The Correlation of Self-efficacy with Anxiety in Stroke Patients

Pawiono, Dewi Agustin, Heni Maryati and Mamik Ratnawati

Diploma III Nursing Program, STIKES Pemkab Jombang, East Java, Indonesia

Keywords: Self-Efficacy, Anxiety, Stroke.

Abstract: The number of stroke disease in Indonesia has been increased in 2013 from 8.3 to 12.1 per 1000 inhabitants.

A person who suffers a stroke will experience paralysis or weakness on the side of the stroke patient. This

results effect the psychosocial problems felt by stroke patients, one of which is anxiety. This study aims to

determine the effect of Self-efficacy with anxiety level in stroke patients. This study used analytic

correlation method with cross sectional approach. The populations in this study were 147 respondents

covered all stroke patients who were treated in the Jombang Hospital. Samples of 37 respondents were taken

using Quota Sampling. Independent variable was self-efficacy; dependent variable was Anxiety, to collect

data with statistical test with questionnaire test that used spearman's rank. The results shows that most of the

respondents had positive self-efficacy and most of the respondents had mild anxiety level with significance

value p = 0.022. It means that there was a relationship of self-efficacy with anxiety level in stroke patients.

Self-efficacy plays an important role to increase confidence in stroke patients. The results of this research

can motivate stroke patients to decrease their anxiety.

1 BACKGROUND

Stroke is a serious neurological problem, and it is

the highest cause of death (Dourman K, 2013). A

person suffering from a stroke will experience

paralysis or weakness on the stroke side of the body.

This is the problem of life. A problem faced by

someone who was hospitalized one of them is a

psychosocial problem. Psychosocial problems that

are usually felt by stroke patients who are treated in

the hospital one of them is anxious. With anxiety

will aggravate the perceived illness. One way to

relieve anxiety is with Self-efficacy.

In ASEAN countries stroke is also a major health

problem that causes death. According to the

American Heart Association (AHA), the stroke

mortality rate in stroke patients in the United States

each year is 50-100 out of 100,000 people. Of all

stroke sufferers in Indonesia, ischemic stroke is the

most common of 52.9% followed sequentially by

intracerebral hemorrhage, embolism and

subarachnoid hemorrhage with an incidence rate of

38.5%, 7.2% and 1,4% (Dinata, Yuliani, 2013).

Basically, stroke is caused by cerebral

thrombosis, cerebral embolism, cerebral ischemia

and cerebral hemorrhage which can lead to paralysis

or weakness on the side of the stroke patient, who

initially can move normally as normal people, but

after a stroke that is marked by loss function of the

body suddenly due to impaired blood flow of the

brain, so that stroke patients will experience physical

disorders, disruption of activity or mobility. This

will lead to problems in the psychological one of

which is anxiety. Cognitive symptoms of anxiety

such as worry, feeling disturbed, fear, confusion and

difficulty concentrating are some of the symptoms of

patients experiencing anxiety. One way to relieve

anxiety is with Self-efficacy. According to Bandura's

theory, people with high Self-efficacy are those who

believe that they can do well with difficult tasks as

something that must be mastered is not something to

be avoided (Suharsono and Istiqomah, 2014) .3

Individuals who have high Self-efficacy , when

faced with a stressful situation will try harder and

last longer and will be more active in the effort than

people who have low Self-efficacy, and will be more

daring to set targets or goals to be achieved

(Sulistiyowati, 2007).

With treatment, it is expected of stroke patients

can increase the chances of life, and in turn can save

the soul of the patient. However, the handling was

done above has not touched the mental aspect,

whereas stroke patients will experience psychosocial

problems such as anxiety (Widarti, 2012) Based on

676

Pawiono, ., Agustin, D., Maryati, H. and Ratnawati, M.

The Correlation of Self-efﬁcacy with Anxiety in Stroke Patients.

DOI: 10.5220/0008330806760681

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 676-681

ISBN: 978-989-758-336-0

background above, the researchers feel interested to

raise the problem of Self-efficacy with Level of

Anxiety In Stroke Patients In Flamboyan Pavilion of

RSUD Jombang.

2 METHODS

The type of study was analytic correlation method

with cross sectional approach. The population of this

study were 147 respondents covered all stroke

patients who were treated in the Pavilion Flamboyan

RSUD Jombang. A sample of 37 respondents was

taken using Quota Sampling. Independent variables

was self-efficacy, dependent variable was anxiety,

data retrieval method with statistical test

questionnaire used spearman's rank.

