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ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
Vol
.
4,
N
o
.
4
,
D
ecem
b
er 20
1
5
, pp
. 24
1~
24
9
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S
SN
: 225
2-8
8
0
6
2
41
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urn
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h
o
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: h
ttp
://iaesjo
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r
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l.com/
o
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e
x.ph
p
/
IJPHS
Javanese Muslim with
Di
abetes
in Yogyakart
a
Managing
The Daily Self-Care Activity
Iman
Perm
an
a
1
,
Mu
flikh T
r
y H
a
rbi
y
a
n
2
1
Ce
nt
re of Isla
mi
c
Me
di
c
i
ne
St
udi
e
s;
De
pa
rt
me
nt
of Communi
ty
He
a
l
t
h
a
n
d Fa
mi
ly
Me
dic
i
ne,
Universitas Muh
a
mmadiy
a
h
Yogy
ak
arta, Indones
i
a
2
Faculty
of Med
i
cine and
Heal
th
Sciences, Univ
er
sitas Muha
mmadiy
a
h Yog
y
ak
arta, Indon
esia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Aug 3, 2015
Rev
i
sed
Sep
20
, 20
15
Accepted Oct 26, 2015
Self-car
e,
capab
i
lit
y in pe
rform
ing cert
a
in a
c
tiv
it
y in m
a
int
a
in
ing
well-being
in daily
life, was regarded important
especially
among people with long-term
condition such as diabetes. Lo
cu
s of
control and
self-efficacy
are among the
self-agen
c
y
f
a
ctors that might influenc
e how people engag
e
with daily
self-
care
ac
tivi
t
y
in
diabe
t
es
m
a
nage
m
e
nt.
While, Javanese
and Islamic valu
es
and norms are other parts of structur
e that su
pport the effor
t
. This stud
y
aimed to seek
further into
the e
xperiences and percep
tions among the
Javanese Muslim on
how th
ey
mana
g
e
d to do s
e
lf-care in diabet
e
s
management.
The stud
y
wa
s do
ne utilizing a m
i
xed method
ap
proach with
the us
age of
t
h
e S
u
m
m
a
ry
o
f
Diabet
es
S
e
l
f-care A
c
tiv
it
y (S
DS
CA)
questionnaire
to
measure
the level of
self-car
e and followed
b
y
further
intervi
e
w to dig
deeper
into th
e
percep
tion and
e
xperien
ces
and
what are
the
opportunity
o
r
o
b
stacle in
perfor
m
ing dail
y
s
e
lf-
c
are. A conv
enien
t
sample of
100 particip
ants has filled the qu
estionna
i
r
es, wit
h
further 24 interviews. The
stud
y
iden
tifi
e
d the m
oderate sel
f-care pr
a
c
t
i
ces
as
a s
e
para
te notion, instead
of an in
tegr
ated
and
com
p
rehe
ns
ive con
cept
a
m
id the un
avai
l
a
bili
t
y
of
a
structured
education progr
am. Five
th
emes were generated from the
interviews, those are: edu
cation
and know
ledge, being in or out of control,
Javanese wa
y –
sensitivit
y
and surrender
,
pea
ce
of m
i
nd and role
of Allah or
God, and
poor
a
ccess to
he
alth
c
a
re.
Keyword:
Diabetes m
a
nagem
e
nt
Java
nese way
Relig
io
n
SDSC
A
Self-ca
r
e
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Im
an Perm
ana,
C
e
nt
re
of
Isl
a
m
i
c M
e
di
ci
ne St
udi
es
,
Depa
rt
m
e
nt
of
C
o
m
m
uni
t
y
Heal
t
h
an
d Fam
i
l
y
M
e
di
ci
ne,
Uni
v
ersitas M
uhamm
adiyah Yogyaka
r
ta,
Kam
pus Te
rpa
d
u
,
Jl
Li
ng
ka
r
Sel
a
t
a
n,
Kasi
h
a
n, B
a
nt
ul
,
Y
o
gy
aka
r
t
a
, I
n
do
nesi
a.
Em
a
il: i
m
an
p
e
rm
an
a@u
m
y.a
c
.id
1.
INTRODUCTION
1.
1.
Diabe
t
es
Diabetes is a
chronic
m
e
tabolic disease that can
be dev
e
l
ope
d w
h
en t
h
e b
ody
i
s
not
suffi
ci
ent
l
y
pr
o
duci
ng i
n
s
u
l
i
n
or
can
n
o
t
u
s
e i
n
sul
i
n ef
fi
ci
ent
l
y
[1]
.
T
h
e pre
v
alence of diabetes has be
en
inc
r
easing for
t
h
e
last sev
e
ral d
e
cad
es.
Acco
rd
in
g
t
o
th
e In
tern
atio
n
a
l
Diab
etes Fed
e
ration’s repo
rt
(201
3), m
o
re th
an
a t
h
ird
of
a b
illio
n
p
e
o
p
l
e (3
81
m
ill
io
n
)
acro
ss the glo
b
e
suffer from
th
is illn
ess,
an
d th
is
repr
esen
ts an in
crease of
m
o
re than 50% from
246
m
i
llion in 2007 [2]. Thus
, it is
pre
d
icted to reac
h m
o
re than
half a
billion (591
m
i
ll
i
on) i
n
20
3
5
. T
h
e m
a
jori
t
y
of cases (
8
0
%
) com
e
from
l
o
w an
d m
i
ddl
e i
n
com
e
count
ri
es, w
h
i
c
h sho
w
s
a
misco
n
cep
tion th
at d
i
ab
etes
is an
illn
ess o
f
th
e wealth
y. In
don
esia h
a
s t
h
e fo
urth
larg
est p
o
p
u
l
ation
in
the
world a
f
ter the Unite
d States, India
a
n
d
C
h
i
n
a [3]
.
Wi
t
h
aro
u
nd 2
39 m
i
llion pe
ople, diabetes prevalenc
e
accounts for
4.8% in
2010
[4], with the tre
nd
of t
h
e prevalence is signi
ficantly
increa
sing a
nd estimated to
increase
further to 5.9% in
2030.
In
deed this prediction
will place Indonesi
a in the ni
nth position of the ten
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 4, No. 4, D
ecem
ber 2015
:
241 – 249
24
2
countries with the
m
o
st
pre
v
a
l
ent diabetes in the
world
in 2030 [5]. While
accordi
n
g to t
h
e
update
data
from
t
h
e I
n
t
e
r
n
at
i
o
n
a
l
Di
abet
es
Fe
derat
i
o
n
(2
0
1
2
b
)
,
I
n
do
nesi
a
h
a
s m
oved t
o
t
h
e seve
nt
h
p
o
si
t
i
on.
Fu
rt
h
e
rm
o
r
e, th
is illn
ess and
its p
a
rticu
l
ar co
m
p
licatio
n
s
, su
ch as
k
i
dn
ey failu
re,
h
e
art d
i
seases, lim
b
a
m
p
u
t
atio
n
s
and
b
lindn
ess,
h
a
v
e
b
e
en
responsib
le f
o
r
h
i
gh
m
o
r
t
ali
t
y r
a
tes
acr
o
s
s th
e g
l
obe. Th
e
W
o
r
l
d
H
ealth
O
r
g
a
n
i
zatio
n
rep
o
r
t
ed
in
20
04
th
at 3
.
4
m
i
l
l
i
o
n
d
eath
s
h
a
v
e
o
ccur
r
e
d
du
e
to
th
e con
s
eq
uen
ces of
h
i
g
h
b
l
ood
sugar
[6]. Moreove
r, t
h
e burdens are
also
affectin
g
no
t on
ly
p
h
y
sically, but
also psychologically. There
f
ore
,
a
m
o
re co
m
p
rehen
s
iv
e t
r
eatm
e
n
t
is con
s
idered
to
b
e
cru
c
ial in
m
a
n
a
g
i
ng
th
is cond
itio
n.
