Family communication in efforts to prevent COVID-19 transmission in Indonesia

This study aims to determine family communication to prevent COVID19. This study uses descriptive qualitative research methods by collecting interview data. This study shows that family communication used by parents and children is very useful in preventing the spread of COVID-19 in Kerrawang Regency. The process of delivering messages related to the dangers of COVID-19 by parents can change children's understanding and behaviour so that preventive actions occur. This research contributes in the form of recommendations to every family so that they can comply with health protocols and always socialise with family members and the community to get used to healthy living by opening airflow in every room in the house, regulating interactions by using masks and keeping a distance in activities at home and outside the house.


INTRODUCTION
COVID-19 is a virus that is feared by some of the world's people because it causes death and limits social interaction between humans. In December 2019, the first case of COVID-19 was reported in Wuhan, Hubei Province. From 18 December to 29 December 2019, five patients were treated with Acute Respiratory Distress Syndrome (ARDS) (Robson, 2020) From 31 December 2019, to 3 January 2020, this case increased rapidly, marked by the reported 44 cases. In less than a month, the disease has spread to other provinces in China, Thailand, Japan, and South Korea (Huang et al., 2020). Initially, this disease was named as 2019 novel coronavirus (2019-nCoV), then WHO announced a new name on 11 February 2020, namely Coronavirus Disease 2019  caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-CoV-2) virus. (World Health Organisation. Coronavirus disease 2019 n.d.) In general, symptoms of COVID-19 infection can interfere with acute breathing such as fever, cough, and shortness of breath. The average incubation period is 5-6 days with the longest incubation period being 14 days. On 30 January 2020, WHO has declared it a public health emergency that is troubling the world (Dewi, 2020). The spread of COVID-19 is transmitted from person to person which widely initially occurred in China and more than 190 other countries (World Health Organization, March 2020). As of March 29, 2020, there were 634,835 cases and 33,106 deaths worldwide, while in Indonesia 1,528 cases have been confirmed positive for COVID-19 and 136 deaths (Ilpaj & Nurwati, 2020). This shows that the spread of COVID-19 cannot be underestimated, the acceleration of its spread only took place within a period of 4 months from December 2019 to March 2020.
Not only does COVID-19 have a harmful influence on the human body, but it may also cause humans to limit societal movements, such as in the field of education. According to an ABC News article from March 7, 2020, school closures have happened in more than a dozen nations because of the COVID-19 epidemic. According to data from the United Nations Educational, Scientific, and Cultural Organization (UNESCO), school closures affect at least 290.5 million children globally, causing their learning activities to be disrupted (Chakraborty & Maity, 2020). The coronavirus outbreak has also shown itself at the university level in the United States, necessitating the suspension of the international student exchange program. Due to Italy's deteriorating situation because of COVID-19, numerous colleges have requested all their students to return from study abroad programs in Italy. This strategy is in response to the Centres for Disease Control and Prevention (CDC) decision on February 26 to elevate Italy's emergency status from Level 2 to Level 3. More than 233 million pupils are absent from school across the country, including the special administrative areas of Hong Kong and Macau, because of the virus. According to the UNESCO Institute of Statistics, Japan has about 16.5 million transferred students. Due to COVID-19, several schools in the United States have cancelled classes (Rubinelli et al., 2020).
In addition to schooling, COVID-19 has impeded human employment in general, from the private to the government levels. Where they are compelled to stay at home and not have social connections with outsiders (save for families that reside in the same house), they must also be able to maintain their distance when one of the family members has done activities outside the home.
In actuality, the spread of the COVID-19 pandemic causes not only physical symptoms and diseases but also has a psychological influence on both victims and the larger population. When diagnosed with COVID-19, individuals may have psychological effects such as feeling melancholy, agitated, or nervous. With news of a rising number of COVID-19 patients, the public may experience emotions of melancholy, tension, and anxiety. Conditions like these are undoubtedly harmful to individuals; thus, it is vital to predict or avoid the psychological impact of COVID-19, one of which is via the role of the family.
The COVID-19 epidemic, which is sweeping the globe, demonstrates the growing importance of the family's role in nurturing, caring for, and teaching children. This event restores the family's original position as the centre of all activities, where most children's education takes place. Good family knowledge and/or positive attitudes will be followed by good conduct and attempts to avoid COVID-19.