In conducting this study the researcher got a

research permit from Institution STIKES Pemkab

Jombang, and then the license was submitted to

RSUD Jombang. After receiving a reply letter from

RSUD Jombang, the reply letter was proposed to the

Head of Flamboyan Pavilion Room of RSUD

Jombang. After getting permission from the Head of

Flamboyan Pavilion Room of RSUD Jombang then

the researcher found respondents and approaches the

respondent by first explaining the intent and purpose

of thestudy to be conducted by the researcher.

3 RESULTS

The results of study would discuss about the

characteristics of respondents based on Self-efficacy

with anxiety level in stroke patients in the

Flamboyan Pavilion of Jombang General Hospital.

The study conducted on 10-25april 2017. Data

collection used questionnaire Self-efficacy and

anxiety questionnaire, research sample as many as

37 respondents.

Table 1 showed that respondents of stroke

patients in the Flamboyan Pavilion of RSUD

Jombang were predominantly 46-65 years old,

amounting to 21 people (56.8%). Based on sex

showed that respondents of stroke patients in

Flamboyan Pavilion of RSUD Jombang were 24

females (64.9%).

Based on education showed that the respondents

of stroke patients in the Pavilion Flamboyan RSUD

Jombang mostly primary school with 23 people

(62.2%).

Table 1: Distribution of stroke patients’ characteristics.

General Data Frequency Percentages

(%)

Age

36-45 Years ol

5 13.5

46-65 Years ol

21 56.8

>65 Years ol

11 29.7

Gender

Male 13 35.1

Female 24 64.9

Education

Elementar

23 62.2

Junior High School 5 13.5

Senior Hi

h School 7 18.9

College 2 5.4

Occupation

Unem

ment 16 43.3

Frame

18 48.6

Retired civil servants 3 8.1

Period of caring

1-5 da

s 22 59.5

6-10 days 9 24.3

11-15 da

s 3 8.1

16-20 days 2 5.4

21-25 da

s 1 2.7

Table 2: Frequency distribution of self-efficacy in stroke

patients.

Self-Efficacy Frequency Percentages

(%)

Positive 23 62.2

Negative 14 37.8

Total 37 100

Table 3: Frequency distribution of the anxiety in stroke

patients.

Anxiety Frequency Percentages

(%)

Not anxiety 11 29.7

Mil

15 40.5

Medium 9 24.3

Stron

2 5.4

Total 37 100

Based on the occupation, it showed that the

respondents of stroke patients in the Pavilion

Flamboyan Jombang Hospitalalmost half worked as

farmers with the number of 18 people (48.6%).

Based on the length of care, it showed that the

respondents of stroke patients in Pavilion

Flamboyan of RSUD Jombang mostly undergo long

treatment in Flamboyan Pavilion 1-5 days as many

as 22 people (59.5%).

The Correlation of Self-efﬁcacy with Anxiety in Stroke Patients

677

Table 5: Cross-tabulation between ages with anxiety in stroke patients.

Age

Anxiet

Total

Not Anxiet

Mil

Mediu

Stron

f % f % f % f % f %

36-45Years

45-65 Years

>65 Years

0.0

28.6

45.5

80.0

38.1

27.3

20.0

23.8

27.3

0.0

9.5

0.0

100

Table 6: Cross-tabulation between educations with anxiety in stroke patients.

Education

Anxiety

Total

Not Anxiet

Mil

Mediu

Stron

f % f % f % f % f %

Elementary

Junior High

Senior High

Colle

26.1

40.0

14.3

100

39.1

40.0

57.1

0.0

26.1

20.0

28.6

0.0

8.7

0.0

100

Table 7: Cross-tabulation between ages with self-efficacy in stroke patients.

Age

Self-Efficac

Total

Positive Negative

f % F % f %

36-45 years

45-65 years

>65 years

60.0

57.1

72.2

40.0

42.9

27.3

100

Table 8: Cross-tabulation between genders with self-efficacy in stroke patients.

Gender

Self-Efficac

Total

Positive Negative

f % F % F %

Male

Female

61.5

62.5

38.7

37.5

100

Table 2 showed that respondents of stroke

patient in Flamboyan Pavilion of RSUD Jombang

mostly had positive Self-efficacy of 23 people

(62.2%), whereas almost half of respondents had

negative Self-efficacy of 14 people (37.8%).

