|Year : 2018 | Volume
| Issue : 2 | Page : 38-43
Effectiveness of family support groups in improving the coping levels and strategies adopted by widows affected by tsunami
Shimy Mathew1, Rosaline Jayakaran2, Anantha K Rajan2, Kamala R John3
1 Secretary, Mid India Board of Education of NL of CMAI, Nagpur, India
2 Former Professor, College of Nursing, CMC, Vellore, India
3 Former Professor, CMC, Vellore, India
|Date of Web Publication||5-Jun-2020|
Source of Support: None, Conflict of Interest: None
Natural disasters tend to disperse families and disrupt communities leading to death, injury, and separation from homes. Following a traumatic event, about 20% of people need some kind of psychosocial support to deal with stress and related problems and 5% of people can be expected to have serious mental health disorders. Amixed methods study was done to assess the effectiveness of family support groups in improving the coping levels and strategies adopted by widows affected by tsunami in selected villages ofNagappatinam district, Tamilnadu. Purposive sampling was used to select 3 0 widows who lost their husbands in Tsunami in 2004, in the 18 proj ect villages of Sirgazhi Taluk ofNagappatinam district. A coping scale prepared by the researcher based on Brief Cope Inventory and Impact of Events Scale and semi structured interview guide were used to collect data during the first week after obtaining oral consent. Participants were divided into groups often members with 2-3 supporters based on their coping and geographical proximity. The groups met once a week for four weeks and discussed aspects of psychological and financial coping and challenges for future. Post-test on coping was done during the sixth week. Study findings showed that family support groups were very effective in improving the coping levels of the widows. The mean difference of the effectiveness of support groups on coping related to psychological, behavioral, and cognitive aspects were highly significant (p<.001). Early psychosocial interventions can help disaster victims cope with various stressors and hence nurses need to intervene at various stages of response and recovery in a disaster.
Keywords: disasters, traumatic event, mixed method study, widows, family support groups
|How to cite this article:|
Mathew S, Jayakaran R, Rajan AK, John KR. Effectiveness of family support groups in improving the coping levels and strategies adopted by widows affected by tsunami. Indian J Cont Nsg Edn 2018;19:38-43
|How to cite this URL:|
Mathew S, Jayakaran R, Rajan AK, John KR. Effectiveness of family support groups in improving the coping levels and strategies adopted by widows affected by tsunami. Indian J Cont Nsg Edn [serial online] 2018 [cited 2022 Aug 16];19:38-43. Available from: https://www.ijcne.org/text.asp?2018/19/2/38/286088
| Introduction|| |
Natural disasters and complex emergencies create new types of vulnerabilities by dispersing and disrupting communities, causing death and injury, and separating people from their homes (Podder, Gohani, & Mitra, 2005). It is reported that more than 95% of all deaths caused by disaster occur in the developing countries.
According to government reports the state of Tamilnadu had been the worst affected on the mainland with a death toll of7793 and Nagappatinam district had 6065 deaths and 5,525 casualties during the tsunami of 2004. There is no scarcity of reflections and commentary on the impact of the disaster. The media looked into every conceivable angle. One area that has so far received less attention is the gender impact of the tsunami and the impact on women in particular (Jayalakshmi, 2005).
Western research shows that after exposure to a traumatic event, about 20% of people need some kind of professional psychosocial support to deal with stress related symptoms or problems and 5% of people can be expected to have serious mental health disorders (de Jong, Prosser, & Ford, 2005).
The World Health Organisation (WHO) has estimated that 30 % to 50% of those directly affected by disaster will have psychosocial problems who will benefit from help and support, whilst 5 % to 10% will develop severe problems needing specific intervention and treatment (Danvers, Somasundaram, Sivayokan, & Sivasankar, 2005). The rate of Post-Traumatic Stress Disorder (PTSD) was found to be 12.5/1000 which was lower than expected after six to nine months of tsunami in Tamilnadu. It was perceived that subclinical psychosocial problems is addressed by informal social mechanisms and counselors of different NGOs (Kar, 2010).