Ind
e
ed
, it is b
e
liev
e
d
that preve
n
tive
m
easures suc
h
as m
odyfi
ng lifestyle,
l
o
w
e
ri
n
g
bo
dy
w
e
i
ght
, kee
p
i
n
g phy
si
cal
l
y
act
i
v
e,
a
r
e
bene
ficial in
decreasing the i
n
cide
n
ce
of dia
b
etes, as
well a
s
preve
n
tin
g t
h
e com
p
l
i
cat
i
ons fr
om
occu
rre
d.
A
ccord
ing
to
Risk
esd
a
s 20
10
or
the Basic
Health Research 2010
re
po
rt
s i
n
I
n
d
o
n
esi
a
(C
om
m
i
si
on
on
Health De
velopm
ent and
Research,
20
10
), th
e ob
esity rate for ch
ildren
b
e
t
w
een
6
to
12
years o
l
d
was
9.
2%,
w
h
i
l
e
f
o
r p
e
o
p
l
e
ol
der
t
h
an
1
8
y
ears
ol
d i
t
was
11.7% [7]. More
over, t
h
e C
oun
try
Health
Repo
rt
fro
m
W
H
O
(
200
6)
sh
ow
s t
h
at th
e
main
h
ealth
pro
b
l
em
s in
I
ndone
sia we
re as
sociated
w
ith
ch
ang
e
s i
n
food
h
a
b
it
[8]
.
F
o
r e
x
am
pl
e, t
h
e p
o
pul
ari
t
y
of fast
f
o
o
d
am
ong a
dul
t
s
an
d chi
l
dre
n
i
s
associ
at
ed wi
t
h
t
h
e
hi
gh
er
i
n
ci
denc
e of
o
b
esi
t
y
. In a
ddi
t
i
on, t
h
e
r
e i
s
an i
n
crea
si
n
g
t
r
end
of sm
oki
n
g
am
ong y
o
u
n
g
pe
opl
e
,
w
h
i
c
h wi
l
l
cause lifestyle
related health
problem
s
. Other problem
s
that also account for
health
problem
s
are substances
abuse,
lack of exercise, sede
ntary
lifestyle
and viol
e
n
ce.
Lack
of s
o
cial support a
nd
national comm
itm
ent,
d
e
sp
ite sev
e
ral pu
b
lic
h
ealth
in
itiativ
es h
a
ve b
e
en
im
p
l
e
m
en
ted
,
is id
en
tified
as m
a
in
o
b
s
tacles in
m
a
n
a
gi
ng
these
problem
s, es
pecially s
m
oki
ng [8].
1.
2.
Self-Care
Sel
f-ca
r
e refe
r
s
t
o
t
h
e act
i
ons t
h
at
peopl
e t
a
ke i
n
pr
om
ot
i
ng
heal
t
h
, p
r
e
v
ent
i
n
g an
d d
e
t
ect
i
ng any
illn
esses, also in
self-treatmen
t
[9
]. Similar d
e
fi
n
itio
n
s
ex
ist, d
e
m
o
n
s
t
r
atin
g
worldwid
e con
s
en
sus o
f
un
de
rst
a
n
d
i
n
g
‘self-care is the ability of individuals, fa
mi
lies and c
o
mmunities to
pr
omote health, prevent
d
i
sea
s
e
a
n
d
ma
in
ta
i
n
h
e
a
lth
a
n
d
to
cop
e
with
illn
ess a
n
d
d
i
sab
ility wi
th
o
r
with
ou
t th
e su
ppo
rt o
f
a
hea
lth
-
care pr
ovi
d
er
’
[1
0]
.
Sev
e
ral stud
ies id
en
tify th
e series
of
self-care activ
ities
in
d
i
ab
etes man
a
g
e
m
e
n
t
co
n
s
isting
of
con
d
u
ct
i
ng
di
e
t
ary
reg
u
l
a
t
i
o
n
,
kee
p
i
n
g p
h
y
s
i
cal
l
y
act
i
v
e, adhe
re t
o
t
h
e m
e
di
cat
i
o
n
,
pe
rf
orm
i
ng f
oot
ca
re, an
d
sel
f-m
oni
t
o
ri
n
g
bl
oo
d
gl
uc
o
s
e [1
1]
,[
1
2
]
.
Furt
herm
ore,
gui
del
i
n
es f
r
o
m
bot
h t
h
e
I
n
t
e
r
n
at
i
onal
D
i
abet
es
Fed
e
r
a
tio
n
(ID
F, 2012
)
,
and
th
e I
ndo
n
e
si
an
End
o
c
r
i
no
l
o
g
i
st A
s
so
ciatio
n
(
P
erk
e
n
i
,
2
011
)
em
p
h
a
size th
e
i
m
p
o
r
tan
ce
o
f
self-care activ
i
ties to
p
r
ev
en
t th
e risk
o
f
com
p
lications for people with
diabetes, as well as
enha
nce quality of life [5],[13]. Inde
e
d
, m
a
intaining a healthy
lifestyle and establishing
a norm
a
l body weight
may preve
n
t the devel
opm
ent of dia
b
etes
as well as
po
ten
tial co
m
p
licatio
n
s
[6
],[9]. Un
lik
e estab
lish
e
d
in
tern
ation
a
l diab
etes
m
a
n
a
ge
m
e
n
t
p
r
ogram
s
(UK or US),
with
i
n
In
don
esia th
e m
a
n
a
gem
e
nt
of di
abet
es i
s
not
co
nsi
d
ere
d
a co
m
p
rehe
ns
i
v
e and i
n
t
e
gr
at
ed pr
o
g
ram
,
wi
t
h
o
n
l
y
part
i
a
l
recom
m
e
ndat
i
ons i
n
t
o
se
p
a
rat
e
self-care
activi
t
y for optim
u
m
diabetes
care
bei
n
g i
n
t
r
o
d
u
c
e
d
due
t
o
c
o
st
and
heal
t
h
care
st
ruct
ure
[
14]
-
[
1
6
]
.
1.
3.
De
terminant fac
t
or
s
in diabetes manage
ment
Self-care is a co
n
c
ep
t th
at en
tails
m
u
lti as
p
ects
of hu
m
a
n
b
e
h
a
v
i
or.
Ho
wev
e
r, th
ere
are sev
e
ral
facto
r
s th
at can
po
ten
tially i
n
fl
u
e
n
ce an
ind
i
v
i
du
al
and
en
h
a
n
ce
o
r
reduce self-care act
iv
ities an
d
behav
i
ou
r.
Recently, new
health a
g
endas
id
entify that
health experienc
e
s are influe
nc
ed not only by
genetics,
or lifestyle
but also by a wide range of social
, econom
ic, political and envi
ronm
ental f
actors [17]. T
h
e conce
p
t of agency
and
st
r
u
ct
u
r
e a
r
e i
m
port
a
nt
u
nde
rl
y
i
ng
fact
o
r
s t
h
at
m
i
ght
i
n
fl
uence
sel
f-c
are b
e
ha
vi
o
r
[
18]
.
