Hrev_master Healthcare in Low-resource Settings 2024; volume 12:11972 Parenting strategies: applying basic psychological needs to children at risk of Internet Gaming Disorder in Indonesia Nur Hidaayah,1,2 Esti Yunitasari,3 Hanik Endang Nihayati,3 Khamida Khamida,2 Ratna Yunita Sari2 1Doctoral Candidate of Doctoral Program, Department of Nursing, Universitas Airlangga, Surabaya, East Java; 2Department of Nursing, Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Surabaya, East Java; 3Department of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia Abstract Every parent desires their child to engage in both play and learning. Often, parents find themselves attributing any challenges to perceived shortcomings in their parenting and struggle to lever- age digital media effectively. This research endeavors to examine the fundamental psychological needs - autonomy, competence, and relationship - in relation to parenting strategies for children vulnerable to Internet Gaming Disorder. Employing an analytical cross-sectional design, the study focused on parents with children aged 8 to 12 years in Gresik City, East Java, Indonesia. A purpo- sive sample of 125 participants was selected. The research employed the satisfaction and frustration of the Basic Psychological Needs (BPN) questionnaire along with a parenting strategy scale. Descriptive statistical tests and multiple linear regression were utilized to analyze the BPN and parenting strate- gies. Simultaneously, BPN significantly influenced parental strategies (p=0.026, which is ≤0.05). In terms of effective contri- butions, autonomy, competence, and relationship collectively accounted for 7.3%, with individual effects of 1.82%, 5.56%, and 0.04%, respectively. Parents whose BPN were fulfilled exhibited effective parenting strategies, reducing the risk of Internet Gaming Disorder. Consequently, there is a crucial role for nurses and healthcare professionals in educating parents about preventing Internet Gaming Disorder in children. Introduction A common grievance among parents in various parts of Indonesia is associated with the provision of internet facilities and permitting children to engage in games.1-4 However, these facili- ties can have a detrimental impact on children. Parental perplexity increases as children begin to exhibit attention disorders, emotion- al dysregulation, disruptions in family relationships, and an exces- sive need for play.5 Consequently, children may overlook school assignments that should be completed at home and engage less with their peers.6 The role of parents’ strategies in educating children in the dig- ital era has not been extensively researched, particularly concern- ing the fulfillment of Basic Psychological Needs (BPN). Research on the use of online games and associated risks in children is scarce compared to studies on online game addiction in adoles- cents and adults.2,3,7 Given the critical importance of childhood for parental involvement in growth, development, meeting basic needs such as nutrition and housing, as well as educating children, it is imperative to prevent online game addiction.6 Data on online game players in Indonesia show an increase from 23.7 million people in 2019 to 28.1 million people in 2020, making Indonesia the seventh-ranked country globally for gamers.8 Despite the benefits, empirical data consistently demon- strates that excessive gaming has negative consequences on phys- ical and psychological functioning.9 Gamers exhibit worse emo- tional responses, impaired prefrontal cortex function, compro- mised cognitive control, diminished working memory and deci- sion-making abilities, decreased visual and auditory functions, and deficiencies in their neural reward system. These parallels Correspondence: Nur Hidaayah, Doctoral Candidate of Doctoral Program, Department of Nursing, Universitas Airlangga, Surabaya, Jalan Dr. Ir. H. Soekarno Street, 60115, East Java, Indonesia. E-mail: nur.hidaayah-2019@fkp.unair.ac.id - nurhid@unusa.ac.id Key words: basic psychological needs; children; Internet Gaming Disorder; parenting strategies. Contributions: NH, conceptualization, data curation, visualization and writing original draft, conceptualization, methodology validation; NH, EY, formal analysis; RYS, NH, methodology; EY, HEN, validation, review and editing; KK, investigation. All the authors have read and approved the final version of the manuscript and agreed to be held accountable for all aspects of the work. Conflict of interest: the authors declare no potential conflict of interest. Funding: this research was funded by Universitas Nahdlatul Ulama Surabaya, Surabaya, East Java, Indonesia. Ethics approval and consent to participate: the research protocol was per- formed following the Helsinki Declaration. Before participating in the study, all respondents signed a voluntary consent form. All procedures involved in this study were approved by the University Health Research Ethics Committee (Nahdlatul Ulama University, Surabaya). Approval code: 273/EC/ KEPK/UNUSA/2021. Patient’s consent for publication: written informed consent was obtained for anonymized patient information to be published in this article. