The socio-demographic profile and coping mechanisms of inmates in Lanao del Sur province, Philippines

The purpose of this study is to examine how the inmates adapt/adjust to jail environments in the prison, in terms of their physical, physiological, social and psychological well-being. The study is beneficial to the inmates, jail managers, political leaders, fellow researches and nurses. This descriptive-correlational study includes ninety-six (96) inmates who were selected using systematic random sampling. This study was conducted within the boundaries of the two jails (Provincial Jail and the Bureau of Jail Management and Penology) in Lanao del Sur Province, 9700, Philippines. The study utilized a researcher-made checklist questionnaire. A pilot study, content validation, and test of the reliability of the survey tool were conducted. Using IBM Software Packages for Social Sciences (SPSS) version 5.0, the following statistical formulas were utilized: frequency percentage distribution, weighted mean (x ̅ ), standard deviation (SD), and Cramer’s V(φc) correlation. Most of the inmates incarcerated in Lanao del Sur Province were young adults, single, male, Muslims, high school graduates, and were imprisoned for five to ten years. Inmates sometimes used psychological, physical-physiological, and social activities as their coping mechanism while inside the jail system. Majority of the inmates never experienced problems pertaining to health and economic concerns but sometimes experienced problems concerning psychosocial matters. Cramer’s V(φc) revealed a strong correlation between the socio-demographic profiles and coping mechanisms of the inmates. Therefore, nurses assigned in the jail facility face must promote the safety, welfare, and well-being of inmates despite the overcrowding situation in the Philippine jail


Introduction
*In the Philippines, the correctional facilities were characterized by poverty, corruption, and underresourcing (Narag and Jones, 2017). It was reported that inmates accounted for a 142,168 total population or 140 inmates for every 100,000 inhabitants. Thus, Philippine jails have exceeded their capacity to accommodate inmates, which leads to over congestion. Prison overcrowding is defined as the mismatch between the prison capacity and the number of inmates to be accommodated (Picken, 2012). Such overcrowding situation inside the prisons has led to multiple health-related problems.
Specifically, a study cited that the cell facilities in the Philippines are characterized by poorly maintained toilet facilities, inadequate food supply, limited water supply, unsanitary conditions, illtreatment (torture), unjust lengthy detention, poor ventilation, lack of natural lighting, inadequate sleeping quarters, lack adequate medical care are some of the most commonly reported horrific condition of the jail facilities (Conde, 2016). Inmates refer to a person charged or convicted with crimes and is confined in jails to serve his/her sentence. However, these individuals must still receive the same basic rights for health attention while being incarcerated. Ultimately, such horrific conditions in the cell facilities can lead to negative impacts on the psychological well-being and general well-being of the inmates (Prakash et al., 2015). Coping Strategies is a behavioral strategy, a mental process and personal techniques used by the inmates to manage a stressful experience, to eliminate psychological distress, and lastly to overcome their emotional issues while they are incarcerated. Thus, inmates need to adapt to the poor condition of the jail environment, and their ability to address their basic psychological and physical concerns while inside the jail. Philippine jails' capacity to accommodate inmates remains a major concern in the country. However, only limited studies have examined the basic needs of inmates and the importance of health access inside the prison. Thus, nurses assigned in the jail face challenges in enhancing and promoting the safety, welfare, and well-being of inmates despite the overcrowding situation in the Philippine jail system. Thus, the purpose of this study is to examine how the inmates are adapting/adjusting to the jail environments inside the prison, in terms of their physical, physiological, social and psychological wellbeing. Furthermore, this study determined concerns and problems confronting inmates inside the jail system. The study used a quantitative research approach that determined how inmates cope with their present situation and improve their living conditions.

Theoretical framework
The study adopted Sister Callista Roy's Adaptation Model which explains that health is not defined as "absence of disease but an ability to cope with all conditions, circumstances, and situations". According to this theory, human makes an effort to strive to respond to environmental stimuli necessary to maintain integrity. Furthermore, humans use a system of adaptive modes or mechanisms as ways of interacting with the changing environment. Such adaptive modes that enhance life processes include physical-physiological, psychological-spiritual, and social-relational integrity (Ursavas et al., 2014). Thus, nurses must be an agent of facilitator in promoting positive adaptation that aims to promote health, well-being, integrity, and quality of life of the inmates.