A
g
ency
re
fers t
o
t
h
e ca
paci
t
y
of
i
ndi
vi
d
u
al
s t
o
m
a
ke
d
ecision
to
w
a
r
d
a co
ur
se of
action
b
a
se
d on
their pas
t
experience
s, future
an
d
p
r
esen
t con
d
ition
s
[1
9
]
,
wh
ereas, stru
ct
u
r
e refers to
an
y so
cial n
o
rm
s, reg
u
l
atio
ns, ru
les an
d
reso
urces
avai
l
a
bl
e, ei
t
h
e
r
hum
an o
r
no
n
-
h
u
m
a
n [1
8]
. T
hus
, e
d
ucat
i
o
n
has se
r
v
ed
as a
cri
t
i
cal
poi
nt
i
n
sel
f
-a
gency
[
18]
.
Evide
n
ces
reve
al the determ
ining
factor of se
lf-effi
cacy [20]
and loc
u
s
of c
ont
rol [21] as
unde
rlying
fact
or
s t
h
at
m
i
ght
ef
fect
som
e
one i
n
m
a
i
n
t
a
i
n
i
ng t
h
ei
r dai
l
y
act
i
v
i
t
y
;
suppo
rt
i
n
g t
h
e dec
i
si
on m
a
ki
ng and
h
o
w
th
ey b
e
h
a
v
e
t
o
p
a
r
ticu
l
ar
ev
en
ts in th
eir liv
es. Fur
t
h
e
r
m
o
r
e, r
e
lig
i
o
n
/
sp
ir
itu
ality [2
2
]-[2
4
]
as well as
healthcare acc
ess, and soci
al suppor
t [2
5]
-[
2
7
]
have
serve
d
as ext
e
rnal res
o
urce
s for th
e pe
o
p
le in
main
tain
in
g
t
h
eir lon
g
term
co
nd
itio
n.
2.
R
E
SEARC
H M
ETHOD
This study wa
s conducted
utilizing a
m
i
x
e
d m
e
thod approac
h
. T
h
e depl
oym
e
nt of SDSC
A wa
s
i
n
t
e
nde
d a
s
a
scree
n
i
n
g t
o
o
l
t
o
gai
n
part
i
c
ul
ar
par
ticip
an
ts fo
r in
terv
i
e
w. C
r
eswell
(201
4) reg
a
rd
s th
is
approach as a
sequential e
xpl
anat
o
r
y
app
r
oa
ch [
28]
. T
h
e p
o
p
u
l
a
t
i
on
of t
h
e st
udy
was t
y
pe 2
di
abet
i
c
p
a
t
i
e
nt
s
fro
m
th
e o
u
t
-p
atien
t
s of th
e In
tern
al Medicin
e
clin
ic fro
m
a p
r
iv
ate h
o
s
p
ital in
Yog
y
ak
arta, In
don
esia.
Accord
ing
to
th
e 20
10
d
a
tab
a
se th
er
e we
re 610 cases
of
diabetes,
which
were
no
t classified
in
t
o
typ
e
s.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Ho
w
Ja
van
e
se
Mu
slim with Dia
b
e
tes i
n
Yog
y
a
k
arta
Ma
n
a
g
i
n
g
th
e
Da
ily S
e
lf-Ca
re Activity (Ima
n Perman
a
)
24
3
Purposive sam
p
ling m
e
thod
was utilized and the sam
p
le
wa
s selected using the follo
wing inclusion criteria:
ove
r 1
8
y
ears
ol
d, m
a
l
e
and fem
a
l
e
, di
agno
sed wi
t
h
t
y
pe
2 di
a
b
et
es fo
r
ove
r 1
2
m
ont
h
s
, u
nde
r t
h
e ca
re o
f
a
consultant a
n
d being treated
according to t
h
e Indonesian
Endoc
rinologi
s
t
guideline
or
Perkeni (2011) [13].
Pat
i
e
nt
s w
o
ul
d
be
excl
ude
d i
f
t
h
ey
were
di
a
g
n
o
se
d a
n
d
we
re
bei
n
g t
r
eat
e
d
fo
r a
m
e
nt
al
heal
t
h
pr
o
b
l
e
m
,
t
h
i
s
was t
o
en
sure t
h
at th
ey
were co
m
p
eten
t to
p
r
o
v
i
d
e
co
nsen
t t
o
b
e
invo
lv
ed
i
n
th
e stud
y.
Th
e sam
p
le
fo
r
th
e qu
estion
n
a
ire
was g
a
in
ed
th
ro
ugh
d
i
rect ap
pro
ach
es
in
th
e waitin
g
room
’s
clin
ic.
Du
ri
n
g
a t
h
ree
m
ont
h dat
a
col
l
ect
i
on pe
ri
o
d
1
00 re
sp
o
n
d
e
nt
s were r
ecr
ui
t
e
d o
u
t
of
2
01 a
p
p
r
oach t
o
gai
n
a
wide
r
pers
pective
of the sel
f-c
are activ
ity of t
h
e
people acce
ssing the clinic
.
Th
e SDSCA qu
estion
n
a
ires resu
lts were u
s
ed
to
in
fo
rm
t
h
e classificatio
n
o
f
p
a
rticip
ants in
to
th
ree
lev
e
ls o
f
h
i
g
h
,
m
o
d
e
rate and lo
w and
sou
g
h
t
furth
e
r in
to v
a
riou
s d
i
m
e
n
s
ion
of self-care activ
ities. Semi-
st
ruct
u
r
e
d
i
n
t
e
rvi
e
w was co
nd
uct
e
d
fol
l
o
wi
n
g
t
h
e res
u
l
t
of t
h
e ques
t
i
onnai
r
es t
o
di
g dee
p
e
r
i
n
t
o
t
h
e
perce
p
t
i
o
ns a
n
d e
xpe
ri
ences
of
t
h
e
part
i
c
i
p
ant
s
.
Pu
r
pos
i
v
e sam
p
l
i
ng
t
echni
q
u
e
was
al
so
per
f
o
r
m
e
d i
n
co
llectin
g
th
e sa
m
p
le fo
r th
e in
terv
iews, to
gain
a rich
er an
d wi
de
r pe
rspe
ct
i
v
e of
th
e sam
p
le. Th
e in
te
rv
iews
were tra
n
sc
ribed ve
rbatim
and them
atic content analys
is was p
e
rform
e
d
to
g
e
n
e
rate th
emes. All n
a
m
e
s were
p
s
eu
don
ym
s to
m
a
in
tain
con
f
i
d
en
tiality o
f
t
h
e stud
y.
The a
d
a
p
t
e
d
v
e
rsi
o
n
of t
h
e S
u
m
m
a
ry
of
Di
abet
es Sel
f
-C
a
r
e Act
i
vi
t
y
– S
D
SC
A
[
1
1]
co
nsi
s
t
s
o
f
1
5
i
t
e
m
s
focusi
n
g
on fi
ve m
a
i
n
t
opi
cs suc
h
as:
di
et
;
exerci
se;
sel
f-m
oni
t
o
ri
n
g
o
f
bl
o
o
d
gl
u
c
ose (SM
B
G);
fo
ot
care;
m
e
di
cat
ion
,
an
d a
n
a
d
d
i
t
i
onal
i
t
e
m
of sm
oki
ng. T
h
e
r
e are also
6 s
u
pplem
entary questions which foc
u
s
o
n
p
a
rticip
an
ts’
p
e
rcep
tio
ns
o
f
th
e i
n
clin
atio
n of
h
ea
lth
care
p
r
o
f
essionals to
co
nv
ey
ed
u
cation
a
l m
e
ssag
e
s
related to each ite
m of self-c
are, exce
pt
for the foot care ite
m
.
