Uncovering the determinants of low involvement of the elderly in chronic disease management: A qualitative approach at Ratih Clinic, Badung
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Oct 6, 2025
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Abstract
The Chronic Disease Management Program (CDMP) aims to improve the quality of life of the elderly through the control of non-communicable diseases such as hypertension and diabetes. However, the participation of the elderly at the Tabanan Ratih Clinic is still low, hampering the effectiveness of the program. This study aims to identify the factors that play a role in the low involvement of the elderly in CDMP. Qualitative research with a descriptive phenomenological approach was conducted at the Ratih Clinic in Badung in March-June 2024. Data was collected through in-depth interviews with 10 elderly people (aged 60-70 years) who had low participation and 6 health workers. Thematic analysis is used to identify determinants. Four main themes were found, namely (1) accessibility and mobility barriers, (2) lack of knowledge and negative perception of CDMP, (3) lack of family and social support, and (4) economic factors and time priorities. The low participation of the elderly is influenced by interrelated multidimensional factors. Recommendations include the provision of free transportation, local culture-based education, family involvement, and the integration of CDMP with community activities such as the elderly Posyandu. These findings support the development of inclusive strategies to increase the involvement of the elderly in chronic disease management, in line with CDMP' goals.
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How to Cite
Budiartami , P. P. and Ani, L. S. (2025) “Uncovering the determinants of low involvement of the elderly in chronic disease management: A qualitative approach at Ratih Clinic, Badung”, Science Midwifery, 13(4), pp. 1080-1088. doi: 10.35335/midwifery.v13i4.2101.
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BPJS. (2014). Prolanis program guidelines. BPJS Kesehatan.
Budiastika, I. M. (2022). Implentasi Ajaran Tri Hita Karana Dalam Kehidupan. Kementrian Agama Republik Indonesia.
Diana, M., Putra, K. W. R., Wijayanti, D. P., Riesmiyatiningdyah, & Yumiati. (2022). Nurse and Holistic Care ,. Nurse and Holistic Care, 2(1), 1–9.
Eran Klein, MD, PhD1 and Jason Karlawish, M. (2011). Challenges and Opportunities for Developing and Implementing Incentives to Improve Health-Related Behaviors in Older Adults. J Am Geriatr Soc., 58(9), 1758–1763. https://doi.org/10.1111/j.1532-5415.2010.03030.x.Challenges
Febriyanti, R. M., Irawan, A. A., Anggriani, N., & Andriyana, Y. (2025). Challenges in implementing Indonesia ’ s community-based chronic disease management program ( Prolanis ): A scoping review. AIMS Public Health, 12(July), 890–915. https://doi.org/10.3934/publichealth.2025045
Fernandez-lazaro, C. I., García-gonzález, J. M., Adams, D. P., Fernandez-lazaro, D., Mielgo-ayuso, J., Caballero-garcia, A., Racionero, F. M., Córdova, A., & Miron-canelo, J. A. (2019). Adherence to treatment and related factors among patients with chronic conditions in primary care : a cross-sectional study. BMC Family Practice, 20(132), 1–12. https://doi.org/https://doi.org/10.1186/s12875-019-1019-3
Fretes, E. D. De, Juniarti, T., & Papua, W. (2022). Factor Determinant Implementation Vaccines for the Elderly. Science Midwifery, 10(4), 2503–2509.
Gusty, R. P. (2023). Jurnal Aisyah : Jurnal Ilmu Kesehatan Health Education Model for Elderly Hypertension on Knowledge , Attitudes , and Adherence to Following the Dietary Approaches to Stop Hypertension ( DASH ). Jurnal Aisyah: Jurnal Ilmu Kesehatan, 8(2), 955–962. https://doi.org/10.30604/jika.v8i3.2093
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House, J. S. (1987). Social Support and Social Structure. Sociological Forum, 2(1), 135–146.
Husnayain, A., Ekadinata, N., & Sulistiawan, D. (2020). Multimorbidity Patterns of Chronic Diseases among Indonesians : Insights from Indonesian National Health Insurance ( INHI ) Sample Data. International Journal of Environmental Research and Public Health, 12(8900), 1–12. https://doi.org/doi:10.3390/ijerph17238900
Kementrian Kesehatan Republik Indonesia. (2023). PROFIL KESEHATAN INDONESIA 2023.
Khasanah, U., Kelliat, B. A., Yati, A., & Besral, B. (2024). The Problems and Needs of Self-Management Among Indonesian Older Adults With Hypertension : A Qualitative Study. Transforming Future Health Care Through Research and Innovation –, 10, 1–11. https://doi.org/10.1177/23779608241282915
Leona, D. F. (2024). International Journal of Research Publication and Reviews A Systematic Review : The Quality of Life among Elderly in Indonesia. International Journal of Research Publication and Reviews, 5(8), 2958–2962.