The family may be characterised as the fundamental unit of society capable of causing, preventing, improving, and influencing family members to enhance the quality of family health. In other words, the family may be seen as the fundamental social setting for promoting health and illness prevention, as well as preventing the spread of numerous diseases, including COVID-19 (Setyastuti et al., 2021).
Interpersonal communication includes family communication. This communication deserves closer examination because, 1) the family is the place where adults and adolescents experience the majority of the most important and intimate interpersonal relationships, and 2) the family is the primary agent of socialisation, where communication and relationship skills are acquired . Communication skills are seen in this situation as a means of influencing others to modify their knowledge and behaviour, similar to how parents encourage their children to avoid the spread of COVID-19.
Families also have the risk of transmitting COVID-19 if one family member is infected and transmits it to other family members so that one household is infected with COVID-19 while at home. The condition of families in Indonesia affected by COVID-19 struggle to protect themselves and their family members from being infected. In addition, the condition of families affected by COVID-19 will affect the family economy, family resilience and family health (Irawaty et al., 2020). With the increasing number of people affected by COVID-19 from day to day, this condition makes families around the world, including Indonesia, also feel worried about dealing with the COVID-19 virus. Indonesia is the fourth most populous country in the world and is thus expected to suffer greatly and over a longer period, when compared to other less densely populated countries (Djalante et al., 2020).
The family which is the smallest system called the microsystem has a pattern of activity, social responsibility and interpersonal relations experienced by individuals in the family (Dorrance Hall et al., 2020). This pattern is in the form of consistent physical and social interactions with family members and will shape the behaviour and habits of the individual. These behaviours and habits will affect the development of individuals and their interactions with other people and the wider environment. Individuals will experience discomfort if a certain situation forces them in a short time to make changes in interaction patterns that affect their behaviour and habits (Monin et al., 2020).
Regarding COVID-19, which is currently spreading to all communities in various parts of the world, based on WHO data (2020) that Indonesia also confirmed that two residents had been infected with COVID-19 while attending an event in Jakarta. The patient initially made direct contact with a foreign citizen (WNA) from Japan who lived in Malaysia. After the meeting, the two Indonesian citizens complained of fever, cough, and shortness of breath (Kuswanti et al., 2020). Not long after, the two victims were increasing day by day.
To prevent the spread of COVID-19, the Indonesian government has taken several steps, such as socialising the social distancing movement, namely by maintaining a safe distance from other humans at least 2 meters, not making direct contact with anyone, and avoiding mass gatherings (Ashidiqie, 2020). The next step is the use of cloth masks which, if made and used properly, can become a barrier for the droplets released by the wearer into the air and the environment. The use of masks should be part of a range of preventive measures, which include frequent hand hygiene, physical distancing where possible, coughing, and sneezing etiquette, and environmental cleaning. Avoid dense crowds in enclosed spaces, especially where physical distancing is not possible, and ensure good environmental ventilation in any enclosed spaces, (Chakraborty & Maity, 2020).
Masks should be used as part of a comprehensive preventative strategy that includes frequent hand cleanliness, physical separation when practicable, coughing, and sneezing etiquette, and environmental cleaning. Avoid high crowds in enclosed locations, especially if physical separation is impossible, and maintain adequate environmental ventilation in all enclosed spaces (Tawai et al., 2021).
The government is making efforts to prevent the spread of COVID-19 with the aim of protecting all Indonesian citizens. The steps taken are aimed at everyone so that they are aware that the spread of COVID-19 is a complex problem because it can inhibit all human activities, which interact more with other humans and of course facilitate the spread of the virus. Based on data that was finally confirmed to be associated with transmission of pneumonia, COVID-19 could be transmitted from human to human (Susilo et al., 2020).
Despite the government's many attempts or procedures, many citizens do not comply with these calls, such as not washing their hands regularly, not wearing masks, keeping their distance, and not touching. Violations committed by the community, on the other hand, force the government to take decisive action, such as establishing health checkpoints in various border locations, both across districts or cities and across provinces. People who travel great distances, such as by land, sea, or air, must obtain a public health centre or hospital certificate of good health. A Rapid Test was stamped on the letter (Ramadhana, 2020).