In gene
ral,
this tool is considere
d
to
have a
g
ood
reliab
ility with
th
e Chro
nb
ach
’
al
p
h
a
was 0.74
[29
]
an
d
h
i
gh
in
ter-ite
m
co
rrelatio
n
,
with
m
o
d
e
rate test-
retest correlatio
n
s
[11
]
.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Dem
ogr
ap
hi
c
Pred
o
m
in
an
tly p
e
op
le atten
d
i
n
g
t
h
e clin
ic th
at were
recr
u
ited were a
g
ed
ove
r 4
0
y
ears
(9
7%)
with
o
n
l
y
3
%
o
f
the sam
p
le b
e
ing
ag
ed b
e
t
w
een
1
8
-3
9 years.
Wh
en co
m
p
ared
to th
e targ
et p
opu
latio
n, t
h
e to
tal
p
e
op
le attend
in
g
t
h
e clin
ic ag
ed
b
e
tween
15
-44
years
wa
s
12.31% c
o
m
p
ared
with
7%
of the recruited
sam
p
le
(age
d
18
-4
4 y
e
ars)
, re
fl
ect
i
n
g
a l
o
w
n
u
m
b
er of y
o
u
n
g
er a
d
u
lts in
bo
th th
e targ
et and
st
ud
y sam
p
le (Tab
le 1).
The m
a
jori
t
y
of
part
i
c
i
p
a
n
t
s
cam
e
from
the re
g
u
l
a
r i
n
c
o
m
e
gro
up
(5
7)
, w
h
i
c
h c
o
m
p
ri
sed of
pr
i
v
at
e
com
p
ani
e
s em
pl
oy
ees (
1
7
)
,
p
e
nsi
o
ner
s
(1
7
)
,
sel
f-em
p
l
o
y
e
d (1
2),
go
ve
rnm
e
nt
of
fi
cers
or
ci
vi
l
serva
n
t
(6
), an
d
pr
ofe
ssi
o
n
al
(
5
). T
h
e
rem
a
i
n
ing
pa
rticip
an
ts cam
e fro
m
th
e no
n-regu
lar i
n
co
m
e
g
r
oup
(43
)
(Tab
le
1
)
.
Thi
s
cat
eg
ori
s
at
i
on si
g
n
i
f
i
e
s
whi
c
h pe
o
p
l
e
had a st
a
b
l
e
and c
o
nsi
s
t
e
nt
sou
r
ce
of i
n
c
o
m
e
, as
m
o
st
Indo
n
e
sian
u
tilize a fee-fo
r-serv
ice
syste
m
of
h
ealth
car
e wh
ere p
e
op
le
n
e
ed
t
o
p
a
y to receiv
e
a
prim
ar
y care
servi
ces
, exce
pt
fo
r t
h
ose cove
re
d by
t
h
e
go
ver
n
m
e
nt
, suc
h
as t
h
e p
o
o
r
,
pensi
one
r
,
and ci
vi
l
servant
s
.
Fu
rt
h
e
rm
o
r
e, amid
th
e n
e
w
d
e
v
e
l
o
p
m
en
t of h
ealth
care serv
ice in
In
don
esia in
to
a mo
re i
n
suran
ce-b
a
sed
sy
st
em
, whi
c
h
req
u
i
r
e
d
t
h
e
p
e
opl
e
wh
o a
r
e
not
el
i
g
i
b
l
e
t
o
be co
ve
red
by
t
h
e g
o
v
e
r
n
m
e
nt
t
o
pay
a m
o
n
t
hl
y
prem
i
u
m
,
has gi
ve
n t
h
e
need
t
o
ha
ve a su
ffi
ci
ent
i
n
com
e
in o
r
de
r t
o
be a
b
l
e
t
o
ha
ve a s
u
st
ai
na
bl
e heal
t
h
care
servi
ce.
T
hus
,
t
h
e n
o
t
i
o
n
of
havi
ng
a re
g
u
l
a
r an
d
su
ffi
ci
e
n
t
i
n
c
o
m
e
i
s
im
port
a
nt
pa
rt
i
c
ul
arl
y
am
ong
pe
opl
e
with
a l
o
ng
term
co
n
d
itio
n, su
ch as
d
i
ab
etes
, to
estab
lish
su
stain
a
b
l
e h
eal
th
care
d
e
liv
ery.
Level
s
of
ed
uc
at
i
on
were
cat
e
g
o
r
i
zed
i
n
t
o
si
x i
t
e
m
s
:
no-f
o
r
m
al
, el
em
ent
a
ry
(p
ri
m
a
ry
school
), J
u
ni
o
r
hi
g
h
(sec
o
nda
r
y
educat
i
o
n),
Seni
o
r
hi
gh
(
C
ol
l
e
ge),
Aca
d
em
y/
Uni
v
e
r
si
t
y
degree, a
n
d
M
a
st
er/
P
hD
deg
r
ee.
Furt
herm
ore, t
h
e level of education was cate
g
orized int
o
three lev
e
ls of low (n
o-form
al,
ele
m
en
tary), med
i
u
m
(j
u
n
i
o
r a
n
d sen
i
or hi
gh
), a
n
d hi
g
h
(
b
ach
el
or
and M
a
st
er a
n
d P
h
D
)
. T
h
e m
a
jo
ri
t
y
of
part
i
c
i
p
ant
s
cam
e from
a
m
e
di
um
and
hi
g
h
l
e
vel
of
educat
i
o
n wi
t
h
38 pa
rt
i
c
i
p
an
t
s
from
m
e
di
um
and 40
fr
o
m
hi
gh, w
h
e
r
eas 22
p
a
rticip
an
ts came fro
m
lo
wer le
vel
o
f
e
d
ucat
i
on
(Ta
b
l
e
1
)
.
3.
2.
L
e
vel
s
of
sel
f
-
c
are
Th
e m
a
j
o
rity
o
f
th
e p
a
rticipan
ts sho
w
ed
to
h
a
v
e
a
m
o
d
e
rate lev
e
l o
f
self-care (78
)
an
d
th
e sam
e
num
ber or
pa
rt
icipants were
s
h
are
d
by
the
hi
ghe
r a
n
d lower level (11) (Ta
b
le
2). This
is
in
accordance
to the
st
udy
by
Pri
m
anda
(
2
0
1
1
) t
h
a
t
al
so fo
u
nd a
m
oderat
e
l
e
vel
of
di
et
ary
be
h
a
vi
o
r
am
ong t
h
e part
i
c
i
p
a
n
t
s
of
he
r
st
udy
i
n
a h
o
s
p
i
t
a
l
i
n
Yogy
ak
art
a
and
ot
he
r
st
udi
es acr
oss
I
n
d
o
n
esi
a
n
’
s se
t
t
i
ng [3
0]
-
[
3
3
]
.
In t
h
e
wh
ol
e s
a
m
p
l
e
there was m
o
re
m
e
n (6) re
po
rted hi
ghe
r self
-care tha
n
w
o
m
e
n (5) a
nd m
o
re w
o
m
e
n (8)
repo
rted lo
we
r levels
of sel
f
-car
e t
h
an m
e
n (3)
.
T
h
e m
a
jori
t
y
of
bot
h m
e
n and
wom
e
n, acr
os
s al
l
age gr
ou
ps re
p
o
rt
ed m
ode
rat
e
lev
e
ls o
f
self-care. Peop
le wi
th
a lo
wer educatio
n
le
v
e
l were
m
o
re ev
iden
t in
th
e lo
w self-care group
and
peo
p
l
e
wi
t
h
a
hi
g
h
er e
ducat
i
on l
e
vel
i
n
t
h
e
hi
gh sel
f
-ca
r
e
gr
ou
p. I
n
t
e
re
s
t
i
ngl
y
,
m
o
re peopl
e wi
t
h
a regul
a
r
in
co
m
e
(9
) repo
rted
a lower l
e
v
e
l of self-care th
an tho
s
e
with
a non
-regu
l
ar in
co
m
e
(2
).
