| 1. |
- Dewi, Fatwa Sari Tetra, et al.
(författare)
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A community intervention for behaviour modification : an experience to control cardiovascular diseases in Yogyakarta, Indonesia
- 2013
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Non-communicable Disease (NCD) is increasingly burdening developing countries including Indonesia. However only a few intervention studies on NCD control in developing countries are reported. This study aims to report experiences from the development of a community-based pilot intervention to prevent cardiovascular disease (CVD), as initial part of a future extended PRORIVA program (Program to Reduce Cardiovascular Disease Risk Factors in Yogyakarta, Indonesia) in an urban area within Jogjakarta, Indonesia.Methods: The study is quasi-experimental and based on a mixed design involving both quantitative and qualitative methods. Four communities were selected as intervention areas and one community was selected as a referent area. A community-empowerment approach was utilized to motivate community to develop health promotion activities. Data on knowledge and attitudes with regard to CVD risk factors, smoking, physical inactivity, and fruit and vegetable were collected using the WHO STEPwise questionnaire. 980 people in the intervention areas and 151 people in the referent area participated in the pre-test. In the post-test 883 respondents were re-measured from the intervention areas and 144 respondents from the referent area. The qualitative data were collected using written meeting records (80), facilitator reports (5), free-listing (112) and in-depth interviews (4). Those data were analysed to contribute a deeper understanding of how the population perceived the intervention.Results: Frequency and participation rates of activities were higher in the low socioeconomic status (SES) communities than in the high SES communities (40 and 13 activities respectively). The proportion of having high knowledge increased significantly from 56% to 70% among men in the intervention communities. The qualitative study shows that respondents thought PRORIVA improved their awareness of CVD and encouraged them to experiment healthier behaviours. PRORIVA was perceived as a useful program and was expected for the continuation. Citizens of low SES communities thought PRORIVA was a “cheerful” program.Conclusion: A community-empowerment approach can encourage community participation which in turn may improve the citizen’s knowledge of the danger impact of CVD. Thus, a bottom-up approach may improve citizens’ acceptance of a program, and be a feasible way to prevent and control CVD in urban communities within a low income country.
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| 2. |
- Dewi, Fatwa Sari Tetra, et al.
(författare)
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An increase in risk factors for cardiovascular disease in Yogyakarta, Indonesia : a comparison of two cross-sectional surveys
- 2015
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Ingår i: Southeast Asian Journal of Tropical Medicine and Public Health. - : Southeast Asian Ministers of Education Organization. - 0125-1562. ; 46:4, s. 775-785
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Tidskriftsartikel (refereegranskat)abstract
- This paper aims to describe changes in risk factors for cardiovascular disease (CVD) over a five year period in urban Indonesia. In 2004 (n=3,205) and 2009 (n=2,467) we conducted cross-sectional surveys of residents in Yogjakarta City, Indonesia evaluating risk factors for CVD. Smoking habits, fruit and vegetable intake, physical activity, blood pressure, weight, and height were recorded. The results of these 2 surveys conducted 5 years apart were then compared. The risk for having a CVD event was also calculated. Behavioral CVD risk factors were more common among men. The predicted risk of having a CVD event increased from 8.4% to 11.3% among men between 2004 and 2009. Effective measures need to be taken to change these behaviors among men in Yogyakarta, Indonesia.
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| 3. |
- Dewi, Fatwa Sari Tetra, et al.