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Received: 13 October 2023. Accepted: 23 February 2024. Early access: 21 March 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:11972 doi:10.4081/hls.2024.11972 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. [Healthcare in Low-resource Settings 2024;12:11972] [page 467] Non -co mmerc ial us e o nly with individuals with substance-related addictions suggest shared predisposing factors, indicating a potential addiction syndrome.10 The onset of gaming behavior in industrialized countries typi- cally occurs around the age of 8 years.11 In Indonesia, where access to games is easily affordable, some games may be expensive for children,3,12 prompting the extension of the current research to cover the age range from 7-8 years and above. Neurobiological examinations in addicted children reveal activity in the bilateral middle and inferior temporal gyrus, responsible for visual process- ing, and the right superior parietal lobule, responsible for spatial orientation, indicating impaired visual and auditory function.9 Magnetic Resonance Imaging (MRI) examinations show lower brain activity in the left inferior frontal gyrus and right inferior parietal lobe compared to matched casual game controls, indicat- ing barriers to control ability, attention and error processing, self- concept, and social anxiety. Pleasurable experiences in the brain due to frequent play result in a lower physiological response in the ventral striatum when anticipating rewards, motivating gamers to play intensely and disregard fatigue, rest, and daily life activities, including assignments and schoolwork.10,13 Satisfaction of BPN supports parents’ awareness of their role in parenting, as evidenced in studies related to game addiction. Parental knowledge about preventing gaming addiction is consid- ered protective, reducing the impact of the risk of peer victimiza- tion through BPN satisfaction mediation.6 On the other hand, fore- casts about gaming and social addiction depend on factors like the level of psychological control exerted by parents, the frustration of needs, or the child’s gender, along with the resulting outcomes. Parents’ experiences of parenting practices are identified as highly relevant to parents’ psychological needs according to Self- Determination Theory (SDT).14 SDT, coupled with parents’ strate- gies in preventing internet gaming disorder, emphasizes autonomy support, structure, and connectedness support.15 A parenting style that includes parental autonomy can support the child’s volitional function, aligning with an authoritative par- enting style, involving guiding the child during play.16 Parents, especially mothers, are advised to initially prohibit children from interacting with captivating objects.17 Mothers are expected to manage the child’s response to rejection through reasoning, polite requests, positive comments, and suggestions. This authoritative parenting approach aims to cultivate committed obedience in chil- dren.18 A parenting style that emphasizes connectedness involves parents expressing love and attention, fostering a close and understanding relationship with their children.14,19,20 Patterns that support competence involve implementing daily task rou- tines, planning joint activities, visualizing environments at risk of game addiction, identifying positive behaviors, and consis- tently enforcing agreed-upon rules. Competence support stimu- lates children’s social and emotional development.14,21 SDT- based parenting, with its focus on need satisfaction, enables parents to better control independence, connectedness, and competence compared to frustrated and dissatisfied parents.22,23 In light of the above, the researcher formulates the research objectives, aimed to analyze the relationship between parents’ basic psychology and parenting strategies in preventing internet gaming disorder in children. Materials and Methods Design and sample This study employed an analytical cross-sectional study approach. Specifically, it included all parents with children of pri- mary school age in the Gresik Regency area, East Java, Indonesia. The sample consisted of parents with children aged 8-12 years in the Gresik area, totaling 125 people. The inclusion criteria were as follows: parents (both father and mother) responsible for their own children, parents who provide