Regarding the COVID-19 problem, of course, the government's efforts to prevent the spread of the virus must also be supported by the wider community. It is parents who have a significant role in protecting their children so that they stay safe and live healthy lives free from COVID-19. Protecting children can be done in many ways, such as persuading children to consume nutritious and nutritious food. (Wardyaningrum, 2010) did research on family communication patterns in determining nutritious consumption for family members. According to the study, family parenting, which includes parents' communication patterns in transmitting messages and exemplifying conduct concerning daily nutritional consumption, influences children's behaviour. The study's findings revealed that dads' and mothers' nutrition knowledge were conventional; while households had self-produced food resources such as vegetables and carbs and were able to receive protein from eggs and milk, there was little creativity in creating meal varieties. Standard parental knowledge prevents children from being innovative in preparing meals for their children so that they can live healthy lives. Parental understanding of food nutrition has a significant impact on children's eating habits. This suggests that the parent's persuasive speech is successful. Parents' teachings regarding food intake can also be linked to the culture that has been carried down from generation to generation in the nuclear family.
The family is the smallest social structure in society that plays a vital role, particularly throughout the periods of character formation and development in a child's early life. Families have a cultural effect on children's early attitudes and interests in everything around them. These cultural influences, such as the practice of consuming nutritious food, are aimed at ensuring children live healthy and disease-free lives, such as the present non-natural catastrophe occurrence, the spread of COVID-19, which may also be prevented by eating nutritious or nutritious food .
During the COVID-19 epidemic, the communication quality with family health workers was poor. The research revealed that the motivation for health professionals to continue practising their profession throughout the COVID-19 epidemic was because it was part of the job that had to be done since they decided to work as health workers from the beginning. According to them, if health personnel do not take their responsibilities seriously during the COVID-19 epidemic, the pandemic would never stop. Communication obstacles that arise because of difficulties meeting family members are replaced by the availability of communication technology, which influences communication quality in the form of closeness and support among family members .
During a crisis, family support is more crucial than before. During the COVID-19 pandemic, however, ensuring public safety means limiting the physical presence of family for hospitalised patients. As a result, healthcare organizations must quickly adapt family-centred procedures and technologies to avoid physical presence limits. Strategies for preserving family integrity must consider doctors' limited time and attention to develop new skills. Internet-based solutions may make routine, predictable, and organised communication easier, which is essential in family-centred care. However, dependence on technology may jeopardise patient privacy while exacerbating racial, socioeconomic, and geographic inequities for people without dependable internet access, devices, or technological knowledge. In response to the present clinical context, we propose a toolkit of techniques for enabling family-centred inpatient treatment during physical separation. Innovations in the implementation of family engagement during hospitalizations may result in long-term success in the provision of family-centred care (Hart et al., 2020).
The spread of COVID-19 in Indonesia which can cause death, of course, makes parents ready to act. Communications made by parents to their children discuss more how to prevent COVID-19 from infecting the body. In addition to following and conveying positive messages in family communication related to government appeals such as washing hands, wearing masks, keeping a distance, and not touching, the interesting thing they also do is often remind their family members such as children not to communicate with others unknown another person. Therefore, this study will focus on efforts to prevent the transmission of COVID-19 at the family level.

METHODOLOGY
The research method used in family communication research to prevent the transmission of COVID-19 uses qualitative methods. The qualitative research method is a research method that emphasises the quality of the data and the sharpness of the data used , with a case study approach. According to Stake (Yin, 2015) Case Study is a research strategy in which the researcher investigates a program, event, activity, process, or group of individuals carefully. Cases are limited by time and activity; and researchers collect complete information using various data collection procedures based on a predetermined time (Creswell et al., 2003).
The location of the research was conducted in Karawang Regency. The object of research is related to family communication for the prevention of COVID-19. Data collection techniques: 1) observation, the researcher conducts passive participatory observations where the researcher is outside the subject and does not participate in the activities in it, only focusing on activities related to research problems about COVID-19; 2) in-depth interviews conducted by researchers to several communities in Karawang Regency, and 3) literature study from journals relevant to this research. Data analysis techniques in this study were data reduction related to COVID-19, data collection, and drawing conclusions related to family communication patterns in Karawang Regency in preventing the spread of COVID-19.
