Hrev_master Healthcare in Low-resource Settings 2024; volume 12:11736 Family support and coping strategies among female inmates: a cross-sectional study in penitentiaries Akhmad Yanuar Fahmi Pamungkas,1 Yulifah Salistia Budi,1 Woro Nurul Seftianingtyas,2 Pipih Salanti,2 Tria Eni Rafika Devi,3 Muninggar Muninggar,2 Miftahul Hakiki,1 Muhammad Al Amin,1 Arni Nur Rahmawati,4 Prita Adisty Handayani,5 Rudiyanto Rudiyanto1 1Institute of Health Science Banyuwangi, Banyuwangi; 2Institute of Health Science Bhakti Pertiwi Indonesia, South Jakarta; 3Institute of Health Science Rustida, Banyuwangi; 4Universitas Harapan Bangsa, Indonesia, Banyumas; 5Institute of Health Science Telogorejo Semarang, Semarang, Indonesia Abstract Family is one of the closest people in helping individuals solve problems and serve as the foundation for developing coping strategies. Several factors influence coping strategies, including problem-solving skills and family support. This study aimed to explore the correlation between family support and coping strate- gies among female prisoners. The research employed a quantita- tive correlation design using a cross-sectional approach and a total sampling technique, with a sample of 33 female prisoners. The study included two variables: family support as the dependent variable and coping strategy as the independent variable. The chi- square test was used for data analysis. The results revealed that a majority of female prisoners received good family support (51.5%), and most of them used emotion-focused coping strate- gies (63.6%). The results indicate a significant correlation between family support and coping strategies for female prisoners, with a p-value of 0.004. It highlights the importance of family sup- port for prisoners in developing effective coping strategies. The findings emphasize that family support plays a crucial role in enhancing coping strategies for inmates, ultimately contributing to an improved quality of life. Introduction Prisoners are individuals who have violated the law, their independence is temporarily revoked to serve prison sentences in detention centers for committing crimes.1 Crime is a form of behavior that violates social rules applied by legal entities.2 Crime can be committed by anyone, male or female. The involvement of women in criminal matters in the life of the general public is indeed an odd thing to see from the inherent nature of women themselves and can occur among children, adolescents, adults, and even the elderly. The psychological factor of a man usually has a high emotional level, however, that does not mean that a woman does not have the potential to commit crimes. We can see that crimes committed by women are usually caused by economic fac- tors and social factors. Individuals who violate the law will receive punishment, both to society and justice. Part of the justice system is the Penitentiary (Prison Law no. 12). Penitentiarys make individuals who originally had freedom become individuals who are limited in many ways. These restrictions involve rules that must be followed, loss of privacy, and separation from the outside world, such as family and friends.1 Being a prisoner is a difficult and unpleasant thing because they have to live in a Penitentiary to serve their sentence and are required to be able to adjust to life in [Healthcare in Low-resource Settings 2024;12:11736] [page 1] Correspondence: Akhmad Yanuar Fahmi Pamungkas, Institute of Health Science Banyuwangi, Banyuwangi, Indonesia. E-mail: yanuarfahmi20@gmail.com Key words: coping strategy; family support; prisoners. Contributions: AYFP conceptualization, data curation, formal analysis, methodology, validation, visualization, writing – original draft, review and editing; YSB conceptualization, investigation, methodology, valida- tion, and writing, original draft, review and editing; WNS resources, investigation, and writing, review and editing; PS formal analysis, vali- dation, writing, review and editing; TERD resources, supervision, and writing, review and editing; MM resources, investigation, and writing – review and editing; MH formal analysis, validation, writing, review and editing; MAA resources, supervision, and writing –review and editing; ANR resources, investigation, and writing, review and editing; PAH con- ceptualization, and writing, original draft, review and editing; RR resources, investigation, and writing, review and editing. Conflict of interest: the authors declare no conflict of interest. Ethics approval and consent to participate: this research has been declared to have passed the ethical test with ethical no. 114/01/KEPK- STIKESBWI/V/2022 by KEPK Health Research Ethics Committee Sekolah Tinggi Ilmu Kesehatan Banyuwangi. During the research, the researcher pays attention to the ethical principles of information to con- sent, respect for human rights, beneficence, and non-maleficence. Patient consent for publication: written informed consent was obtained for anonymized patient information to be published in this article. In this research, the data collection process was carried out by directly distrib- uting questionnaires to respondents which began with an informed con- sent process to obtain approval from the respondents. Funding: this research did not receive external funding. Availability of data and materials: all data generated or analyzed during this study are included in this published article. All supporting data was obtained from the prison in Banyuwangi, the results of this research will be continued for intervention by the research site Acknowledgement: we would like to thank various parties who have helped realize this research: Head of Sekolah Tinggi Ilmu Kesehatan Banyuwangi, Research assistant officer at Banyuwangi Penitentiary. Received: 9 September 2023. Accepted: 17 November 2023. Early access: 5 December 2023. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:11736 doi:10.4081/hls.2023.11736 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Non -co mmerc ial us e o nly a Penitentiary. When imprisoned, female prisoners are isolated from the outside world, separated from their loved ones, lose pri- vacy, and subject to prison rules, which can cause psychological distress to prisoners due to the new situation.3,4 Several countries in East and Southeast Asia have the highest number of female prisoners. In general, Southeast Asia is at the highest level, namely, Thailand is ranked 5th, the Philippines is ranked 7th, Vietnam is ranked 8th, Indonesia is ranked 9th followed by Myanmar at ranked 11th5. Data in Indonesia showing the largest number of prisoners in 2018 are in the Regional Offices of North Sumatra, East Java, West Java, DKI Jakarta, and the Central Java Regional Office ranks 5th in Indonesia with a total of 9,493 prisoners, and Class II Brebes penitentiary occupies the top 15 in Central Java, this figure shows a high number and is a stressor for prisoners. The situation experienced by prisoners becomes a stressor that causes stress for most prisoners. Stressor situations include prison time, friendships in prison, environment, and family support but a crucial impact on prisoners is family sup- port because positive psychological support from the family can improve psychological well-being. The impact of stress on prisoners who are serving criminal sentences in prison always has physical and psychological impacts.6,7 There are 898 female prisoners in the Penitentiary (Prison) area in East Java. Many factors influence coping strategies, including physical health, a positive view of the problems faced, problem-solving skills, materials, and family support from within, such as emotional factors dealing with stress as well as spiritual aspects. Handling stress is very dependent on a person’s coping, the majority of female prisoners have positive and negative coping.8–10 Female prisoners in penitentiary need motivation and support from family or closest people to avoid anxiety and emotional prob- lems. Since they are apart from family support, to avoid anxiety and emotional problems, female prisoners can do positive coping strategies that can provide benefits to female prisoners how to relax, pray to get closer to each other’s beliefs, support friends in prison, listen to music, joke, or try to think of good things, express feelings by sharing with friends in prison, and help others.11–13 Coping is related to the form of effort made by individuals to pro- tect against psychological pressures, due to social experiences. Hence, psychologically, good coping is able to provide strength effects (feelings about self-concept and life), emotional reactions, reduce levels of depression or anxiety, and balance between nega- tive and positive feelings.14,15 Coping strategies used by prisoners will help them cope with the responsibility and pressure that comes with certain behaviors. The behavior that appears can be in the form of negative action responses, but can also be in the form of positive action responses through family support. Family support can come from parents, spouses or lovers, siblings, or even from loyal pets. With high family support, they have low-stress levels, are more successful at coping, and experience positive things in life more positively.16,17 Based on this explanation, the purpose of this study was to determine the correlation between family support and coping strategies for women prisoners at the Banyuwangi Penitentiary. Materials and Methods The study was a quantitative correlation design using a cross- sectional. The sampling method employed was total sampling, encompassing the entire population, resulting in a sample size of 33 participants. The study comprised two variables: family support as the dependent variable and coping strategies as the independent variable. For data collection, the Family Support Scale (FSS) by Carl J. Dunst was used to measure family support. The FSS demonstrated good validity (alpha > 0.8) and reliability (Cronbach’s alpha = 0.725) with 20 valid items falling into cate- gories of good (74-100), sufficient (47-73), and low (0-46). The coping strategy variable utilized the Way of Coping Questionnaire by Folkman and Lazarus (1986), which demonstrated validity (alpha > 0.7) and reliability (Cronbach’s alpha = 0.725) with 36 valid items. Scoring in this instrument categorized problem- focused coping (37.5-75) and emotion-focused coping (76-100), both of which were filled out by all respondents. Participants were categorized based on their detainee type and length of detention to investigate potential correlations with coping strategies. Data collection involved distributing questionnaires directly to respondents after obtaining informed consent. The ques- tionnaire results were then analyzed using the chi-square statistical test, with a p<0.05 signifying a significant correlation and a p>0.05 indicating a lack of significant correlation. Researchers ensured ethical considerations by informing par- ticipants about the research, obtaining informed consent, and pro- viding the option to decline participation. The study received ethi- cal approval (Ethical No. 114/01/KEPK-STIKESBWI/V/2022) from the Health Research Ethics Committee Sekolah Tinggi Ilmu Kesehatan Banyuwangi. Results Based on Table 1, it is explained that most of the characteris- tics of the respondents by age show that there were 