Effectiveness of Ayah 3A (Asih Asuh Anak) as a Supportive Media for Parenting to Improve Family Mental Health Efektivitas Ayah 3A (Asih Asuh Anak) sebagai Media Pendukung Pola Asuh Orang Tua untuk Meningkatkan Kesehatan Mental Keluarga

Article history: This study describes the effectiveness of the “Father 3A (Asih Asuh Anak)” program to support online parenting to improve family mental health. Sixty participants were involved, namely fathers of children and adolescents aged 7-18 years in densely populated areas. Information was sent as text messages via Short Message Service (SMS) or WhatsApp (WA). This study was conducted to solve the community’s need for online tools that support family mental health. The method of the “Ayah 3A” program was sending some messages about parent-child attachments, co-parenting, and daily self-care which were sent at a scheduled time. The shared material was adapted from theoretical concepts and previous studies’ findings. Besides provided online material, face-to-face meetings were also held for consultation sessions with psychologists. The effectiveness of this program was evaluated by a questionnaire of parenting skills and mental health. Meanwhile, evaluation of program implementation showed that 86% of the whole sample (n = 52) returned post-intervention questionnaires, and 66% of subjects followed this program completely. The results revealed that it was improving in knowledge and skill of parenting (p = 0.035; ES = 3.86) and mental health (p = 0.012; ES = 1.85). Besides, feedback evaluation from participants both quantitative and qualitative, regarding this program was quite effective.


INTRODUCTION
This research begins with the gap between the need for parents to have a parental role in parenting and parenting competencies so that they can create mental health in the family. This problem can be overcome by providing parenting support as an intervention that helps parents improve their knowledge and skills in parenting. Based on this phenomenon, researchers are encouraged to conduct family mental health research by utilizing science and technology as a medium to provide interventions.
The family itself is the smallest social unit that can determine the communities' quality of life. The quality of one's family is influenced by parenting implementation. Through parenting, parents and children interact with each other using physical, mental or psychological, emotional, and behavioral aspects. As research at the national and international level has been conducted, the findings showed that the role of parents is very impactful on children and family's mental health (Reupert, A.E., Maybery, D.J., & Kowalenko, 2013). However, the father's role is significant on mental health in the family, even though it tends to have not received attention in our community. In reality, conventional parenting has a tendency to emphasize the process of parenting and the dynamic interaction in the family on the mother figure. On the other hand, the literature on family mental health suggests that a father's mental condition affects children's risk of behavioral and emotional disorders.
Some other studies showed that the role of fathers is essential in supporting the emotional, cognitive, and social development of children. Even research shows that parenting from the father is critical in forming a child's self-image (Reupert & Mayberry, 2018). However, more studies are needed to examine the effectiveness of  parenting interventions so that the results can be applied as community services. Suggestions from previous studies also revealed that research on the effects of parenting interventions on the mental health of children and parents is still urgently needed, especially in diverse populations and forms of psychological problems, and the age of the child (Kennedy et al., 2009;Wade et al., 2018). This makes it necessary to research interventions that can improve interaction and communication in parenting. Based on these conditions, this research will be conducted on families with children (7-18 years) who live in densely populated areas. Consideration of location selection due to emotional problems is considered the correct respondent to get intervention. This research is also expected to emphasize the integration between health, technology, science, and society, which are theoretical and applicable to humanity. Hopefully, through this research, it can be disseminated and developed applications that deliver psychological services to the community. This research aimed to present the science of psychology and parenting through real applications by online media and tools close to our society tod and target fathers who have not been involved in parenting by society or even in parenting research. Hopefully, through this research, fathers as the subject of study can improve their knowledge and skills in parenting. The outcome is going to have an impact on increasing family mental health.