their children with gadgets, and par- ents with children aged 8-12 years engaging in gaming for at least 1-3 hours per day in the last 3 months. Exclusion criteria com- prised parents who were absent due to sickness, job relocation, or having children in ill condition. Variable, instrument and data collection This research encompassed demographic characteristics vari- ables: child gender, parent age (years), child age, number of chil- dren, parent education, household income, family structure, and work. The independent variable was BPN (autonomy, competence, and relationships), while the dependent variable was parenting strategies. Two instruments were utilized in this study. First, the Basic Psychological Needs Frustration (BPNF) questionnaire: con- trolling for the Big Five Personality Traits.24 The validity test yield- ed a correlation value for each question ranging from 0.369 to 0.857, with a reliability Cronbach alpha of 0.915. Second, the Digital Parenting questionnaire: perceptions on Digital Risks.25 The validity test resulted in a correlation value for each question ranging from 0.486 to 0.700, with a reliability Cronbach alpha of 0.789. Procedure The initial step in this study involved obtaining permission from the Research Ethics Commission and the research site. Data collec- tion commenced on November 1, 2021, with questionnaires distrib- uted using a Google form to parents in the respondent group willing to participate, accompanied by proof of information permission. Data analysis Data management and analysis were conducted using SPSS 22.0. The influence of BPN (Competence, Relatedness, and Autonomy) on parenting strategies in children was analyzed using the Multiple Linear Regression test with a significance value of p<0.05. Ethical clearance The research protocol adhered to the Helsinki Declaration. Prior to participation, all parents willing to be respondents signed a voluntary consent form. All procedures in this study were approved by the University Health Research Ethics Committee (Nahdlatul Ulama University, Surabaya), with the approval code: 273/EC/KEPK/UNUSA/2021. Results The characteristics of the respondents indicate that 125 parents participated in the study, with 79% being female and 21% male. The respondents’ ages ranged from 33 to 50 years, with an average age of 40.42. The children involved in the study were between 8 and 12 years old, with an average age of 11.1. Regarding parental employment, 30.3% were employed full-time, 13.2% were part- time, 11.6% were housewives, and 5% worked from home. Further Transforming Healthcare in Low-Resource Settings: A Multidisciplinary Approach Towards Sustainable Solutions [page 468] [Healthcare in Low-resource Settings 2024;12:11972] Non -co mmerc ial us e o nly details can be found in Table 1. The results of the BPN analysis, consisting of autonomy, relatedness, and competence, indicate that autonomy has no significant effect on parenting strategies (0.068), relatedness also shows no significant effect (0.923), while competence has a significant effect on parenting strategies (0.005). Simultaneously, the combination of autonomy, relatedness, and competence collectively affect parenting strategies (0.026). In terms of the effective contribution (SE), autonomous, relatedness, and competence together contribute 7.3%, with individual effects being autonomous 1.82%, relatedness 0.04%, and competence 5.56%. For the relative contribution (SR), autonomous contributes 24.97%, relatedness 0.61%, and competence 76.28%, as illustrated in Table 2. Discussion This study aims to demonstrate a strong correlation between BPN and parenting strategies among parents with children at risk for internet gaming disorders. The sample criteria include parents who provide Internet (Wi-Fi) facilities at home along with gadgets for their children. Additionally, participants consist of parents who live in the same household or do not live separately from their children, parents whose children play online games for at least 3 hours a day, and parents willing to participate in the study. These findings underscore the significance of the quality of parental involvement, particularly for parents with strong BPN, in employing effective parenting strategies for children at risk of internet gaming disorder. Basic psychological needs of parents The results of the partial t-test for each BPN variable, specifically the autonomy variable, indicate no significant impact on parenting strategies. This lack of impact is attributed to parents experiencing pressure when confronted with disciplined parenting patterns that yield substantial parental autonomy in child care. Parents may feel helpless due to the reliance on gadget media for many children’s activities during online school, making