According to Lincoln and Guba, in case of study research, ideal sources in this study are individuals who can notice and respond to all environmental stimuli . Creswell defines resource individuals in qualitative research as those who have first-hand knowledge of the events under investigation (Creswell et al., 2003). This study's resource people will be shown in the form of a table, as follows in Table 1. In-depth interviews and literature reviews were used to acquire data. Due of the COVID-19 pandemic circumstances, which prevented researchers from conducting in-person interviews, interviews were performed online using the Zoom.us program. Existing data were sorted and reorganised to be rebuilt, and data sources and family communication theory were triangulated.

RESULTS AND DISCUSSION
Communication in a family is the delivery of messages from fathers, mothers, parents, children, husbands, wives, in-laws, grandfathers, grandmothers and vice versa as recipients of messages. The message conveyed in the communication can be in the form of information, advice, instructions, direction, or asking for help. Communication that occurs in the family is a unique communication, and communication that occurs within the family will certainly involve at least two people who have characteristics, values, opinions, attitudes, thoughts, and behaviours that are unique and different (Rahmah, 2018). Regarding the role of parents, explaining that being a good parent then requires more than just intellect, but also touches on the personality dimension and involves emotions (Kuswanti et al., 2020).
The family plays a part in all the events that happen to its members. In role theory, the conduct required of someone with a status is defined. In other words, the role is that each family member thinks that any position he occupies might lead to expectations from others around him. As a result, the function of the family is a specific activity that a person performs in the framework of a family .
A family is said to be healthy if it meets crucial requirements for a child's development, such as having time to be together, having excellent consumption habits for fellow family members, respecting one another, and each member feeling tied in a relationship. When anything happens in the family, the family as a group can solve it in a good and productive manner (Permatasari et al., 2020).
Family communication is communication that occurs within a family, which is a way for a family member to interact with other members, as well as a forum for forming and developing the values needed as a guide to life. The handle of a child's life is useful so that children can live their lives when they are in a community environment, what happens if a family communication pattern does not occur harmoniously will certainly affect the development of children (Utamidewi et al., n.d.).
The COVID-19 pandemic situation must still be addressed, and family life has been drastically altered. The function of the family in dealing with the present pandemic scenario is a supportive aspect in the home environment. Due to the obstacles connected with social upheaval, such as financial uncertainty, parental duties, and workrelated pressures, the COVID-19 pandemic poses an extreme danger to the well-being of children and families (e.g., changes in structure, and routines).
As the smallest institution, the family must be able to deal with this circumstance and safeguard its members. Have faith in your family's capacity and strength (strength family). Mutual respect and affection, commitment, constructive communication, spending time together in a positive way, spiritual well-being, and the capacity to handle stress and crises successfully describe strong families under healthy family settings. Family strength is described as a set of interactions and procedures that help and safeguard families and their members (Utamidewi, 2017).
Families can take the following strategies to lower their exposure to COVID-19 and build family resilience: 1) Determine what your family members require. 2) Pay attention to family members' problems. 3) Provide comfort and assistance in calming down. 4) Assist in connecting with numerous alternative options that are required. 5) Guard against worse-case scenarios. 6) Keep expectations in check.
Furthermore, during the COVID-19 pandemic, the application of family communication management and systems thinking in managing families to maintain harmony is critical. Always maintain interpersonal contact, accept responsibility for one another in preserving personal and family hygiene with a healthy lifestyle, and be honest in expressing all family difficulties. directing the fulfilment of the intended outcome, such as ensuring that children are cared for both physically and psychologically to mitigate the many effects of the COVID-19 pandemic, a mitigation effort is required to eliminate various hazards and promote psychological well-being during limitations on various activities.
During the Covid19 epidemic, the family is the foundation for all its members. All activities are carried out at home; children study at home, and those who work do so as well, and are encouraged to do so. The load on the family is rising currently, such as: 1) enhancing family health; 2) carrying out the function of education; 3) improving family protection; 4) making parenting more effective; and 5) maintaining family resilience. The family, as the foundation of the answer to the COVID-19 epidemic, serves as a source of first aid for family members.