Research objectives
This research paper seeks to determine the following purposes:  To determine the socio-demographic profile of inmates in terms of age, religion, marital status, education and length of imprisonment.  To determine the problems confronting inmates inside the jail in terms of physiologic health, psychosocial and economic concern.
 To determine the coping mechanism most commonly used by the inmates while in prison in terms of the physical, social and psychological aspects.  To determine the correlation between the sociodemographic profile and the coping mechanisms used by the inmates while in prison.

Hypothesis testing
Ho1: There is no significant relationship between the socio-demographic profile and the coping mechanisms used by the inmates while inside the prison.

Study design
This study utilized a descriptive-correlational design. As a descriptive study, it aims to determine and explore the socio-demographic, psychophysical adaptations and problems confronting inmates inside the jail system. As a correlational study, it aims to identify the presence of an association between the socio-demographic profile and the coping mechanism used by the inmates while in prison.

Setting and sample
This study was conducted within the boundaries of the two jails (Provincial Jail and the Bureau of Jail Management and Penology) in Lanao del Sur Province, 9700, Philippines.
The target population of the study was the one hundred forty-four (144) inmates in the two jails in Lanao del Sur Province. From them, the sample of the study included ninety-six (96) inmates who were selected using systematic random sampling.

Ethical consideration
Research ethics were primarily observed and maintained throughout the conduct of the study. Ethical approval was obtained from the College of Health Sciences-Graduate Studies Ethics Committee with a file number [CHSGS/2019102502301].
The study adopted the standard World Health Organization (WHO) informed consent for research study to ensure that respondents: A) voluntarily participated in the study; B) informed about the rights, benefits and possible risks involved in participating in the study; and C) explained their rights to withdraw at any time without giving any valid reasons.

Measurement/instrument
Part I of the survey questionnaire is the sociodemographic profile of the inmates according to their age, religion, marital status, highest educational attainment, and length of imprisonment. Part II deals with the coping mechanism most commonly used by inmates which are further subdivided into (a) the physical/physiologic factors, (b) social activities of inmates; and (c) psychological adaptations of inmates. Part III is the physiologic health, psychosocial and economic problems confronting inmates inside the jail.
Moreover, a summated rating scaling was used to determine, understand, and explore the relationship of the variables under study. Accordingly, a mean score of 2.34-3.00 is interpreted as "Always", 1.67-2.33 means "Seldom", and 1.00-1.66 mean score reflects "Never".
A modified Likert-type researcher-made checklist questionnaire was utilized based on the review of related literature and studies, specifically on the physical adaptation and psychological coping mechanisms of the inmates. The questionnaire underwent content validation by experts in the Nursing profession. Furthermore, pilot testing was conducted to at least five (5) inmates from the three (3) jails, with a total of fifteen (15) inmates, who were then excluded from the actual research sample. Afterward, the survey questionnaire was tested for reliability using the reliability test before its actual conduction and obtained a 0.835 Cronbach Alpha score.

Data collection procedure
The researchers first secured permission from the Provincial Jail and the Bureau of Jail Management and Penology. An explanation of the study's purpose and procedure to the inmates was given through informed consent. Afterward, the respondents answered the self-reported questionnaire (SAQ) for 10-15 minutes. Data were collected from January to March 2017. Data organization, tabulation and statistical treatment ensued thereafter

Data analysis
Using IBM Software Packages for Social Sciences (SPSS) version 5.0, the following statistical formulas were utilized: Frequency percentage distribution, weighted mean (x̅ ), and standard deviation (SD) for descriptive statistics. For the inferential statistics, the researcher utilized Cramer's V(φc) statistical tool in testing the hypothesis that determines the association between two nominal variables.

