Social Care in Improving Self-Concept of Leprosy Patients

Introduction: Many infectious diseases occur in developing countries with low socioeconomic conditions. One such is leprosy. Leprosy is common in developing countries as a result of the country's limited ability to provide adequate services, including among some health workers. Such health workers are lacking knowledge and understanding of the false beliefs of leprosy and its resulting disabilities. The purpose of this research is to formulate a social care model in improving self-concept of leprosy patients in Probolinggo District. Methods: This research used explanatory research survey method with a crosssectional approach. The sample was 56 respondents. The variables were family support, social care and self-concept. The data were collected using a questionnaire modelled on Liandi, Richard H's concept and The Tennessee SelfConcept Scale. The data were then analyzed by Partial Least Squares (PLS) to test the hypothesis and form the empirical model. Results: The results showed social care was able to improve the self-concept of leprosy patients (T=5.800, T >1.96). Conclusion: Therefore, it is expected that nurses continuously synergize in maintaining social care conditions with the community in order to improve the self-concept of leprosy patients. ARTICLE HISTORY Received: September 7, 2018 Accepted: April 21, 2020


INTRODUCTION
Infectious diseases are common in developing countries with low socioeconomic conditions. One such is leprosy (Montaya, 2010). Leprosy is common in developing countries as a result of the country's limited ability to provide adequate services in the areas of health, education, and socioeconomic welfare in the community; leprosy is still feared by the community, among families, and even including some health workers (Lucinda, 2014). The World Health Organization (WHO) (2013) indicates that Indonesia has 17,012 cases of leprosy, although its leprosy prevention is better, as indicated by being ranked 4th after India, Brazil and Nepal. As of December 2015, in the preceding ten years, Indonesia succeeded in reducing leprosy morbidity by 85% from 107,271 people to 17,012 people (WHO, 2013). From these data, East Java is the province with the most leprosy patients, with the number of patients reaching 4,293 cases, with patients who have a lifelong disability as many as 184 and, childhood sufferers as many as 117 in the region of Madura, Tapal Kuda and Pantura (Ministry Of Helath (MOH), 2015). The case of leprosy patients in Probolinggo regency ranks seventh after Tuban, while the first order is Sampang Regency (Ministry Of Helath (MOH), 2015). Leprosy patients will experience body image or present their individual self-image. Illness and serious injury can damage self-concept, including disability. Adapting the behavior of illness can affect a person's feelings about their identity (Hobfolf, 2006). Threats to body image as well as self-esteem are often accompanied by feelings of shame, inadequacy and guilt. In a healthcare setting, people sometimes have to adjust to a situation that threatens their self-esteem, (Hasselhorn, 2010) and leprosy patients will experience some problems, both physically, psychologically, socially, and economically (Misch, 2010). A preliminary survey conducted in February 2016 from medical records at Glagah Puskesmas Probolinggo District showed that there were 34 patients recorded from 2012 to 2015 and that most of the patients (41.03%) had experienced disability of Busier Pausi (PB), while those with disability level of Multi Basiler (MB) was as much as 58.97%. From the results of field observations with the help of health cadres from Glagah Puskesmas, researchers found that leprosy patients feel their self-esteem (selfconcept) is very low. Patients isolate themselves from society, even families. The main goal is for patients to socialize to the community to improve their selfconcept through s social approach. Social care in the provision of health services needs to be done (Curtis, van der Heijden,Kümmerlin, van Dam, & van der Schoot, 2009) so that,hopefully, the family is not just resigned to the state of patients who also isolate themselves from the family.Thus the nurse must also attend the family and patient to provide health education. The purpose of this research is to formulate a social care model in improving the selfconcept of leprosy patients.

MATERIALS AND METHODS
This research used explanatory research survey method with a cross-sectional approch. The sample was 56 respondents. The variables in this study were family support, social care and self-concept. The data were collected by three kinds of instruments. The family support was measured by questionnaireadopted from Liandi (2011). The social care using questionnaires whas developed by researchers based on Richard H's concept (2015). The Tennessee Self-Concept Scale (Fitts, 1965) was used for measuring self-concept. The analysis technique used is a model based on variance or componentbased, known as Partial Least Squares (PLS). PLS is a powerful analysis, since it does not assume that data should be of a certain scale, can work with a small sample, and can also be used to confirm the theory (Ghozali, 2009). This study was approved by the Hafshawaty Pesantren Zainul Hasan Institute of

RESULTS
The results showed respondents' characteristics consist of gender, age, education level, marital status and time of leprosy diagnozed.
According to Table 1, most respondents were male (57%, 32 respondents), 27 % were over 40 years old, 62% of them were married, and had suffered from leprosy for 1-5 years (43%). Table 2 explains about family support. Most of the family have low empathy for leprosy patients (45%), low encouragement of leprosy sufferers (45%), provide less facilitation for patients (45%) and also low participation (43%) to leprosy patients. Based on Table 3, social care can be explained asdominated by low levels in all domain. The respondents received low opportunity, freedom and attention (45%). Table  4 decribes the leprosy patient' self-concept. Selfimage category was 45% in moderate scale, and a mostly low scale for the self-esteem (45%) and role dimensions (43%). Table 5 shows that the indicator of the family support (encouragement and facilitative) was not significant (p value > 0.05), so the indicator should be discarded and only family support variable 1 is significant as an indicator of the family support variable. All indicators of the social care were significant (p value <0.05), so that all indicators are maintained as indicators of social care variables. Indicator of self-concept variable (self-role and self-ideal) was not significant (p value > 0.05), so the indicator must be discarded and only self-image, self-esteem and personal identity were significant and maintained in the model. Table 6 explains the path coefficient of paramaters based on PLS test. Individual reflective size is said to be valid if it has a loading correlation loading with the latent variable construct measured, ≥ 5%, or the Tstatistic value must be greater than 1,96 (two-party test) at the significance level α = 5%. Table 6 shows that family support influences the self-concept of leprosy patients (T=4.953), family support affects social care (T=3.960), and social care influences the self-concept of leprosy patients (T=6.285).

