The community health worker experience and perception toward mental illness: A multi-settings cross-sectional study in Indonesia.

BACKGROUND: The experiences and perceptions of Community Health Workers toward mental illness are vital for tailoring interventions, reducing stigma, improving access to services, and fostering community engagement in mental health initiatives. AIMS: This study investigates the experiences of community health worker and their perception of mental illness. METHODS: A multi-settings cross-sectional study was conducted among 487 Community Health Workers. Their experience and perception toward mental illness were studied with questionnaires, which examined their general perception, religious-related perception, cause, treatment, and expectation for mental treatment. RESULTS: Most participants concurred that serving as a community health worker enhances their communication abilities (90.4%), strengthens connections with community health center staff (84.8%), boosts self-confidence (84.6%), and refines their capacity to identify signs of mental disorders (77%). Most notably, they consider their fellow community health workers essential to their extended family. Furthermore, a notable proportion associates' mental illness with religious elements, with 19.5% believing it can result from a lack of religious worship and a minority attributing it to witchcraft or black magic (3.5%). In terms of treatment, 14.2% think Ruqyah can cure mental illness, 6.4% believe in treatment by religious scholars, and a similar percentage (6.4%) think no medication or treatment is necessary for mental problems. CONCLUSION: Participants overwhelmingly recognize the positive impact of serving as community health workers, citing improvements in communication, relationships with health center staff, self-confidence, and mental disorder identification. The strong bond among community health workers, likened to an extended family, emphasizes their collective importance. Additionally, the majority advocates for compassionate treatment of individuals with mental illness. These findings underscore the complex interplay of professional, communal, and cultural elements in addressing community mental health.

Effectiveness of an Integrative Empowerment Intervention for Families on Caring and Prevention of Relapse in Schizophrenia Patients.

Introduction: Patients with schizophrenia require extended treatment and recovery, leaving their families and support systems feeling helpless. Integrative empowerment is a strategy that utilizes outside-in and inside-out empowerment to increase the ability of families to care for their loved ones and prevent relapse. Objective: This study aimed to investigate the impact of integrative empowerment intervention on enhancing the family's ability to care for and prevent relapse in patients with schizophrenia. Methods: The study employed a quasi-experimental with a pre-test and post-test control group design. The research sample was comprised of 70 individuals from nuclear families residing in Semarang, all of whom were responsible for the care of individuals with schizophrenia. The participants were divided into two groups: the treatment group, consisting of 35 individuals, and the control group, also comprising 35 individuals. Participant selection was carried out using purposive sampling. Module and booklet were produced as an intervention tools. The integrative empowerment intervention program spanned a period of 5 weeks, involving one session per week, each lasting approximately 60-90 min. Data analysis was conducted through the utilization of the Wilcoxon and Mann-Whitney tests. The significance level for the study was set at p<.05. Results: There was a significant change in the family's ability to care for patients with schizophrenia before and after the integrative empowerment intervention (p<.001), while there was no change in the control group's ability to care for patients with schizophrenia (p>.05). Integrative empowerment had a significant impact on increasing the family's ability to care for and prevent relapse in patients with schizophrenia (p<.001). Conclusions: Nurses can help families strengthen their positive caregiving experiences through the home visit program by utilizing integrative empowerment. This study's findings highlight the importance of integrative empowerment in enhancing the family's ability to care for and prevent relapse in patients with schizophrenia.

Family Empowerment Strategies for Relapse Prevention in Individuals With Schizophrenia: A Scoping Review.

The current scoping review aimed to provide an overview of family empowerment strategies used in relapse prevention among individuals with schizophrenia. Three major topics were explored: (a) the family empowerment model used in relapse prevention among individuals with schizophrenia; (b) family intervention strategies; and (c) special considerations for integrating family empowerment in relapse prevention among individuals with schizophrenia. There is a need to identify and use family resources and strengths, such as acceptance of schizophrenia, development of spirituality, involvement in daily activities, and understanding of behaviors that exacerbate symptoms, to reduce relapse risk. The family empowerment paradigm incorporates new information and coping skills, family support, meaning-making, life objectives, self-reflection, and good family experiences. Families as agents of care at home should be provided with stress management and family psychoeducation to improve family resilience. Further research is needed to understand family empowerment and develop comprehensive guidelines regarding relapse prevention management among individuals with schizophrenia. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Development of an integrative empowerment model to care for patients with schizophrenia disorder.

