Available online on 15.11.2022 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright  © 2022 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access   Full Text Article                                                                                                                                                                             Research Article 

Effective Communication The Foundation of Family Resilience Towards Healthy Adolescent

Reni Chairani¹, Bondan Palestin², Ani Nuraeni³

^1,3 Department of Nursing, Health Polytechnic of Jakarta I, Indonesia

² Department of Nursing, Health Polytechnic of Yogyakarta, Indonesia

INTRODUCTION

Communication is a very basic need in human life. Communication makes it easier for someone to convey information, messages, or ideas to others, so that harmonious relationships are established, including relationships in the family. Families need to build effective communication in order to achieve resilience in the family, because through communication the family can adapt to all very dynamic changes. Family adaptability is manifested by assertive behavior among family members, and it is easier to interact in the face of change so that the family becomes resilient.^1,2

Family resilience is the family's ability to survive, and rise from the problems or crises being faced, which causes the family to become stronger. Resilience implies tenacity and the ability to live independently and achieve family well-being. The involvement of all family members is very much needed, considering that family resilience is a collective strength in solving problems, one of which is adolescent health problems.^3,4

Adolescent health problems occur because of the unpreparedness of adolescents in adjusting themselves to physical, cognitive, mental, and social changes. Referring to the profile of Indonesian youth, according to UNICEF, 17% of the total population of Indonesia are teenagers aged 10-19 years with health risk factors during the pandemic, namely: the number of adolescents who smoked cigarettes increased (18.8%), experienced weight gain overweight (15%), increased unhealthy eating patterns (40%), decreased physical activity (49%), fewer opportunities to express opinions (63.1%), and felt more distant from family (25%). This profile complements the results of Basic Health Research (2018) which states that smoking behavior has started since the age of 10 years with routine use of cigarettes every day (13.4%), and there are adolescent using alcohol (9.63%).^5–7

The data above proves that adolescents are a group that is very vulnerable to maladaptive behavior that can cause illness and death. This is very reasonable considering that adolescence is a transition period for the formation of self-identity, tends to break away from dependence on family, and is more peer-oriented. This condition can actually be used as a teenager's potential to be developed and directed so that adolescents can think positively, creatively, be more responsible for solving problems faced in the phase of growth and development.⁸

Adolescents really need family support in overcoming their helplessness, so that maladaptive behavior such as drug use can be prevented through the establishment of harmonious communication between parents and adolescents by providing each other with psychosocial support and affection. This further clarifies the function of the existence of the family as a support system that is needed by adolescents. The description of effective communication as a subdomain of family resilience that can improve adolescent adaptive behavior to achieve healthy adolescents is the goal of the research conducted by the author.^9,10

MATERIALS AND METHODS

Quasi-experimental quantitative research conducted in the period June-September 2022 with a pre-post test with control group design to prove the hypothesis that the average score of adolescent healthy behavior in preventing health problems in families who apply the AMPiBI resilience model is higher than adolescents whose families do not apply the resilience model. AMPiBI. The promotion of promotive and preventive efforts for families who apply the AMPiBI resilience model is carried out 8 times through home visits and group activities at halfway houses. The sample size in the study was 76 families of street youth assisted by shelter homes spread over 5 urban areas, namely: Akur Kurnia Kramat Jati, East Jakarta, Tabayun, Bogor Regency, Bina Insan Mandiri, Depok City, Cinta Anak Negri Bekasi City, and Ahmad Dahlan Yogyakarta. Sample inclusion criteria: families who have teenagers aged 12-20 years, teenagers living with their parents, families and teenagers are under construction of a halfway house, and are willing to be sampled.

The questionnaire was compiled based on a literature review and modification of the questionnaire that was used by researchers in 2006 with the reliability coefficient r calculated compared to r table. (knowledge = 0.630; attitude = 0.837; and skills = 0.790).

This research has passed the ethical test from the Ethics Commission of the Yogyakarta Health Polytechnic number e-KEPK/POLKESYO/0692/V/2022 dated May 6, 2022, and has applied the basic ethical principles, namely: respect for human dignity, beneficence, and justice that guarantees human rights. respondent's rights and anticipation of ethical problems. All respondents were provided with information about the objectives, benefits, and procedures of the research in easy-to-understand language. Efforts to reduce the negative stigma of street youth assisted by shelter homes are carried out by ensuring that all respondents receive treatment according to the protocol, and the same benefits without discrimination. This is done to fulfill the element of right to fair treatment, namely the right to get fair treatment.

