Effectiveness Difference of Family Psychoeducation Model and

Family Centered Empowerment Model on Knowledge and Attitude in

The Poor Family of Preventing Hypertention on Families in Jember

Distric

Kurniawan Erman Wicaksono

, Ristya Widi Endah Yani

and Elfian Zulkarnain

Magister Program of Public Health, Jember University, 37 Kalimantan Street, Jember, Indonesia

Faculty of Dentistry, Jember University, Mastrip Street, Jember, Indonesia

Keywords: Psychoeducation, Empowerment, Family

Abstract: Hypertension is one of the leading causes of death in Indonesia that has been the focus of non-infectious

disease management as the main program in Indonesian Health Program. One of the health development

efforts is the provision of health education as an implementation in behaviour change of poor families against

the prevention of hypertension. The purpose of this study was to analyse the differences in the effectiveness

of family psychoeducation model and family centered empowerment model on the knowledge and attitude of

poor families in preventing hypertension in the family. This study is a quasi-experimental with non-

randomized control group pre-test-post-test design used two intervention groups. Population target were 33

poor families and selected by using purposive sampling. The data were analysed by using Mann-Whitney

Test and used mean value from each group to know the effectiveness. The results showed the mean value of

knowledge (mean = 6.27) and attitude (mean = 4.45) of the family psychoeducation group model was more

than high the mean knowledge value (mean = 5.00) and attitude (mean = 3.63) in the family centered

empowerment model. Family psychoeducation models are more effective in increased knowledge and

changed the attitude of poor families in prevented hypertension in families than family centered empowerment

models.

1 BACKGROUND

Hypertension is one of the leading causes of death in

the world. The prevalence of hypertension is

increasing every year. The results of study by

(KARTIKASARI et al. 2012), show that the

prevalence of hypertension increases with age, the

lower education, unemployment status and high per

capita expenditure. Most cases of hypertension in the

community are not identified. Most of the cases of

unidentified hypertension are among the poor,

including poor people with pre-paid health care

coverage (Penelitian et al. n.d.).

According to the World Health Organization

(WHO) and the International Society of Hypertension

(ISH) in (Efendi & Larasati 2017), there are 600

million people with hypertension worldwide, with 3

million of whom die annually. Seven out of every 10

hypertensive sufferers did not receive adequate

treatment. Basic Health Research Results

(RISKESDAS) in 2013 shows that in non-

communicable diseases data, the prevalence of

hypertension in Indonesia tends to increase to 26.5%

based on measurement (Muhadi 2016). Jember

regency is one of the areas in Indonesia with the

number of hypertension patients ranked first with a

prevalence of 27.4%. The problem of hypertension

problem in Jember Regency until now has not

fulfilled the target of 100%. The lowest coverage in

Jelbuk sub-district is in Sukojember village with

coverage rate of 10.12%. The low coverage outcomes

in Sukojember Village stem from the small number

of poor people's visits with pre-paid health care

coverage to health services of 5.08%.

Increased coverage can be achieved by increasing

the knowledge of the poor. Knowledge of health

issues will affect behavior as a medium-term outcome

of health education (Iqbal & Putra 2017). Health

education is one form of activity which is a health

development strategy to change the behavior of poor

Wicaksono, K., Yani, R. and Zulkarnain, E.

Effectiveness Difference of Family Psychoeducation Model and Family Centered Empowerment Model on Knowledge and Attitude in The Poor Family of Preventing Hypertention on Families

in Distric Jember.

DOI: 10.5220/0008320700730077

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 73-77

ISBN: 978-989-758-336-0

families in preventing health problems (Ministry of

Health of the Republic of Indonesia, in (Lestari 2011)

Provision of health education in the form of family

intervention aims to strengthen the family system. So

that the family can prevent the recurrence of disease

in family members who have hypertension.

Family psychoeducation model and family

centered empowerment model is an intervention

conducted and is the development of health education

model that treats the family as a source that focuses

on solving health problems that occur in family

members experiencing health problems. This study

was conducted to examine the differences in the

effectiveness of the family psychoeducation model

and the family-centered empowerment model in

improving the knowledge of poor families about

family health problems with family members who

have hypertension.

