Barriers to Physical Activity Programs in Patients with Type 2 Diabetes Mellitus (T2DM) in Yogyakarta: A Qualitative study


Mahendro Prasetyo Kusumo
Wiwik Kusumawati


The difficulty of the community to understand health behavior is the main cause of poor physical activity behavior. The aim of this study is to explore health education barriers to controlling blood glucose patient with DM in primry health care. The Forum Group Discussion (n = 22) and interview (n = 5) methods were to explore the patient's desire to overcome educational barriers. Informants were patients with DM aged of 26-69 year-old from two community health center and two private health center in Sleman Regency, Indonesia. The questions were around barriers to physical activity programs for controlling blood glucose. The data were analyzed using Opencode. Boring educational training is the leading cause of physical activity and dietary control in patients with DM. Formal language in delivering material is the cause of patient boredom to take part in the training. Despise and feeling of anxiety to ask questions during the educational procedure that the patient feels. Also, in terms of health service providers, limited human resources have resulted in a lack of maximum education programs for patients with DM in Yogyakarta.Tense atmosphere and language that is difficult to understand have a negative impact on patient behavior to change physical activity behavior and controlled eating patterns in patients with DM.


Author Biographies

Mahendro Prasetyo Kusumo, Master of Hospital Administration, Postgraduate Programme, Universitas Muhammadiyah Yogyakarta, Indonesia; Departement of public Health, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Indonesia

Scopus ID: 57218885421

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Wiwik Kusumawati, Departement of medical education, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Indonesia

Scopus ID: 57160948400

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How to Cite
Kusumo, M. P., & Kusumawati, W. (2021). Barriers to Physical Activity Programs in Patients with Type 2 Diabetes Mellitus (T2DM) in Yogyakarta: A Qualitative study. Unnes Journal of Public Health, 11(1).