THEORITICAL FRAMEWORK
The role of parenting in the family's mental health will be mutually influenced and mutually related to the mental health condition of each family member. A study of literature has been carried out by researchers on studies that examine the effect of mental health and interactions within the family and support-focused interventions parenting and the development of skills that can improve the functioning of family members. The limitations of research in the realm of parenting and family mental health are: lack of replication in populations outside the West, even countries in America, Europe, and Australia are also promoting studies that test the effectiveness of the program care to be applied as a community-based service (Millward et al., 2018;Wade et al., 2018).
In Indonesia, studies on the effect of parenting on family mental health have been carried out; however, the need for relevant and practical research is still needed. A survey conducted on parents in one state of Australia shows that most parents with children aged 0-18 have good mental health, but 2 out of 5 parents experience depression, anxiety, or drug addiction since having children. Another study of 2,600 parents, where 1,044 are fathers, finds that mental health problems are commonly experienced by parents, with more than a quarter reporting distress psychologically classified as moderate to severe (Millward et al., 2018). This explains that the topic of parenting is one of the most critical topics in mental health.
Parenting is essential for the family's mental health; it is necessary to research parenting support programs that can improve parenting skills. McFarland and Fenton (2018) describe implementing a recovery-focused program with a small number of subjects, namely parents with mental disorders. This research used a case study design with a small sample; however, the program results are pretty promising. The research seeks to reveal how the views and assessments of the community about mental illness can impact parenting to the child. This study emphasizes the importance of removing stigma and helping parents with mental illness develop behavior to seek care-related assistance.
Another study researched the acceptability and feasibility of brief parenting interventions for parents with a borderline personality disorder that uncovered some significant findings relevant to the treatment and care of adults with the disorder (Gray et al., 2018). This research supports the view that there are substantial benefits to using this approach to parenting support in the family. Real benefits derived from intervention programs is a consultation conducted on how to become a parent. It becomes essential for service providers for adults, which is often not considering the subject's parenting status.
Other studies address therapeutic interventions with a single session that can facilitate semi-structured conversations between parents and children about mental health (Hoadley et al., 2018). The evaluation of the research is positive towards the approach because it can improve communication in the family and share the understanding of mental health issues in the family. Interaction and communication open relationships between parents and children regarding mental health issues increase family action to create a situation that supports health mentally.
One of the studies that became a reference for researchers to design programs Parenting support is an approach adopted from parenting support programs text-based (SMS4Parents) in increasing positive parenting by parents (Fletcher et al., 2018). The method used is a group of expert consultants who provide ranking assessments of the content of text messages that will be sent to parents according to the dimensions of importance, clarity, acceptability, and consistency with evidence. The studies carried out became the starting point for exploring the effectiveness of each similar intervention. Several studies on the relationship between parenting and mental health have been explored, including the impact of interventions on the mental health of children and parents. Considering the results of the studies that have been carried out, basically more excellent knowledge of the effects of parenting interventions on mental health children and parents are still very much needed, especially in diverse populations and spectrums severity of symptoms and age of the child.

RESEARCH METHODOLOGY Participants
The Ayah 3A (Asih Asuh Anak) program will be provided online and face-to-face at the Sukomanunggal sub-district in collaboration with Simomulyo Primary Health Care as a health facility that also has a mental health worker program in her area. Researchers devised population mapping following the research objectives, namely families with children aged 7-18 years in densely populated areas. Mapping also explored problems experienced by children and the care provided by their parents. Researchers identified 60 families in Simomulyo Baru, Simomulyo, and Sukomanunggal who met the research criteria. Identification of the strength, cohesiveness, and flexibility of the group is carried out to accommodate the needs of each member.