A qualitative study through focus group discussions nine months after the tsunami in Tamil Nadu by Rajkumar, Premkumar, and Tharyan (2008) reported that participants reconstructed meaning for the causes and the aftermath of the disaster in their cultural idioms. Qualitative changes in their social structure, processes, and attitudes towards different aspects of life were revealed. Survivors valued their unique individual, social, and spiritual coping strategies more than formal mental health services. The results of this study suggested that interventions after disaster should be grounded in ethno-cultural beliefs and practices and should be aimed at strengthening prevailing community coping strategies. Therefore this study was planned to explore the experiences of widows of tsunami and to assess the effectiveness of family support groups in improving the coping levels and strategies adopted by these women in selected villages of Nagappatinam District in Tamilnadu.
The objectives of the study were to
- explore the psychosocial experiences of women who had lost their husbands in tsunami
- assess the coping levels and strategies adopted by widows affected by tsunami
- assess the effectiveness of family support groups in improving the coping levels and strategies of widows
- find association between coping levels and selected demographic variables
| Methods|| |
A mixed methods study with Qual-Quant sequential design was used in the study. The study was conducted in 18 villages of Sirghazhi Taluk of Nagappatinam district affected by tsunami in December 2004. A total of 32 women who had lost their husbands in tsunami listed in the post disaster survey by a tertiary hospital were purposively chosen and contacted to get consent. Thirty women who were living in the affected area and had not remarried and living alone were included in the study. Two women had moved out of the area and were not traceable.
Part 1 -Demographic profile of the widows.
Part 2 -Interview guide: Semi structured interview guide was used to generate data on their experiences after tsunami. Questionnaire had two parts. Part one was related to basic needs and part two on physical, psychological, and financial impact of tsunami. Some of the questions included were ‘How did your husband die in tsunami?', What do you think are the different effects of this incident on you?', What were the psychological effects after the incident?', Can you share your memories and nightmares after the incident?, Who were the people helped you cope with the loss and feelings?, and what were the measures you took to find support and relief?. Part 3- Coping scale: A Coping Scale, prepared by researcher based on Brief Cope Inventory (Carver, 1997) and Impact of Events Scale (Horowitz, Wilner, & Alvarez, 1979) was used to measure the level of coping of the participants. Items were modified specifically on coping after disaster to suit the study. The scale included statements on trust in God, engaging in work, seeking support, and managing emotions etc.
The coping scale consisted of 30 items in a four point rating scale with positive and negative statements. Final scoring was converted into percentages and was categorized as follows:
0-25 :Poor coping
25.1-50 :Minimal coping
50.1-75 :Moderate coping
Content validity was checked by medical and nursing experts. Reliability was checked by doing a pilot study among 5 widows in a non project village in the same district. Items were modified to suit the study. Interview guide and coping scale was translated to Tamil and back translated to English. Permission was obtained from the tertiary hospital who conducted the disaster relief project to access the women. Verbal consent was obtained from women for the interview and also to tape record the interview.
The data were collected in two parts. In the first part demographic details were first filled and using open interview method the participants were asked to express their experiences of tsunami and their loss using the semi structured interview guide. The interviews were conducted individually and the conversations were audiotaped. Following the interview the coping scale was administered to the participants. Data were collected from 4 to 5 women everyday in the first week of data collection.
The concept of support groups was first introduced by the disaster action organization which was founded by the survivors and bereaved people from major UK and overseas disasters. According to them a family support group is a group of people affected by the same disaster who gather to support each other by sharing information, giving each other emotional and practical support and /or focusing on issues important to them. The group can include bereaved family members, survivors and their families and others affected by the disaster. People affected by a disaster often feel that the lasting effects of their trauma can only be understood by those who share experiences of the same event. In the support groups survivors also can learn by observing more effective coping strategies and can practice interpersonal skills such as self disclosure and assertion.
In this study family support groups were formed by widows who had scored high on coping and were willing to support other widows by giving emotional support, sharing information, practical guidance by focusing on issues important to them. Support group meetings were conducted once a week for four consecutive weeks. Participants were divided into groups of ten members with 2 to 3 supporters based on their coping and geographical proximity. Widows with > 65% coping were chosen as supporters. They discussed aspects of psychological and financial coping and challenges for future. Each meeting lasted for 3 to 4 hours. The aim of the meeting was to facilitate sharing of their experiences, challenges they face in their daily life and allow the widows with higher coping levels share their coping strategies and support widows who had very low coping levels. Post-test on coping was done during the sixth week.
| Results and Discussion|| |
Content Analysis was done for the qualitative data obtained. Categories were derived and conceptually ordered based on properties and dimensions for certain questions.
