Background: Cancer adolescents experience body changes as a result of the disease and side effects of treatment. The impact is felt in many aspects, including physical, psychological and social, which impact on changes in self-concept. This is exacerbated by the inability of adolescents to attend school. Even though school is the most suitable place for adolescents to develop cognitive, social, emotional, and behavioural aspects. The frequency of school absences and changes in self-concept will result in disruption of the achievement of adolescent developmental tasks.
Aims: To examine the relationship between self-concept and school absence, to analyse the predictors for school absence and self-concept of adolescents with cancer and healthy adolescents in Indonesia, and to analyse causal mediation of health status on school absence with self-concept as the mediator.
Methods: Design of the study was cross-sectional, correlational study. Study was conducted in hospitals, and secondary schools. Sampling technique was using matched sampling. Sample was 188 respondents. Statistical analysis was used Spearman’s rho, negative binomial regression, zero-inflated Poisson regression, and multiple linear regression.
Result: There was a statistically significant difference in self-concept in the domain of social competence (p = .00) and athletic competence (p = .00) in cancer adolescents and healthy adolescents. The school absence among cancer adolescents was significantly different from that of healthy adolescents (p = .00). Athletic competence (r = -.24, p < .05) and global self-worth (r = -.22, p < .05) had a negative correlation with school absence in cancer adolescent. Whereas in healthy adolescents, age had a significant correlation with a positive direction towards school absence (r = .33, p < .01). There was no self-concept domain in healthy adolescents that had a statistically significant correlation with school absence. Adolescents who had cancer (β = 3.11, p = .00) predicted school absence in both groups. Meanwhile, several models of self-concept in both groups were appropriate in this study. Health status (β = -.34, p = .01), age (β = .05, p = .03), school absence (β = -.00, p = .47) predicted social competence (R2 = .13, p = .00). Health status (β = -.18, p = .23), gender (β = .23, p = .02), and school absence (β = -.02, p = .01) predicted athletic competence (R2 = .16, p = .00). Moreover, factors predicted global self-worth (R2 = .08, p = .01) were health status (β = .14, p = .27), age (β = -.03, p = .25), gender (β = .20, p = .02), and school absence (β = -.02, p = .01). The causal mediation revealed that the total effect between health status and school absences (β = 17.45), direct effect for health status and school absence (β = 16.44), and causal mediation effect for athletic competence as a mediator (β = 1.01) had a significant effect.
Conclusion: This study found that health status predicted school absence among adolescents in Indonesia. Meanwhile, health status, age, school absence predicted social competence. Athletic competence was predicted by health status, gender, and school absence. Health status, age, gender, and school absence were predictors of global self-worth among adolescents in Indonesia. While athletic competence was a mediating factor in relation to school absences in adolescents in Indonesia.

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