(författare)
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Health promotion using youtube: The experiences and preliminary findings from the indonesian inahealth channel
- 2021
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Ingår i: Open Access Macedonian Journal of Medical Sciences. - : Scientific Foundation SPIROSKI. - 1857-9655. ; 9:E, s. 1596-1605
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The YouTube channel is a promising platform to deliver health promotions because it can reach a large population. However, few studies report experiences delivering health promotion on the YouTube channel especially in Low-and-Middle-Income Countries. In 2017, we established a digital health promotion program named INAHEALTH YouTube channel.AIM: We aim to report the experiences and lessons learned on how to develop a health promotion program using the YouTube platform.METHODS: The steps of developing a health promotion program using a YouTube channel started from assessment, designing working system, piloting the system, implementing, evaluating, and revising the system regularly. The performance of the INAHEALTH YouTube channel and its videos needs regular monitoring not only by considering the appropriateness of health message to the target audience but also how to engage the audience.RESULTS: There are 16 playlists with 399 videos, about 100K subscribers per June 30, 2021. The characters of viewers are 18–34 year (55.3%), more men (54.8%) and comes from Indonesia (93.4%). The word cloud analysis, found that audience were concerned about their/their family sickness and looking for information. The traffic sources of INAHEALTH channel were dominated by suggested video (46.7%). However, the engagement of the videos was still low. Some recommendations to develop a health promotion channel on YouTube: Understanding the audience, delivering video content suitable to the audience, encouraging enjoyable interactions, and managing the online experience.CONCLUSIONS: Health organizations can use these experiences of developing and improving the performance of YouTube channel promotions in delivering health information.
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| 4. |
- Dewi, Fatwa Sari Tetra, et al.
(författare)
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'Maintaining balance and harmony' : Javanese perceptions of health and cardiovascular disease
- 2010
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Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Community intervention programmes to reduce cardiovascular disease (CVD) risk factors within urban communities in developing countries are rare. One possible explanation is the difficulty of designing an intervention that corresponds to the local context and culture.Objectives: To understand people’s perceptions of health and CVD, and how people prevent CVD in an urban setting in Yogyakarta, Indonesia.Methods: A qualitative study was performed through focus group discussions and individual research interviews. Participants were selected purposively in terms of socio-economic status (SES), lay people, community leaders and government officers. Data were analysed by using content analysis.Results: Seven categories were identified: (1) heart disease is dangerous, (2) the cause of heart disease, (3) men have no time for health, (4) women are caretakers for health, (5) different information-seeking patterns, (6) the role of community leaders and (7) patterns of lay people’s action. Each category consists of sub-categories according to the SES of participants. The main theme that emerged was one of balance and harmony, indicating the necessity of assuring a balance between ‘good’ and ‘bad’ habits.Conclusions: The basic concepts of balance and harmony, which differ between low and high SES groups, must be understood when tailoring community interventions to reduce CVD risk factors. The basic concepts of balance and harmony, which differ between low and high SES groups, must be understood when tailoring community interventions to reduce CVD risk factors.
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| 5. |
- Dewi, Fatwa Sari Tetra, et al.
(författare)
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Mobilising a disadvantaged community for a cardiovascular intervention : designing PRORIVA in Yogyakarta, Indonesia
- 2010
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Ingår i: Global Health Action. - : CoAction Publishing. - 1654-9716 .- 1654-9880. ; 3, s. 4661-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Cardiovascular disease (CVD) is a burden for developing countries, yet few CVD intervention studies have been conducted in developing countries such as Indonesia. This paper outlines the process of designing a community intervention programme to reduce CVD risk factors, and discusses experiences with regard to design issues for a small-scale intervention.DESIGN PROCESS: THE DESIGN PROCESS FOR THE PRESENT COMMUNITY INTERVENTION CONSISTED OF SIX STAGES: (1) a baseline risk factor survey, (2) design of a small-scale intervention by using both baseline survey and qualitative data, (3) implementation of the small-scale intervention, (4) evaluation of the small-scale intervention and design of a broader CVD intervention in the Yogyakarta municipality, (5) implementation of the broader intervention and (6) evaluation of the broader CVD intervention. According to the baseline survey, 60% of the men were smokers, more than 30% of the population had insufficient fruit and vegetable intake and more than 30% of the population were physically inactive, this is why a small-scale population intervention approach was chosen, guided both by the findings in the quantitative and the qualitative study.EXPERIENCES: A quasi-experimental study was designed with a control group and pre- and post-testing. In the small-scale intervention, two sub-districts were selected and randomly assigned as intervention and control areas. Within them, six intervention settings (two sub-villages, two schools and two workplaces) and three control settings (a sub-village, a school and a workplace) were selected. Health promotion activities targeting the whole community were implemented in the intervention area. During the evaluation, more activities were performed in the low socioeconomic status sub-village and at the civil workplace.
