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The Correlation between Family Support and Quality of Life in Mothers with
Positive HIV in Surabaya

Article  in  Indian Journal of Public Health Research and Development · January 2019

DOI: 10.5958/0976-5506.2019.02278.2

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 DOI Number: 10.5958/0976-5506.2019.02278.2

The Correlation between Family Support and Quality of Life

in Mothers with Positive HIV in Surabaya

Ika Nur Pratiwi1, Purwaningsih1, Sevina Ramahwati1

1
Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia

ABSTRACT
The quality of life of mothers with positive Human Immunodeficiency Virus (HIV) is a concern due to a lack
of family support. The aim of this study was to determine the relationship between family support and the
quality of life of mothers living with positive HIV in Surabaya. This was a descriptive correlational study
with a cross sectional approach. The subjects were 30 mothers with positive HIV from two public health
care facilities in Surabaya who were already confirmed to have positive HIV by healthcare professionals
without manifestation of Acquired Immune Deficiency Syndrome (AIDS). Family Support Questionnaires
used were family support and World Health Organization Quality of Life (WHOQOL) HIV for quality of
life. The data was analysed using Spearman’s Rho correlation test with P value < 0.05. The result showed
that the majority of respondents are in early adulthood (26-35 years). Some respondents had HIV for less
than 4 years and used anti retro viral (ARV) for 2 years. There was a moderate positive correlation between
family support and quality of life of mothers with positive HIV (P = 0.026, Spearman’s rho = 0.48). The
better the family support, the higher the quality of life which may be achieved by the clients.

Keywords: family support, quality of life, mother, HIV

Introduction years (68%), followed by the age group of 20-24 years

HIV cases cause various effects on sufferers, in
addition to reducing the body’s resistance and the
emergence of opportunistic infections (OIs), patients can
also experience psychological and social problems.1 The
HIV epidemic is a global crisis and a serious challenge
to developmental and social progress. Since its start
in 1981, AIDS has become a major health problem
worldwide. There have been more than 78 million
people infected with HIV by the end of 2013 with
people living with HIV/AIDS amounting to 35 million.2
In Indonesia, the number of new HIV infection cases is
known to be 8,908 people, these cases have increased
twice compared to 2013 where 6,528 (42.0%) cases were
women. According to the type of work, the housewife
group ranks highest.3 The highest percentage of the age
of HIV infection was reported in the age group 25-49
Corresponding Author:
Ika Nur Pratiwi
Faculty of Nursing Universitas Airlangga,
Surabaya, Indonesia
Email: ikanurpratiwi@fkp.unair.ac.id
(18,1 %). East Java entered second province (19,249
cases) after DKI Jakarta (32,782 cases).4 The city of
Surabaya has the largest number of cases of HIV in East
Java.5 HIV cases in Surabaya have the potential to cause
problems because until 2016, the age group affected by
HIV was highest in the age range of young adults, the
productive phase. Young adulthood begins at the age of
25 years and ends at age 40.5
HIV cases caused various effects on sufferers in
addition to reducing the body’s resistance and the
emergence of opportunistic infections (OIs), patients
can also experience psychological and social problems.1
Family support can have a positive impact on improving
the quality of life for people with HIV.6 Quality of life in
people with HIV is very important to understand because
this infectious disease is chronic and progressive so that
it has a broad impact on all aspects of life. Quality of life
is an important component in evaluating the well-being
and life of people with HIV.7 Family support has an
important role to improve coping with one’s adaptation
to situations that are full of pressure, reduce morbidity
and discipline treatment for clients and indirectly support
family support to improve one’s physical health.8
 2704 Indian Journal of Public Health Research & Development, August 2019, Vol.10, No. 8

