THE INFLUENCE OF FAMILY SUPPORT GUIDELINES TOWARDS FAMILY

FUNCTION IMPROVEMENT IN ADOLESCENT

WITH UNWANTED PREGNANCY

I Gusti Ayu Pramitaresthi1, Ova Emilia2, Wenny Artanty Nisman 3

1
School of Nursing, Faculty of Medicine Udayana University
23
Master in Nursing Science, Faculty of Medicine Universitas Gadjah Mada
Corresponding Author: +6281805454031, email: gekmita27@gmail.com
ABSTRACT

Objective:This study were to determine the effect of family support guidelines application
to increased the family function in adolescents with unwanted pregnancy.
Methods:This study used Quasi Experiment with pretest and posttest Nonequivalent
Control Groups Design. The study was conducted in KYC Bali Province. The subjects in
this study were adolescents with unwanted pregnancy who came with her parents.
Consecutive Sampling was used to determine the total sample of 56 respondents, then the
randomize allocation was conducted to divide into two groups: 28 people of intervention
group and 28 people of control group. Collecting data used the questionnaires. Analysis
used Mann Whitney test to evaluate the difference between intervention and control group
and Wilcoxon test to determine the family function changes in adolescents with unwanted
pregnancy after intervention.
Result:This study showed significantly of the family function changes in adolescents with
unwanted pregnancy after received assistances with family support guidelines (p<0,05).
Conclusion:Application of family support guidelines can improve family function in
adolescents who experience unwanted pregnancy.

Keywords: Unwanted Pregnancy, Family Support Guidelines, Family Function.

1
Nursing Student, School of Nursing, Universitas Gadjah Mada
2
Supervisor, Faculty of Medicine, Universitas Gadjah Mada
3
Supervisor, School of Nursing, Universitas Gadjah Mada

INTRODUCTION
1
 Pregnancy could be a desire but also disaster if pregnancy is experienced by unmarried
adolescents. Pregnancy among adolescent women became one of the problems that developed
quite rapidly in many countries both developed or developing countries, including Indonesia
(Dariyo, 2004). Unwanted pregnancy is a condition of the couple does not want the birth of a
pregnancy. Pregnancy is the result of a sexual act or sexual relationship either intentional or
unintentional (Widyastuti, 2009).
In 2011, the World Health Organization (WHO) says there are 19% of the 16 million
adolescents aged 15-19 years worldwide experience unwanted pregnancy. In the United
States, each year more than 100 adolescents experience unwanted pregnancy. Teen pregnancy
rates are quite high in Indonesia. It can be seen through observations and a survey of the
Badan Koordinasi Keluarga Berencana Nasional (BKKBN) in 2013, found that of the total
population of adolescents (aged 14-19 years) with 34 million or 19.6% experienced unwanted
pregnancy and promiscuity numbers throughout the city large in Indonesia exceeded 50%.
qualitative study done by PKBI during 2013 which states that the highest percentage of
teenage with unwanted pregnancy in Bali, Mataram and Yogyakarta.
Data obtained through the unwanted pregnancy in adolscents of Bali from PKBI
programs that is Kita Sayang Remaja Youth Clinic (KYC). KYC Bali Province noted,
adolscents with unwanted pregnancy in Bali in 2013 as many as 177 cases with an average in
a month is 15 cases. Then, the data in 2014 found 111 cases with an average of one month is
the case in 11 cases. This data was revealed by the adolescent counseling to KYC Bali
Province.
Adolscents with unwanted pregnancy effect on adolescents is much larger when
compared with the effects of unwanted pregnancy at older age group both physically, and
psychologically. This happens because in adolescence growth and changes in physical,
cognitive and psychological not optimal. If the process is not yet optimal growth and
development, and coupled with the adolscents with unwanted pregnancy then the effect will
be felt much heavier (Gray, 2001).
Teens need of attention and help from those around him, both directly and indirectly in
addressing this crisis period. Support most expected by teenagers in the face of this crisis is
the her family support, especially of parents and siblings (Hurlock, 2004). The family has a
crucial influence on health and health beliefs associated with individual behavior (Schor,
1993). Families help teenagers with unwanted pregnancy in the decision. When teenagers
with unwanted pregnancy is not accompanied by the family can lead to destructive behaviors
such as choosing to terminate a pregnancy and suicide (Steinberg and Duncan, 2002).
Based on the results of preliminary studies on KYC Bali province on January 22, 2015
it is known that the form of support for families toward unwanted pregnancy that family
involvement in mentoring young people with adolscents with unwanted pregnancy when
counseling to decision-making. but in practice, not all adolescents with adolscents with
unwanted pregnancy bring his family by reason of embarrassment, fear or do not dare, do not
close or have a busy family. Adolescents with unwanted pregnancy tend to cover up a
mistake of his family, it is the primary obstacle in the implementation of interventions in
adolescents with unwanted pregnancy .
This is the reason to increase family functioning. Families optimal support must meet
the criteria for family functions. Research from David H. Olson (1999) mentions that there are
three dimensions of family functioning (Circumplex Model of Marital and Family Systems) is
a cohesion function, the function of flexibility and communication functions.
Therefore, health care should overshadow adolescents with unwanted pregnancy if it
finds the case requires family assistance obligations during the counseling process until the
decision making. Then, accompanying family must be given health education and family
support as guidance guide the family in dealing with their teenagers with unwanted