Background: The main factor that causes a family the inability to care for patients with schizophrenia disorder is inadequate family-centered empowerment. Nevertheless, the family-integrated empowerment model has not been developed yet. This study aims to develop a integrative empowerment model to care for patients with schizophrenia disorder. Design and methods: The mixed methods research design was divided into two stages. The first stage used a cross-sectional method with a questionnaire to 135 families who cared for patients with schizophrenia disorder using purposive sampling. Data analysis was obtained using Partial Least Squares (PLS). The second stage is a focused group discussion (FGD) conducted with six families, seven health workers, and six social workers, and discussions with two experts for model development. Results: The integrative empowerment-based family empowerment model is developed from Outside-in empowerment (path coefficient = 0.309; t = 3.292) and Inside-out empowerment (path coefficient = 0.478; t = 4.850). Family factors is the most potent variable in shaping Inside-out empowerment (path coefficient = 0.217; t = 2.309). Moreover, re-meaning of caregiving is the strongest indicator that builds the Inside-out empowerment variable (t = 42.643). The value of Q2 is 0.433 indicates that this model can be generalized, since 61% of family ability to provide care for schizophrenia patients. Conclusions: Re-meaning of caregiving is the most potent indicator in shaping Inside-out empowerment, which is the strongest factor forming this model. Nurses assist families to be able to find activities that can generate positive meaning when caring for patients with schizophrenia disorder.

Relationship between social support and family caregiver burden in schizophrenia patients.

Objectives: To assess the impact of social support on family caregivers of schizophrenia patients. Method: The cross-sectional, observational study was conducted at Menur Mental Health Hospital, Surabaya, Indonesia, from June to July 2021, and comprised family caregivers aged 20-60 years who lived with schizophrenia patients. Data was collected using the Indonesia version of Zarit Burden Interview and the social support questionnaire. Data was analysed using SPSS 25. RESULTS: Of the 160 subjects, 87(54.4%) were males and 73(45.6%) were females, and 88(55%) were adults, while 36(22.5%) had duration of care >10 years. All the 160(100%) patients had been receiving regular treatment. There were 64(40%) respondents who reported having good social support. The correlation between social support and the family caregiver burden related to schizophrenia patients was significant (p< 0.05). CONCLUSIONS: There was a significant relationship between social support and burden on family caregivers of schizophrenia patients.

Self-efficacy and social support have relationship with academic burnout in college nursing students.

Objectives: To analyse the relationship of self-efficacy and social support with academic burnout of nursing students. Method: The correlational, cross-sectional study was conducted in August 2021 at the Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia, and comprised nursing students in the 4th and 6th semesters of their academic programme. Data was collected using self-efficacy and social support questionnaires as well as the Maslach Burnout Inventory-Student Survey. RESULTS: Of the 184 subjects, 160(87%) were females and 24(13%) were males; 98(43.3%) were from the 4th semester and 86(46.7%) were from the 6th; 66(36.4%) were aged 20 years, followed by 65(35.9%) aged 21 years; and East Java was the hometown for 163(88.6%) students. Self-efficacy (p=0.005; r=-0.205) and social support (p=0.000; r=-0.265) were significantly associated with academic burnout. CONCLUSIONS: Higher self-efficacy and social support levels may lead to lower academic burnout among nursing students.

Analysis of factors related to the resilience of street children in Surabaya City, Indonesia.

OBJECTIVES: The inability to adapt to difficult and stressful situations in the environment leads to low resilience ability in street children. Knowing the influencing factors is important to help them achieve optimal resilience. This study aims to analyze the relationship between factors related to street children's resilience. METHODS: This study used a correlational design with a cross-sectional approach. The population was street children in two halfway-home in Surabaya (Kampung Anak Negeri and Sanggar Alang-Alang). The sample was 129 respondents obtained using simple random sampling. The independent variables were unpleasant past experience, antisocial behavior, level of depression, age, sex, length of time being street children and positive support. The dependent variable was resilience. Data were collected using questionnaires and analyzed by Spearman Rho-test with p<0.05. RESULTS: The result showed, that unpleasant past experiences (p=0.00 and r= -0.313), level of depression (p=0.00 and r= -0.279) and positive support have an association with resilience (p=0.000 and r=0.331). The lowest unpleasant past experiences and depression levels and the higher positive support will make higher resiliency in street children. CONCLUSIONS: This study has explained the unpleasant past experiences and depression levels as risk factors and the positive support as a supportive factor for street children's resilience.

Determinants of Burden in Family Caregivers of Individuals With Schizophrenia: A Systematic Review.

The current systematic review was performed to determine the specific burdens placed on families of individuals with schizophrenia. Scopus, PubMed, and CINAHL databases were searched, resulting in 21 articles that met inclusion criteria. Results showed that treatment of individuals with schizophrenia poses a burden on families. Most caregivers experienced emotional and financial problems that affected their quality of life. Influencing factors in caregivers were age, sex, educational level, family status, income, time spent with the individual per day, knowledge regarding schizophrenia, attitude, and psychological stress. Influencing factors in individuals with schizophrenia were age, sex, severity of illness, social function, and treatment adherence. Environmental factors were stigma, social support, and professional support from health care providers. Family caregivers of individuals with schizophrenia need to be empowered to improve resilience and acceptance in caring for these individuals. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 38-43.].

Psychometric properties of the Indonesia version religious health fatalism questionnaire in diabetic foot ulcer outpatients.

