Self-Image Strengthening Program in Children With Disabilities and Chronic Illnesses: A Quasi-Experimental Research
Introduction: Children with disabilities/chronic illnesses often have difficulties in socializing and tend to have a low self-image. Parents, as the main children’s self-image-forming factor, also ex-perience difficulties in dealing with their children. This study aims to increase children’s and parents’ knowledge about self-image and acceptance, hence improving children’s self-image. Methods: A quasi-experimental research study with the intervention of three modules for children and parents was carried out between June and September 2022. Thirty children and their parents from the Community for Empowerment of Parents of Children with Special Needs, the Heart Warrior Community, and the Foundation for De-velopment of Disabled Children were included. Pretest and posttest were measured and statistically tested using the Wilcoxon test. At the end of the interventions, the Rosenberg Self-Esteem Scale, Self-Harm Inventory, Strengths and Difficulties Questionnaire, and Pediatric Quality of Life were measured. Results: There was a sig-nificant increase in knowledge on 3 child modules and 1 parent module. The Rosenberg Self-Esteem Scale score is 17.17 ± 2.618 (good self-image); the Self-Harm Inventory score is 2.18 ± 3.275 (low risk of self-injury); the Strength and Difficulties Questionnaire score is 18.37 ± 5.230 (moderate difficulty); and the Pediatric Qual-ity of Life value is 34.64 ± 12.077 (good quality of life). Conclusion: The self-image strengthening module intervention is effective in increasing children’s and parents’ knowledge. Children with dis-abilities/chronic illnesses have a good self-image, low self-harm tendencies, and relatively good quality of life.
Introduction
Children with physical disabilities and chronic illnesses have limitations not only in activities but also in social functioning. They tend to have low self-esteem and experience isolation from their peers[1]. Asher and Coie's study found that children with disabilities and chronic illnesses who experienced peer rejection tended to have less interest in school, inhibited social experiences, and were motivated to be harmed. It affected self-concept and academic performance too[2].
Children with low self-esteem often have difficulty managing emotions, tend to withdraw from peer groups, and are socially isolated[3]. Self-image is related to children's understanding of their conditions and successful psychosocial functioning. Understanding their conditions can help them set realistic goals and manage their emotions[4]. Family support and peer relationships also play an important role in influencing children’s self-image. Children who receive positive support from parents, teachers, and peers have a more positive self-concept[5]. However, parents are often unable to provide this support because they have difficulty accepting their children’s disabilities and chronic illnesses, feel depressed and tired, and lack knowledge about their children’s conditions. In addition, many parents don't understand the importance of mental health.
This study aims to increase children's knowledge of self-image, managing emotions, and dealing with peer pressure, as well as parents' knowledge of children’s disability and chronic illness conditions, managing expectations and acceptance, mental health literacy, and stress management. It is expected that the interventions for children with disabilities and chronic illnesses and their parents will improve children's self-image.
Methods
This study is quasi-experimental research with a one-group pretest-posttest design method. This study was conducted in Malang, East Java, from June to September 2022. All subjects have given their written informed consent with oral and written explanations beforehand. This research received permission from the Research Ethics Commission of Universitas Brawijaya, number 104/EC/KEPK/05/2020.
The children and parents involved in this research were members of the Community for the Empowerment of Parents of Children with Special Needs (ABK), the Community of Heart Warriors (KPJ), and the Foundation for the Development of Disabled Children (YPAC). This research was conducted using non-probability sampling with a consecutive sampling method. The inclusion criteria in this study were all children and parents who were part of the Community for the Empowerment of Parents of Children with Special Needs (ABK), the Heart Warrior Community, and the Foundation for the Development of Disabled Children, Malang, Indonesia, in June-September 2022. The exclusion criteria in this study are children and parents who cannot read the questionnaire.
This study measures changes in children's and parents' knowledge. The interventions consisted of 3 training modules for children and 3 training modules for parents. The topics for children’s training modules included improving self-image, managing emotions, and dealing with peers. Parents were given modules on strategies for becoming prosperous parents of disabled children (managing expectations and acceptance, stress management, and mental health literacy), seminars on physical disabilities and chronic illnesses, and the role of family support in strengthening children's self-image, as well as parenting and communication skills. Before and after each training module, a pretest and posttest were carried out according to each topic. Training modules are conducted in hybrid (online and offline) three-session seminars in each community. The interval of each session was around 2 weeks with a duration of around 8 hours, including delivery of material, rest, and prayer. A 30-minute discussion was delivered after each topic. The pretest and posttest scores obtained were compared and statistically tested using the Wilcoxon test.
At the end of the intervention series, the Rosenberg Self-Esteem Scale (RSES), Self-Harm Inventory (SHI), Children's Strengths and Difficulties Questionnaire (SDQ), and Pediatric Quality of Life Questionnaire (PedQoL) were measured. Interpretation of the RSES is carried out by calculating the average score of all respondents. The average score of ≥15 means a child has a good self-image, whereas those with less have a poor self-image. SHI interpretation is carried out by calculating the average score of all respondents. Scores with a mean value of ≥5 have a high risk of engaging in self-harming behavior or being suspected of being a borderline personality. The SDQ questionnaire is interpreted by calculating the total mean value and classified based on interval values. The score interval 0 to 13 is classified as mild difficulty, 14 to 27 as moderate difficulty, and >27 as severe difficulty. The PedQoL questionnaire is interpreted by calculating the total mean value and classified based on interval values. A score interval of 0 to 18 means a high quality of life, a score of 19 to 37 a excellent quality of life, a score of 38 to 57 a moderate quality of life, a score of 58 to 76 a poor quality of life, and a score of more than 76 a catastrophic quality of life.
Results
Demographic data on 30 children shows that the majority gender is male, with an average age of around 11 years, and the highest education is elementary school. It was found that before intervention, children tended to remain silent when angry. When experiencing bullying, children also tended to remain silent or report it to their parents and/or teachers. Most children are close to both parents and tend to have activities with their parents. A total of 16 respondents were children with chronic illnesses (congenital heart disease, rheumatic heart disease, and other heart disease in children), and 14 respondents were children with
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