2
pregnancy. This is expected to improve the function of the family is most needed in the
process of handling adolescents with unwanted pregnancy. Under these conditions,
researchers interested in doing research. This study aimed to analyze the increase in family
function in the group that received assistance with the guidelines of family support than the
group with routine intervention in adolescents who experience unwanted pregnancy in KYC
Bali Province.

METHODS

1. Study design and partisipants

This study used Quasi Experiment with pretest and posttest Nonequivalent Control
Groups Design. The study was conducted in KYC Bali Province. The subjects in this study
were adolescents with unwanted pregnancy who came with her parents. Consecutive
Sampling was used to determine the total sample of 56 respondents, then the randomize
allocation was conducted to divide into two groups: 28 people of intervention group and 28
people of control group.
2. Measure
The independent variables in this study are guidelines for family support. The
dependent variable in this study was a family function (cohesion, flexibility and
communication) in adolescents with unwanted pregnancy. Control variables in this study
were age, education level, and economic status. Collecting data using a questionnaire
designed by the researchers with reference to the three dimensions of family functioning in
Circumplex Model of Marital and family Systems (Olson, 1999).
3. Data collection procedures
The study begins with a study permit to the Faculty of Medicine, University of
Gadjah Mada and taking care of ethical clearance letter issued by the Medical and Health
Research Ethics Committee (MHREC) Faculty of Medicine, University of Gadjah Mada.
Then, researchers permit research into the KYC Bali Province. Once licensing is
completed, the researchers chose to study co-author and research began on July 31, 2015.
At the first visit, the prospective respondents who came to KYC Bali meet researchers
conducted anamnesis companion for reasons related to her arrival. When potential
respondents who visited met the inclusion criteria, the study co describes an overview of
research, research objectives and asked the willingness of potential respondents to
participate in the study. If a potential respondent is willing to participate, the researcher
companion asked potential respondents to sign informed consent. Fellow researcher gave a
questionnaire containing demographic data to the respondent and provide time for five
minutes to respondents to fill out the questionnaire. After the demographic data collected,
researchers companion did pretest by giving questionnaires to measure family functioning
(cohesion, flexibility and communication) to the respondent. Furthermore, the
implementation of visits three times that in the 6th, 11th and 14th for the respondent and
family came to the study. On a recent visit (day 14) was measured posttest.
4. Statistical methods
Analysis used the Mann Whitney test and the Wilcoxon test used is the predictive
value of α = 0.05 and CI = 95%.

RESULTS

3
1. Characteristics of participants
Table 1 shows that most adolescent age is the age of 18 years, the intervention
group of nine people (32.1%) and the control group consists of eight people (28.6%).
Respondents were predominantly Hindu that the intervention group as many as 24 people
(85.7%) and the control group as many as 14 people (50%). Education level of respondents
in the intervention group and control the majority of graduate SMP (Junior High School)
that has the same number as many as 13 people (46.4%).
Family economic level respondents mostly had revenue >Rp. 1.000.000, - namely
in the intervention group as many as 14 people (50%) and a control group of 15 people
(53.6%). Then the age of first intercourse respondents ie intervention groups at the age of
17 years as many as eight people (28.6%) and group cases at the age of 18 years as many
as eight people (28.6%). On the table also explained that the data characteristics of
respondents homogeneous.