18 people (54.5%) aged 20-35 years with an education level of almost half being high school as many as 16 people (48.5%). A total of 17 peo- ple (51.5%) of the prisoners’ marital status were widows and almost half of the prisoners had lived in the penitentiary for 0-9 months as many as 16 people (48.5%) and a number of 32 people (97%), almost all of the respondents were Muslim. The activities carried out by almost half of the prisoners in penitentiary were worship, 14 people 42.4%, and most of the cases involving respon- dents were criminal acts of drug abuse 19 people (57.6%). Regarding the result from 33 respondents, Table 2 showed that the correlation between family support and coping strategies for female-assisted residents was obtained from 17 people using fam- ily support in a good category. There were 21 people (63.6%) female-assisted residents who used emotional-focused coping, while 16 female-assisted residents experienced adequate family support and 12 people (36.4%) used problem-focused coping. This showed that most respondents have good family support as many as 17 people and most respondents used Emotional Focus Coping strategies which was 21 people (63.6%). The results of the chi- square statistical test on the correlation between family support and coping strategies among inmates obtained a significant p- value, namely 0.004 (p<0.05). This shows that there is a correla- tion between family support and coping strategies among inmates at the Banyuwangi Prison Institution in 2022. Discussion The results indicate that a majority of female prisoners received family support categorized as good. Family support, char- acterized as a form of family therapy, assists families in addressing Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions [page 2] [Healthcare in Low-resource Settings 2024;12:11736] Non -co mmerc ial us e o nly multiple health issues simultaneously. This support is typically provided by family members who have experience with the rele- vant issues in their social environment, offering emotional support and influencing acceptance behavior.18 Family visits to female prisoners in prison play a crucial role in affirming their existence and status within the family, fostering a positive outlook. During these visits, families demonstrate continued respect, love, and enthusiasm for the female prisoners.19 Family support can manifest in various forms, including internal family support from spouses, siblings, and other close relatives, as well as external family sup- port. The factors influencing family support can be categorized into internal and external factors. Internal factors encompass stages of development, education, knowledge level, and economic, emo- tional, and spiritual factors. External factors include family back- ground, socioeconomic status, and cultural influences. These fac- tors collectively contribute to the dynamics of family support for female prisoners.20 Effective family support can be influenced by factors such as age, marital status, and the duration of time female prisoners have spent in prison. Analysis of the age of female prisoners in prison reveals that the majority fall within the productive age range. This finding aligns with prior research suggesting that individuals in their productive age may encounter challenges related to desires and capabilities, potentially leading to criminal activities.21 By this age, individuals often possess mature attitudes and are receptive to advice from their families. Considering marital status, the majority of female prisoners are widows, emphasizing the continued need for robust family support in prison. This aligns with previous research, indicating that widows, having experienced married life, may face prolonged stress in the absence of family support.22 Support from parents, children, and close relatives becomes crucial for these individuals. Families of female prisoners frequently visit the prison, particularly during the initial months of incarceration, as over half of new respondents had lived in correctional institu- tions for 0 to 9 months. Research suggests that the duration of prison time is linked to an individual’s resilience in coping with problems, underscoring the importance of family support during incarceration.23 Family support is evident in the proactive efforts of female prisoners’ families, who take the time to visit and demon- strate care. This involvement helps female prisoners feel valued and cherished, as families pay attention to their well-being and inquire about both the health of the detainees and their families. These supportive actions contribute significantly to the overall well-being and adjustment of female prisoners within the prison environment. The study’s findings revealed that the majority of female pris- oners in Banyuwangi Penitentiary employed emotion-focused cop- ing strategies, with 21 individuals (63.6%) utilizing this approach. The ability of an individual to cope is influenced by various ele- ments, encompassing physical health, constructive attitudes or beliefs, problem-solving abilities, social skills, social support, and material resources. Coping strategies are methods employed to modify the environment or situation, or to resolve perceived or encountered difficulties.24 These influencing factors play a vital role in determining a person’s success in managing stress or anxi- ety, as coping strategies encompass not only problem-oriented but also emotionally oriented approaches. The aim of coping strategies is to navigate situations and demands perceived as pressing, chal- lenging, burdensome, or surpassing available resources.25 In this study, a notable emphasis is