Objective: The higher the level of education of a person, the wider the horizons of his thinking, so it is very helpful when a person grapples with stressful life events and develops coping skills to deal with stress. The stress faced by the caregiver will affect and increase expressed emotion. Caregivers with high expressed emotion are at risk of causing family members of person they cared for to experience stress.
Methods: This is an observational analytic study with a cross-sectional design. A total of 56 family caregiver at Surabaya Community Health Centre participated in this study. The measuring instrument used is a sociodemographic questionnaire and a Family Questionnaire (FQ) assessing expressed emotion.
Results: Statistical analysis generated a significant p-value of 0.000 with alpha of 0.05, thus the p-value ≤ 0.05. It indicated a significant association between education level with the expressed emotion of caregiver.
Conclusion: The education level of the family of caregiver will affect their expressed emotion

Cempaka, Anindya Arum

English

JURNAL KESEHATAN PRIMER

P a g e  | 1    Jurnal Kesehatan Primer Vol 6, No 1 Month Mei, pp. 1-8 P-ISSN 2549-4880, E-ISSN 2614-1310    Journal DOI:  https://doi.org/10.31965/jkp Website: http://jurnal.poltekeskupang.ac.id/index.php/jkp  Influence of family caregiver education level with their expressed emotion in caring for the elderly    Anindya Arum Cempaka   Nursing Faculty, Widya Mandala Surabaya Catholic University, Indonesia     Email:   anindya@ukwms.ac.id  ARTICLE INFO  ABSTRACT/ABSTRAK Artikel Histori:  Received date: Sept/24/2021 Revised date:  Oct/06/2021 Accepted date:  Nov/15/2021  Keywords:    Caregiver; level of education; expressed emotion;    Introductions:    The higher the level of education of a person, the wider the horizons of his thinking, so it is very helpful when a person grapples with stressful life events and develops coping skills to deal with stress. The stress faced by the caregiver will affect and increase expressed emotion. Caregivers with high expressed emotion are at risk of causing family members of the person they cared for to experience stress. This study aims to analyze the Influence of family caregiver education level with their expressed emotion in caring for the elderly.  Methods:  This is an observational analytic study with a cross-sectional design. A total of 56 family caregivers at Surabaya Community Health Centre participated in this study. The measuring instrument used is a sociodemographic questionnaire and a Family Questionnaire (FQ) assessing expressed emotion. Results:  Statistical analysis generated a significant p-value of 0.000 with the alpha of 0.05, thus the p-value ≤ 0.05. It indicated a significant association between education level with the expressed emotion of the caregiver. Conclusion: The education level of the family of caregivers will affect their expressed emotion. P a g e  | 2    Kata Kunci:   Caregiver; tingkat Pendidikan; ekspresi emosi    Pendahuluan: Semakin tinggi tingkat   pendidikan   seseorang maka semakin luas wawasan berpikirnya sehingga sangat membantu ketika seseorang bergulat dengan peristiwa kehidupan yang penuh tekanan dan mengembangkan kemampuan coping untuk mengatasi stres.  Stress yang dihadapi caregiver akan mempengaruhi dan meningkatkan Ekspresi Emosi. Caregiver dengan ekspresi emosi tinggi beresiko menyebabkan anggota keluarga yang diasuhnya mengalami stress. Penelitian ini bertujuan untuk menganalisis pengaruh tingkat Pendidikan family caregiver terhadap ekspresi emosinya selama mengasuh anggota keluarga yang berusia lanjut. Metode:  Penelitian ini menggunakan metode analitik observasional dengan pendekatan cross sectional. Jumlah responden dalam penelitian ini adalah 56 orang family caregiver yang merawat lansia di Surabaya. Alat ukur yang digunakan adalah kuesioner sosiodemografik dan Family Questionnaire (FQ) menilai ekspresi emosi. Hasil:  Dari hasil perhitungan secara statistik diperoleh nilai signifikan  p value  =  0.000  dengan memakai alfa sebesar 0,05 maka nilai p-value ≥ 0,05 sehingga  terdapat pengaruh tingkat Pendidikan caregiver dengan ekspresi emosi caregiver. Kesimpulan:  Tingkat Pendidikan family caregiver akan memengaruhi ekspresi emosinya. Caregiver dengan ekspresi emosi tinggi beresiko menyebabkan anggota keluarga yang diasuhnya mengalami stress. Sedangkan stres yang berlebihan dapat memicu kecemasan dan depresi.    Copyright© 2021 Jurnal Kesehatan Primer All rights reserved Corresponding Author: Anindya Arum Cempaka  Nursing Faculty, Widya Mandala Surabaya Catholic University, Indonesia  Email:   anindya@ukwms.ac.id P a g e  | 3     INTRODUCTION The higher the level of education of a person, the better their skill in expressing their means so that the ability to express what their feeling is in accordance with the breadth of understanding they have (Kristanti and Andromeda, 2018). All of these factors are helpful when a person is grappling with stressful life events and developing coping skills to deal with stress. Having the ability to solve problems, develop ideas, and implement plans will be very helpful when dealing with stress due to unwanted life events (Krause, 2019).  