A sim
i
lar p
a
ttern
of
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 4, No. 4, D
ecem
ber 2015
:
241 – 249
24
4
self-care activ
i
t
y to
th
e wh
o
l
e sa
m
p
le was id
en
tified
acro
ss
th
e in
terv
iew particip
an
ts with
m
o
d
e
rate self-care
activ
ity b
e
in
g rep
o
rted (Tab
le
2
)
.
Tabl
e
1.
Dem
ogra
p
hi
c cha
r
act
eri
s
t
i
c
s of
q
u
es
t
i
onnai
r
e sam
p
l
e
Gender
(
n
=nu
m
ber of people)
Ag
e - n
=
(%)
18 – 39
40 -
59
≥
60
M
a
le
43
1 (
2
.
3
)
26 (
60.
5)
16(
37.
2)
Fem
a
le
57
2 (
3
.
5
)
29 (
50.
90)
26 (
45.
6)
Total Nu
m
b
e
r
100
3
55
42
Occupation (
n
=)
Private e
m
ployee
Pensioner
Self-e
m
p
loyed
Gover
n
m
e
nt officer
Pr
ofessional
Regular inco
m
e
Housewif
e
L
a
bour
er
Far
m
e
r
Housem
aid
Une
m
p
l
oyed
Non-regular inco
m
e
17
17
12
6
5
57
33
4
2
2
2
43
E
ducation (
n
=)
No f
o
r
m
al educati
o
n
E
l
em
entar
y
(
p
r
i
m
a
r
y
school)
Low
er education level
Junior
high (
s
econ
d
ar
y
)
Senior
high (
C
ollege)
Mediu
m
educat
ion level
Acade
m
y/Universi
ty D
e
gree
M
a
ster
/ PhD – higher
degr
ee
H
i
gher educat
ion
level
5
17
22
5
33
38
36
4
40
.
Tabl
e
2.
Le
vel
s
o
f
sel
f
-care
Overall level of se
lf-care
Whole sa
m
p
le
(
n
=100)
Interview
sam
p
le
(
n
=24)
high
moderate
low
High
moderate
low
11
78
11
4
16
4
Self
-care/ gender
Male
Fe
m
a
le
6
5
33
45
3
8
2
2
7
9
1
3
Self
-care/ age
18-
39
40-
59
>60
0
6
5
2
40
36
1
9
1
0
1
3
1
10
5
1
3
0
Self
-care/ education
Higher
Med
i
u
m
Lo
wer
4
6
1
34
27
17
2
5
4
2
1
1
5
7
4
1
2
1
Self
-care/ inco
m
e
Regular
Non-
r
e
gular
7
4
44
34
9
2
2
2
11
5
3
1
M
o
re
ove
r, the
curre
nt stu
d
y
has also f
o
u
n
d
self-ca
r
e is m
o
d
e
rately p
r
acticed
as separate n
o
tions
instead of an integrat
ed an
d com
p
rehe
nsi
v
e
conce
p
t
i
n
di
abet
es
m
a
nage
m
e
nt
, i
n
t
h
e l
i
nge
ri
n
g
of t
h
e
l
ack of
ad
equ
a
te kn
owledg
e and
the i
m
p
l
e
m
en
tati
o
n
o
f
gu
id
eline,
wh
ich
represen
ts th
e lack
o
f
stru
ctur
al su
ppo
rt
(Table
2).
It is also in accordance t
o
seve
ral studi
es across indone
sian’s setting which em
phasize the un-
i
n
t
e
grat
e
d
of
di
abet
es m
a
nage
m
e
nt
i
n
p
r
act
i
ce [
30]
-
[
3
3
]
.
From
the ques
tionnai
r
e data
participa
n
ts re
ported
that the
m
o
st frequent
self-care activities they
were i
n
cl
i
n
ed
t
o
pe
rf
orm
i
n
v
o
l
v
e
d
t
a
ki
ng t
h
ei
r m
e
di
cat
i
on (M
=
8
8
%
) a
nd
f
o
l
l
o
wi
ng
a recom
m
ended di
e
t
(D=
8
4
%
)
t
o
e
n
sure
t
h
ei
r
bl
oo
d
gl
uc
ose
rem
a
i
n
s st
abl
e
(Fi
g
ure
1
)
.
Seve
ral
part
i
c
i
p
ant
s
em
phasi
ze t
h
e nee
d
t
o
get
m
e
di
cat
i
o
n an
d
fol
l
o
w
doct
o
r
’
s
or
der
as t
h
e fi
rst
measure of
tre
a
tm
ent.
‘The wa
y is co
n
s
u
lting
to
a
do
cto
r
, g
o
t
medica
tio
n
s
, an
d
also
fro
m
o
t
h
e
rs in
fo
rma
tion
a
s
well’
(M
r
Jawe
n)
‘Abou
t th
e trea
tmen
t (fo
r
d
i
a
b
e
tes)
, it va
ries, d
e
p
e
n
d
on th
e
p
e
rso
n
. Fo
r
me,
I try t
o
fo
llo
w
my
doct
o
r’
s
advi
c
e t
o
t
a
ke
t
h
e
m
e
di
ci
ne.
I t
a
ke
the me
dicine
e
very mor
n
ing,’ (Mr Mak
m
ur)
Lack
of info
rmatio
n
in
regard
s of
fo
o
t
care
wa
s
foun
d fro
m
th
e m
a
j
o
rity of
p
a
rti
c
ip
an
ts t
h
at
expl
ai
ne
d
be
hi
nd
t
h
e l
o
w
sc
or
e.
‘
N
o
I
ha
ven'
t
been
to
l
d
a
bou
t
fo
o
t
ca
re’ (Mrs Su
ti)
‘No
,
I ha
ven
’
t
(kn
o
w
n
ab
ou
t fo
o
t
ca
re)
.
Wh
o will d
o
th
e foo
t
ca
re trea
tmen
t?
Is it Dr Irfa
n?
Wo
u
l
d
he
do it? My
feet are
dirty’ (
M
rs Asti)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Ho
w
Ja
van
e
se
Mu
slim with Dia
b
e
tes i
n
Yog
y
a
k
arta
Ma
n
a
g
i
n
g
th
e
Da
ily S
e
lf-Ca
re Activity (Ima
n Perman
a
)
24
5
Fi
gu
re
1.
Perce
i
ved
sel
f-ca
r
e a
c
t
i
v
i
t
y
(wh
o
l
e
sam
p
l
e
n=10
0)
3.
3.
Themes gener
a
ti
on
Furt
her
ex
pl
o
r
at
i
on f
o
un
d se
veral
t
h
em
es t
h
at
ge
nerat
e
d
fr
om
t
h
e i
n
t
e
rvi
e
ws
, t
h
ose a
r
e:
ed
ucat
i
o
n
an
d
k
nowledg
e, b
e
ing
in
or ou
t o
f
co
n
t
ro
l, Jav
a
n
e
se
way -
sen
s
itiv
ity an
d su
rrend
e
r, p
e
ace o
f
m
i
n
d
and
ro
le
of
Allah, poor access
to healt
h
ca
re
.
3.
3.
1.
Education
an
d kn
owledge
One
of t
h
e
key
fi
ndi
ngs
of t
h
i
s
st
udy
was t
h
e gaps i
n
kn
o
w
l
e
d
g
e o
f
effe
ct
i
v
e di
abet
es
m
a
nagem
e
nt
an
d th
e con
c
ep
t of
self-care, d
e
sp
ite
th
e maj
o
rity of
p
a
rti
c
ip
an
ts
d
e
m
o
nstratin
g m
o
d
e
rate self-care activ
ity.
