Barriers to Understanding Health Education in Patients with Diabetes Mellitus (DM) in Yogyakarta: Qualitative Study
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Abstract
Poor physical activity behavior has its roots in a lack of understanding of the importance of healthy living. This study explores health education barriers to controlling blood glucose in a patient with DM in primary health care. The Forum Group Discussion (n = 22) and interview (n = 5) methods were used to explore the patient’s desire to overcome educational barriers. Informants for the study were patients with DM aged between 26-69 years from two community health centers and two private health centers within Sleman Regency, Indonesia. The informants were then questioned about barriers to physical activity programs for controlling blood glucose. The data collected was analyzed using Opencode, and the results revealed that boring educational training is the leading cause of physical inactivity and dietary control in patients with DM. Furthermore, the use of formal language in delivering material is the cause of patient boredom to take part in the training. Also, limited health human resources have resulted in a lack of maximum education programs for patients with DM in Yogyakarta. Therefore, a tense atmosphere and the use of complex language have a negative impact on patients to change physical activity and control eating patterns.
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How to Cite
Kusumo, M. P., & Kusumawati, W. (2022). Barriers to Understanding Health Education in Patients with Diabetes Mellitus (DM) in Yogyakarta: Qualitative Study. Unnes Journal of Public Health, 11(1), 14-22. https://doi.org/10.15294/ujph.v11i1.43917
References
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Creswell, J.W. & Clark, V.L.P. 2011. Designing and Conducting Mixed Methods Research. California: SAGE Publications.
Dickinson, J.K. 2018. The Experience of Diabetes-Related Language in Diabetes Care. Diabetes Spectrum, 31 (1): 58–64. https://doi.org/10.2337/ds16-0082.
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): 1–9. https://doi.org/10.1136/bmjopen-2015-010249.
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: 119. Available at: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=21333011.
Healthcare and Social Security Agency. 2014. Panduan Praktis Edukasi Kesehatan (page 22). Jakarta: BPJS Kesehatan. https://bpjs-kesehatan.go.id/bpjs/arsip/detail/34
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, 12. John Wiley & Sons, Ltd. https://doi.org/10.1002/14651858.CD003054.pub4.
Ibeachu, C., Selfe, J., Sutton, C.J. & Dey, P. 2019. Knee Problems are Common in Young Adults and Associated with Physical Activity and Not Obesity: the Findings of A Cross-Sectional Survey in A University Cohort. BMC Musculoskeletal Disorders, 20 (116): 1-7. https://doi.org/10.1186/s12891-019-2487-2
Idris, F. 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). Journal of the Indonesia Medical Association, 64 (3): 115–21. https://repository.unsri.ac.id/8848/.
Jancey, J.M. et al. 2009. Perceptions of Physical Activity by Older Adults: A Qualitative Study. Health Education Journal, 68 (3): 196–206. https://doi.org/10.1177/0017896909339531.
Kemenkes RI. 2017. Impelementasi Gerakan Masyarakat Hidup Sehat (Germas) dalam Rangka Mewujudkan ASN Sehat. 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): 23–35. https://doi.org/10.2337/ds15-0041.
Kusumo, M.P., Hendrartini, J., Sufro, Z.M. & Dewi, F.S.T. 2020. A Qualitative Study to Explore the Perception of Patients Towards Diet in Javanese Culture. Enfermeria Clinica, 30 (6): 183–187. https://doi.org/10.1016/j.enfcli.2020.06.041.
Kusumo, M.P., Hendrartini, J., Sufro, Z.M. & Tetra, F.S. 2020. Theater Performing Arts (TPA): Community Empowerment to Improve Blood Glucose Control Behavior in Yogyakarta. International Journal of Endocrinology and Metabolism, 18 (4): 1-7. https://doi.org/10.5812/ijem.103106.
Kusumo, M.P., Prabandari, Y.S. & 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. https://doi.org/10.1177/0272684x211022173.
