Analysis of Family Spiritual Factors with Resilience Theoretical

Approach in Overcoming Problem of Family Stigma Endemic

Leprosy at Community Health Service (Puskesmas) in Jombang

Regency of East Java Indonesia

Nasrudin

, Ah Yusuf

, Rachmat Hargono

and Tjipto Suwandi

School of Public Health, Universitas Airlangga, Surabaya, Indonesia

School of Nursing, Universitas Airlangga, Surabaya, Indonesia

Keywords: Family Resilience, Family Stigma, Family Spirituality

Abstract: The decrease of prevalence of leprosy has caused the leprosy patient and the families to a social stigma. In

this case, the high burden of stigma received by the family due to the leprosy suffered by one of family

members need resources, support, and resilience. It hopes that the family is able to perform its role in caring

the family members who suffer from leprosy and reducing the stigma. The spirituality of family is an

important factor of the value system and trust for family life in strengthening family resilience. This factor

is influential on coping, support, family acceptance of leprosy patients and the process of treatment and

stigma on family. By applying the theory of family resilience, the purpose of this research is to investigate

of the family spiritual factor in overcoming stigma on the family. This research used a cross-sectional

design. The research subject is 174 family of lepers, the population of the research in 15 health community

service (puskesmas) in Jombang regency of East Java. The samples are 120 families, taken using a Multi-

Stage Random Sampling technique. The samples are 120 families, taken by using a Multi-Stage Random

Sampling technique. The Hypothesis test used a chi-square test with a p-value <0,05. The result shows that

73 (60,8%) families had moderate and high family stigma while 46 (52,5%) moderate spiritual family and

60 (50%) of medium resilience. Furthermore, based on hypothesis test, it is obtained that family spiritual

factor has an effect on family resilience (P = 0,000), and family resilience has an effect on family stigma (P

= 0,000). The conclusion is that family spiritual factors influence family resilience to overcome family

stigma. Therefore, it is suggested that the intervention to overcome the family stigma must concern with

family resilience and family spiritual factors.

1 INTRODUCTION

The conceptual model of stigma according to (Link

& Phelan, 2001) is a stigma that exist when the

elements of labeling, stereotyping, separation, loss

of status, and discrimination occur in a power

situation that allows stigma components to unfold.

The caused of stigma in leprosy patients are

complex, as Wim H Van Brakel (2012) identifies

that socio-cultural, fear of causes, manifestations,

effects and death from disease, economic,

psychological, religious and spiritual (Van Brakel

2012; Sermrittirong 2014; Link & Phelan 2013).

Public stigma effects on the family raises stigma

problems for the family and also has an effect on the

family's behavior of stigma to leper family members.

The results of research in 2017 explains that 39

families of leprosy patients in six community service

of endemic leprosy in Jombang regency of East Java

was 29 (74.4%) family stigma, from the hypothesis

test, it was obtained that individual factors involved

individual stigma, self-concept, and level leprosy

defect impact on family stigma (P = 0.000). In this

case family factors involved family support, family

coping mechanisms, knowledge and family

perceptions of leprosy affected on family stigma (P

= 0,000), while economic status has no effect on

family stigma (P = 0.07). Environmental factors that

influence family stigma only the stigma of the

community that affects the stigma of the family (P =

0.007) and stigma does not occur by health providers

(Nasrudin, Hadi et al., 2018)

398

Nasrudin, ., Yusuf, A., Hargono, R. and Suwandi, T.

Analysis of Family Spiritual Factors with Resilience Theoretical Approach in Overcoming Problem of Family Stigma Endemic Leprosy at Community Health Service (Puskesmas) in Jombang

Regency of East Java Indonesia.