2 METHODS

2.1 Study Design, Population and

Sampling

This research was quasi experimental with non-

Randomize Control Group Pretest-Posttest Design.

The total population of 43 poor families and samples

in this study were 33 respondents of poor families in

Sukojember village, Jelbuk sub-district, Jember

regency with purposive sampling. The sample

members in this study were grouped into 3 groups,

groups given intervention family psychoeducation

model, the group given intervention family centered

empowerment model, and the control group.

2.2 Data Collection

The data collection in this research used the technique

of collecting pre-test and post-test of knowledge and

attitude of poor family in preventing hypertension in

family member using knowledge and attitude

questionnaires. This study piloted in two different

intervention groups. Then each group were tested

with different interventions, namely family

psychoeducation model consisting of 5 sessions, and

family centered empowerment model consisting of 4

sessions. The knowledge aspect questionnaire

consisted of 15 statements and an attitude

questionnaire consisting of 10 statements.

2.3 Data Analysis

Data analysis to know differences of knowledge and

attitude of poor family in preventing family

hypertension between control group and intervention

group before and after health education with different

method, namely family psychoeducation model and

family-centered empowerment model using Kruskall

Wallis statistic test. While the data analysis to

determine the difference of family effectiveness

psychoeducation model and family-centered

empowerment model to change the behavior of poor

family in preventing hypertension in family, using

Mann Whitney statistic test and mean value from

each intervention group.

3 RESULTS

The result of posttest knowledge found that 7

respondents (63.6%) from intervention group 1

(family psychoeducation model) had high knowledge

about prevention of hypertension in family, and 5

respondents (45.5%) from intervention group 2

(family centered empowerment model ) also had a

high knowledge about prevention of hypertension in

the family. The result of posttest shows that there was

not respondent with low knowledge about prevention

of hypertension in family, either in intervention group

1 (family psychoeducation model) or intervention

group 2 (family centered empowerment model).

Mann Whitney statistical test results on pretest

and posttest values of poor family knowledge about

prevention of hypertension in families of each

intervention group obtained p=0.403 with a

significant level α= 0.05. The conclusions can be

derived from the statistical test is that there was no

difference in the pretest and posttest results between

the intervention group 1 (family psychoeducation

model) and the intervention group 2 (family centered

empowerment model).

The posttest result of attitudes found that 9

respondents (81.8%) of the intervention group 1

(family psychoeducation model) had a good attitude

in preventing hypertension in the family, and 5

respondents (45.5%) from intervention group 2

(family centered empowerment model ) also had a

good attitude in the prevention of hypertension in the

family. Posttest results showed that there were not

respondents with less attitude in preventing

hypertension in families, either in the intervention

group 1 (family psychoeducation model) or

intervention group 2 (family centered empowerment

model).

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

Mann Whitney statistical test results on the pretest

and posttest values of poor families in preventing

hypertension in families of each intervention group,

obtained p value = 0,083 with a significant level of

0.05. This shows that p value is more than the

significant value (0.083> 0.05). The conclusions can

be derived from the statistical test is that there is no

difference in the pretest and posttest results of poor

family attitudes in preventing family hypertension

between the intervention group 1 (family

psychoeducation model) and the intervention group 2

(family centered empowerment model).

Statistical analysis of differences in pretest and

posttest values between the intervention group 1

(family psychoeducation model) and the intervention

group 2 (family centered empowerment model) were

not significantly different. Realistically, however, the

posttest value in each intervention group showed a

significant improvement over the pretest value in

each group. The highest average of the difference of

health education test result to the increase of

knowledge and attitude was the family

psychoeducation intervention model, ie the

knowledge component of 6.27 and the attitude

component of 4.45.

Table 1: Result of posttest analysis of poor family

knowledge in preventing hypertension in family between

intervention group.

Aspect

Intervention

Group 1 (Family

Psychoeducation

Model)

Intervention

Group 2 (Family

Centered

Empowerment

Model)

Amount

Knowledge

63.6

45.5

Table 2: Result of posttest analysis of poor family attitude

in preventing hypertension in family between intervention

group.