Lantara, N. F. 2015. The Roles of Woman as Leader and Housewife. Journal of Defense Management, 5 (1): 1–5. https://doi.org/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): 1-8. https://doi.org/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): 1677–1685. https://doi.org/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, 12: 1–17. https://doi.org/10.2147/DMSO.S183776.
National Institutes of Health. 2002. The Diabetes Prevention Program (DPP): Description of Lifestyle Intervention. Diabetes Care, 25 (12): 2165–2171. doi: 10.2337/diacare.25.12.2165.
Perkumpulan Endokrinologi Indonesia. 2015. Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015. Jakarta, Indonesia: PB. PERKENI. https://caiherang.com/wp-content/uploads/2019/10/Konsensus-DMT2-Perkeni-2015.pdf
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, 15 (1): 1160. https://doi.org/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): 226–234. Available at: https://www.semanticscholar.org/paper/Impact-of-Visual-Aids-in-Enhancing-the-Learning-%3A-Shabiralyani-Hasan/32294f38a1d5b424de3540f91037039cc7873ade%0Awww.iiste.org.
Smith, G.L., Banting, L., Eime, R., O'Sullivan, G. & van Uffelen, J.G.Z. 2017. The Association between Social Support and Physical Activity in Older Adults: A Systematic Review. International Journal of Behavioral Nutrition and Physical Activity, 14 (56): 1-21. https://doi.org/10.1186/s12966-017-0509-8
Suhl, E. & Bonsignore P. 2006. Diabetes Self-Management Education for Older Adults: General Principles and Practical Application. Diabetes Spectrum, 19 (4): 234–240. Available at: http://athenaeum.libs.uga.edu/handle/10724/9567.
Svavarsdóttir, M.H., Sigurardóttir, Á.K. & 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, 15 (1): 1–9. https://doi.org/10.1186/s12909-015-0370-x.
Tucker, P. & Gilliland, J. 2007. The Effect of Season and Weather on Physical Activity : A Systematic Review. Public Health, 121 (12): 909–922. https://doi.org/10.1016/j.puhe.2007.04.009.
Wagner, A.L., Keusch, F., Yan, T. & Clarke, P.J. 2019. The Impact of Weather on Summer and Winter Exercise Behaviors. Journal of Sport and Health Science, 8 (1): 39–45. https://doi.org/10.1016/j.jshs.2016.07.007.
Walker, K.C., Valentiner, L.S. & 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, 12: 145–152. https://doi.org/10.2147/PPA.S150008.
World Health Organization. 2016. Global Report on Diabetes. Geneva: WHO.
Bingham, M. 2018. Timely News for the Multidisciplinary Care Team. Diabetes Spectrum, 31 (4): 290–294. https://doi.org/10.2337/ds18-0061.
Creswell, J.W. & Clark, V.L.P. 2011. Designing and Conducting Mixed Methods Research. California: SAGE Publications.
Dickinson, J.K. 2018. The Experience of Diabetes-Related Language in Diabetes Care. Diabetes Spectrum, 31 (1): 58–64. https://doi.org/10.2337/ds16-0082.
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): 1–9. https://doi.org/10.1136/bmjopen-2015-010249.
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: 119. Available at: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=21333011.
Healthcare and Social Security Agency. 2014. Panduan Praktis Edukasi Kesehatan (page 22). Jakarta: BPJS Kesehatan. https://bpjs-kesehatan.go.id/bpjs/arsip/detail/34
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, 12. John Wiley & Sons, Ltd. https://doi.org/10.1002/14651858.CD003054.pub4.
Ibeachu, C., Selfe, J., Sutton, C.J. & Dey, P. 2019. Knee Problems are Common in Young Adults and Associated with Physical Activity and Not Obesity: the Findings of A Cross-Sectional Survey in A University Cohort. BMC Musculoskeletal Disorders, 20 (116): 1-7. https://doi.org/10.1186/s12891-019-2487-2
Idris, F. 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). Journal of the Indonesia Medical Association, 64 (3): 115–21. https://repository.unsri.ac.id/8848/.
