Development of an adolescent coping model in seasonal flood-prone areas: a qualitative feasibility study

Researchers describe the adolescent coping model in flood-prone areas by integrating the theory of disaster coping process, self-care management for vulnerable populations, and model of coping. This model was administered to adolescents in disaster-prone areas by community mental health nurses. The draft version of the framework is described based on the disaster coping process, middle-range theory of self-care management for vulnerable populations, and model of coping.

Vulnerability and vulnerable populations are essential concepts in healthcare systems. Vulnerable populations are social groups that experience health inequalities due to a lack of resources and increased risk exposure. Self-care management theory for vulnerable populations is an approach that aims to identify various variables that affect self-care management, health status, and quality of life of populations experiencing health changes. The central concepts in the model are contextual factors, vulnerability, and intrapersonal factors. The contextual factors are community values and community resources. The vulnerabilities are modifiable factors and non-modifiable factors. The intrapersonal factors are assertiveness, coping behavior, knowledge, self-efficacy, and social support.

There are six concepts of coping approaches. A composure based on perceived self-control was characterized by mastering. Individuals with mastering approach coping grew to control and gain confidence over the situation. They have an optimal way of coping. The alleviating approach to coping was characterized by distraction, verbalization, communication, and creating hopes to help the overwhelming and chaotic situation. The volunteering approach to coping was characterized by considering it a matter of course that they should participate, but the commitment was limited. The acquiescing approach was characterized by enduring the situation and redefining it to cope, even if it means having to relinquish mental and physical wellbeing. The sacrificing approach to coping was characterized by conflicting interests, affected mood in a negative, diffused pain and muscle tension, suffering, and mental and physical exhaustion. The preoccupying approach was characterized by constantly dwelling upon their feelings. They were very vulnerable and experienced agitated emotions, withdrawal, and being burdened.

Sources of coping include health, positive beliefs, problem-solving skills, social skills, social support, and material sources. The three concepts of the disaster coping process are anticipation, impact, and post-impact.

(1) The period of anticipation is when something has not happened yet, and the most critical issue is to assess whether and when it will happen. The cognitive assessment process will also evaluate how individuals will manage threats and how an assessment process related to the sense of control occurs, such as whether the floods can be prevented, how to prevent them, what are the necessary steps to minimize or prevent damage, what damage can be prevented, or what damage cannot be prevented. This is called anticipatory coping. This later makes the individual use coping strategies, whether to stay away psychologically, avoid threats, reject or seek relevant information, or respond in action.

The conceptual framework for the development of the coping model theory was created by integrating the coping model theory of Johansson et al.,¹² self-care management theory of Dorsey and Murdaugh¹³ for vulnerable populations, and disaster coping process theory of Lazarus Richard and Folkman.¹⁴

The process of integrating the three theories into a coping model is as follows. The first process is to conduct a literature study of research results with keywords such as “adolescence,” “flood,” and “mental health.” As a result, flood victims can experience long-term psychological problems if not identified and treated early.¹⁵ The stress experienced during a flood is caused by having to leave the house, feeling isolated when surviving in a flood location, and lack of sleep. The stress of the post-flood recovery period is related to the uncertainty of obtaining assistance, requiring more guidance regarding rebuilding, relocating, and flood mitigation guidance.¹⁶

The second process is to conduct a literature study related to middle-range nursing theory by adding keywords such as “coping,” “self-efficacy,” “children/adolescents,” and “vulnerable groups.” Researchers found the coping approach model,¹² the disaster coping theory,¹⁴ and the theory of self-care management for vulnerable populations.¹³

The final process is to integrate the existing concepts based on the three theories through the following stages of theoretical analysis: (1) determining the origin of the theory, (2) testing the meaning, (3) analyzing logical adequacy, (4) determining usefulness, (5) explaining the level of generalization and parsimony abilities, and (6) determining the testability of a theory.¹⁷ The coping model was prepared based on the analysis process to connect to other concepts and find causality, correlation, and interaction of the three theories (Figure 1).

Figure 1.

The development of a coping model for children in flood-prone areas uses the self-care management theory approach of Dorsey and Murdaugh (2003) for vulnerable populations, Johansson et al.’s¹² coping approach, and Lazarus and Folkman’s¹⁴ disaster coping process.

Feasibility studies can determine the practicality of conducting interventions that can be evaluated using face-to-face interviews. In addition, the feasibility of interventions can be evaluated from the point of view of the nursing model, intervention, and patients.¹⁸ The current study uses a qualitative method to evaluate the proposed model. This design was chosen to guide the feasibility goal for future pilot trials. This study qualitatively analyzed data to explore and provide an in-depth understanding of adolescents’ experiences in flood disasters.

The sample size for feasibility testing must be considered. The number of samples of <10 participants is sufficient to evaluate the acceptance, process, and practicality of the research.¹⁸ The minimum sample size for a pilot study is 8–10.^19,20 The current study will include a minimum of 10 participants as our goal is to evaluate the feasibility of the adolescent coping model in adolescents living in flood-prone areas from a teenage perspective.