Table 3 showed that respondents of stroke

patient in Flamboyan Pavilion of RSUD Jombang

almost half had mild anxiety level of 15 people

(40.5%).

Table 4 showed that 37 respondents of stroke

patients in Flamboyan Pavilion of RSUD Jombang

had positive self-efficacy mostly had mild anxiety

level that was 12 people (52.2%), whereas from

respondent with negative self-efficacy almost half

had moderate anxiety level as many as 6 people

(42.3%).

Table 5 showed that of 37 respondents of stroke

patients in Flamboyan Pavilion of RSUD Jombang,

aged 46-65 years, almost half experienced mild

anxiety level of 8 people (38.1%).

Table 6 showed that 37 respondents of stroke

patients in the Flamboyan Pavilion of RSUD

Jombang with elementary school education, almost

half experienced mild anxiety about 9 people

(39.1%).

Table 7 showed that 37 respondents of stroke

patients in Flamboyan Pavilion of RSUD Jombang,

46-65 years old, most of them had positive self-

efficacy of 12 people (57.1%).

Table 8 showed that 37 respondents of stroke

patients in the Flamboyan Pavilion of RSUD

Jombang, most of them had positive self-efficacy of

15 people (62.5%) and almost half have negative

self-efficacy of 9 people (37.5%).

4 DISCUSSION

4.1 Self-Efficacy to Patients with

Stroke

Based on Table 2 showed that the respondents of

stroke patients in the Flamboyan Pavilion of RSUD

Jombang mostly had positive Self-efficacy of 23

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

678

people (62.2%), while almost half of the respondents

had negative Self-efficacy of 14 people (37.8%).

According to Bandura (1997) in the book of

psychological theories (Ghufron and Risnawita,

2016) Self-efficacy can be derived from 4 factors:

Master Experience, Vicarious Experience, Verbal

Persuasion and Physiological State, which is an

experience / achievement ever achieved by

individuals in the past, these four sources will affect

a person's perception of his illness and its

management.6 According to (Walker, 2007) the

longer the acceptance of his illness would affect the

patient's Self-efficacy and there was a positive

correlation between perception and the patient's

Self-efficacy, that was, if the perception was good

then Self-efficacy increases.

Based on these facts and theories, the researcher

concluded that positive self-efficacy was supported

by some stronger factors and stronger willingness so

that individuals who have higher self-efficacy will

be more trying to overcome illness suffered than

individuals who had negative self-efficacy.

Table 7 showed that 37 respondents of stroke

patients in Flamboyan Pavilion of RSUD Jombang,

46-65 years old, most of them had positive self-

efficacy as many as 12 people (57.1%).

According to Bandura (1997) older individuals

had more time span and experience in overcoming

things when compared to younger individuals.

Based on existing facts and theories of

individuals aged 46-65 years had high self-efficacy.

This was because older individuals were more

focused and more striving to achieve the desired

healing or outcome so they still hadstrong belief in

themselves to heal.

Table 8 showed 37 respondents of stroke patients

in Flamboyan Pavilion at RSUD Jombang, most of

them had positive self-efficacy as many as 15 people

(62.5%) and almost half had negative self-efficacy

was 9 people (37.5% ).

According to Bandura (1997) in the book of

psychological theories (Ghufron and Risnawita,

2016) In some areas of a particular job men had

higher self-efficacy compared to women, and vice

versa self-efficacy women excel in some jobs

compared with men. Men usually had high self-

efficacy with jobs that demand mathematical of

technical skills.

According to the analysis of researcher, female

had a high level of confidence in dealing with the

disease that she suffered. In addition, women had a

more calm and persevering in undergoing treatment

of the illness.

Based on Table 4 showed that from 37

respondents of stroke patients in Flamboyan

Pavilion of RSUD Jombang which had self positive

efficacy, most of them had mild anxiety level is 12

people (52.2%), while from respondent own self

negative efficacy almost half have medium anxiety

level that was as many as 6 people (42.3%). From

the above data could be concluded that the higher

Self-efficacy affected owned respondents lighter

level of perceived anxiety.

According to Bandura (Blackburn & Davidson,

1994) described what matters in relieving anxiety,

among others, as follows: Self-efficacy was as an

individual's mind to his or her own ability to cope

with situations. Outcome Expectancy had a sense as

an individual estimate of the likelihood of

consequences. Certain consequences that may had

an effect on suppressing anxiety (Sarafino, E.P &

Smith, 2011). Based on the most important thing

that must be owned by individuals to be able to carry

out healthy behavior is Self-efficacy.