In Surabaya, there are four public health care
facilities which provide HIV/AIDS treatment services;
public health care Sememi, public health care Perak
Timur, public health care Putat Jaya and public health
care Dupak.9 Some mothers of HIV who were met at
the Public health care Dupak said that they came to the
Public health care Dupak rarely accompanied by family,
and still fulfilled their daily needs without assistance from
the family. They often feel that they are excommunicated
by their families even though they live in one house after
their husbands die, they worry that their neighbours will
move away with the disease so they choose to keep it a
secret. They also revealed disturbances in appetite, sleep
disturbances, disruption of relationships with family and
the environment and physical discomfort due to taking
ARVs. The purpose of this study was to determine the
relationship of family support and quality of life of
mothers with HIV positive in Surabaya.
life and general health conditions. The questionnaire is
presented in a 5-grade Likert scale.11 The WHOQOL-
BREF has been recommended as the most suitable
instrument for assessing the QOL of various people.12
This questionnaire have been tested for validity and
reliability with the Cronbach Alpha test.
Data Analysis: The results were analysed using
Spearman’s correlation test due to the skewed distribution
of data with a significance level of α<0,05.
Results
There were 30 mothers with HIV who were
respondents to the study. The majority are 26-35 years
old (50%), as many as 60% of respondents are still
married, have used ARVs for 2 years (50%) and have
children ≥1 - ≤ 2 (57%) (table 1).

Method Table 1: Participants demographics. (N = 30)

Study Design, Setting, and Sampling: A cross- No. Category f %

sectional data collection on mothers with HIV positive 1. 17-25 years 2 7%
was conducted. The population in this study were 16 26-35 years 15 50%
Age
HIV positive women in public health care Dupak and 36-45 years 10 33%
20 HIV positive women at public health care Sememi 46-55 years 3 10%
so that the population was 36 HIV positive women. 2. Elementary school 7 23%
Inclusion criteria to enter the study were; HIV positive
Junior high school 10 33%
mother whose status is known to the family, able to
read and write, doesn’t stay nomadic and which is Education Senior high school 10 33%
not accompanied by AIDS. This study used purposive Bachelor 2 7%
sampling which obtained 30 samples at public health No School 1 3%
care Dupak and public health care Sememi. 3. Married 18 60%
Marital status
Widow 12 40%
Study Variables: The independent variable in this study
was family support which was measured using a family 4. Enough 9 30%
Health Last 2
support questionnaire based on the theory of family Good 14 47%
Weeks
support from house which had been tested for validity Very good 7 23%
and reliability. This consisted of 18 question items 5. Health
Healthy 28 93%
representing 5 sub-variables, namely informational Conditions
support (11-13), award support (14-16), instrumental (during
Not Healthy 2 7%
support (6-10), emotional support (1-5) and social research)
network support. The questionnaire is presented in 6. 0 – 2 years 15 50%
4-grade Likert scale.10 Duration
3 - 4 years 6 20%
using ARVs
The dependent variable in this study is the quality > 4 years 9 30%
of life (QOL) of mothers who were HIV positive who 7. Years of ≤ 4 years 17 57%
were measured using the life quality from WHOQOL- being tested
for HIV > 4 years 13 43%
HIV BREF. This questionnaire consists of 31 questions
with 29 items included in the calculation of scores and 8. Islam 28 93%
Religion
two items of questions that measured the quality of Christian 2 7%
 Indian Journal of Public Health Research & Development, August 2019, Vol.10, No. 8 2705

Conted… Table 2: Frequency distribution of family support

and quality of life
9. ≥1 - ≤ 2 17 57%
Number of Variables measured Category f %
>2 8 27%
children
Have no children 5 17% Less 5 17%
10. entrepreneur 5 17% Family Support Enough 4 13%
Work
Others 25 83% Well 21 70%
11. Family Enough 18 60%
income > UMR Surabaya 4 13% Quality of life Well 10 33%
a month Very good 2 7%
(Surabaya
Total 30 100%
UMR Rp. < UMR Surabaya 26 87%
3.045.000) The results showed that there is a significant
Most families provided good family support for HIV correlation between family support and the quality of
positive mothers, as many as 21 people (70%) (table 2). life of mothers with HIV positive in Surabaya (table 3).

Table 3: Relationship between family support and quality of life

Family Quality of life

Total p-value r-count
support Enough Well Very good
Less 5 17% 0 0% 0 0% 5 17%
Enough 3 10% 1 3% 0 0% 4 13%
0,026 0,405
Well 10 33% 9 30% 2 7% 21 70%
Total 18 60% 10 33% 2 7% 30 100%
Description: p = significance value (<0.05) r = correlation coefficient (> 0.3494).