Jancey, J.M. et al. 2009. Perceptions of Physical Activity by Older Adults: A Qualitative Study. Health Education Journal, 68 (3): 196–206. https://doi.org/10.1177/0017896909339531.
Kemenkes RI. 2017. Impelementasi Gerakan Masyarakat Hidup Sehat (Germas) dalam Rangka Mewujudkan ASN Sehat. 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): 23–35. https://doi.org/10.2337/ds15-0041.
Kusumo, M.P., Hendrartini, J., Sufro, Z.M. & Dewi, F.S.T. 2020. A Qualitative Study to Explore the Perception of Patients Towards Diet in Javanese Culture. Enfermeria Clinica, 30 (6): 183–187. https://doi.org/10.1016/j.enfcli.2020.06.041.
Kusumo, M.P., Hendrartini, J., Sufro, Z.M. & Tetra, F.S. 2020. Theater Performing Arts (TPA): Community Empowerment to Improve Blood Glucose Control Behavior in Yogyakarta. International Journal of Endocrinology and Metabolism, 18 (4): 1-7. https://doi.org/10.5812/ijem.103106.
Kusumo, M.P., Prabandari, Y.S. & 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. https://doi.org/10.1177/0272684x211022173.
Lantara, N. F. 2015. The Roles of Woman as Leader and Housewife. Journal of Defense Management, 5 (1): 1–5. https://doi.org/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): 1-8. https://doi.org/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): 1677–1685. https://doi.org/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, 12: 1–17. https://doi.org/10.2147/DMSO.S183776.
National Institutes of Health. 2002. The Diabetes Prevention Program (DPP): Description of Lifestyle Intervention. Diabetes Care, 25 (12): 2165–2171. doi: 10.2337/diacare.25.12.2165.
Perkumpulan Endokrinologi Indonesia. 2015. Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015. Jakarta, Indonesia: PB. PERKENI. https://caiherang.com/wp-content/uploads/2019/10/Konsensus-DMT2-Perkeni-2015.pdf
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, 15 (1): 1160. https://doi.org/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): 226–234. Available at: https://www.semanticscholar.org/paper/Impact-of-Visual-Aids-in-Enhancing-the-Learning-%3A-Shabiralyani-Hasan/32294f38a1d5b424de3540f91037039cc7873ade%0Awww.iiste.org.
Smith, G.L., Banting, L., Eime, R., O'Sullivan, G. & van Uffelen, J.G.Z. 2017. The Association between Social Support and Physical Activity in Older Adults: A Systematic Review. International Journal of Behavioral Nutrition and Physical Activity, 14 (56): 1-21. https://doi.org/10.1186/s12966-017-0509-8
Suhl, E. & Bonsignore P. 2006. Diabetes Self-Management Education for Older Adults: General Principles and Practical Application. Diabetes Spectrum, 19 (4): 234–240. Available at: http://athenaeum.libs.uga.edu/handle/10724/9567.
Svavarsdóttir, M.H., Sigurardóttir, Á.K. & 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, 15 (1): 1–9. https://doi.org/10.1186/s12909-015-0370-x.
Tucker, P. & Gilliland, J. 2007. The Effect of Season and Weather on Physical Activity : A Systematic Review. Public Health, 121 (12): 909–922. https://doi.org/10.1016/j.puhe.2007.04.009.
Wagner, A.L., Keusch, F., Yan, T. & Clarke, P.J. 2019. The Impact of Weather on Summer and Winter Exercise Behaviors. Journal of Sport and Health Science, 8 (1): 39–45. https://doi.org/10.1016/j.jshs.2016.07.007.
Walker, K.C., Valentiner, L.S. & 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, 12: 145–152. https://doi.org/10.2147/PPA.S150008.
World Health Organization. 2016. Global Report on Diabetes. Geneva: WHO.