Procedure
According to this program module guide, the Ayah 3A (Asih Asuh Anak) program is delivered for a month with a follow-up program. Before starting the program, subjects will fill out the GHQ-12 questionnaire to measure pre-intervention mental health conditions. In addition, parenting data were also obtained from parents according to the dimensions in parenting. The program will be given online by sending a text message via WhatsApp group (WAG) or SMS containing education of knowledge and skills on child and adolescent care. The material provided considers dimensions of significance, clarity, and accuracy so that the research group will determine material according to theoretical concepts. In addition to being online, parents and children will take part in the face-to-face session to practice parenting skills in cases at hand in real life.
Fathers who were also agents of change in this study were asked to spend quality time with children at least 7 hours a week. Considering the limitations and inputs of previous studies, the intervention in this study will allow parents to meet and discuss mental health in the family community directly. In addition, the core of this intervention program is to teach skills, strategies, communication with children, reduce stress, and design routine functional activities. However, it is possible if parents ask for additional material discussion.
This study aims to improve children's mental health and improve parenting skills by mediating parents' mental health. Mental health improvement was measured by comparing scores before and after intervention on the standard GHQ-12 questionnaire measurement and structured interviews on the mental health dimension. In addition, feedback on improving parenting skills will also be obtained from the results of the research evaluation.

Data Collection
The instrument for collecting data in this research was the General Health Questionnaire (GHQ), which is an instrument for detecting psychological disorders in general. In its development, GHQ has been translated into various languages and used in many countries, including Indonesia. Multiple studies that have been conducted prove that the validity and reliability of the GHQ are satisfactory (Sosialita & Hamidah, 2019). GHQ has four versions with different numbers of items for each performance. The full version of the GHQ-60 instrument contains 60 items, the short version of the GHQ-30 does not include questions about physical illness, the GHQ-28 consists of 28 items to detect somatic symptoms, anxiety, and insomnia, and the HQ-12 is the most concise version consisting of 12 items for detection and research (Witteman et al., 2011in Sosialita, 2020.
This study used GHQ-12 by considering the ability to detect psychological disorders and the more extended versions (Witteman et al., 2011in Sosialita, 2020. Items on the GHQ-12 contain questions that see the psychological conditions of the subject without questions about physical illness. The GHQ-12 has been translated into Indonesian through the process of developing and strengthening the instrument. Researchers used the Indonesian version of GHQ-12, translated by the Mapi Research Institute as an authorized institution that hands in the copyright from the owner of GHQ, David Goldberg, to do translations and adaptations into various languages. Related to this, the data that was used in this research was from the GHQ-12 scale score.

Data Analysis
The data analysis procedure was carried out by comparing scores before and after the intervention program was given. Comparing the scores of subjects before and after being given the Ayah 3A program can be seen by comparing the gain scores on the GHQ-12 scale. The data analysis technique used the t-paired technique (paired sample t-test). The statistical test results obtained are also used to calculate the effect size so that the level of effectiveness of the intervention program can be known. The effectiveness of the Ayah 3A program (Asih Asuh Anak) is seen from the changes in the value of the dependent variable before and after the intervention. In this study, researchers evaluated the magnitude of the program's effectiveness on mental health. Hypothesis testing in this study uses SPSS 22.0 for Windows, while the effect size calculation is done manually using the effect size value formula.