Socio-demographic profiles of the inmates as respondents of the study
The result of this study as presented in Table 1 indicated that most of the inmates in Lanao del Sur Province were young adults (n=68 or 70.8%), male (n=90 or 93.8%), Muslims (n=93 or 96.9%), who were single (n=39 or 40.6%), have reached high school (n=41 or 42.7%), and were imprisoned for five to ten years (n=38 or 39.6%).  Table 2 depicts the problems most commonly confront inmates inside the jail. The majority of the inmates sometimes perceived that the problem that concerns the most among the three problems is those concerning psychosocial matters (x̅ =2.32, SD±0.74). This is followed by health concerns (x̅ =1.32, SD±0.95) which are never experienced by the inmates. On the other hand, most of the inmates also never experienced problems with economic concerns (x̅ =1.07, SD±1.03).  Table 3 depicts the coping mechanisms most commonly used by inmates as respondents of the study. Among the three (3) coping mechanism activities, the majority of the inmates' perceived psychological activities as their most commonly used coping mechanism (x̅ =2.46, SD±0.71). This is followed by physical-physiological activities (x̅ =2.42, SD±0.66). Meanwhile, most of the inmates perceived social activities as their least means of coping (x̅ =2.19, SD±0.64). In general, inmates sometimes used psychological, physical, physiological, and social activities as their coping mechanisms during their stay inside the jail.

Association between the socio-demographic profile and coping mechanism of inmates
This study aimed to test the significant association between the respondents' sociodemographic profile and coping mechanisms as presented in Table 4. Cramer's V(φc) revealed a strong correlation on the following: a) age and physical-physiological activities of coping mechanism (φc=11.67; p=0.003); b) marital status and physical-physiological activities of coping mechanism (φc=7.94; p=0.019); c) age and social activities of coping mechanism (φc=13.01; p=0.001); d) age and psychological activities of coping mechanism (φc=6.87; p=0.032); e) marital status and psychological activities of coping mechanism (φc=6.88; p=0.032); and lastly f) education and psychological activities of coping mechanism (φc=9.85; p=0.020).

Problems confronting inmates inside the jail
The majority of the inmates never experienced problems with health and economic concerns but sometimes experienced the problem concerning psychosocial matters. Many studies demonstrate inconsistency with the findings of the present study. According to a study in India, it has been cited that imprisonment for a long time faces many physical and mental difficulties. Specifically, the general psychological impact of incarceration says that inmates experience major trouble and most stress at the beginning of the punishment (Prakash et al., 2015). Specifically, inmates experience negative mental states ranging from helplessness, hopelessness, depression, poor self-esteem, disturbed self-image, and worst psychiatric morbidity (Picken, 2012). Anxiety and eventually depression are primary concerns and psychological disturbances in inmates' lives when ignored can lead to more serious mental illness. Furthermore, a higher level of stress and unmanaged anxiety may lead to more serious mental health problems (Alshammari, 2019). Thus, the tough life in prison worsens the situation which deteriorates the quality of life and well-being of inmates (Prakash et al., 2015).
In lieu of this, the disturbances in the psychological well-being of a person also affect the physiological regulation of the body's response to stressors. A person's vulnerability to mental health poses a risk to physical health (Alshammari, 2019). Overcrowding is a demonstrated risk factor for tuberculosis transmission and a particularly common risk factor in prisons. Moreover, prisons have some of the highest primary tuberculosis and multidrug-resistant tuberculosis (MDR-TB) prevalence rates in the world (Van Harreveld et al., 2007). A study in Saudi Arabia has integrated a control strategy in the spread of infectious/contagious diseases in a community population, including those in the prisons. Thus, preventing the transfer of contagious illness from the susceptible person to another person (Ashraf and Ahmad, 2019). In addition, increasing concerns in the correctional facilities are sexually transmitted diseases. Policies are being developed to prevent the transmission of HIV and hepatitis in penitentiary systems. A study was reported that there is a higher incidence of sexually transmitted diseases in the prison population compared to those in the general population perhaps because of injecting behavior and risky sexual behavior (Prakash et al., 2015). In a similar study in Lanao Del Sur Province, these results agree with Sadang et al. (2019), who reported that the increasing number of genitourinary infections in the country is alarming and is now a major health concern to the general public. Hence, in this context, nurses need adequate preparation to respond to address such health problems.
Maintaining the quality of care to inmates is one of the indispensable roles of competent healthcare practitioners including nurses. The focus in the commitment to serve inmates competently which aim towards health maintenance, health promotion, disease prevention and improvement of well-being . Jail warden nurses must be prepared to meet the healthcare needs and prisoner's well-being. The nurse must also address and meet the physical and physiologic needs of inmates and interventions must focus on personal hygiene, physical mobility, and nutrition (Mejia et al., 2019a). Furthermore, a standardized health education program must be developed to tackle important key health strategies that focus on promoting a healthy lifestyle (Mejia et al., 2019b). Health promotion must focus on health-related habits, behavior, and practices including social skills, interpersonal relationships, physical health, safety, personal hygiene, physical environment. Such health-promotion initiatives promoting health and well-being (Haider et al., 2018). Thus, jail-warden nurses are in the perfect position to identify and address physical, psychological, emotional, behavioral, social, cultural and spiritual needs of inmates and must learn to prioritize and manage the physical, medical, psychological, spiritual, and social aspect of care (Mejia et al., 2019c).

