factors that

influence and become a source of coping mechanism.

The results of a study showing a family support

relationship with coping mechanisms indicates that

family support influences an individual to choose the

coping mechanism they use to respond to stressors,

whether adaptive or maladaptive coping mechanisms

are emerging. Individuals can adapt well to problems

they face with the family support they receive from

family members.

The existence of family support relationships with

coping mechanisms in patients with pulmonary

tuberculosis is in line with the study of Das et al.

(2017) who believe that individuals who receive

family and friends’ support show good coping

mechanisms that are adaptive and resilient. Nursalam

et al. (2009) state that family support can reduce

stress. The better the support given to family

members who are experiencing psychological

disorders, such as stress, the more the stress is

reduced. Research conducted by Tintin et al. (2016)

indicates that family support can improve

psychological responses to individuals when facing

problems. Psychological disorders including stress,

anxiety, and depression are closely related to coping

mechanisms. The maladaptive coping mechanism

leads to psychological disorders; an adaptive coping

mechanism will prompt an individual to respond to

the stressor positive. One source of individual coping

mechanisms, whether adaptive or maladaptive, is the

social support they receive from their family.

5 CONCLUSIONS

Family support is related to coping mechanisms.

Patients with pulmonary tuberculosis are dominated

by good family support. The coping mechanisms of

respondents is adaptive. Health institutions and health

workers should optimize family support to increase

patients’ coping mechanisms.

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