RESULT

The results of this study describe the difference in the average score of adolescent healthy behavior in families that apply the resilience model with families that do not apply family resilience, as well as the domain of family resilience that has the most influence on increasing adolescent healthy behavior.

Table 1. Frequency distribution of respondents based on their characteristics

Based on the results of the analysis presented in the table above, it shows that the majority of the youth groups in both groups are between the ages of 17 and d. 20 years. The education level of parents in the intervention group was mostly junior high school (50.0%) while the comparison group had more elementary school education (44.7%). Most of the parents in both groups worked.

Table 2. Frequency distribution of street adolescent problems

Table 3. Analysis of differences in family resilience in preventing of street adolescent problems

The difference in the total mean score of the Family Belief System in the intervention and comparison groups was 14.14 (Standard Deviation 0.468). Meanwhile, the family organization pattern score was 17.78 (SD 1.6) and the communication score was 17 (SD 1.176). Based on statistical analysis of the mean difference for the two unpaired samples, it shows that there is a difference in the mean of the three variables at a significance level of 5% (p=0.000). Likewise for the variable of adolescent maladaptive behavior, there was a difference in scores between the intervention group and the control group (p=0.000).

DISCUSSION

The results of this study prove that families who apply the AMPiBi family resilience model can increase the average score of their adolescent healthy behavior, and communication within the family is one of the important domains in improving adolescent healthy behavior. Changes in healthy behavior that occur in a person are influenced by predisposing, enabling, and reinforcing factors.⁸ The existence of effective communication in the family is a reinforcing factor to improve the ability of adolescents to monitor health and have healthy behavior. This study is in line with the results of research conducted by Thoyibah et al. which states that there is a significant relationship between family communication patterns and juvenile delinquency, because functional communication that is applied can prevent adolescent maladaptive behavior including those related to health.¹¹

Good communication patterns are one of the important factors in the implementation of family functions which will have an impact on increasing family resilience. Poor communication is one of the causes of conflict between adolescents and their families. Poor communication can occur because of the low frequency of children's willingness to talk to their parents, which triggers parental anger, but it should be realized that this condition can also occur due to the attitude of parents who are less concerned about their child's development. This condition is in accordance with the results of this study which showed that 71% of families in the intervention group and 63% of families in the control group had difficulty communicating with their adolescents. The results of previous qualitative research conducted by Chairani, et al stated that although the family was difficult to communicate with, the family was grateful that the teenager was still open and honest, making it easier for parents to give advice, because the family was afraid that their teenager would use drugs or alcohol.^12,13

The right communication technique for adolescent can be done by displaying open communication. Open communication is done by providing opportunities to express personal feelings, actively listening, encouraging adolescents to ask questions according to their needs. An open family attitude to develop effective communication will make adolescents feel accepted and valued as human beings, so that a positive self-concept can be formed. Similar research conducted by Luthfa and Muflihah, stated that adolescent smoking behavior can be prevented through the application of functional and open communication patterns. This opinion is reinforced by the statement that communication between parents and children about drugs can be a protective factor in preventing drug use, the study also reports that parents pay attention to communication techniques during conversations with their adolescents. The process of delivering messages from parents to children during the conversation needs to be considered, because the way messages are delivered from parents can affect the effectiveness of anti-drug use messages. Therefore, all the results of this study are considered by researchers to educate and train families of street teenagers about effective communication techniques between families and adolescents.^14–16

Families are given a pocket book on tips to improve family resilience to make it easier for families when accompanying teenagers through their stages of growth and development, especially the ability to communicate with teenagers. Increased family communication skills can be proven by an increase in the average communication pattern from 59.71 to 77.66. Interpersonal communication can make families closer to teenagers after knowing there are problems that occur in their teens. In addition, it can form family resilience and strengthen family functions to face increasingly tough challenges.

Improving family communication skills is very important to increase family resilience. Education about effective communication in the family which is implemented in the application of the Amphibian tiered intervention model, aims to make the family have an effective communication pattern between family members, which can strengthen the family's resilience in dealing with family problems.

The increase in the behavior of street youth and the resilience of street youth families is influenced by the behavior of adolescents and the resilience of previous street youth families. Therefore, in implementing the Amphibian tiered nursing intervention model, the concept of flexibility and negotiation is very much concerned. Examples of the application of the concept of flexibility and negotiation are providing opportunities for youth in their groups to choose topics to be discussed by considering prior knowledge, meeting times for health education and coaching, and selecting group members to serve as self-help groups who provide mutual support. The distribution of information is given when street youth and their families receive education about the topics in the pocket book in groups at halfway houses or individually during home visits. The application of the AMPiBi family resilience model can be an enabling factor that facilitates the improvement of adolescent healthy behavior. Considering the form of nursing action in the model is oriented to the cognitive and behavioral domains, which is carried out through health education programs, coaching, mentoring, and 5 home visits. Family resilience can be used as a guide in efforts to prevent, overcome, and strengthen families who are vulnerable to crisis, so that they become a resource to overcome problems. Family resilience also has an effect on increasing high self-esteem in family members including adolescent in it.^17,18

CONCLUSION

Communication within the family becomes a very important part, because there is openness, mutual empathy, freedom of expression, negotiation, agreement in making decisions, and being proactive in preventing crises.