Discussion they face in relation to their physical, psychological, and

This study shows that there is a significant correlation
between family support with the quality of life of
mothers who are HIV positive in Surabaya. Contingency
(r) it obtained 0.405 which means that the relationship
of family support with the quality of life of mothers who
are HIV positive has a moderate strength correlation.
Family support is one factor that is significantly related
to quality of life in HIV clients where clients with good
family support are more likely to have a good quality
of life.6 Families who support people in China who are
living with HIV/AIDS (PLWHA) have a 61% chance,
1% more to get a good quality of life compared to those
who do not support.13
The majority of respondents received good family
support while the rest received less family support and
sufficient family support. The role of the family is very
important in client health care.14 Family support is needed
by HIV sufferers as a support system or main support
system so that they can develop effective responses or
are coping to adapt well in dealing with the stressors
social illness. Family support can have a positive impact
on the quality of life for people with HIV.15 Furthermore,
among HIV-infected adults whose relationships between
social support and psychological adjustment were
examined, greater support, including financial and
spiritual support, was found to reduce psychological
distress, such as symptoms of depression.16
The existence of family support will make families
able to function with various intelligence and reason, so
that it will improve their health and adaptation in life.8 In
concept, the existence of chronic diseases such as HIV/
AIDS will reduce the quality of life of patients. This
disease can develop even worse if the client experiences
pressures from both family and society. This will affect
the physical and psychological conditions of the client.6
The long and prolonged pressure will have an impact on
the immune system and accelerate the progression of the
disease. If the pressure from the client can be controlled,
the modulation of the immune system is to be better so
that the quality of life becomes good.17
 2706 Indian Journal of Public Health Research & Development, August 2019, Vol.10, No. 8
The results showed that the majority of respondents
had a quality of life in sufficient condition. Quality of
life is an individual’s ability to enjoy satisfaction during
life.18 Clients with HIV who have sufficient quality of
life categories up to very good categories can also be
affected by regular consumption of ARVs. ARV therapy
will stop HIV activity, restore the immune system and
reduce the occurrence of OIs, improve quality of life
and reduce disability.4 Quality of life itself is influenced
by various factors, namely the presence of sex, age,
education, occupation, marital status, income, religion,
how long the client has HIV, how long the client has
consumed ARVs and so on. A good environment around
HIV clients can improve the quality of life of clients.2
About 50% have used ARVs for 2 years with the
healthy condition during data collection. Zhang reported
that approximately 81% of HIV-infected patients in
China had symptoms when they began ART.19 Another
study indicated that the QOL of patients with symptoms
would see more pronounced improvements than those
without symptoms after ART.2 Generally, with the
increase of therapy time, the QOL of people infected
with HIV showed a rising trend from baseline to 24
months. However, more in-depth research is needed to
better understand the underlying causes for the plateau
and, in some cases, decrease. In particular, greater
attention should be paid to patients after 6 months in
order to continuously improve patient quality of life.
Educational factors influence the quality of HIV
positive mothers. Individual education factors will relate
to the level of insight and knowledge.12 The level of
education is one of the factors that influences the quality
of life of clients of HIV and AIDS.2 Based on the results
of the study, it was found that the average duration of
suffering was approximately 4 years. Long suffering from
the disease is a significant factor affecting quality of life.13
In this aspect of limitation explained the obstacles
or limitations of researchers during conducting research,
among others: filling out questionnaires takes longer.
The thing that is feared is influencing the respondent’s
answer because this filling in of the form can disrupt
the respondent’s daily activities and the respondents’
collection techniques that are different between public
health care Dupak and Sememi, are feared to influence
respondents’ answers in filling out the questionnaire.
The public health care Dupak collection technique meets
the respondent directly (door to door) while at the public
health care Sememi they are collected by respondents at
one time.
Conclusion
Family support is related to the quality of life of
HIV-positive mothers in Surabaya. The better the family
support, the higher the quality of life of the client. The
majority of HIV positive mothers have good family
support. Further development in information has other
factors (health worker support, community behaviour,
the effect of ARV therapy etc.) that can affect the quality
of life of patients with HIV/AIDS.
Ethical Clearance: This study did not use animals and
does not mention the identity or medical record of the
respondents. The ethical approval for this study was
granted by the IRB committee of the Faculty of Nursing
at the Airlangga University no. No. 186-KEPK June
2016.
Source of Funding: Self-funded.
Conflict of Interest: None.
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