Abram L Wagner (2019) ‘The impact of weather on summer and winter exercise behaviors’. Elsevier B.V., 8, pp. 39–45. doi: 10.1016/j.jshs.2016.07.007.
Balk, E. M. et al. (2015) ‘Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force’, Annals of Internal Medicine, 163(6), p. 437. doi: 10.7326/M15-0452.
Bingham, M. (2018) ‘Timely News for the Multidisciplinary Care Team’, Diabetes Spectrum, 31(4), pp. 290–294. doi: 10.2337/ds18-0061.
Dickinson, J. K. (2018) ‘The experience of diabetes-related language in diabetes care’, Diabetes Spectrum, 31(1), pp. 58–64. doi: 10.2337/ds16-0082.
Dinas Kesehatan Kabupaten Sleman (2020) ‘Profil Kesehatan Kabupaten Sleman Tahun 2020’, Dinas Kesehatan Sleman.
Emmy Suhl, P. B. (2006) ‘Diabetes Self-Management Education for Older Adults: General Principles and Practical Application’, Diabetes Spectrum, 19(4), pp. 234–240. Available at:
Engström, M. S. et al. (2016) ‘What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored patient-reported outcome measure for the Swedish National Diabetes Register’, BMJ Open, 6(3), pp. 1–9. doi: 10.1136/bmjopen-2015-010249.
Fachmi Idris (2014) ‘Pengintegrasian Program Preventif Penyakit Diabetes Melitus Tipe 2 PT Askes (Persero) ke Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan) The Integration of Prevention Program of Diabetes Mellitus type 2 PT Askes (Persero) into Health BPJS’, J Indon Med Assoc, 64(3), pp. 115–21.
Greaves, C. et al. (2011) ‘Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions’, BMC public health, 11, p. 119. Available at:
Healthcare and Social Security Agency (2014) ‘Panduan Praktis Edukasi Kesehatan’, Panduan Praktis Edukasi Kesehatan, p. 22.
Healthcare and Social Security Agency (2019) ‘Peraturan Badan Penyelenggara Jaminan Sosial Kesehatan Nomor 7 Tahun 2019 tentang Petunjuk Pelaksanaan Pembayaran Kapitasi Berbasis Kinerja’, pp. 1–26.
Hemmingsen, B. et al. (2017) ‘Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus’, Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. doi: 10.1002/14651858.CD003054.pub4.
Jancey, J. M. et al. (2009) ‘Perceptions of physical activity by older adults: A qualitative study’, Health Education Journal, 68(3), pp. 196–206. doi: 10.1177/0017896909339531.
Jhon W. Creswell-Vicki L. Plano Clark (2011) Designing and Conducting Mixed Methods Research. 2ad Editio. Edited by C. A. Vicki Knight, Lauren Habib, Ashley Dodd. Thousand Oaks, California: SAGE Publications, Inc.2455 Teller Road, Thousand Oaks California 91320.
Kemenkes RI (2017) ‘Impelementasi gerakan masyarakat hidup sehat (germas) dalam rangka mewujudkan asn sehat’. Jakarta, Indonesia: KEMENTERIAN KESEHATAN RI, p. 16.
Kementerian Kesehatan Republik Indonesia (2014) ‘Peraturan Menteri Kesehatan Republik Indonesia Nomor 45 Tahun 2014 Tentang Penyelenggaraan Surveilans Kesehatan’, Kemenkes, pp. 1–27. doi: 10.1024/0301-1526.32.1.54.
Kementerian Kesehatan Republik Indonesia (2018) Prevalensi Diabetes Mellitus di Indonesia. Jakarta, Indonesia.
Kementrian Kesehatan Republik Indonesia (2018) ‘Riset Kesehatan Dasar 2018’. Jakarta, Indonesia: Kementrian Kesehatan Republik Indonesia.
King, K. M. et al. (2017) ‘Perceptions of adolescent patients of the “Lived experience” of type 1 diabetes’, Diabetes Spectrum, 30(1), pp. 23–35. doi: 10.2337/ds15-0041.
Kusumo, M. P., Hendrartini, J., Sufro, Z. M. and Dewi, F. S. T. (2020) ‘A qualitative study to explore the perception of patients towards diet in Javanese culture’, Enfermeria Clinica, 30(October), pp. 183–187. doi: 10.1016/j.enfcli.2020.06.041.
Kusumo, M. P., Hendrartini, J., Sufro, Z. M. and Tetra, F. S. (2020) ‘Theater Performing Arts ( TPA ): Community Empowerment to Improve Blood Glucose Control Behavior in Yogyakarta’, 18(4). doi: 10.5812/ijem.103106.Research.
Kusumo, M. P., Prabandari, Y. S. and Dewi, F. S. T. (2021) ‘Measuring the Knowledge, Attitude and Practice of Patients With Diabetes Mellitus—The Design and Development Process’, International Quarterly of Community Health Education, p. 0272684X2110221. doi: 10.1177/0272684x211022173.
Lantara, N. F. (2015) ‘The Roles of Woman as Leader and Housewife’, Journal of Defense Management, 05(01), pp. 1–5. doi: 10.4172/2167-0374.1000125.
Lascar, N. et al. (2014) ‘Attitudes and barriers to exercise in adults with type 1 diabetes (T1DM) and how best to address them: A qualitative study’, PLoS ONE, 9(9). doi: 10.1371/journal.pone.0108019.
Lidegaard, L. P. et al. (2016) ‘Barriers to and motivators for physical activity among people with Type 2 diabetes: patients’ perspectives’, Diabetic Medicine, 33(12), pp. 1677–1685. doi: 10.1111/dme.13167.
Mikhael, E. M. et al. (2019) ‘Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Dovepress Self-management knowledge and practice of type 2 diabetes mellitus patients in Baghdad, iraq: a qualitative study’, Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, pp. 12–13. doi: 10.2147/DMSO.S183776.
National Institutes of Health (2002) ‘The Diabetes Prevention Program (DPP): Description of lifestyle intervention’, Diabetes Care, 25(12), pp. 2165–2171. doi: 10.2337/diacare.25.12.2165.
Peraturan Kementrian Kesehatan (2015) ‘Peraturan Menteri Kesehatan Republik Indonesia nomor 71 tahun 2015’. Jakarta, Indonesia: Mentri Kesehatan, p. 15. Available at:
Peraturan Presiden Republik Indonesia (2013) ‘Peraturan Presiden Republik Indonesia nomor 12 tahun 2013 tentang Jaminan Kesehatan’. Jakarta, Indonesia: Kementerian Kesehatan RI, p. 39.
Perkumpulan Endokrinologi Indonesia (2015) Konsnsus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015. 2015th edn. Jakarta, Indonesia: PB. PERKENI.
Ranasinghe, P. et al. (2015) ‘Knowledge and perceptions about diet and physical activity among Sri Lankan adults with diabetes mellitus: a qualitative study’, BMC Public Health. BMC Public Health, 15(1), p. 1160. doi: 10.1186/s12889-015-2518-3.
Shabiralyani, G. et al. (2015) ‘Impact of Visual Aids in Enhancing the Learning Process Case’, Journal of Education and Practice, 6(19), pp. 226–234. Available at:
Svavarsdóttir, M. H., Sigurardóttir, Á. K. and Steinsbekk, A. (2015) ‘How to become an expert educator: A qualitative study on the view of health professionals with experience in patient education Approaches to teaching and learning’, BMC Medical Education. BMC Medical Education, 15(1), pp. 1–9. doi: 10.1186/s12909-015-0370-x.
Tucker, P. and Gilliland, J. (2007) ‘The effect of season and weather on physical activity : A systematic review’, pp. 909–922. doi: 10.1016/j.puhe.2007.04.009.
Walker, K. C., Valentiner, L. S. and Langberg, H. (2018) ‘Motivational factors for initiating, implementing, and maintaining physical activity behavior following a rehabilitation program for patients with type 2 diabetes: a longitudinal, qualitative, interview study’, Patient Preference and Adherence, Volume 12, pp. 145–152. doi: 10.2147/PPA.S150008.
World Health Organization (2016) Global Report on Diabetes, World Health Organization. Geneva.