it challenging to monitor whether children are engaging in assignments or playing. Parents with lower income levels may prioritize their work, leading to decreased attention to their children. Housewives, in turn, may allow their children to explore Transforming Healthcare in Low-Resource Settings: A Multidisciplinary Approach Towards Sustainable Solutions Table 1. Demographic characteristics of parents of elementary school students (N=125). Characteristics Frequency (f) Percentage (%) Child gender Men 86 68.8 Women 39 31.2 Parent age 30-49 3 2.4 50-64 120 96 > 65 2 1,6 Child age 8-10 46 36.8 11-12 79 63.2 Number of children 1-2 68 54.4 3-4 57 45.6 Education Basic 17 13.6 Middle 66 52.8 Higher 42 33.6 Household incomes High 26 20.8 Medium 16 12.8 Low 83 66.4 Family structure Nuclear 108 86.4 Binuclear 1 0.8 Single parent 5 4 Extended 11 8.8 Work Full-time job 4 3.2 Part-time job 34 27.2 Unemployed 17 13.6 Housewife 70 56 Table 2. Basic psychological needs of parents of elementary school students. Model Unstandardized Standardized t p F R R Square SE SR coefficients coefficients B Std. Error Beta Constant 52.933 6.882 7.692 0.000 3.199 0.026 0.271 7.3 Autonomous -1.065 0.578 -0.172 -1.844 0.068 1.8232 24.975 Relatedness 156 1.608 0.009 0.097 0.923 -0.045 -0.616 Competence 1.861 0.656 0.259 2.836 0.005 5.5685 76.281 [Healthcare in Low-resource Settings 2024;12:11972] [page 469] Non -co mmerc ial us e o nly the gaming world if the children are not demanding and prefer staying indoors. The support of the three BPN (autonomy, competence, and relatedness) within an individual’s social environment contributes significantly to the psychological well-being of parents.18 The findings of this study align with research articles indicating that parental basic need satisfaction serves as a predictor of autonomy support from parents. This conclusion is corroborated by Costa (2019), demonstrating that parents who perceive their basic needs as fulfilled are more likely to employ practices that support autonomy with their children.26 Additionally, the need for gender autonomy influences the fulfillment of the BPN for autonomy, which tends to be more pronounced in women.27 The results of this research indicate that the variable of relationship does not significantly affect parenting strategies. According to the questionnaire results, many parents foster relationships among family members, particularly with their children, by engaging in shared gaming activities. They often come together after exhausting activities outside and find entertainment through cellphone features. Parents who experience frustration in their relationship with their children may permit their children to play games as a reward after studying, and not monitoring their children’s screen time for more than 3 hours per day may pose a risk of interference with internet gaming. It’s noteworthy that in this study, only 21% of participants were mothers, contrasting with the majority (79%) of participants who were fathers. The lack of effect observed for the relatedness variable may also be influenced by gender, as fathers tend to maintain attachment relationships with their children more than mothers. The competence variable significantly influences parenting strategies, indicating that parents are content with their compe- tence and believe they are effectively managing parenting tasks. However, caution is warranted if parents feel frustrated with their competence, as this may lead to reduced confidence in resolving their child’s issues, particularly concerning difficulties related to playing internet games. The findings of this study align with research articles, demonstrating that parents who experience satis- faction BPN tend to exhibit greater independence in decision-mak- ing and increased confidence in their parenting skills. This sug- gests that they are more likely to enhance their ability to make informed decisions and apply reasoning to relevant rules for their children.26 Furthermore, parents’ screen time when interacting with gadgets and their attitudes are closely linked to children’s screen time. Parents employ active, restrictive, and collaborative strate- gies in managing technological device use. The study emphasizes the need for parents to acquire more information about evolving digital risks, as they may lag behind their children’s proficiency in playing advanced games.28,29 Based on the simultaneous F-test results, it is evident that Competence, Relatedness, and Autonomy each have a significant partial effect on parenting strategy. The regression test results indicate the percentage of influence exerted by BPN, either individually or collectively, on parenting. This is further supported by simultaneous results on R Square, suggesting a relationship