Fu
rt
h
e
rm
o
r
e, th
e m
a
j
o
rity of in
terv
iew
p
a
rt
icip
an
ts
we
r
e
u
n
a
w
a
r
e
of
any str
u
ctur
ed
edu
catio
n
a
l
pr
ogr
am
in
place and m
a
ny, whe
n
des
c
ribing th
eir a
c
tivity, highlighte
d
a com
p
lete
lack of unde
rstanding
for a
n
y
p
a
rticu
l
ar self-care activ
ity.
‘N
o,
t
h
ere
i
s
n
o
(
a
ny e
d
ucat
i
o
n
a
l
sessi
o
n
)
’
(Mrs Siti)
‘
I
ha
ve
n
o
id
ea (a
bou
t an
y edu
c
a
tiona
l progra
m
s)
’
(M
rs A
s
ti)
Particip
an
ts reg
a
rd
ed
th
e do
cto
r
or d
i
etician as
th
e two
k
e
y so
u
r
ces of inform
at
io
n
from th
e h
ealth
care p
r
o
f
essi
o
n
al
s. F
u
rt
herm
ore
,
i
n
re
gar
d
s of
ho
w t
o
g
a
i
n
k
n
o
w
l
e
d
g
e
,
Persa
d
i
a
has
been
pr
om
ot
ed b
y
participa
n
ts as
an
orga
nisation
whe
r
e they c
a
n access
va
l
u
able knowle
d
ge on
how t
o
manage
their conditi
on.
Ind
e
ed
, th
is is p
a
rticu
l
arly ev
id
en
t for those p
e
op
le
with li
mited
fu
nd
s; Persad
ia was th
e
m
a
in
so
urce of
di
abet
es m
a
nagem
e
nt
and
ed
ucat
i
o
n
.
‘Es
p
eci
al
l
y
be
f
o
re Ra
m
a
d
a
n
...We w
e
re t
o
l
d
t
h
at
d
u
ri
n
g
Ra
ma
d
an w
e
di
d
n
’t
st
o
p
ex
erci
si
ng,
by
ri
ppi
ng
new
s
p
ape
rs w
i
t
h
o
u
r
f
eet
. It
w
a
s c
o
unt
e
d
a
s
a
n
ex
erci
se as w
e
l
l
.
.
.
Th
at
’s i
t
.
S
o
,
si
nce I
h
a
ve
j
o
i
n
ed (
t
he aer
obi
c)
at
t
h
e PK
U...
my kn
ow
l
e
dge
has
get
t
i
ng
bet
t
e
r espe
ci
al
l
y
abo
ut
di
abet
e
s
’
(M
r
R
i
pan)
‘Well, yesterday at the (
a
erobic session)
... the dietici
an has
told us.
..
Use this and that. I
f
you want
to
ea
t eg
g, ea
t
th
is mu
ch, u
s
i
n
g
du
m
m
i
e
s. T
h
ere w
e
re vari
ous t
o
y
s
t
h
ere,
egg, c
a
ke, bre
ad
al
l
f
r
om
pl
ast
i
c
, y
o
u see
.
T
h
ey w
e
re
bel
o
n
g
s t
o
t
h
e
me
di
cal
sc
h
ool
’
(Mr Ad
il)
‘Blood c
h
eck was done ever
y week at wee
k
ly exercise
in
hos
pital after the exercise. Before that we
will get a
blood pressure c
h
eck.
After the exerci
se,
one will get a
bl
ood sugar c
h
e
ck for
8,000
ru
p
i
ah
. You
w
o
u
l
d
ha
ve to
pa
y fo
r a
13
,000
in
th
e la
b. Th
ere, you
would
o
n
l
y ha
ve to
pa
y on
ly
8,
00
0.
’
(M
rs Is
m
i
).
3.
3.
2.
B
e
i
n
g
i
n
or ou
t of
c
o
n
t
r
o
l
Th
e p
e
rcep
tio
ns o
f
who
is tak
i
n
g
th
e responsib
ility fo
r th
e o
u
t
co
m
e
o
f
someo
n
e
else’s effo
rt m
i
g
h
t
influe
nce the
adhe
re
nce to s
e
lf-care ac
tiv
it
y. Fu
rt
h
e
rm
o
r
e, th
e
m
a
in
self-ag
e
n
c
y factor b
e
h
i
nd
th
is lack
of
p
r
actices is t
h
e attitu
d
e
of
pu
ttin
g
so
m
e
th
in
g or so
m
e
o
n
e else ov
er the
m
selv
es in
tak
i
ng
respon
sibilit
y in
m
a
nagi
n
g
t
h
e
m
sel
v
es, w
h
i
c
h resem
b
l
a
nce
s
t
h
e n
o
t
i
o
n
of
ext
e
r
n
al
heal
t
h
l
o
c
u
s
of c
o
n
t
rol
[
2
1]
,[
34]
.
Seve
ral
part
i
c
i
p
a
n
t
s
ha
ve rel
i
e
d o
n
h
u
sb
an
d, wi
fe o
r
ot
he
r im
port
a
nt
pers
o
n
i
n
t
a
ki
n
g
care o
f
t
h
em
sel
v
es, or e
v
en t
o
rely on
th
eir
d
o
cto
r
s
witho
u
t
ev
en consi
d
ere
d
to as
k
what ha
s ha
ppene
d
t
o
t
h
eir
own body.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJPHS Vol. 4, No. 4, D
ecem
ber 2015
:
241 – 249
24
6
‘I w
a
l
k
w
h
en
i
n
st
ruct
e
d
by
m
y
chi
l
d
re
n,
usu
a
l
l
y
o
n
e
a
rl
y
mor
n
i
n
g,
but
I
al
s
o
t
a
ke c
o
n
cern
o
n
m
y
ch
ild
ren
’
s f
a
mily, esp
ecia
lly
th
e g
r
an
d
c
h
ildren
,
g
e
tting
up
in time,
p
r
ep
a
r
i
n
g
brea
kf
ast fo
r th
em,
most
of t
h
e time’
(M
rs Tata
)
‘I can
’
t resist n
o
t
d
r
in
king
someth
ing
like… th
e li
ke of sweet ice tea, coffee…sometime
s
,
when
I visit
my friend
, t
h
ey serve me with th
a
t
ki
n
d
o
f
drin
k
whic
h I c
oul
dn’t resist
… But, f
o
r
me, it’s not a bi
g
deal (forgetting the me
dication)
. I
don’t he
sitate to eat the meal…s
omet
imes I take more (food)
or
less th
an
it, it
dep
e
nd
s to
my
mood
’
(M
r
M
a
km
ur)
‘No,
I have
n’t
(asked
anyt
h
ing)
. Dr L had
never
given
me any rec
o
mme
ndatio
ns
. It’s just “what do
you feel, mam?”’
(Mrs Siti)
A
lth
oug
h, th
ere ar
e sev
e
r
a
l
oth
e
r
s
wh
o r
e
lied
o
n
t
h
eir
ow
n ef
fo
r
t
t
o
look
af
ter
th
ei
r
co
nd
itio
n
,
even
to adjust the
dosage
of m
e
dication.
‘
Well, th
a
t
(th
e
a
b
ility to
co
n
t
ro
l myself a
n
d
th
e b
l
oo
d
su
gar co
n
t
ro
l) co
mes fro
m
my o
w
n
ab
ilities.