DOI: 10.5220/0007543703980402

In Proceedings of the 2nd International Conference Postgraduate School (ICPS 2018), pages 398-402

ISBN: 978-989-758-348-3

The amount of stigma burden received by

families due to family members suffering from

leprosy raises its internal stigma and family stigma

of the community. Resilience, support, and

strengthening of family resilience are needed by the

family in carrying out the family function of caring

for family members suffering from leprosy and

overcoming the stigma for the family, family

internal stigma and stigma for leprosy patients. The

strengthening of family resilience includes three

major components, namely, strengthening the family

belief systems, strengthening the structure and

function of the family as a unit or system

(organization patterns), strengthening

communication patterns and family strength system

in overcoming problems (communication / problem-

solving) (Walsh 2003; Walsh 2006; Walsh 2009;

Black & Lobo 2008; Walsh 2013). Nasrudin 2015,

Nasrudin 2017). Family spirituality is the basis of

family values and belief systems, the core of all

coping and family adaptation, and families seek and

rely on the spiritual support of family members as a

family way to deal with stigma problems (Kim et al.,

2011, Kim et al., 2013, Suk-Sun Kim, Yeoun Soo

Kim-Godwin 2016). Spiritual is also a family

domain that being a source of family strength and

family resilience, hence this research analyses

family spiritual factor with family resilience theory

approach in overcoming family stigma.

2 METHODS

This study used a cross-sectional design and it was

conducted on November 2016 to January 2017. The

study population was leprosy family in 21 endemic

leprosy community health service in Jombang

regency of East Java, consisted of 174 families of

leprosy patients and they had been diagnosed with

leprosy and recorded in community health service

(puskesmas) data registration. The sample was 120

families and sampling were taken by using Multi-

Stage Random Sampling. In addition, hypothesis test

was taken by using chi-square test with value p-

<0,05.

Furthermore, methods of data retrieval used

filling questionnaires by each family of the research

respondents. Each family is represented by a family

member who taking care directly for lepers in the

family. Assessment topics include 1). Family

spiritual factor, 2). Family resilience, and 3). Family

stigma. Family spiritual factor data collection is the

family's answer to Family Religiosity Coping,

Family Interdependence in religious and spiritual,

Family Support and Togetherness in Religious and

spiritual, and Family Spirituality. The collection of

family resilience is the family's answer to the family

ability to help others, growing stronger, acceptance,

adjustment, and survival. The questionnaire used to

measure the spiritual family is modified instrument

religion and problem-solving scale (RPS) based on

the concept of religion and the problem-solving

process: three styles of coping (Pargament et al.,

2013), spiritual response questionnaire from

Nursalam (Nursalam, 2016), and American Family

Strengths Inventory on the component Spiritual

Well-Being (SWB) (Dhar et al, 2011; DeFrain,

2008). The family resilience measurement

questionnaire used the Walsh Family Resilience

Questionnaire (WRFQ) (Walsh 2006) and the

concept of family resilience processes (Lietz et al.,

2016). Measurements of family stigma was based on

the concept of stigma (Goffman 1963), the concept

of stigma and social stigma components (Link &

Phelan 2001; Link & Phelan 2013), and the concept

of family stigma (Park & Park 2014) and modified

with the Explanatory Model Interview catalog

(EMIC) stigma scale for community (ILEP 2011;

Weiss et al. 2006; Rensen et al. 2011; Van Brakel

2006). Data analysis was taken gradually including

univariate analysis continued to bivariate analysis

followed by descriptive and analytic. The bivariate

analysis used frequency distribution while bivariate

analysis applied test chi-square if statistically

eligible, if it does not qualify then it would use the

test of Fisher's Exact Test of pValue-value<0.05

3 RESULT AND DISCUSSION

3.1 Influence of Family Spiritual Factor

to the Resilience of Leprosy Family

in Jombang East Java of Indonesia

2018

Based on Table 1, it is obtained that spiritual family

and sub-variable influence the family resilience

(P=0,000). It can be seen that family religious

coping, family interdependence in religious and

spiritual, family support and togetherness in

religious and spiritual, and family spiritual have a

significant influence on family resilience. Based on

table 2, it found that the influence of variable factors

and spiritual sub-family variables on family

resilience after the statistical test obtained value P =

0.000. It can be deduced that family interdependence

in religious and spiritual factors, family support and

Analysis of Family Spiritual Factors with Resilience Theoretical Approach in Overcoming Problem of Family Stigma Endemic Leprosy at