The communication pattern of street adolescent families that increased significantly was due to education and guidance on effective communication within the family, which was implemented when implementing the family resilience model. The analysis also proves that family communication patterns can strengthen family resilience to make efforts to improve adolescent healthy behavior, because adolescents really need support from their families.

ACKNOWLEDGEMENTS

The authors thank to Health Polytechnic of Jakarta I for funding this research, all participants and research assistants.

CONFLICT OF INTEREST

The author declared that don’t have conflict of interest

REFERENCES

1. Kaakinen JR, Coehlo DP, Steele R, Robinson M. Family health care nursing: Theory, practice, and research. FA Davis; 2018.

2. Saltzman WR, Lester P, Beardslee WR, Layne CM, Woodward K, Nash WP. Mechanisms of risk and resilience in military families: Theoretical and empirical basis of a family-focused resilience enhancement program. Clin Child Fam Psychol Rev. 2011; 14(3):213-30. https://doi.org/10.1007/s10567-011-0096-1

3. Walsh F. Strengthening family resilience. Guilford publications; 2015.

4. Walsh F. Applying a family resilience framework in training, practice, and research: Mastering the art of the possible. Fam Process. 2016; 55(4):616-32. https://doi.org/10.1111/famp.12260

5. Vranda MN, Rao MC. Life skills education for young adolescents-Indian experience. J Indian Acad Appl Psychol. 2011; 37(9):9-15.

6. Chairani R, Palestin B, Netty E. Street Literacy as an Effort to Improve Healthy Behavior of Street Teenagers: Is it effective? J Drug Deliv Ther. 2022; 12(2-S):151-4. https://doi.org/10.22270/jddt.v12i2-S.5450

7. RI K. Hasil utama riskesdas 2018. Jakarta Kemenkes RI. 2018;

8. Allender J, Rector C, Rector C, Warner K. Community & public health nursing: Promoting the public's health. lippincott williams & wilkins; 2013.

9. Kayiranga G, Mukashema I. Psychosocial factor of being street children in Rwanda. Procedia-Social Behav Sci. 2014; 140:522-7. https://doi.org/10.1016/j.sbspro.2014.04.464

10. Martono N. Sosiologi Perubahan Sosial: Perspektif Klasik. Mod Postmod dan Postkolonial, Jakarta Rajawali. 2011;

11. Thoyibah Z, Nurjannah I, Sumarni D. Correlation between family communication patterns and juvenile delinquency in junior high school. Belitung Nurs J. 2017; 3(4):297-306. https://doi.org/10.33546/bnj.114

12. Lestari S. Psikologi Keluarga: Penanaman Nilai dan Penanaman Konflik dalam Keluarga. Prenada Media; 2016.

13. Chairani R, Hamid AYS, Sahar J, Nurachmah E, Budhi TE. Strengthening resilience in families of street adolescents with embedding spiritual values. Enferm Clin. 2019; 29:600-5. https://doi.org/10.1016/j.enfcli.2019.06.009

14. Fithria F. Hubungan Komunikasi Keluarga Dengan Konsep Diri Remaja. Idea Nurs J. 2011; 2(1):32-7.

15. Luthfa I, Muflihah KN. Komunikasi Keluarga Berhubungan Dengan Perilaku Merokok Pada Remaja di Kota Semarang. J Keperawatan BSI. 2019; 7(1). https://doi.org/10.36090/jkkm.v1i1.294

16. Kam JA, Miller-Day M. Introduction to Special Issue. J Fam Commun [Internet]. 2017; 17(1):1-14. https://doi.org/10.1080/15267431.2016.1251922

17. Chew J, Haase AM. Psychometric properties of the family resilience assessment scale: A singaporean perspective. Epilepsy Behav. 2016; 61:112-9. https://doi.org/10.1016/j.yebeh.2016.05.015

18. Walsh F. Family resilience: A developmental systems framework. Eur J Dev Psychol. 2016; 13(3):313-24. https://doi.org/10.1080/17405629.2016.1154035