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| 6. |
- Dewi, Fatwa Sari Tetra, 1969-
(författare)
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Working with community : exploring community empowerment to support non-communicable disease prevention in a middle-incom country
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Non communicable diseases (NCD) are recognized as a major burden of human health globally, especially in low and middle-income countries including Indonesia. This thesis addresses a community intervention program utilizing a community empowerment approach to study whether this is a reasonable strategy to control NCD.Objective: To explore possible opportunities, common pitfalls, and barriers in the process of developing a pilot community intervention program to prevent NCD in an urban area of a middle-income country.Methods: The study was conducted in Yogyakarta Municipality. The baseline risk factor survey in 2004 (n=3205) describes the pattern of NCD risk factors (smoking, physical inactivity and low fruit and vegetable intake) and demographic characteristics using STEPwise instrument. A qualitative study was conducted in order to illustrate peoples’ perceptions about NCD risk factors and how NCD might be prevented. A pilot intervention was developed based on the baseline survey and the qualitative data. The pilot intervention was conducted in four intervention communities while one community served as the referent area. The intervention was evaluated using quantitative and qualitative approaches. Finally, a second cross-sectional survey conducted in 2009 (n= 2467) to measure NCD risk factor changes during the five year period.Results: Baseline qualitative data showed that people in the high SES (Socio Economic Status) group preferred individual activities, whereas people in the low SES group preferred collective activities. Baseline survey data showed that the prevalence of all NCD risk factors were high. The community intervention was designed to promote passive smoking protection, promote healthy diet and physical activity, improve people’s knowledge of NCD, and provide a supporting environment. A mutual understanding between the Proriva team and community leadership was bargained. Several interactive group discussions were performed to increase NCD awareness. A working team was assigned to set goals and develop programs, and the programs were delivered to the community. There were more frequent activities and higher participation rates in the low SES group than in high SES group. The repeated cross-sectional surveys showed that the percentage of men predicted to be at high risk of getting an NCD event had significantly increased in 2009 compared to 2004.Conclusion: The community empowerment model was a feasible choice as a “moderate”strategy to accommodate with people’s need when implementing a community intervention that also interacts with the service provided by the existing health system. A community empowerment approach may improve program acceptance among the people.
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| 7. |
- Ihyauddin, Zulfikar, et al.
(författare)
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The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample.
- 2022
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Ingår i: BMC health services research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Indonesia is in the middle of a rapid epidemiological transition with an ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia.Secondary analyses were conducted of cross-sectional data from adults aged≥40years (n=12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity.Being obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity (p<0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p<0.05) and work absenteeism (21% increase, P<0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p<0.05), being overweight was negatively associated with CHE incidences (50% decrease, p<0.05).Combined together, obesity, overweight, physical inactivity and tobacco use contributed to an increased number of NCDs as well as medical costs and productivity loss in Indonesia. Interventions addressing physical and behavioural risk factors are likely to have substantial benefits for individuals and the wider society in Indonesia.
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| 8. |
- Kusumaningrum, Fitrina Mahardani, et al.