Table 1
Survey of characteristics participants in the KYC Province of Bali
July-October 2015 (n=56)
4
 Characteristics of Intervention Control p-value
participants n % n %
Age: 0,827*
 14 years 1 3.6 0 0
 15 years 4 14.3 3 10,7
 16 years 1 3.6 4 14,3
 17 years 6 21.4 7 25
 18 years 9 32.1 8 28,6
 19 years 4 14.3 2 7,1
 20 years 2 7.1 2 7,1
 21 years 1 3.6 2 7,1
Total 28 100 28 100
Religion: 0,090**
 Hindu 24 85,7 14 50
 Islam 2 7,1 12 42,9
 Kristen protestan 2 7,1 1 3,6
 Budha 0 0 1 3,6
Total 28 100 28 100
Level of education: 0,358**
 SD 3 10,7 3 10,7
 SMP 13 46,4 13 46,4
 SMU 11 39,3 9 32,1
 Diploma 1 3,6 3 10,7
Total 28 100 28 100
Level of family finances: 0,540**
 >Rp. 1.000.000,- 14 50 15 53,6
 Rp.500.000-Rp. 12 42,9 11 39,3
1.000.000,-
 <Rp. 500.000,- 2 7,1 2 7,1
Total 28 100 28 100
The age of first 0,367**
intercourse:

5
  14 years 2 7,1 0 0
 15 years 3 10,7 6 21,4
 16 years 1 3,6 6 21,4
 17 years 8 28,6 4 14,3
 18 years 7 25 8 28,6
 19 years 4 14,3 1 3,6
 20 years 3 10,7 2 7,1
 21 years 0 0 1 3,6
Total 28 100 20 100
*Mann-Whitney Test **Fisher Exact Test

2. Analysis of differences in family functioning (cohesion, flexibility and

communication) between the intervention and control group
Based on the table 2 is known that the difference in a family function in the
intervention group was higher than the control group.
Table 2
The differences in family functioning (cohesion, flexibility and communication) between the
intervention and control group in July-October 2015 (n=56)
Variable Intervention Control p-value
Low High Low High
Cohesion:
Pretest 10 (35,7%) 18 (64,3%) 16 (57,1%) 12 (42,9%) 0,111
Posttest 0 (0%) 28 (100%) 22 (78,6%) 6 (21,4%) 0,000*
Flexibility:
Pretest 14 (50%) 14 (50%) 13 (46,4%) 15 (53,6%) 0,791
Posttest 2 (7,1%) 26 ( 92,9%) 14 (50%) 14 (50%) 0,000*
Communication:
Pretest 10 (35,7%) 18 (64,3%) 17 (60,7%) 11 (39,3%) 0,064
Posttest 0 (0%) 28 (100%) 18 (64,3%) 10 (35,7%) 0,000*
*pvalue<0,05 with Mann-Whitney test = there is a difference score of family function

3. Analysis of changes in family functioning (cohesion, flexibility and communication) in

adolescents who experience unwanted pregnancy before and after receiving assistance
with family support in the KYC guidelines Bali Province
Based on Table 3 are known assistance with family support guidelines in the
intervention group significantly influence changes in family functions with p <0.05.

Table 3
Changes in family functioning (cohesion, flexibility and communication) in the intervention group and
control in July-October 2015 (n=56)
Variable Intervention Control
Pretest Posttest p-value Pretest Posttest p-value
(%) (%) (%) (%)
6
 Cohesion:
Low 10 (35,7%) 0 (0%) 0,002* 16 (57,1%) 22 (78,6%) 0,064
High 18 (64,3%) 28 (100%) 12 (42,9%) 6 (21,4%)
Total 28 (100%) 28 (100%) 28 (100%) 28 (100%)
Flexibility:
Low 14 (50%) 2 (7,1%) 0,001* 13 (46,4%) 14 (50%) 0,317
High 14 (50%) 26 ( 92,9%) 15 (53,6%) 14 (50%)
Total 28 (100%) 28 (100%) 28 (100%) 28 (100%)
Communication:
Low 10 (35,7%) 0 (0%) 0,002* 17 (60,7%) 18 (64,3%) 0,317
High 18 (64,3%) 28 (100%) 11 (39,3%) 10 (35,7%)
Total 28 (100%) 28 (100%) 28 (100%) 28 (100%)
*Nilai p<0,05 pada uji Wilcoxon = ada perubahan nilai skor fungsi keluarga

4. Analysis of the relationship outside variables to changes in the level of family function
(cohesion, flexibility and communication)
Based on the results of Table 4 shows that the educational level variable has a value
of p <0.05, which means the relationship between the level of education to change the level
of family functioning in adolescents with unwanted pregnancy.