The coping mechanism of inmates
Most of the inmates sometimes used psychological, physical-physiological, and social activities as their coping mechanisms while inside the jail system. This study is supported by studies in India, Malaysia, and the Philippines. According to a study in India, it has been cited that imprisonment leaves a negative impact on the psychological and physical health of the inmates and deteriorates their mental balance. Specifically, the general psychological impact of incarceration says that inmates experience more stress and major trouble at the beginning of the punishment (Prakash et al., 2015). Since prison inmates have higher levels of stress, anxiety, and suicide than the general population, correctional institutions need to aid the inmates to mentally cope with imprisonment. Furthermore, the health education program is an important key health strategy in controlling and managing the stress-levels (Mejia et al., 2019a). The high level of anxiety and stress can be reduced through religious practices, yoga, and meditation which reduces the stress level and improves inmates' state of mental health (Prakash et al., 2015). Another study determined mindfulness as an alternative method in managing anxiety, depression, burden, and other related mental health problems. These results agree with the study by Albagawi et al. (2019), which stated that self-efficacy helps an inmate to firmly believe in their ability to adapt and respond to difficult situations, solve and cope with complex problems and manage any associated problems. The self-efficacy of inmates is an essential factor as it positively influences their ability to function effectively and adapt to stressful situations inside the jail. Also, self-efficacy is vital in psychology because how inmates motivate themselves determines a person's capabilities in improving their well-being through individual life experience and encouragement (Maat et al., 2018). Nurses' role is geared toward managing the anxiety and stress level of inmates through integrating interventions that enhance their coping skills (Alshammari, 2019). However, not all coping strategies available apply to inmates due to the strict prison environment. An emotion-focused coping strategy is particularly more effective (compared to appraisal-focused and problem-focused coping strategies) because it has a beneficial impact on the psychological well-being of inmates. Such coping strategy involves distraction activities, hostility management, exercise, meditation, and using relaxation procedures. Thus, the cognitive manner of the emotion-focused coping strategy involves redefining the perception of the current stressful situation inside the correctional facilities (Van Harreveld et al., 2007).
Since the prison population around the world continues to rise, and the prison capacity continues to be pressured, measures should be taken to alleviate the consequences of overcrowding (Picken, 2012). This made the inmate prone to physical and physiological problems because of being confined in a limited space inside the cell. The need to provide regular outdoor activities, physical recreation, and physical exercises for inmates to provide relief and relaxation. This is one of the measures that help inmates cope up effectively inside the correctional facilities (Prakash et al., 2015). A study in Malaysia pointed out that inmates as individuals must be allowed to engage themselves in physical activities like fitness activities and exercise. Also, health is not only evaluated in terms of the absence of disease but also determined by the individual's level of physical fitness. Physical fitness needs to be regarded as a predictor of general health and considered as the best indicator of one's health (Elumalai et al., 2019).
Lastly, social isolation is common among inmates and is manifested by fewer family visits each month and had been recently victimized by aggravated assault network (Van Harreveld et al., 2007). Thus, the need to provide comprehensive assessment and interdisciplinary plan of care for catering to the social needs of inmates is a key domain for the provision of a more humane approach in the care of inmates as a human being (Mejia et al., 2019b). The need for a social manner of the emotion-focused coping mechanism involves sharing feelings with other inmates in the form of social networks (Van Harreveld et al., 2007). A study in Turkey emphasized the importance of social activities as a means to promote channel of communication, sharing of messages and information, and facilitate interaction among inmates (Ozturk, 2019). Therefore, more opportunities and visiting time for inmates can improve their adjustment to incarceration and coping, as well as their well-being. Similarly, inmates were found to participate actively in programs involving socialization, socializing activities, and social gathering. Such celebrations inside prison helped them cope with social struggles. In fact, therapeutic groups and social communities are significantly important for inmates' adjustment and coping during their stay in prison (Picken, 2012).