Meiriana, A., Trisnantoro, L., & Padmawati3, R. S. (2019). Implementasi program pengelolaan penyakit kronis (prolanis) pada penyakit hipertensi di puskesmas jetis kota yogyakarta. JURNAL KEBIJAKAN KESEHATAN INDONESIA : JKKI VOLUME, 08(02), 51–58.
Parta, I. P. W. A., Suarjana, N., & Nyandra, M. (2024). Factors Affecting Attendance of Participants in the Chronic. Jurnal Kesehatan, Sains Dan Teknologi (JAKASAKTI), 3(1), 99–109. https://jurnal.undhirabali.ac.id/index.php/jakasakti/index%0AResearch Article e-ISSN:
Rachmawati, S., And, H. P.-P., & Zairina, E. (2019). The implementation of a chronic disease management program (Prolanis) in Indonesia: a literature review. Journal of Basic and Clinical Physiology and Pharmacology, 30(6). https://doi.org/https://doi.org/10.1515/jbcpp-2019-0350
Rahmawati, R., & Bajorek, B. V. (2018). Access to Medicines for Hypertension: a survey in Rural Yogyakarta Province, Indonesia. Rural and Remote Health, 203.
Ranjbaran, S., Pourrazavi, S., Latifi, A., & Chollou, K. M. (2024). Impact of health literacy and illness perception on medication adherence among older adults with hypertension in Iran : a cross-sectional study. Front. Public Health, 12(March), 1–7. https://doi.org/10.3389/fpubh.2024.1347180
Ratih, K. (2024). Profil Kesehatan Klinik Ratih Badung Tahun 2023.
Raviola, Muhsina, W., & Gumayesty, Y. (2021). HUBUNGAN AKTIVITAS PROGRAM PENGELOLAAN PENYAKIT KRONIS DENGAN KEPATUHAN DIET PASIEN DIABETES. PREPOTIF : Jurnal Kesehatan Masyarakat, 5(April), 424–433.
S., F. A. S., & , Elizabeth Y. Y. Vinsur, E. S. (2019). Analisis faktor yang mempengaruhi Lansia datang ke Pelayanan Kesehatan. Jurnal Ners Dan Kebidanan, 6(2), 189–196. https://doi.org/10.26699/jnk.v6i2.ART.p189
Sabrina, L. Y., & Rahayu, S. R. (2023). Determinan Pemanfaatan Program Pengelolaan Penyakit Kronis ( Prolanis ). HIGEIA JOURNAL OF PUBLIC HEALTH, 7(4), 610–624.
Simorangkir, L., Pakpahan, R. E., & Sartikamanurung, R. D. (2025). THE RELATIONSHIP OF COMPLIANCE WITH THE CHRONIC DISEASE MANAGEMENT PROGRAM ( PROLANIS ) WITH THE QUALITY OF LIFE OF HYPERTENSIVE PATIENTS AT THE ROMANA TANJUNG ANOM CLINIC IN 2024. 9(1), 86–99.
Subuh, M. (2024). FAKTOR-FAKTOR PENENTU PARTISIPASI DALAM PROGRAM PROLANIS : STUDI KASUS DI PUSKESMAS KOTA CILEGON FACTORS DETERMINING PARTICIPATION IN THE PROLANIS PROGRAM : A CASE STUDY IN CILEGON CITY COMMUNITY HEALTH. JURNAL KEBIJAKAN PEMBANGUNAN DAERAH: Jurnal Penelitian Dan Pengembangan Kebijakan Pembangunan Daerah, 8(2), 165–176. https://doi.org/10.56945/jkpd.v8i2.336
Sugianto, A. A., Kurniawan, B., & Udayana, S. (2023). Individual Determinant Factors of Patients with Hypertension and the Utilization of Chronic Disease Management Program ( Prolanis ) Services in First-Level Healthcare Facilities in Pesawaran District , Lampung , Indonesia. International Journal of Current Science Research and Review, 06(06), 3815–3821. https://doi.org/10.47191/ijcsrr/V6-i6-71
Wicaksono, T. A., Nugraheni, A., Wahyudi, F., & Ardhianto, P. (2021). FACTORS ASSOCIATED WITH MEDICATION ADHERENCE IN HYPERTENSION IN. DIPONEGORO MEDICAL JOURNAL, 10(6), 426–432.
Winberg, D., Tang, T., Ramsey, Z., & Bazzano, A. N. (2025). Evaluating Financial Incentives as a Tool to Increase Medication Adherence for Patients with Type 2 Diabetes Mellitus : A Systematic Review and Meta ‑ Analysis. Diabetes Therapy, 16(3), 527–545. https://doi.org/10.1007/s13300-025-01694-y
NCDs at a Glance 2025, (2025). https://www.paho.org/sites/default/files/2025-03/ncds-glance-2025-21-mar.pdf