A purposive sampling was selected for the development of an adolescent coping model, with the participants living in flood-prone areas. Participants were recruited by researchers involving health cadres in the study area. Disaster mental nursing experts, child nursing experts, and disaster experts are also involved in evaluating the post-drafting model based on the results of in-depth interviews. Participants’ inclusion criteria are as follows: 13–18 years old, able to speak Indonesian, live and attend school in flood-prone areas, have experienced flooding, and have permission from parents to participate in research activities.

Acceptability can be determined through content based on the results of in-depth interviews with adolescents, and discussions of the results of mental nursing experts, child nursing experts, and disaster experts.

Qualitative data were collected by conducting individual semi-structured interviews. Face-to-face interviews were audio-recorded and transcribed. Interviews were conducted with teenagers for 30–60 min to fit the model framework created based on theory. The data were collected from April 2021 to September 2021. Each interview was conducted face-to-face in a safe place where the participants felt comfortable. In-depth interviews were initiated by asking the participant: “Please tell me about your experiences in flooding.” Then, participants were encouraged to talk in detail about their experiences. All interviews were recorded, and the recordings were immediately transcribed. Expert consultation on the model is carried out for 45–60 min based on the expertise of each expert.

Transcripts regarding field findings were analyzed using the content analysis method.²¹ The analytical process included the following steps: (1) each transcript was read, after which feasibility descriptions from the text were extracted in meaning units; (2) meaning units were used to shorten the sentence into simple phrases and create a code so that the meaning is not lost; (3) similar codes were grouped, and subcategories were created; and (4) subcategories with similar content were collected and structured into categories.

This research was conducted based on the principles of the Declaration of Helsinki and the Indonesian ethics for medical health research involving human subjects. The research was approved by the ethics review board of the Faculty of Nursing Universitas Indonesia (IRB approval number: Ket-179/UN2.F12.D1.2.1/PPM 2021). Using the informed consent form for parents, the aim, procedures, and potential risks and benefits were explained to each eligible informant. Confidentiality and anonymity were assured. All data were kept in a secure file.

A total of 15 participants living in disaster-prone areas participated in the research. Of these participants, 10 were female. All participants have experienced flooding more than twice and lived with families in ancestral lands. Table 1 describes the characteristics of the participants.

The interview data regarding participants’ experiences in seasonal flood-prone areas were categorized, analyzed by semantic units, and grouped based on similar experiences. From the interview data, 29 subcategories and 5 categories provided a practical framework regarding the coping model framework, contents of vulnerability, contextual, and intrapersonal factors, and coping (Table 2).

The vulnerabilities are (1) modifiable (physical and psychological health problems, source of income, environment, and education) and (2) unmodifiable (inherent characteristics).

I am worried about the flood; what if the flood lasts a long time and the water gets higher? I could not sleep well during the flood … It was dark because the power went out, making the atmosphere tense. After the flood, there is still a worry about what if it floods again. Tired of cleaning mud, trash and dead animals like rats, frogs, and cockroaches. An unpleasant situation when cleaning the house after the flood. (P2)

I am worried what if the floods last long and the water keeps rising. My family did not evacuate and survived on the 2nd floor. I could not sleep well at night. After the flood, I am still worried because my house always floods first. It is closest to the river. (P6)

I am sad for my parents because, during the flood, they cannot go selling around. My father does not get money. It is sad if the long flood means you cannot sell for a long time. After the flood, I am relieved because my father can sell it again. But I still worry about what if it floods again in the future. (P8)

… rarely get sick and never know how to maintain physical health, let alone mental health … (P13)

The knowledge possessed by the participants includes (1) general knowledge of the causes, (2) how to prevent, and (3) what to do during a flood.

Flood is a natural disaster during the rainy season when the water rises to the settlements. The way to prevent flooding is that we don’t have one in our area because the area is prone to flooding. There is nothing you can do when there is a flood; wait for the flood to recede. (P4)

Floods occur because the area is low-lying and near a river, so when the river water is high during the rainy season, it can inundate the village; how to prevent flooding by elevating the house so it does not flood. When it floods, you must secure things at home so they do not get wet. (P5)

Floods are natural disasters caused by rainwater which causes rivers to overflow. How to prevent it by not throwing garbage into the river. The garbage piled up and clogged the river. During a flood, what can be done is to stay in the flood location or evacuate. (P9)

Expert discussions include three key informants from National Board for Disaster Management and Academics of disaster nursing experts. The results of expert panels were included in developing an adolescent coping model in seasonal flood-prone areas. The results are as follows:

Implementing the global target achievement of the Sendai Framework in Indonesia uses the Disaster Risk Reduction (DRR) paradigm.

Based on categories, expert panels, and the conceptual framework of the present study, the coping model was developed for adolescents in seasonal flood-prone areas (Figure 2).

Figure 2.

Coping model for adolescents in flooding prone areas.