Socio-demographic profile and coping mechanism of inmates
The study findings revealed a strong correlation between the socio-demographic profiles and the coping mechanisms of the inmates. Further, the results are also contrasting with the statement of Llego et al. (2019) which stated that age has no relationship with the psychological aspect in coping mechanisms. Accordingly, emotional intelligence (EI) is the ability to control emotions in ones' self, and the ability to use that consciousness to direct actions. Thus, it contradicts the notion that as people grow old, the more they become emotionally intelligent.
Second, a strong correlation between the gender (socio-demographic profile) and the coping mechanisms of the inmates. A similar study in India has cited that those coping strategies are associated with adjustment and the well-being of male inmates (Picken, 2012).
Next, studies and literature have examined the correlation between the years of imprisonment (socio-demographic profile) and the coping mechanism of the inmates. This suggested that years of imprisonment and coping strategies used to deal with the environment can affect the well-being of inmates. In fact, the general psychological impact of incarceration says that inmates experience major trouble and most stress only at the beginning of the punishment. This shows that adaptation and adjustment can change over time and suggests that inmates use some sort of coping mechanisms to enable this adjustment (Picken, 2012).
A lot of limitations were noticed in this paper. Several studies have already assessed the sociodemographic profile of inmates and determined the coping mechanisms of inmates. However, this matter regarding the correlation between the sociodemographic profiles and coping mechanisms of the inmates is needed to explore more in future studies. Furthermore, studies about the relationship between problems confronting inmates and their coping mechanisms have yet to be explored in future researches.

Conclusion and recommendations
Jail-warden nurses must be prepared to provide quality health care and put importance on the healthcare needs and well-being of inmates. Thus, nurses in correctional facilities must address the physical, psychological, emotional, behavioral, social, cultural and spiritual needs of inmates as their rights as a human. Also, the nurse must learn to prioritize and manage the physical, medical, psychological, spiritual, and social aspects of care. Specifically, jail warden nurses must also address and meet the physical and physiologic needs of a patient and interventions must focus on personal hygiene, physical mobility, and nutrition. The nurse must also address psychological status and psychiatric issues as one of the key domains to provide a more humane and comprehensive approach in healthcare. Also, the nurses' role is geared toward managing the anxiety and stress level by integrating interventions that enhance the coping skills of the inmates. The need to conduct clinical interventions that will focus on providing psycho-social support among inmates must be developed. Correctional facilities must aid the inmates to mentally cope with imprisonment. Thus, institutional changes could improve coping techniques. Institutional opportunities and programs are highly beneficial for inmates.

Acknowledgment
Special appreciation to all the inmates from both Provincial Jail and the Bureau of Jail Management and Penology who participated in the study.

Informed consent
Informed consent was secured from all inmates who have participated in the study.