The caregivers of the elderly in Indonesian society are generally family, in this case, a spouse, child, son-in-law, grandson, close relative, or relative who lives in the same house. Families have the opportunity to monitor the elderly and observe the symptoms of the elderly deviation early and make important decisions as soon as possible. Family attitudes and support are beneficial for the development of healthy elderly personalities without interference (Flynn et al., 2013).  Family support also includes the expressed emotion. Expressed emotion is a perception in the form of verbal and non-verbal. It is an important aspect in determining the effectiveness of interpersonal communication, consisting of several attitudes, namely hostility, excessive criticism, and inappropriate support. Expressed emotion is divided into two categories, namely high expressed emotion, and low expressed emotion. High expressed emotion is defined by negative expression in the form of attitude full of criticism and hatred, negative thoughts, and negative attitudes towards the elderly who have certain diseases (Pardede, 2020; Li & Murray, 2015).  Agitation, delusions, hallucinations, and aggressiveness are behavioral and psychological problems associated with dementia in elderly as well as with caregiver burden. The caregiver’s expressed emotion level significantly mediates the relationship of the psychological problems experienced by elderly. The caregiver’s low level of expressed emotion will result in caregiver attitudes and behaviors that tend to not blame the elderly P a g e  | 4     for their illness (Wong and Zelman, 2020). Meanwhile, Family caregiver with high expressed emotions (hostile, criticizing, unfriendly, stressing and blaming) may cause the family members they cared for to experience stress (Weintraub et al., 2017).  METHODS This is an observational analytic study with cross-sectional design.  The research methods carried out with the aim to determine the association between dependent variable and the independent variable. The sampling technique is simple random sampling. This study falls within the scope of mental nursing with target population of family caregiver who cared for the elderly within five work areas in Surabaya in 2020. A total of 56 participant participated in this study. The research instrument used is a sociodemographic questionnaire and a Family Questionnaire (FQ) to assess expressed emotion. Data was collected by filling out the questionnaire through a form to minimize contact. The data is processed with a statistical software, the chi square test was conducted to assess the association between the independent and dependent variables.  RESULTS The bivariate test in this study was Chi Square test. This is due to the normality of the data which was tested with Kolmogorov-Smirnov and Shapiro Wik tests resulting in p-value of < 0.05. Table 1 shown that the participants with low education level accounted for 46%, while participants with high level of education accounted for 54%. Statistical analysis generated a significant p-value of 0.000 with alpha of 0.05, thus the p-value ≤ 0.05.  Table 1. the association between education level and expressed emotion. Family caregiver education level Expressed emotion (EE) N % p value Low EE High EE Low (Illiterate, elementary, and Junior high school) 9 17 26 46% 0,000 High  (Senior high school, college education and higher) 11 19 30 54%  Total 20 36 56 100%   P a g e  | 5     DISCUSSION  In this study, education level was categorized as 1 of 2 groups: Low (Illiterate, elementary school and junior high school), and higher education (senior high school, college education and higher).   From the table above, it is shown that the participants with low education level accounted for 46%, while participants with high level of education accounted for 54%. Statistical analysis generated a significant p-value of 0.000 with alpha of 0.05, thus the p-value ≤ 0.05. this means that the H0 is rejected, concluding that there is a significant influence of caregiver education level with their expressed emotion. This is in line with research conducted by Rashidpour et.al. (2019) which stated that the higher the level of education of the family caregiver, the lower the expressed emotion of the family caregiver. Education level will affect stress level because the higher the education, the lower the caregiver’s physical and mental burden (Nuralita et al., 2020; Yadav et al., 2018). In addition, education is expected increase individual’s self-awareness thus they have more empathy and can control their emotions (Rashidpour et al., 2019).  Education will help in developing communication skills, problem solving, data analyzing, developing ideas, implementing plans, motivating effort, and building self-confidence (Mirowsky & Ross, 2017).  