If I fo
llo
w th
e
d
o
c
t
o
r,
I ha
ve
to
ea
t th
ree times a
d
a
y
, and
th
e vita
mi
n
s
, th
ere a
r
e
a
lot o
f
th
em. Bu
t
fo
r me, it is
my o
w
n
(ab
ility
)
’
(M
r Fa
ja
r)
‘Well, (if
I we
re in
vited
fo
r a
mea
l
) I g
o
t
med
i
ca
tio
n
from th
e d
o
cto
r
,
so
I ra
ised
th
e d
o
s
e a
little
bit... Us
ually, one extra table
t
. If us
ually I took two tablets, then I to
ok three. There is a Glimepirid,
w
h
i
c
h us
u
a
l
l
y
4 t
abl
et
s a
day
.
I ha
d o
n
e i
n
t
h
e mor
n
i
n
g al
on
g w
i
t
h
2 t
abl
et
s of
Met
f
o
rmi
n
. If
I h
ad t
o
go
to an occasion, I’d
take
thr
ee’
(M
r Ja
we
n)
3.
3.
3.
Javanese
way
– sen
s
itivity
and surre
nder
A n
o
t
i
o
n o
f
Ja
vene
se cul
t
u
re
of
tepo
seliro
o
r
b
e
ing
sen
s
itiv
e to
o
t
h
e
rs’
in
terest was i
n
flu
e
n
tial in
how pe
ople behave
d towards
their di
abetes managem
e
nt,
whet
her it was
not pushi
ng to access free service
s
,
not
wa
nt
i
n
g
t
o
bot
her
any
one
el
se, n
o
t
t
a
ki
ng
t
o
o
l
o
ng
wi
t
h
a d
o
ct
o
r
s
o
ot
h
e
r
peo
p
l
e
wo
ul
d
be see
n
q
u
i
c
ker
.
‘Bei
n
g
se
nsi
t
i
ve...
It
act
ual
l
y
t
e
po
sel
i
r
o (
b
ei
ng
sensi
t
i
ve
t
o
ot
her’
s si
t
u
at
i
on)
. Te
po
s
e
l
i
r
o i
s
w
e
respect
ot
hers
.
Tep
o
Sel
i
r
o.
..
Yes I k
n
ow
(
m
y ri
ght
s t
o
hav
e a f
r
ee se
rvi
ce)
, si
nce I h
a
d
pu
bl
i
c
he
al
t
h
in
su
ran
ce.
Bu
t
to
th
e Ja
van
e
se, let sa
y,
b
e
in
g sensitive. We wou
l
d
feel
u
n
c
omfo
rt
a
b
l
e, b
e
ca
u
s
e it is
free, why bot
h
er to
ask for
things
...t
he
n again,
no
one
said that the
service was
pai
d by t
h
e
gove
r
n
m
e
n
t
,
b
u
t
my
he
art
w
o
ul
d
n
’t
j
u
st
d
o
i
t
’
(M
r Ja
wen
)
‘The time with the doctor was so tight..
.I m
e
an
...
I could
not have
a long cons
ultation time... I w
a
s
conce
r
n of
the other patients which
was a
lot
of
them waiting... i
n
case
I was disturbi
ng them’
(M
r
s
Ism
i
)
B
e
i
ng a Ja
va
n
e
se m
eans hav
i
ng t
o
l
o
ok
fo
r ot
hers
’ sa
ke
i
n
m
a
nagi
ng
soci
al
rel
a
t
i
o
n
s
hi
p
,
t
a
ki
n
g
th
in
gs slow.
‘Basically, acc
o
rdi
n
g to Jav
a
nese way
,
ever
ything
we
do
we should
do i
t
slowly... don't bother t
o
t
h
i
n
k
anyt
h
i
n
g,
i
f
you
get
t
i
r
e
d
, s
o
be i
t
.
.
.
af
t
e
r yo
u
got
bet
t
e
r t
h
en
yo
u c
a
n st
a
r
t
t
o
w
o
rk
a
gai
n’
(M
rs
Su
ti)
‘So
,
th
ere will
co
me a time, th
e Ja
van
e
se w
o
u
l
d
sa
y, ‘u
rip itu
kan ka
ya
k
mu
ter’, life is l
i
ke a
circle,
somet
i
mes w
e
w
e
re up,
an
d at
t
hat
t
i
m
e, I w
a
s at
t
h
e bot
t
o
m
.
Event
ual
l
y
, i
t
w
oul
d go
...
t
h
ere’s n
o
w
a
y t
h
at
w
e
al
w
a
ys ke
pt
at
t
h
e b
o
t
t
o
m
’
(M
r Arif
)
3.
3.
4.
Peace
of
mi
nd
an
d r
o
l
e
o
f
Al
l
a
h
or G
o
d
Seve
ral participants m
e
ntioned
the im
portance of kee
p
ing the p
eace of
mind to m
a
nage their
well-
b
e
ing
,
wh
ich
t
o
so
m
e
ex
ten
t
is b
e
liev
e
d
to
h
e
lp
th
em in
main
tain
in
g
their b
l
o
o
d
sug
a
r lev
e
l. Th
is no
tio
n
em
erged
am
ong
part
i
c
i
p
a
n
t
s
fr
om
t
h
e i
n
t
e
rt
wi
ne
d i
n
fl
ue
nc
e of
Ja
vanes
e
cul
t
u
re
an
d
Isl
a
m
i
c val
u
es.
I
ndee
d
,
th
is find
ing
em
p
h
a
sized
th
e no
tio
n of th
e li
m
i
tatio
n
of
th
e qu
estionn
air
e
to
cap
t
ur
e
w
h
at lies
b
e
yon
d th
e
social aspects
of hum
a
n being.
‘Peace
of mi
nd is number one
to support
us i
n
cu
ring the illness.
The
more
we believe (in Allah)
, the
mo
re we will be in
a
ca
lmn
e
ss’
(M
r M
a
km
ur
).
for me,
peace
of mind play
s big part. If we are ha
ppy
, no thoughts bur
d
e
n
,
it will keep the dise
ase
s
aw
ay
.’
(M
r
Ja
wen
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Ho
w
Ja
van
e
se
Mu
slim with Dia
b
e
tes i
n
Yog
y
a
k
arta
Ma
n
a
g
i
n
g
th
e
Da
ily S
e
lf-Ca
re Activity (Ima
n Perman
a
)
24
7
G
o
d
serv
ed as
an
im
p
o
r
tan
t
ex
tern
al f
act
o
r
t
h
at w
a
s r
e
sponsib
le in
i
n
f
l
u
e
ncin
g
t
h
eir
ef
fort to
self-
care for thei
r
diabetes.
‘Alth
oug
h, I do
n’t wo
rk,
b
u
t
th
e o
n
e
tha
t
g
i
ves life is G
o
d. So
, on
e w
h
o
g
r
o
w
s a
p
l
a
n
t
,
must a
l
so
wa
ters it, so
o
n
e wa
y
o
r
an
o
t
her, we
mu
st
b
e
fu
lfilled
b
y
God
’
(M
r
Jawe
n
)
3.
3.
5.
Po
or access to
heal
th
c
a
re
The int
r
oduction
of the Jam
k
esm
a
s card for t
h
e
poor
has certainly began t
o
inc
r
ea
se access to
di
abet
es ed
uca
t
i
on an
d re
gul
ar bl
o
o
d
su
gar
m
oni
t
o
ri
n
g
,
weekl
y
f
o
r t
h
o
s
e
m
e
m
b
ers of
Persadi
a
,
fo
r
peo
p
l
e
who
use
d
t
o
e
x
clude
d
from
accessing healt
h
care
due
to t
h
eir ec
onom
ic status.