Background: Religious health fatalism belief that health outcome is only determined by God without seeking treatment. Tools are needed to measure fatalism among patients with chronic disease, especially diabetic foot ulcer (DFU) patients. The aim of this study was to conduct psychometric test of religious health fatalism questionnaire (RHFQ) including translation, validation, reliability, and cut-off point among DFU out-patients. Design and methods: This study employed cross sectional design, using self-report questionnaire. Data were collected from diabetes clinic in five hospitals, Indonesia. The inclusion criteria were patients who had history of DFU more than 2 years. Total sample in this study was 184 patients. This study was conducted from April to June 2021. Permission to use the RHFQ was permitted by the original author. We conducted translation and adaptation questionnaire to Bahasa. We employed reliability test with internal consistency, construct validity, and convergent validity. Construct validity was evaluated using exploratory factor analysis (EFA). Cut-off point RHS was analyzed using receiver operating characteristic (ROC). ROC was evaluated using correlation score between total score RHFQ and CDRISC-25 Indonesia version. Previous study mentioned that resilience is a predictor of religious. The Cronbach's alpha for RHFQ Indonesia version was adequate. Results: EFA showed adequate with Kaiser-Meyer-Olkin (KMO) value of 0.72 and the Bartlett's test of sphericity was significant. According to ROC curve analysis, the cut-off point at a score 67.5 indicated the best sensitivity and specificity. Conclusions: RHFQ Indonesia version had reliability and validity for screening religious health fatalism among DFU outpatients.

Development of a family resiliency model to care of patients with schizophrenia.

Families who care for schizophrenia suffer stress and lose the ability to treat. Family stress can be mediated by resilience. Objective: This study aimed to develop a family resilience model based on family-centred nursing for persons with schizophrenia. This study used a mixed-method cross-sectional approach. The population was a family of caregivers for persons with schizophrenia at Mental Hospital in Surabaya, Indonesia. The respondents were 137 families recruited by simple random sampling. Variables include family factors, risk factors, protective factors, patient factors, family stress, family resilience and family ability to care for persons with schizophrenia. The data were collected using questionnaires and then analysed with partial least squares. The statistical results afforded material for focus group discussions with six families and 10 health workers (psychiatrists, psychologists and nurses) in order to improve the model. The result showed family stress was influenced by family factors (path coefficient = -0.145; t = 2.26), risk factors (path coefficient = 0.753; t = 16.7) and patient factors (path coefficient = 0.159; t = 3.23). Family resilience is influenced by risk factors (path coefficient = 0.316; t = 2.60), protective factors (path coefficient = 0.176; t = 2.22) and family stress (path coefficient = 0.298; t = 2.54). Family resilience affects the family ability to treat persons with schizophrenia (path coefficient = 0.366; t = 5.36). The family resilience model increases family capability by 13.4%. The model helps families through stress management by controlling the burden and stigma so that families are able to survive, rise, growing stronger and be better at caring for persons with schizophrenia.

Perceived barriers on mental health services by the family of patients with mental illness.

BACKGROUND: Various efforts have been made by the Indonesian government to improve mental health services. In 2014, the government established Law no 18, which is about mental health and the treatment of people with mental illness covered by the universal health coverage. However, many people still experience difficulty in accessing mental health services. In Indonesia, family plays the role of a caregiver to people with mental illness. OBJECTIVE: This study aims to identify the perceived barriers on mental health services by families whose members suffers from mental illness. METHODS: This study is a qualitative research study with a phenomenological approach. Sampling was conducted by purposive sampling with a sample size of 12 participants. Data were collected using semistructured in-depth interviews. Thematic analysis was performed using Colaizzi steps. RESULTS: The obtained results presented three themes. Theme 1, mental health service affordability; theme 2, mental health service availability; and theme 3, negative attitudes (stigma). CONCLUSION: Families whose members suffered from mental illness still experienced barriers in relation to mental health services even with universal health coverage. Improved mental health services are related to the health insurance coverage, affordability, availability of mental health services and stigma reduction in the health professionals and wide community.

Family members' perspective of family Resilience's risk factors in taking care of schizophrenia patients.

OBJECTIVES: The study was conducted to illustrate the risk factors of family resilience when taking care of patients with schizophrenia. METHODS: The research used qualitative design with an interpretive phenomenology approach, with in-depth interviews. The subjects were 15 family members who cared for patients with schizophrenia at the Menur Mental Hospital, Surabaya, Indonesia. The samples were obtained by purposive sampling technique. The data was collected by interview and using field notes, then analyzed by Collaizi technique. RESULTS: This research produced two themes, they were care burden and stigma. Care burdens felt by families were confusion about the illness, emotional, physical, time, financial and social burdens, which leads to decrease in family quality of life. Families also experienced stigma called labeling, stereotyping, separation and discrimination. Stigmas meant that families faced psychological, social and intrapersonal consequences. This decreased the family quality of life and functionality of the family, and there were opportunities for negative results to family resilience. Health workers, especially psychiatric nurses, should review care burdens and stigma to develop nursing interventions so families are able to achieve resilience. CONCLUSIONS: This research explained how care burden and stigma are risk factors that must be managed by families to survive, rise up, and become better in caring for patients with schizophrenia. Nurses have a central role in assessing the level of care burdens and stigma in order to help families achieve resilience. Further research may focus on family-based nursing interventions to lower care burden, and community-based interventions to reduce stigma.