Paired t- test was used to analyze the effectiveness of family support group on coping. SPSS version 17 was used for analysis. Chi square test was used to assess the association between the coping levels and demographic variables.
Study revealed that majority of the widows were in the age group of 31-60 years. Majority (83%) of them were Hindus and 80% of them were illiterate. The average number of years they were married ranged from 11 to 40 years.
Financial status revealed that majority (53%) of them were fish vendors before the tsunami and 26% were housewives. After tsunami 50% of them stayed at home and 30% continued to be fish vendors. Their monthly income ranged from Rs. 1000 to Rs. 5000. Most (80%) of their husbands were fishermen before tsunami. Majority had four to six family members in their family while 63% of them lived in thatched houses. This finding is supported by disaster mitigation after the super cyclone in Orissa (Kanugo, 2005) which revealed that of the 4,090 vulnerable families in 85 panchayats, 90% were women headed households widows with no occupation.
The current study revealed that 73% of the widows had lost one family member in tsunami and 7% lost three family members. Half of them had some kind of physical injury during tsunami, 66.6% received first aid and 33.3% were hospitalized. They were hit by boats, or caught in thorny bushes and many had swallowed the water which they describe was black colored mixed with mud and sand.
The first objective was to explore the psychosocial experiences of women who had lost their husbands in tsunami. All of them said they were psychologically affected and the memories were haunting them. Most of them (90%) said they get nightmares related to tsunami. Guilt feelings related to tsunami were seen in 70%. Few (13%) of them took drugs to overcome psychological problems. “Ifeel as if I’ve gone mad”, “Iam shocked”, “My heart is aching”, “lam being mentally tortured”, “It is as if we are holding our lives in our hands. We are living with terror each moment of our life “were some of the ways they expressed their feelings. Some of them had guilt feelings related to their husband’s death. “We live with those guilt feelings each day. It will end only when we go to the grave “. Poddar et al. (2005) in their report about survivors in Nicobar Islands reported that people there experienced similar survivors’ syndrome. Blame and guilt surface to the conscious self, imagining how they could have saved or prevented the loss. The current study also identified that 83% of them faced financial difficulties after tsunami and 97% received immediate financial aid from the government upto 2 lakhs. Most of them had spent the money they had received from the government by either marrying off one of their children or paying debts. Very few had deposited some amount in their banks for the children’s future. Sharma (2006) when mentioning about the recovery status of tsunami victims after a year says that fertile lands earlier used for agriculture turned saline or were completely lost to sea, boats and nets of fishermen were damaged or lost and houses were swept off or broken beyond repair. As a result, the tsunami left a colossal economic impact. All of them faced social issues. People curse them when they meet face to face. One of them said “My life has become a shame. The people humiliate us telling the one who has broken her thali “. They said they usually stand in a corner during family functions and leave as soon as possible and hardly interact with their relatives. Similar findings were reported by Dethombe (2005) on his report on tsunami. Echterling (1993) among survivors after a flood in US said victims had psychological symptoms even after seven years.
The second objective was to assess the coping levels and strategies adopted by widows. The present study showed that 96.7% had moderate coping levels that is the score between 50.1-75%. The mean coping score in the pretest was 70. The current study also revealed that 86% of their houses were either completely or partially destroyed. Reconstruction of houses was done by NGOs. Half of them had got some kind of an occupation to earn their living. All of them had atleast two meals a day. It was found that 60% were able to provide only three meals a day for their children and no other basic needs.Widows had sought help from NGOs, neighbors, and friends. Half of them were provided help and support by NGOs. Of the studied widows, 76% received psychological support from their families. Some of them said they never went near the sea shore after tsunami.
The third objective was establishment of family support groups to improve coping levels of the widows affected by tsunami. The widows cried bitterly during the support group meetings, laughed sometimes at each other’s jokes and pranks. At the end of the meeting they expressed that they hardly had opportunities like this to share and discuss what they were going through and opportunities available to overcome their hardships. The discussions were centered around the topics chosen for that particular day as listed below:
First week: General impact of tsunami on widows and their families.