Maintaining family health and vigour in resuming family duties is a critical factor that must be maintained.
Guidelines for Preparedness to Face Coronavirus Disease (COVID-19) The 3rd revision, which conveys the most effective steps in the community (Faridi et al., 2020), including: 1) Performing hand hygiene using hand sanitiser if hands do not look dirty or washing hands with soap if hands look dirty; 2) Avoid touching eyes, nose and mouth; 3) Practice coughing or sneezing etiquette by covering your nose and mouth with the inside of your upper arm or a tissue, then throw the tissue in the trash; 4) Wear a medical mask if you have respiratory symptoms and perform hand hygiene after disposing of the mask; 5) Maintain a distance (at least 1 meter) from people who experience respiratory symptoms.
Researchers interviewed several parents as resource persons to prevent the occurrence of COVID-19 prevention, they always apply government advice such as washing hands and keeping a distance. The appeal is also always conveyed from parents to children in language that is easy to understand and practice. Parents are the nuclear family who have a close emotional bond with their children and the intensity of the meeting that always happens almost 24 hours. The children as supporting informants explained that parents were always reminded to keep their bodies clean and keep their distance, but only to people they did not recognise. This indicates that the children still strongly believe that the known people (neighbours themselves) are not infected with COVID-19. The following is an excerpt from an interview with an AM source: "Because we live in the village, we still know the people here very well, and we are not worried about them, because generally, they work in this village too, don't go out anywhere, especially the coronavirus, so we free the children to interact with whomever the residents are here, because if it is limited, there is a fear of being offended by fellow neighbours, and this can damage the friendship line later. The point is we are only wary of newcomers" (AM resource person, 28 March 2020).
Interview data explained that to maintain a distance, it was enough with people who were not recognised, while neighbours were free to interact as usual. This is done so that there is no offence in neighbourly life. This is what parents teach their children to maintain a harmonious life, because, on the other hand, community life in the village is only carried out in the village. Regarding the prevention of COVID-19, one of the informants said that the positive messages used to remind children to stay healthy and free from COVID-19 were to "stay at home and reduce activities outside the home." This is done because of the number of immigrants passing through the lane in the Karawang Regency. Parents always remind their children to be vigilant by staying or doing activities at home.
Prevention of COVID-19 by staying at home is always reported by various media and delivered by competent sources in their fields, such as the presentation from doctor Reisa Broto Asmoro, a General Practitioner who said that everyone must maintain a clean and healthy lifestyle, a balanced diet, get enough rest, exercise regularly, do not panic, and do not stress and just stay at home. Doctor Tirta Mandira Hudi, who is a volunteer doctor, said that when traveling and returning home, the first thing to do is to wash your hands, face, and others first and maximise it to stay at home.
The sentence staying at home is a "persuasive message" that aims to accommodate all people without exception so that they do not carry out activities outside the home, moreover these activities must meet and gather with many people which of course poses a considerable risk of being infected with COVID-19. Appeals from the government regarding sentences at home are also often conveyed by parents to children in every family communication process that occurs. The results of the interview with AY's interviewees: "We are afraid of the parents' ban, so we stay at home more so that the virus doesn't spread in our bodies. At home, we can do many things, such as helping parents, especially mothers. Well, if the girls clean the house, wash, and others. It is the same for boys. Not only that, by staying at home, we and our parents often joke around which makes our hearts happy and happy (Informant AY, 29 March, 2020)." The interview excerpt above states that staying at home is a way to prevent the spread of COVID-19. Being at home can still do various activities ranging from independent study, helping parents work and others. The message conveyed by parents can be applied well by children. Staying at home, the family communication process that is established is very good because many jokes are inserted that make the child and parent happy and happy so that it can make the relationship more harmonious. Based on the existing concept, it is explained that family communication has many aspects as elements that form the creation of harmonious relationships for all communication participants involved in it. All communication participants have a role and provide colour and influence for the creation of warm and encouraging family member relationships (Setiawan & Azeharie, 2017). Good relations also have an impact on the openness of children and parents as the nuclear family.