Inner model test result
The self-concept model of leprosy patients is composed of three variables: family support, social care and self-concept. Self-concept in leprosy patients is directly affected by family support and social care. Self-care conditions of leprosy patients can be reinforced indirectly through social care channels reinforced by family support (Hamim, 2015). Based on the outer weights of the outer model test, there are several indicators of each latent variable that are not significant, so it must be reconstructed first to obtain the ideal model.
Based on Table 7, the results of the reconstruction of the leprosy self-concept model developed from three main variables, including family support, social care and self-concept, show the self-concept of lepers is directly influenced by family support and social care. Among family support for the latent variable is empathy, while the conditions of leprosy self-care on the latent variable, which is the main determinant, are self-image, self-esteem and role, which can be strengthened indirectly through social care channels with the latent variables among them, freedom. and attention, reinforced by family support.
The result showed that the model formed from this prediction has good predictability relevance. Based on Q 2 Interpretation, a construct has a good predictor relevance when it has a value of Q 2 > 0 (Chin, 1998). In this model Q 2 was 0.459 (Q 2 > 0).

DISCUSSION
The influence of family support on self-concept of leprosy patients Based on the results of research, it shows the influence of family support on the self-concept of leprosy patients with a T-Statistics value of 4.718 (T >1.96). There is influence of family support to self concept of leprosy patients as all four types of social support (i.e., emotional, instrumental or real support, information support, and assessment support) are involved in the interactive process between the social network of individuals (i.e, family and peers) and individuals with heart failure in maintaining self-care behavior that improves health and wellbeing. However, further research is needed, in particular longitudinal and experimental design, to determine the effectiveness of social support on self-care behavior in individuals with heart failure, as this review reveals most of the cross-sectional, correlational research limits the ability to infer causality (Lucinda, 2014).
Thus, the important role of family support is to change the mindset of lepers and other people to bring about the quality of a better work life. These conditions will cause the desire of the patient to socialize with the surrounding environment and includes activities that exist within each household, . This is directed to improve working life conditions, which can raise the spirit of the sufferers in carrying out the task of achieving a normal life. Similarly, people around the patient will feel an integral part of their everyday life.

The influence of family support on social care
The condition of the influence of family support on social care has T-statistics of 3.977 (T > 1.96). Thus, there is influence of family support to social care. The condition of good support will have an impact on good culture so that the patient's activity can be improved maximally; the nurse will also benefit from the positive activity. Therefore, all components in the society are expected to maintain the existing conditions so that society will continue to be part of  (Friedman, 2013). Social services are divided into two groups. First is social services, which are very complicated and comprehensive and so difficult to determine identity (Curtis et al., 2009). These services include education, social assistance in the form of money by the government, medical care and public housing. The second is clear social service scope and its services, although these are always changing. This service can stand on its own, for example child welfare and family welfare, but it can also be a part of other institutions, such as social work in schools, medical social work, social work in public housing and social work in industry. Social service in the broad sense is any service intended to improve the social welfare of human, while, in the narrow sense, it is the service given to some people who are less fortunate (Desi, 2011). Thus, in a synergy,the better the support of the family will have an impact on the overall social attention, because how can social attention can be maximized if there is no support from the family on the patient.

The effect of social care on the self-concept of leprosy patients
The results showed the influence of social care on the self-concept of leprosy patients. Table shows the influence of social care on self-concept of leprosy patients with a T-statistics score of 5.800 (T >1.96). There is influence of social care to self-concept of leprosy patients. The concept of self defines all ideas, thoughts, feelings, and beliefs that involve individual knowledge about self and affects the relationship with others (Stuart & Sundeen, 2006). Self-concept consists of self-image, self-esteem, role of self, selfidentity and self-ideal, while the factor that influences the formation and development of self-concept is age. Self-concept is formed along with increasing age whereby this difference is more related to development tasks. Education also influences selfconcept. A person with a high level of education improves his achievement. If his achievement increases, then his self-concept will change. Socioeconomic status affects the acceptance of others toward him. Family relationships of a person who has a close relationship with his or her family members will identify with others and want to develop the same personality pattern, if this is a same-sex character it will develop a self-concept worthy of his sex. Other people make us know ourselves by knowing others first. How another knows ourself will contribute to form self-concept. Individuals are accepted by others, respected and liked because of their condition and individuals will tend to be respectful and accept him. Conversely, when others always underestimate themselves, blame, and reject, they will tend to not like him.

CONCLUSION
There is influence of family support to the selfconcept of leprosy patients. The findings show the influence of family support on the self-concept of leprosy patients. The better the family support, the higher the self-concept of leprosy patients. There is influence of family support to social care. From the results of analysis, it shows the influence of family support to social care, The better the family support, the better the social attention of society to leprosy patients.There is influence of social care to selfconcept of leprosy patients. Results analysis shows an influence of social care on self-concept of leprosy patients; the better social care or social attention of people to leprosy patients, the higher the self-concept of leprosy patients.