Table 4
Multivariate analysis of external variables to changes in the level of family functioning (cohesion,
flexibility and communication) of respondents in i the KYC Province of Bali in July-October
2015
Variable Cohesion Flexibility Communication
Wald OR Wald OR Wald OR
Level of 0,053* 3,734 0,002* 9,595 0,009* 6,820
education
Level of 0,591 1,053 0,366 0,835 0,484 1,449
family finance
*p-value with regresi logistic test, p<0,05

DISCUSSION

1. Characteristics of participants
Life characteristics of the respondents indicate that most adolescent age is the age
of 18 who belong to the late teens. According Havinghurst (1995), when it was a teenager,
the individual has a social relationship that is wider than the previous childhood. This
suggests that individuals teen no longer depend on their parents. Parental controls already
started to decrease during this phase. Supposedly teenagers have passed through its
development tasks well, just because he felt he had grown and matured reproduction of the
more daring teens to take risks.
Respondents were predominantly Hindu because a study conducted in the province
of Bali are predominantly Hindu According to Crain (1992), the way people in life is
strongly influenced by socio-cultural factors that influence individual behavior patterns.
Education level of respondents in the intervention group and control the majority of
graduate SMP (Junior High School). Adolescents with low levels of education and low
aspirations stages tend to be more often led to sexual activity (Kusmiran, 2013).
Family economic level respondents mostly had revenue >Rp. 1.000.000, - that the
economy is at a good level. Social and economic life settled family is one of support which
forms the happiness of family life.

7
 The age of first intercourse respondents ie intervention groups at the age of 17
years. According to Thornburg (1982) pointed out that in this age teens are at the stage of
productive time to maturity of the reproductive system and the sex drive (libido). Thus, the
biological changes that occur and can lead to the activation of hormonal sexual behavior.
2. The influence of family support guidelines to increase the cohesion function
Results reveal that there is an increase in the value of family closeness function
(cohesion) in the intervention group after receiving assistance with family support
guidelines. It can be seen from the increase in value of the posttest and test different
functions of family closeness (cohesion).
Ginting (2004) stated that the incidence of unwanted pregnancy significantly both
quantitatively and qualitatively affect the lack of closeness function. Efforts are being
made in order to achieve increasing closeness in the family values one through the
implementation of guidelines for family support. This was confirmed also by the research
Corcoran (1999) which shows that the family has an important role affecting the lower and
higher emotional attachment feelings of closeness or adolescents. During the process the
teens face unwanted pregnancy, family support is indispensable. Including those closest
family with teenagers. Giving meaning to the family's reaction to the pregnancy and
unwanted pregnancy especially become very important.

3. The influence of family support guidelines to increase the flexibility function

The results show that there is an increase in the value of the posttest and test
different functions of the family flexibility (flexibility) in the intervention group after
receiving assistance with family support guidelines.
Corcoran (1999) in his research that flexibility is a significant factor on the
incidence of unwanted pregnancy in adolescents. In the group of teenagers who become
pregnant have a low flexibility function because of its leadership in the family largely
controlled by the father (paternal) and there is no democracy or a balance of leadership in
the family. Implementation of the guidelines that family support is one of the efforts
undertaken in order to achieve increasing the value of flexibility in the family.
4. The influence of family support guidelines to increase the communication function
The results show that there is an increase in the value of the posttest and test
different functions of family communication (communication) in the intervention group
after receiving assistance with family support guidelines.
Lee (2001) showed that communication between parents and teens have a
significant effect on the incidence of unwanted pregnancy in adolescence and depression in
teenagers with unwanted pregnancy. Balanced system in the family tend to have very good
communication, while the system is unbalanced tend to have communication that is not
good. Balanced system in the family tend to have very good communication, while the
system is unbalanced tend to have communication that is not good. Implementation of the
guidelines that family support is one of the efforts undertaken in order to achieve
increasing the value of communication in the family.
5. Factors that affect the function of the family
The results showed that the respondents' education level variables that affect the
function of the family: the function of cohesion, the function of flexibility and
communication functions. According to Mubarak (2006), the higher the education level,
the more easily juvenile teenagers receive information so that more and more able to adjust
in the lead role as a teenager.

IMPLICATIONS AND CONTRIBUTION

8
 Results of this study are expected to provide information for further research and
family support guidelines can be used as one of the methods in the intervention of adolescents
with unwanted pregnancy visiting adolescent reproductive health services.

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