Based on these facts and theories, stroke patients

should have confidence in the treatment and

treatment could maintain their life. Basically, any

patient with an illness would have a disruption to

more physical functioning when the patient has inner

confidence or has the ability to perform certain

behaviors. Patients had confidence in their ability to

cope with various treatments so as to overcome the

pain of their illness known as self-efficacy. The

respondents with positive self-efficacy had a mild

anxiety level. This was because the patient had a

positive efficacy or self-confidence to heal, and with

care and treatment had been done to maintain his

life.

The anxiety of patients with Stroke in

Flamboyan Pavillionof RSUD Jombang

Based on Table 3, it showed that the respondents

of stroke patients in the Pavilion Flamboyan

Jombang Hospital almost half had a mild anxiety

level of 15 people (40.5%).

According to Davis and Palladino (1997) anxiety

had a sense as a general feeling that has behavioral

characteristics and cognitive or psychological

symptoms. 19% of men and 31% of women had

experienced anxiety. While Hall and Lindzey (2001)

added, anxiety was the tension resulting from threats

to security, both real and ordinary imagination

(Safaria dan Nofrans, 2012).

Based on the results of the study the researchers

concluded that stroke patients in Pavilin Flamboyan

RSUD Jombang hadmild anxiety level, this wa

because stroke patients have more confidence level

about the disease they face.

The Correlation of Self-efﬁcacy with Anxiety in Stroke Patients

679

Table 5 showed that 37 respondents of stroke

patients in Flamboyan Pavilion of RSUD Jombang,

46-65 years old, almost half had mild anxiety level

of 8 people (38.1%).

According to (Kaplan & Sadock, 1997), that

anxiety disorders could occur at any age, more often

in young adulthood, ie at age 21-44 years.

This was contrast to what was found by

researchers, the age that experienced anxiety most of

the respondents aged 46-65 years. According to the

analysis of age researchers were more often

experienced psychological problems. When

someone aged 46-65 years then they will face

various kinds of problems both in terms of physical,

psychological, and social. From some of these

problems, when someone did not have strong beliefs

would experience anxiety.In addition, when

conducted research on stroke patients in the Pavilion

Flamboyan RSUD Jombang at the age of 46-65

years so that ultimately the anxiety felt by stroke

patients more in the age range 46-65 years.

Table 6 showed that 37 respondents of stroke

patients in the Flamboyan Pavilion of RSUD

Jombang were mostly 23 elementary school students

(62.2%), some had minor anxiety about 9 people

(24.32%) and a few had severe anxiety a total of 2

people (5.4%). This was supported by (Struart &

Sundeen, 1998), that the lower education level of a

person then the knowledge obtained tend to be less.

Conversely, the higher education would be easier to

think rationally and capture information.

Based on facts and theories, one's education

greatly affected the level of anxiety. This was

because a person with a lower level of education had

less experience and knowledge that would affect a

person's knowledge. One of them was the

knowledge of the disease that was suffered, so it

would cause a negative response that is anxiety.

4.2 The Correlation of Self-Efficacy

with Anxiety Level of Patients with

Stroke

In this section would be discussed about the

correlation of self-efficacy with anxiety. Based on

statistical test results showed correlation coefficient

r = 0.376 and significance value p = 0.022 which

means smaller than 0.05 then H1 accepted. This

means there was a correlation of Self-efficacy with

anxiety levels in stroke patients in the Flamboyan

Pavilion of RSUD Jombang. This means that the

higher self-efficacy of stroke patients, the lower

anxiety of the stroke patients. Similarly, the lower

self-efficacy of stroke patients affected the higher

perceived anxiety of the stroke patient.

The results of this study were in line with

previous research conducted by (Anwar, 2009) on

the relationship between Self-efficacy with the

anxiety of speaking in front of the students at the

University of North Sumatra psychology faculty

who showed the result that there was a significant

negative relationship between Self-efficacy with

public speaking anxiety in public faculty of

psychology of Universitas Sumatera Utara.

From the results of this study with the results of

research from researchers themselves about self-

efficacy with anxiety, it could be concluded that the

level of self individual efficacy would affect anxiety

in the individual in the face of a problem. Or with

another sentence that self-efficacy owned by stroke

patients could improve or alleviate anxiety for stroke

patients.