People with higher education level will find it easier to receive information or guidance given to overcome their problems so that they are able to face social pressure and role conflicts (Nurfatimah and Entoh, 2018).  Based on a report by Effati-daryani et al. (2020), education level has an inverse statistical association with the three variables (depression, anxiety, and stress). If education level increases; depression, stress, and anxiety will decrease. Education can widen people’s knowledge and help them understand situation and increase the quality of their reaction to the events, especially during critical moments. People with high education level are expected to be able to more accurately follow up on deteriorating situation according to various resources such as scientific journal, cyberspace, media, etc.  (Effati-daryani et al., 2020). P a g e  | 6     According to Sadath et al. (2017), stress faced by caregivers will affect and increase expressed emotion. Caregivers with high expressed emotion (hostile, criticizing, a lot of pressure and blame) cause family members they cared for to also experience stress (Weintraub et al., 2017). Excessive stress can trigger anxiety and depression. It is supported by a study by Baetens et al., (2015) (2015) and Peris et al. (2015) which stated that the expressed emotions of family is correlated to depression in family members they cared for.  CONCLUSION The education level of the family of caregiver will affect their expressed emotion. Caregiver with high expressed emotion is at risk of putting the family they cared for in stressfull situation. The results of this study highlight the importance of an appropriate psychosocial intervention to manage the expressed emotion of caregivers in order not to negatively affect the elderly they cared for. Future research is expected to be able to accomodate the need of an appropriate interventions to reduce caregiver’s expressed emotion in order to provide maximum care at home for elderly.  REFERENCES  Baetens, I. et al. (2015) ‘The Relationship Between Parental Expressed Emotions and Non-suicidal Self-injury: The Mediating Roles of Self-criticism and Depression’, Journal of Child and Family Studies, 24(2), pp. 491–498. doi: 10.1007/s10826-013-9861-8.  Effati-daryani, F. et al. (2020) ‘Depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19’, pp. 1–10. doi: 10.1186/s40359-020-00464-8.  Flynn, S. J. et al. (2013) ‘Facilitators and barriers to hypertension self-management in urban African Americans: Perspectives of patients and family members’, Patient Preference and Adherence, 7, pp. 741–749. doi: 10.2147/PPA.S46517.  P a g e  | 7     John Mirowsky, J. and Ross, C. E. (2017) Education, social status, and health. New York: Routledge. doi: https://doi.org/10.4324/9781351328081.  Krause, N. (2019) ‘Assessing the relationships among stress, god-mediated control, and psychological distress/well-being: Does the level of education matter?’, Journal of Social Psychology, 159(1), pp. 2–14. doi: 10.1080/00224545.2018.1431604.  Kristanti, E. P. and Andromeda, N. (2018) ‘Mengapa saya tidak asertif? tinjauan asertifitas dari tingkat self-esteem mahasiswa, Jurnal Psikovidya, 22(1), pp. 86–99.  Nuralita, N. S., Camellia, V. and Loebis, B. (2020) ‘Relationship between caregiver burden and expressed emotion in families of schizophrenic patients’, Open Access Macedonian Journal of Medical Sciences, 8(B), pp. 586–591. doi: 10.3889/oamjms.2020.3692. Nurfatimah, N. and Entoh, C. (2018) ‘Hubungan Faktor Demografi Dan Dukungan Sosial Dengan Depresi Pascasalin’, Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan, 11(2), pp. 89–99. doi: 10.33533/jpm.v11i2.229.  Pardede, J. A. (2020) ‘Ekspresi Emosi Keluarga Yang Merawat Pasien Skizofrenia’, Jurnal Ilmiah Keperawatan Imelda, 6(2), pp. 117–122. doi: https://doi.org/10.2411/jikeperawatan.v6i2.403.  Peris, T. S. and Miklowitz, D. J. (2015) ‘Parental Expressed Emotion and Youth Psychopathology: New Directions for an Old Construct’, Child Psychiatry and Human Development, 46(6), pp. 863–873. doi: 10.1007/s10578-014-0526-7.  Rashidpour, P. et al. (2019) ‘The effect of family-expressed emotion on schizophrenia relapse rate’, Journal of Critical Reviews, 6(5), pp. 252–258. doi: 10.22159/jcr.06.05.40. P a g e  | 8     Sadath, A. et al. (2017) ‘Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis’, Asian Journal of Psychiatry, 25, pp. 163–168. doi: 10.1016/j.ajp.2016.10.023.  Statistik, B. P. (2017) Survey sosial ekonomi nasional, Badan Pusat Statistik. Jakarta.  Weintraub, M. J. et al. (2017) ‘Integrity of Literature on Expressed Emotion and Relapse in Patients with Schizophrenia Verified by a p-Curve Analysis’, Family Process, 56(2), pp. 436–444. doi: 10.1111/famp.12208.  Wong, C. S. C. and Zelman, D. C. (2020) ‘Caregiver expressed emotion as mediator of the relationship between neuropsychiatric symptoms of dementia patients and caregiver mental health in Hong Kong’, Aging and Mental Health, 24(10), pp. 1690–1699. doi: 10.1080/13607863.2019.1636200     