(författare)
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Factors related to quality of life in community-dwelling adults in Sleman Regency, Special Region of Yogyakarta, Indonesia: Results from a cross-sectional study
- 2024
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Ingår i: PLOS ONE. - 1932-6203. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundQuality of life studies in low- and middle-income countries have demonstrated the influence of socioeconomic factors on the quality of life (QoL). However, further studies are required to confirm this association in developing countries with rapidly ageing populations. Using Ferrans et al.'s QoL model, this study aimed to identify the factors associated with the QoL of community-dwelling adults in Indonesia.MethodsA cross-sectional study among 546 community-dwelling adults aged 50+ years was conducted in Yogyakarta, Indonesia, in 2018. QoL was measured using the Short Form 12 questionnaire, which consists of a summary of physical and mental health. We performed stepwise logistic regression analyses to determine odds ratios (ORs) with 95% confidence intervals (CIs) and examined the association between the QoL (physical and mental health) and demographic characteristics, socioeconomic status, financial management behaviour, multimorbidity status, nutritional status, cognitive impairment status, depression status, and independence. Statistical significance was set at p<0.05.ResultsAmong the respondents, 15% reported poor physical health, and 9.2% reported poor mental health. Good physical health was significantly associated with the absence of chronic disease (OR 2.39; 95% CI: 1.07-5.33), independence in activities of daily living (OR 3.90; 95% CI 1.57-9.67) and instrumental activities of daily living (OR 4.34; 95% CI 2.28-8.26). Absence of depression was significantly associated with good mental health (OR 2.80; 95% CI 1.3-5.96).ConclusionThe QoL of community-dwelling adults in Indonesia is associated with activities of daily living and instrumental activities of daily living, as well as the absence of chronic disease and depression. Efforts should be made to prevent chronic disease and delay functional decline through healthy lifestyles and routine physical and mental health screenings.
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| 9. |
- Schröders, Julia, 1985-
(författare)
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Diversity, dynamics and deficits : the role of social networks for the health of aging populations in Indonesia
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: This thesis takes as a predicate that humans are social animals and as such, that their social networks and health are intrinsically connected. A guiding heuristic of this thesis was the Berkman model which conceptualizes how social networks impact health. Considering social networks as a ‘mesosocial’ level between individuals’ health and larger social structures permits assessments of four processes, or pathways: macro↔meso↔micro. The overall aim of this thesis was to contribute to a better understanding of the role of social networks for the health of aging populations in the Southeast Asian context of Indonesia. This work was divided into four sub-studies (I-IV) aiming to i) review existing evidence on social networks and adult health; ii) assess the health effects of social networks; iii) examine how macro-level conditions affect health behavioral pathways through social networks; and iv) understand the macro-level determinants of social network formations.Methods: This thesis employed a mixed methods design integrating evidence syntheses (I) with quantitative (II, III) and qualitative (IV) approaches. The four sub-studies included different conceptual angles on structural, functional and quality aspects of social networks, i.e., network diversity (II), dynamics (III), deficits and loneliness (IV). Following the PRISMA guidelines, a systematic literature review covering the years 2000 to 2015 was conducted. For the two quantitative studies, data on older adults aged 50+ years from the fourth (2007/08) and fifth (2014/15) waves of the Indonesian Family Life Surveys, were analyzed. First, employing an outcome-wide epidemiological approach, evidence for causal effects of social network diversity on 19 outcomes along the disablement process spectrum were evaluated using multivariable regression adjustments, propensity score matching, and instrumental variable analyses. Second, following a systems-approach to conceptualize social networks on four ecological levels, causal mediation analyses were performed to cross-sectionally examine the mediating role of social networks and their dynamics between a latent socioeconomic position indicator and two healthcare utilization outcomes. Also, the socioeconomic patterning of healthcare utilization and network dynamics were analyzed longitudinally, i.e., before and after Indonesia’s Universal Health Coverage implementation. The qualitative study draws on eight focus group discussions with 48 ‘older adult children’. Data were collected in four rural villages in the Gunung Kidul regency during 2016. The theoretical framework was inspired by symbolic interactionism and sensitizing concepts of systemic networks and network deficits, interpersonal emotions, and the social construction of risks. Data were analyzed using Grounded Theory. The final mixed-methods synthesis (I-IV) was based on notions of systems-thinking, ecological transitions theory, and a framework for studying social processes in aging.Results: The results showed (i) that despite an increased focus on social determinants of health, in Indonesia, social networks remained an under- and unresearched social determinant of