Self efficay person was associated with several

factors, among others: gender, age, education and

employment. Self-efficacy determines the form of

action they would choose to do, as strong as the

individual could survive in the face of the problems.

According to Bandura, self-efficacy was useful for

training control of anxiety itself. When people

experience high anxiety they usually had low self-

efficacy, while those with high self-efficacy would

feel able to overcome obstacles and perceive threats

as a challenge that was unnecessary to avoid. With a

high Self-efficacy, individuals will run their business

with enterprising, not easily give up, and would

make every effort to get maximum results in the face

of its duties. While individuals with low Self-

efficacy would feel easily give up and easily

desperate in the face of problems. This means that

stroke patients with low Self-efficacy did not dare to

face the problem and easy to give up.

According to Adler and Rodman (Ghufron dan

Risnawita, 2016) there were two factors that cause

anxiety, namely: negative experiences in the past.

Anxiety that could arise may be palpitations, cold

sweats, tremors and other anxiety responses.

Another factor that was unpleasant thoughts would

happen to him. While factors that may affect anxiety

include: age, physical condition and education level.

Bandura (Blackburn and Davidson, 1994)

describes what matters in relieving anxiety, among

others, as follows: Self-efficacy was an individual's

estimate of his or her own ability to handle

situations. Outcome expectancy had an

understanding as an individual estimate of the

possibility of certain consequences may have an

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

680

effect on suppressing anxiety (Safaria dan Nofrans,

2012).

Thus, Self-efficacy and anxiety played an

important role in stroke patients who were

undergoing treatment at the Hospital. Self-efficacy

played an important role in providing confidence

that with the conduct of treatment and treatment of

the disease would be able to maintain thepatient's

life. Self-efficacy was one way to relieve anxiety in

stroke patients who were undergoing treatment at the

Hospital. The self-efficacy is expected to reduce the

anxiety in stroke patients.

5 CONCLUSIONS

Self-efficacy has relation with anxiety level on

stroke patient. Self-efficacy plays an important role

to increase confidence in stroke patients. The results

of this research can motivate stroke patients to

decrease their anxiety. For further research, we

recommend to study research development on other

factors related to self-efficacy or anxiety.

REFERENCES

Anwar, astrid. I. . (2009) ‘Hubungan Antara Self-efficacy

dengan Kecemasan Berbicara di Depan Umum pada

Mahasiswa Fakultas Psikologi Universitas Sumatra

Utara’, Medan: Universitas Sumatra Utara.

Dinata, Yuliani, S. (2013) ‘Gambaran Faktor Resiko dan

Tipe Stroke pada Pasien Rawat Inap di Bagian

Penyakit Dalam RSUD Kabupaten Solok Selatan

Periode 1 Januari 2010 - 31 Juni 2012’,

http://jurnal.fk.unand.ac.id.

Dourman K (2013) ‘Waspadai Stroke Usia Muda’,

Jakarta: Cerdas Sehat.

Ghufron dan Risnawita (2016) Teori-teori Psikologi.

Jogjakarta: Ar-Ruzz Media.

Kaplan & Sadock (1997) Terapi Psikiatri. Jakarta: EGC.

Safaria dan Nofrans (2012) Manajemen Emosi. Jakarta:

Bumi Aksara.

Sarafino, E.P & Smith, T. . (2011) Biopsychosocial

Interactions. United States of America: John Willey &

Sons Inc.

Struart & Sundeen (1998) Keperawatan Jiwa. Edisi 3.

Jakarta: EGC.

Suharsono and Istiqomah (2014) ‘Validitas Dan Reabilitas

Skala Self-efficacy’, http://ejournal.umm.ac.id/.

Sulistiyowati, P. (2007) ‘Hubungan Antara Burnout

dengan Self-efficacy pada Perawat di Ruang Rawat

Inap RSUD Prof. Dr. Margono Soekarjo Purwokerto’,

Http://jurnalonline.unsoed.ac.id.

Walker (2007) ‘Importance of Illness Beliefs and Self-

efficacy for Patients with Coronary Heart Disease’,

Journal ofAdvanced Nursing, 48(3), 216-225.

Widarti, dkk (2012) ‘Respons Psikologis (Kecemasan dan

Depresi) dan Respons Biologis pada Pasien Stroke

Iskemik dengan Pendekatan Model Home Care

Holistic’, Jurnal Ners : Poltekes Kemenkes Surabaya.

The Correlation of Self-efﬁcacy with Anxiety in Stroke Patients

681