between BPN and parenting strategies when considered together. The Standard Error (SE) variables of autonomy, relatedness, and competence also influence the parenting strategy. Previous research findings demonstrate that the satisfaction of BPN in parents contributes to both long-term and short-term happiness. Autonomy, competence, and attachment are identified as important mediators in shaping personality and providing parental support for children’s happiness and mental health. Moreover, these findings contribute to the existing literature on this subject.30 Parental strategy from the parents’ statement The parenting strategy, as indicated by parents’ statements, reveals a strict approach to overseeing children’s use of gadgets, particularly engaging in online games. Parents emphasize limiting children’s playtime to 1-2 hours per day, with a majority (90%) expressing the desire to understand how to control their children’s usage. Their motivation stems from a wish to protect their children from potential threats posed by malicious gaming sites on the Internet. Upon reviewing the responses to the research questionnaire, it becomes apparent that parents who detail their respective parenting strategies regarding their children’s digital media use are seeking effective strategies for parenting. Parents need to gain a better understanding of their children’s development while safeguarding their privacy from exposure to personal information and health issues.31 Various parenting strate- gies can be employed. Previous research articles have elucidated that a supportive parenting style fulfills three BPN, ultimately enhancing overall well-being. Interventions aimed at equipping par- ents with the knowledge and skills to implement warmth, structure, and autonomy support are deemed essential.32 A limitation of this study was the inability to conduct direct interactions with the participants’ parents due to the pandemic. For future research, it is suggested to employ a cross-sectional analytic design with a survey or direct interaction with parents to ensure results align with expectations. Recommendations stemming from this study propose implementing parenting strategies in seven ways, including persuasion, control, protection, monitoring, managing/reducing children’s screen time during online gaming, supporting children to use digital media appropriately (choosing age-appropriate applications), and minimizing gadget use, especially during family gatherings, as BPN have a strong relationship with parenting strategies. This study used a purposive sampling technique because, at the time of research Indonesia was facing the Covid-19 pandem- ic, and researchers could not meet directly with research respon- dents. There are also several influential variables in the study that have not been examined, namely the mother’s personality factor and the health status of the mother and her child. Implications Our results suggest that parents should be made aware of the importance of continuing to provide autonomy support to their children even after they become adults. It is crucial for parents to comprehend and acknowledge their children’s feelings, particular- ly during challenging transition periods. Additionally, they should foster an environment that encourages children to make their own decisions without imposing their opinions. Parents should recog- nize that establishing a psychologically controlling environment is counterproductive if they aim to promote healthy social media use by their children. Researchers may find it valuable to consider chil- dren’s psychological needs and parenting styles when developing interventions to encourage healthy social media use and self- directed learning. Conclusions The research results demonstrate that parents with effective and robust parenting strategies can play a crucial role in preventing the risk of internet gaming disorders in school-aged children. Additionally, such strategies can aid in averting the enduring consequences of internet gaming addiction in children, including obsessive tendencies, anxiety, stress, persuasion, and anti-social Transforming Healthcare in Low-Resource Settings: A Multidisciplinary Approach Towards Sustainable Solutions [page 470] [Healthcare in Low-resource Settings 2024;12:11972] Non -co mmerc ial us e o nly behavior. The three variables exerting the most significant influence on Parenting Strategy are Autonomy, Competence, and Relatedness. The primary limitation of this research is its conduction during the COVID-19 pandemic, leading to continued online learning. Consequently, the questionnaire was distributed via a Google form, facilitated by the homeroom teacher, who then informed all students. 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