Community Health Service (Puskesmas) in Jombang Regency of East Java Indonesia

399

togetherness in religious and spiritual, and family

spiritual have a significant influence on family

resilience

Table 1. Cross-tab about the influence of family spiritual

factor to the resilience of leprosy family in Jombang

district East Java Indonesia in 2018

The percentage of family spiritual and family

resilience rates are almost half at moderate (> 45%)

and only a small (<20%) rate is high. The results

indicate that the family spirituality particularly the

family resources on the family's basic value system

is still weak. Thus, these factors then may cause to

family endurance and resilience to cope stress.

The family spirituality of Froma Walsh has

greatly influenced the family's ability to deal with

their problems, strengthens family relationships and

resilience reflected in family dynamics as a system

in carrying out family functions, parenting styles,

family dynamics, family development, and spiritual

relationships between generations. The spiritual

component of the family includes 1). Personal faith,

2). Spiritual and religious praxes (contemplative

practices, rituals, and ceremonies), 3). Faith

communities, 4) Faith communities, and connection

with nature, 5). Ability to express creative activities

(Expression through the creative arts), 6).

Community service / social activism, 7). An intimate

relationship with transcendence, 8). Relationship

with God (Walsh 2009; Walsh 2010; Walsh 2013).

According to Kim's research about the family

(2016), the spiritual strength would strengthen

family health including family commitments,

improve emotional health, develop healthy living

behaviours, improving healing process (Kim and

Godwin 2016). Furthermore, based on Nalika et al

(2013) study, the spiritual role model of chronic

disease shows that there are four dimensions of

spiritual influence and family care, they are, coping,

support, acceptance, treatment process (Nalika,

Warren and Canaway, 2013)

3.2 The Influence of Resilience Factor

to a Stigma of Leprosy Family in

Jombang District of Indonesia in

2018

After the statistical test, it is obtained that the effect

of family resilience on family stigma in table 2 was

P = 0,000, which means that family resilience has an

effect on family stigma. The influence of sub-

variable of resilience of family is only sub-variable

of other helping have p-value = 0,064, while sub-

variable Growing stronger (P = 0,000), Acceptance

(P = 0,000), Adjustment (P = 0,000), and Survival (P

= 0,000) it is concluded that there is an influence of

family stigma. This condition cause a stressor of the

situation for the family, the ability of the family to

survive. The ability of family resilience is needed in

overcoming a stressful situation, the ability of the

family to adapt, help each other, accept the condition

of leprosy patients. The change of family structure

that support the process of treatment and care as well

as the ability to survive together will help families to

solve problems and adapt to stressors and will not

appear in family stigma (Walsh 2003; Walsh 2006;

Walsh 2009; Walsh 2016).

Table 2. Cross-tab the influence of resilience factor to a

stigma of leprosy family in Jombang district of Indonesia

in 2018

Family resilience is the ability to bounce back from

ICPS 2018 - 2nd International Conference Postgraduate School

400

adversity and then become stronger and able to take

lessons from the difficulties encountered. Walsh

(1998) three major components, namely: family

belief systems, family structure and function as an

organizational pattern, communication pattern and

family strengthening system (communication /

problem-solving )(Walsh 2003; Walsh 2006; Walsh

2009; Black & Lobo 2008; Walsh 2013).

4 CONCLUSIONS

The spiritual family includes family religious

coping, family interdependence in religious and

spiritual, family support and togetherness in

religious and spiritual, and family members spiritual.

These factors have influenced on the occurrence of

family resilience as well as the stigma to the family

with leprosy patient.

ACKNOWLEDGMENTS

Appreciation and gratitude to Directorate for

Research and Community Service, Directorate

General of Development and Research

Enhancement, The Ministry of Research,

Technology and Higher Education that provide

financial aid for doctoral dissertation research

(PDD) in 2018 period under the title "Analysis of

family spiritual factors with resilience theoretical

approach in overcoming problem of family stigma”

endemic Leprosy at community health service

(Puskesmas) in Jombang regency of East Java

Indonesia.

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