Regarding openness, violence for women victims of domestic violence in Pekanbaru (Sari, 2018) shows that physical violence is carried out in the form of slapping, grabbing, and kicking, while psychological violence is obtained, cursing, humiliating, and pressure. The communication experiences of women victims of domestic violence tend to be negative or unpleasant in the form of being threatened, insulted, and humiliated by their husbands and becoming the subject of neighbour gossip. Good family communication can 'persuade' its members to act positively. The message conveyed is easy to understand and unique, because parents can know the characteristics of their children or vice versa, from child to parent.
This unique persuasive message based on data from all sources (parents) states that: "We parents, especially mothers, are very protective of their children, for example, teaching them not to accept strangers, and when outside the house, we tell our children to run and not to approach new people. Moreover, those people were from the red zone area. Because our area is an industrial route." (YU resource person, 29 March 2020) The interview excerpt explains that maintaining a distance is an important action, starting from approximately 1-2 meters to a more extreme distance of not receiving guests and trying to run or stay away if unknown people approach. This sentence is said very often and followed by all children in Karawang.
"We were taught by parents, we must be able to keep our distance, not to receive guests from outside, what else is unknown. When we see a new person approaching, we immediately run. Because we were afraid of contracting the corona-19, we were taken to the hospital, after that we got sick and died. Because to be honest, our area uses trans buses from Jakarta, West Java, Central Java, East Java, and Sumatra." (TM resource person, 29 March 2020).
An independent effort to protect oneself from the spread of COVID-19 is to maintain a distance by staying away from people who are not recognised, especially those from other districts and provinces. Staying away is the same as running towards the house and not accepting any foreign guests who come. This action is done very often, this indicates that the interpersonal messages in the family environment conveyed by parents are a form of socialization that has succeeded in persuading their children. Based on the concept of family communication which is one form of interpersonal communication, it is stated that this communication is important to be seen more closely because the family is the main agent of socialization, where communication and relationship skills are obtained from the family, (Permatasari et al., 2020) Information related to the dangers of COVID-19 received by parents and children must of course be carried out with maximum prevention. These preventive actions that are applied by parents and children are a form of self-awareness to live a healthy life. Parents in this study play a key role in giving persuasive messages to children, so that in general the results of the study are that the COVID-19 problem is important and must be prevented starting from yourself. This is intended to protect others such as the nuclear family and the surrounding community.
Information that is considered important and must be applied properly, when reviewed based on the Elaboration Likelihood Theory, is included in the concept of a central route. Information received through a central channel, then actively thinks about that information, and considers it by paying attention to other information that is already owned. The use of the central pathway to consider an argument or information carefully, and in the end the view changes because of the information or argument you receive, then it happens after going through a long 'struggle' that occurs in the brain. This change of view is more permanent and is usually followed by a change in behaviour. This means that the central line is an important path, the information that passes through this path is certainly information that is considered important (Littlejohn, 2011)

Figure 1. Elaboration Likelihood Theory
Source: (Griffin et al., 2018) Research and discussion show that every family must socialise and adhere to reduce the risk of COVID-19. These things, namely: 1) Minimizing risk by paying attention to ventilation (open windows and doors) so that fresh air flows, avoid being in closed rooms, especially for vulnerable families; 2) Regulating interactions by providing separate rooms if there are family members who experience COVID-19 symptoms and work outside the home, as well as reducing interactions with vulnerable members, and using masks, especially around the elderly and toddlers; and 3) Keep your distance, if possible for family members who work outside the home and maintain social distancing.

CONCLUSION
Based on the results of the study, it can be concluded that family communication used by parents and children is particularly useful in preventing the spread of COVID-19 in Karawang Regency. The process of delivering messages related to the dangers of COVID-19 by parents can change children's understanding and behaviour so that preventive actions occur. This is done by parents because they think that this information related to the virus is important if ignored can cause the body to become mildly ill to death. Prevention is carried out such as diligently washing hands, wearing masks, not touching, and maintaining distance, such as staying away from immigrants or other people who pass through Karawang Regency.
This research contributes in the form of recommendations to every family so that they can comply with health protocols and always socialise with family members and the community to get used to healthy living by opening airflow in every room in the house, regulating interactions by using face masks and keeping a distance in every activity inside the house and outside the house.