RESULTS AND DISCUSSION
The results showed that Ayah 3A (Asih Asuh Anak) program was quite effective as a parenting support media used by fathers in this research. Based on the findings of this research, the Ayah 3A program was able to increase the knowledge and skills of fathers in carrying out parenting roles. This has impacted the mental health status of family members. Both fathers and children showed a significant improvement in their mental health status.
Based on the initial assessment that has been carried out, it identified 60 families with children aged 7-18 years in Simomulyo Baru, Simomulyo, and Sukomanunggal area that met the research criteria. The following is an overview of the research subjects: .33 Mapping the condition of the research subjects was followed by taking pretest data using the GHQ-12 scale to see general mental health and structured interviews regarding parenting and stress experienced. Assuming pretest data was carried out in stages, namely filling out the mental health scale accompanied by a research assistant and conducting interviews with research assistants. After the pretest data from the mental health the scale was obtained and then processed, it was found that 45 people from 60 research subjects had low mental health conditions and 15 people had moderate mental health. As many as 34 children have average mental health conditions, as many as 26 people have joint mental health. The following is a description of the mental health conditions of the research subjects: Besides improving mental health, this study also provided intervention to increase father's knowledge and skills of parenting. In general, the increase in subject knowledge can also be seen from the average pretest score of 8,283 and the average post-test score of 19,367. There is a difference in knowledge between before and after giving the material. The effectiveness test was carried out manually with Cohen's d calculations to determine how much influence the parenting material provided had in increasing subject knowledge. The results of manual analyses showed that providing parenting materials on subject knowledge is 3.86, which means that it is quite effective in increasing subject knowledge.
The intervention process is carried out online through education regarding parenting. Parenting materials are sent via text messages via SMS and chat messages via WhatsApp (WA) in six sessions for a month. In addition, subjects can interact synchronously with psychologists and psychologist assistants regarding questions and discussions about the material. Issues can also consult on a scheduled face-to-face consultation. The Ayah 3A program (Asih Asuh Anak) is carried out by combining synchronous and asynchronous interventions, according to previous research, which revealed that online methods that combine synchronous and asynchronous would be more effective (Fletcher et al., 2018;Gray et al., 2018;Hoadley et al., 2018;McFarland & Fenton, 2018).
Analysis of pretest and post-test data was evaluated from the score on the GHQ-12 scale and the gain score between before and after implementing the Ayah 3A program. Previously, the researcher conducted an assumption test to see the normality and variance of the data to determine the appropriate data analysis method. Test for normality and homogeneity in this study using SPSS 20 for Windows. Furthermore, the difference test before and after treatment in the research subject group used a paired t-test. The following are the results of the analysis of the difference test: Table 3.

Test Result Difference Between Before and After Intervention Paired Samples Correlation
Correlation Sig. Pair 1 (Ayah) Before-After 0.768 0.012 Pair 1 (Anak) Before-After 0.946 0.000 Based on table 3, it is known that the correlation between these variables before and after treatment tends to be significant. This means that the mental health of research subjects between before and after the Ayah 3A program tends to show changes. After that, an effectiveness test was conducted to determine the effectiveness of the Ayah 3A program to improve mental health. The effectiveness value is seen from the calculation of the ES (Effect Size) value with the following results:  86. This showed that the Ayah 3A (Asih Asuh Anak) program tends to be effective for improving mental health in the subjects of this study.
In addition, the provision of education also tends to be effective in increasing the knowledge of fathers in this study related to their parenting knowledge. The results obtained indicate that the 3A program is sufficient to expand subject knowledge, especially fathers regarding childcare skills in the family. This supports an increase in the mental health status of fathers and children in general. Cited the results of previous studies that the provision of online interventions tends to be effective when combining synchronous and asynchronous methods (Sosialita, 2020), so this Ayah 3A (Asih Asuh Anak) program can be considered as one of the effective media in improving mental health. In addition, providing education regarding parenting also increases subject knowledge to contribute to improving mental health.
However, the program's implementation also encountered obstacles related to the pandemic situation, requiring direct contact and interaction restrictions. This has an impact on the delay in the process of providing interventions, primarily face-to-face consultation activities. As previously explained, the Ayah 3A (Asih Asuh Anak) program was implemented online with synchronous and asynchronous methods based on considerations of the effectiveness of online interventions from previous studies.
The obstacles to conducting face-to-face consultations made some subjects choose to receive intervention without a face-to-face consultation. Inequality of treatment obtained by the subject can affect the outcome of the intervention. The findings of this study can be concluded that the Ayah 3A program given to families in densely populated areas, namely the Sukomanunggal District, the working area of Simomulyo Health Center, is quite effective. The provision of online intervention programs using synchronous and asynchronous methods, and combined with face-to-face meetings, is seen as one of the effective intervention media in overcoming mental health problems to be considered to improve people's mental health.

CONCLUSION
The results showed that Ayah 3A (Asih Asuh Anak) program was quite effective as a parenting support media used by fathers in this research. Based on the findings of this research, the Ayah 3A program was able to increase the knowledge and skills of fathers in carrying out parenting roles. This has impacted the mental health status of family members. Both fathers and children showed a significant improvement in their mental health status.