placed on emotion-focused coping, which centers on addressing the emotions arising from the chal- lenges faced. Emotion-focused coping entails prioritizing efforts to Transforming Healthcare in Low-Resource Settings: a Multidisciplinary Approach Towards Sustainable Solutions Table 1. Respondents’ characteristics (n=33). Characteristic Frequency Percentage (%) Age 20-35 years old 18 54.5 36-45 years old 8 24.2 46-65 years old 7 21.3 Education Elementary school 4 12.1 Junior high school 9 27.3 Senior high school 16 48.5 Higher education 4 12.1 Marital status Single 3 9.1 Married 13 39.4 Widow 17 51.5 Religion Islam 32 97 Christian 1 3 Duration of occupies Prison 0-9 months 16 48,5 10-24 months 11 33.3 25-36 months 4 12.1 > 36 months 2 6.1 Activity in Prison Physical Exercise 7 21.2 Worship 14 42.4 Coaching 7 21.2 Other activitiwa (related) 5 15.2 Reasons to enter prison Drug abuse 19 57.6 Tax 1 3 Embezzlement 7 21.2 Fraud 5 15.2 Child protection 1 3 Family support Good 17 51.5 Enough 16 48.5 Coping strategy Problem-focused coping 12 36.4 Emotion-focused coping 21 63.6 Table 2. Correlation between family support and coping strategies for women prisoners (n=33). Coping strategy p Problem focus coping Emotional focus coping Support family f % f % f % Good 2 11.8 15 88.2 17 100 0.004 Enough 10 62.5 6 37.5 16 100 [Healthcare in Low-resource Settings 2024;12:11736] [page 3] Non -co mmerc ial us e o nly alleviate the negative emotions experienced when confronting problems. This approach significantly impacts the success of female prisoners in managing stress and controlling anxiety in the face of threatening situations. Several factors contribute to shaping coping strategies, including physical health, positive perspectives on encountered problems, problem-solving skills, and the support provided by family and material resources. Recognizing and understanding these influencing factors are crucial for compre- hending the coping mechanisms adopted by female prisoners and can inform interventions aimed at enhancing their overall well- being in correctional settings.26 The age distribution of female prisoners in the prison predom- inantly falls within the productive age range, characterized by a capacity for effective problem-solving. Furthermore, nearly half of the respondents have an educational background at the high school level, indicating a reasonable ability to analyze problems. Female prisoners, as individuals employing emotion-focused coping, often find solace in surrendering themselves through religious practices, with worship to God being a prevalent coping mechanism. This coping mechanism is further exemplified by statements from assisted residents, revealing that they frequently turn to their clos- est friends for support when facing problems. Seeking meaning in each problem, approaching God through prayer, avoiding procras- tination of problems, assuming self-responsibility, discomfort with solitude, and actively seeking solutions are key aspects of the cop- ing strategies adopted. The study establishes a significant correla- tion between family support and coping strategies for female pris- oners at the Banyuwangi Penitentiary. Family support, considered a form of family therapy, proves instrumental in addressing various health problems within the family unit.18 This support can manifest as internal family support from spouses and siblings, as well as external family support. Influencing factors for family support encompass both internal and external aspects, with internal factors including stages of development, education, knowledge levels, economic, emotional, and spiritual factors. External factors encompass family, socio-economic status, and cultural back- ground. Recognizing these factors provides valuable insights for understanding the dynamics of family support and its impact on coping strategies employed by female prisoners in correctional set- tings.20 In this study, 48.5% of respondents possessed a high school education level, indicating a reasonable understanding of the fam- ily’s role in managing individuals. Consequently, respondents actively sought maximum family support, as evidenced by 51.5% reporting good family support. The spiritual activities of respon- dents during their incarceration indicated that 42.4% engaged in worship. The study’s findings revealed that a majority of respon- dents, specifically 63.6%, employed coping mechanisms primarily focused on emotions. Emotion-focused coping strategies entail an individual’s efforts to manage emotional responses in highly stressful conditions.27 Coping strategies, in general, involve ways to modify the environment or situation, addressing problems being felt or faced. These strategies are influenced by several factors, including physical health, positive beliefs or perspectives, prob- lem-solving skills, social skills, and social and material support. The success of coping strategies is contingent on factors such as physical health, positive perspectives on encountered problems, problem-solving skills, and the support provided by family and material resources.24 These factors collectively influence an indi- vidual’s ability to effectively control stress or anxiety in the face of threatening situations.26 Understanding these dynamics is crucial for comprehending how individuals, in this case, female prisoners, navigate and cope with the challenges presented during their time in correctional facilities.28 Conclusion In conclusion, this study reveals that a majority of female pris- oners receive good family support, and the predominant coping strategy employed by them is emotion-focused. 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