Aspect

Intervention

Group 1 (Family

Psychoeducation

Model)

Intervention

Group 2 (Family

Centered

Empowerment

Model)

Amount

Attitude

63.6

45.5

4 DISCUSSION

The result of knowledge test on prevention of family

hypertension in group 1 (family psychoeducation

model) and group 2 (family centered empowerment

model) got the change between before and after given

intervention. This is indicated by the number of

respondents with low knowledge about prevention of

hypertension in the family is reduced. Knowledge of

respondents about prevention of hypertension in the

family between before and after given intervention

experienced a significant difference. This proves that

health education intervention with family

psychoeducation model and family centered

empowerment model effectively improve respondent

knowledge about prevention of hypertension in

family. According to (McBride & Singh 2018) health

education is an effort to convey health messages to

the community, groups, or individuals. The purpose

of message delivery is to improve health knowledge

for the better and expected to affect behavior.

Provision of such intervention in each group are

equally able to improve the knowledge of

respondents. Intervention in the form of health

education with family approach model, namely

family psychoeducation model and family centered

empowerment model have fulfilled the concept of

health education in predisposing factors. According

to (Suerni, T, Keliat, BA, Helena 2013), stated that

health education using family-oriented approach to

make family (caregiver) able to know fulfillment of

their own needs, able to increase understanding about

what to do to the problem with existing resources plus

external support, and improve the ability in decide the

right action to improve the healthy living status of his

family members.

Changes in attitudes of respondents that occurred

can not be separated from the use of appropriate

model of health education. Health education model

can be used as a motivation for the subject to quickly

be able to receive new information, ideas, ideas, and

opinions (Andari 2014). The use of health education

model by taking into account the target characteristics

of family psychoeducation model and family centered

empowerment model, can help the effort to deliver

the message so easily understood and applied by the

family.

The family is a support system capable of

providing full support in an effort to improve the

health status of family members through behavior

change. Family behavior can be changed by

increasing understanding of a health problem.

Increased understanding can be achieved through the

provision of health information with an appropriate

approach model (Wiyati et al. 2010). A good level of

family understanding, will affect the attitudes and

actions of families in efforts to prevent health

problems, so that health problems can be resolved and

there is an increase in health status in the family.

Effectiveness Difference of Family Psychoeducation Model and Family Centered Empowerment Model on Knowledge and Attitude in The

Poor Family of Preventing Hypertention on Families in Distric Jember

The family psychoeducation model is a form of

health education that uses a family approach model

through a flexible model, because it combines

information-related health issues and ways to cope

with certain situations that can cause a health

problem. The family psychoeducation model focuses

on educating participants, with the aim of participants

being able to perform their health duties

independently (Wulandari et al. 2016). The

implementation of family psychoeducation model is

divided into 5 sessions, ie problem identification

session, concept and treatment education session,

stress management education session, burden

management session, and family empowerment

education session in utilizing health service source

(Mirsepassi et al. 2018).

Family centered empowerment model is a model

of health education with family approach. This model

of health education aims to establish families in

controlling the family's health status by strengthening

the family system (Mohalli et al. 2016). Objectives

after being given health information using this model

of health education, it is hoped the family can

improve or control the health status of the family by

increasing the family's ability to perform the

functions and duties of family health. The

implementation of the family centered empowerment

model is divided into 4 sessions, ie problem

identification session, family ability identification

session, knowledge improvement session, and

evaluation evaluation session (Vahedian-Azimi et al.

2016). The change of knowledge and attitudes of

participants after being given health education is a

success of the learning process in health education

that is influenced by the model used. This is in

accordance with the statement of (Lucksted et al.

2012), that the family psychoeducation health

education model has different information settings

and content from other health education models that

focus on developing participant skills aimed at

preventing family health problems. The explanation

above can be concluded that family psychoeducation

model has a better level of effectiveness than family

centered empowerment model based on test result

difference.

5 CONCLUSIONS

There is a difference of knowledge and attitude of

poor family in preventing hypertension in family

before and after done family psychoeducation model

and family centered empowerment model. Family

psychoeducation family intervention is more

effective to change the behavior of poor family in

preventing hypertension in family based on average

difference of test result.

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Effectiveness Difference of Family Psychoeducation Model and Family Centered Empowerment Model on Knowledge and Attitude in The

Poor Family of Preventing Hypertention on Families in Distric Jember