Second week: Psychological impact and ways to cope with it.
Third week: Financial problems encountered after tsunami and strategies available to cope with it.
Fourth week: Facing the future - potential difficulties and solutions. Similar intervention were carried out by British Red Cross for victims of various victims of disasters (British Red Cross, 2005).
According to Bergeron (2006), nine Indonesian survivors of tsunami were sent to South Mississippi to interact with the victims of hurricane Katrina. The aim of this interaction was to share their knowledge and to learn more when they return to their region still piecing together tsunami stricken communities. In the post test after the support group meeting, majority had maximum (59.9%) or moderate (40.9%) coping levels (see [Figure 1].
|Figure 1: Effectiveness of Family Support Groups in Improving the Coping Levels of the Widows|
Click here to view
The mean difference of their coping levels was 14.8 and highly significant at ρ <.001. Study findings showed that family support groups were very effective in When the effectiveness of support groups on various aspects of coping was assessed it was found that the mean difference was highly significant related to their psychological, behavioral and cognitive aspects (see [Table 1]. Their physical problems decreased and they were able to cope physically. They had also found ways to cope financially because all of them had some means of livelihood by the end of support groups. These findings are supported by studies done by WHO (Danvers et al., 2005) that 30 to 50% of those directly affected by disasters will benefit from help and support.
|Table 1: Effectiveness of Family Support Groups on Various Aspects of Coping|
Click here to view
British Red Cross (2005) reported that survivors of various disasters and their loved ones said that meeting others who have suffered and who grieve, those who experience the devastation and shock caused by a similar disaster, was a help and lessens the feeling of terrible isolation. They also expressed that support group members understand them in a way that other friends and family could not. Emotions like anger, shock, and grief are inescapable and quickly become destructive. The only remedy is to channel them into a constructive activity such as a support group meetings/ activities.
When the association between coping levels and selected demographic variables was analyzed, it was found that the mean coping levels were similar with respect to demographic variables like age, religion, education, number of married years, present occupation, income per month, number of family members, and loss in terms of money. There was no significant association between the coping levels and demographic variables.
| Conclusion|| |
As the incidence of the disasters increase, there is immense need for nurses to intervene at various stages of response and recovery. This study was conducted one and half years after the tsunami affected the region. These kind of interventions done in the early stages after a disaster can help vulnerable groups like women and children cope with the disaster earlier on and help them return to their normal day to day life as early as possible. This study shows the need for early psychosocial interventions which can help disaster victims cope with their various kinds of stress to prevent long term mental health problems after a disaster. It is also necessary for nurses to be trained in providing psychosocial interventions in the community.
Study also emphasizes the need for a network of supporters among the disaster victims to help them return to normal lives. Study also proves that women although being the most vulnerable group with little support and encouragement are able to adapt and cope and can form strong bonds with same kind of victims. They are more empathetic and understanding, and provide adequate support and guidance when need arises.
Although we cannot cure the impact and pain they undergo, nurses can help in coping and adjustment process of the victims.
Conflicts of Interest: The authors have declared no conflicts of interest.
| References|| |
Bergeron, K. (2006, March 24). Tsunami survivors coming- Nine Indonesians to share expertise, Sun Herald
Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4
de Jong, K., Presser, S., & Ford, N. (2005). Addressing psychosocial needs in the aftermath of the tsunami. PLoS Med, 2(6)
, e 179. doi.org/10.1371 / journal.pmed.0020179
Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine, 41(3)
Kanungo, I. (2005). Impact of super cyclone on marginalized sections in Orissa. Health for the Millions, 30(6)
Kar. N (2010). Indian Research on disaster and mental health. Indian Journal of Psychiatry,52
Poddar, D.P., Gohani, S., & Mitra, S. (2005). Swimming in rough waters: Counseling tsunami survivors. Healthfor the Millions, 30(6)
Rajkumar, A. P., Premkumar, T. S., & Tharyan, P. (2008). Coping with the Asian tsunami: Perspectives from Tamil Nadu, India on the determinants of resilience in the face of adversity. Social Science & Medicine, 67(