non-communicable diseases and inequalities therein, respectively; (ii) that social network diversity conferred a vast array of strong and long-term – yet heterogeneous and gender-specific – effects across the entire disablement process, i.e. affecting pulmonary health outcomes, proinflammatory processes, physical and cognitive functioning, and disability states; (iii) that both social networks on various ecological levels and their dynamics were socio-economically patterned and mediated the association between socioeconomic position and healthcare utilization outcomes while showing stronger mediating effects after Universal Health Coverage implementation; (iv) that ‘older adult children’ experienced their own aging as a process of ‘bargaining for a sense of security’ which reified how and why loneliness emerged amidst the challenges of social, demographic and epidemiological transitions and how in response to this, unconventional compromises, which affected both their networks of caretakers and the places of old-age care, were being made.Conclusion: The results explicated several previously less understood pathways and particularly spoke to the so-called ‘downstream experiences’, ‘upstream questions’, and offered a holistic perspective. Notions of ‘transitions’ within different levels collectively conveyed an understanding that such transitions created risks, and that networks played a crucial interstitial role in both cushioning or exacerbating effects of and on these risks. The final mixed-methods synthesis allowed a comprehensive view on various dimensions of social networks and enabled a multi-contextual and multi-dimensional integration of findings. Collective insights were distilled into two main discussion points which were divided based on their ‘upstream’ and ‘downstream‘ foci. The first explicated the macro-social phenomena that appeared in this thesis i.e., epidemiological transitions, population aging, social change, and discussed – with a focus on network diversity, dynamics and deficits – the meso-social effects on and of such macro-level transitions. The later elucidated both the ‘social network-health’ nexus by explicating the ‘Janus face’ of social networks, as well as the transitions in the interplay of formal and informal social networks and their implications for old-age care. After presenting methodological considerations, the thesis concludes with selected implications for research, policy, and practice which emphasize on strengthening social network research in low and middle-income countries, addressing the precarious conditions of older adult women in rural economies, and promoting the role of the healthcare system.
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| 10. |
- Schröders, Julia, 1985-, et al.
(författare)
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Effects of social network diversity in the disablement process : a comparison of causal inference methods and an outcome-wide approach to the Indonesian Family Life Surveys, 2007-2015
- 2020
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Ingår i: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Social networks (SN) have been proven to be instrumental for healthy aging and function as important safety nets, particular for older adults in low and middle-income countries (LMICs). Despite the importance of interpreting health outcomes in terms of SN, in many LMICs – including Indonesia – epidemiological studies and policy responses on the health effects of SN for aging populations are still uncommon. Using outcome-wide multi-method approaches to longitudinal panel data, this study aims to outline more clearly the role of SN diversity in the aging process in Indonesia. We explore whether and to what degree there is an association of SN diversity with adult health outcomes and investigate potential gender differences, heterogeneous treatment effects, and effect gradients along disablement processes.Methods: Data came from the fourth and fifth waves of the Indonesian Family Life Survey fielded in 2007–08 and 2014–15. The analytic sample consisted of 3060 adults aged 50+ years. The primary exposure variable was the diversity of respondents’ SN at baseline. This was measured through a social network index (SNI), conjoining information about household size together with a range of social ties with whom respondents had active contact across six different types of role relationships. Guided by the disablement process model, a battery of 19 outcomes (8 pathologies, 5 impairments, 4 functional limitations, 2 disabilities) were included into analyses. Evidence for causal effects of SN diversity on health was evaluated using outcome-wide multivariable regression adjustment (RA), propensity score matching (PSM), and instrumental variable (IV) analyses.Results: At baseline, 60% of respondents had a low SNI. Results from the RA and PSM models showed greatest concordance and that among women a diverse SN was positively associated with pulmonary outcomes and upper and lower body functions. Both men and women with a high SNI reported less limitations in performing activities of daily living (ADL) and instrumental ADL (IADL) tasks. A high SNI was negatively associated with C-reactive protein levels in women. The IV analyses yielded positive associations with cognitive functions for both men and women.Conclusions: Diverse SN confer a wide range of strong and heterogeneous long-term health effects, particularly for older women. In settings with limited formal welfare protection, intervening in the SN of older adults and safeguarding their access to diverse networks can be an investment in population health, with manifold implications for health and public policy.
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