Influence of family caregiver education level with their expressed emotion in caring for the elderly: (Study at the Surabaya community health center)

Poltekkes Kemenkes Kupang Online Journal

The higher the level of education of a person, the wider the horizons of his thinking, so it is very helpful when a person grapples with stressful life events and develops coping skills to deal with stress. The stress faced by the caregiver will affect and increase expressed emotion. Caregivers with high expressed emotion are at risk of causing family members of the person they cared for to experience stress. This study aims to analyze the Influence of family caregiver education level with their expressed emotion in caring for the elderly. Methods: This is an observational analytic study with a cross-sectional design. A total of 56 family caregivers at Surabaya Community Health Centre participated in this study. The measuring instrument used is a sociodemographic questionnaire and a Family Questionnaire (FQ) assessing expressed emotion. Results: Statistical analysis generated a significant p-value of 0.000 with the alpha of 0.05, thus the p-value ≤ 0.05. It indicated a significant association between education level with the expressed emotion of the caregiver. Conclusion: The education level of the family of caregivers will affect their expressed emotion

Widya Mandala Catholic University Surabaya Repository

Influence of family caregiver education level with their expressed emotion in caring for the elderly

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Influence of family caregiver education level with their expressed emotion in caring for the elderly

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JURNAL KESEHATAN PRIMER

Poltekkes Kemenkes Kupang Online Journal

Widya Mandala Catholic University Surabaya Repository