‘Before t
hat
pak Duk
u
h (the head
of the village)
had
given
me s
o
me
.. well.. I
am poor s
o
pak
Duk
uh
is g
i
ving
h
i
s
a
t
ten
tio
n to
m
e
(b
y
g
i
ving
the Ja
m
k
esma
s ca
rd
)
.
Fo
r in
stan
ce, if I go to
t
h
e
h
o
s
p
ita
l
and
need s
o
met
h
ing t
o
re
duce the bur
d
en. All
my t
h
r
ee ch
ildren
ha
ve it.
My hu
sb
and
h
a
s it. I do
t
o
o
’
(M
rs Suti)
‘I di
dn
’t
p
a
y i
n
h
o
s
p
i
t
a
l
.
I us
ed Ja
mkes
mas
.
I j
u
st
came t
o
puske
m
a
s aski
ng f
o
r a ref
e
rr
al
, ca
me t
o
PKU, free
. All
was
free, free
co
ns
ultation, free
lab
c
h
eck...Ot
h
erwise, I woul
d have
pay
a
lot,
at
least 200 thous
a
nds
rupiah f
o
r every c
h
eck.’
(Mrs Siti)
The
go
ver
n
m
e
nt
p
r
o
v
i
d
es
t
h
e ba
sic healthcare service with the
p
r
o
v
i
s
i
on
o
f
Jam
k
esm
a
s card
or
Jami
na
n K
e
se
hat
an
Ma
syar
akat
(C
om
m
uni
t
y
Heal
t
h
I
n
su
ra
nce)
f
o
r
t
h
e p
o
o
r
,
a
n
d
Aske
s o
r
A
s
ur
ans
i
K
e
sehat
an
(Health
In
su
ran
ce) fo
r th
e civ
il serv
an
t. In
o
r
d
e
r
to
g
e
t th
e b
e
n
e
fit o
f
th
e serv
ice, it h
a
s a p
a
rti
c
u
l
ar
h
ealth
serv
ice syste
m
, in
clu
d
i
n
g
th
e
referral
syste
m
th
at
m
u
st b
e
fo
llowed
.
Th
e g
e
n
e
ral practitio
n
e
r is serv
ed
as th
e
first lin
e of treatm
e
n
t
an
d th
e
g
a
te
k
e
ep
er fo
r referring
to th
e
sp
ecial
ist.
‘It is free (to go to the county hospital)
, but
had
to
go ther
e every three
days
,
go to c
o
mmunal clinic
ag
ai
n
,
f
i
n
d
h
o
s
p
i
t
a
l
ref
e
re
nce
,
t
o
o
muc
h
t
o
do
,
as i
f
w
e
d
o
n
’t
h
a
ve
anyt
h
i
ng el
se
t
o
d
o
.
Ot
he
r t
h
a
n
doi
ng my
ow
n
busi
n
ess,
goi
ng
about to t
h
e
hos
pital ever
y
three
days
mak
e
s me
tired’
(Mr
Jaw
e
n)
.
‘I sho
u
l
d
g
o
t
o
th
e pu
skesma
s, th
en
Sa
rjito
ho
sp
it
a
l
. At
tha
t
time… I
h
a
d
t
o
wa
ke up
a
t
4
a
n
d
wen
t
to
Sarjito t
o
take
the number…
even whe
n
I
went a
fter daw
n
,
I was i
n
queue in t
h
e posi
tion numbe
r
1
0
0
.
S
o
, I
should
d
o
th
e w
h
o
l
e p
r
o
ces for the wh
o
l
e
day
. L
e
t
say…
t
h
e l
a
b
o
rat
o
ri
u
m
…
i
t
ope
ns
at
8, i
f
I got
n
u
m
b
er
80
, I got
my bl
oo
d dr
aw
n
at
10
.
T
h
e
n
, I sh
oul
d
e
a
t
an
d a
f
t
e
r
t
w
o
h
o
u
rs,
I
s
h
oul
d g
o
back
.
So
, i
t
w
o
ul
d
be f
i
ni
she
d
at
l
e
a
s
t
at
2.
T
h
e
next
day
, I
s
h
o
u
l
d
co
me
b
a
ck a
gai
n t
o
t
a
k
e
t
h
e res
u
l
t
a
n
d
see th
e in
tern
ist for
a
co
nsu
lta
tion
.
After th
a
t
, th
e in
tern
ist w
o
uld
g
i
ve
a
referen
ce t
o
the
ca
rd
io
log
i
st for th
e
n
ext two
d
a
y
s’
(M
r Sa
di)
4.
CO
NCL
USI
O
N
The m
a
jori
t
y
of
peo
p
l
e
sam
p
l
e
d hi
ghl
i
g
ht
ed a
m
oderat
e
l
e
vel
of sel
f
-
care pre
d
om
i
n
ant
l
y
t
a
ki
ng
responsibility for the m
a
naging thei
r m
e
dication,
diet and occasional e
x
ercise. The
r
e wa
s no e
v
idence
of a
n
y
str
u
ctur
ed
educatio
n
pr
ogr
ammes w
ith
in
the health ca
re sector to e
duc
at
e peo
p
l
e
on
di
abet
es m
a
nagem
e
nt
;
ed
u
cation
t
o
o
k
m
o
re th
e format o
f
prov
id
i
n
g ad
ho
c info
rmatio
n
d
u
ring
a
co
nsu
ltatio
n.
Persa
d
i
a
o
ffe
r
e
d
heal
t
h
sem
i
nars
, a
n
e
x
cel
l
e
nt
so
u
r
ce
of i
n
f
o
rm
at
i
on an
d s
u
p
p
o
rt
, a
n
d
t
h
e
peo
p
l
e
accessing the
s
e dem
onstrated m
o
re in dept
h and accurate
diabetes educ
ation and knowledge. Furt
he
rm
ore,
this can be served as an e
v
idence of
ho
w s
o
ci
al
sup
p
o
r
t
can pl
ay
an im
port
a
nt
rol
e
i
n
m
a
nagi
n
g
i
ndi
vi
d
u
al
s’
co
nd
itio
n.
Thi
s
st
u
d
y
al
so
reveal
e
d
t
h
e r
o
l
e
of
rel
i
g
i
o
n
and Ja
va
nese c
u
l
t
u
re i
n
i
n
fl
ue
nci
n
g pe
o
p
l
e
i
n
m
a
nagi
ng
th
eir
d
a
ily self-care. Being
a Jav
a
n
e
se h
a
s
p
l
ayed
a ro
le
in
m
a
in
tain
in
g d
a
ily m
a
n
a
g
e
men
t
o
f
th
e illn
ess;
eith
er
, as a h
i
nd
r
a
n
ce or
opp
or
tun
ity to
self
-
car
e.
W
h
ile, h
e
alth
car
e serv
ices, so
cial suppo
r
t
and
also
r
e
lig
io
us
bel
i
e
fs, t
h
e be
l
i
e
f of t
h
e m
a
i
n
r
o
l
e
of
Al
l
a
h,
have
pl
ay
ed as st
r
u
ct
u
r
es t
h
at
i
n
fl
ue
nci
n
g i
n
di
vi
du
al
s i
n
m
a
nagi
n
g
t
h
ei
r
dai
l
y
li
ve i
n
di
abet
es
m
a
nag
e
m
e
nt
.The
se t
e
net
s
hav
e
em
erged a
nd em
bed
e
d wi
t
h
i
n
t
h
e
n
o
t
i
o
n
of sel
f-a
gency, suc
h
as loc
u
s
of c
o
ntrol a
n
d
self-efficacy
that have
played
as im
por
tant
determinant fact
ors i
n
main
tain
in
g
t
h
eir d
a
ily activ
ity.
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NC
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tiona
l Di
abet
es Feder
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tio
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h e
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