Factors relating to depressive symptoms of caregivers for older care recipients in Indonesia.

Objectives: Family care is a large part of an informal workforce and there are increasing unmet demands for ageing populations, particularly in low and middle-income country settings. This study investigates relationships and care requirements for older care recipients and their caregivers within the household and identifies factors relating to depressive symptoms among caregivers of older persons.Method: Data were derived from the Indonesian Family Life Survey (IFLS Wave 5). Multiple logistic regressions were used for analyses. Outcomes were Center for Epidemiologic Studies Depression Scale (CES-D score ≥10 as having moderate to severe depressive symptoms).Results: Over half of care recipients aged 50 years and over reported requiring intermediate or high-level care intensity. Primary caregivers were most often spouses for older males and adult children for older females. Factors associated with depressive symptoms among caregivers were not working (adjusted odds ratio, AOR 1.86; 95% Confidence Interval 1.19- 2.90), primary school education (AOR 5.01; 1.96-12.8), living in rural area (AOR 1.38; 1.01-1.88), and having multiple older care recipients in the household (AOR 1.98; 1.43-2.75). Having care recipients with medium or high functional limitation levels (AORs 2.27; 1.51-3.42 and 3.36; 2.00-5.63, respectively) and not receiving household co-resident support were associated with caregivers' depressive symptoms (AOR 1.32; 1.01-1.89).Conclusion: To meet the anticipated future demands for elderly care, addressing factors relating to depressive symptoms, especially amongst those not working, low education, living in rural areas could help mitigate adverse effects for caregivers. Caregivers could benefit from the provision of adequate support, including screening for depressive symptoms.

Exploring Medications for Hypertension Advertised Online: A Qualitative Study in Indonesia.

INTRODUCTION: Patients with hypertension often self-medicate and are increasingly purchasing their medications online. This study aimed to identify the medications and products used for hypertension offered by Indonesian online marketplaces and the availability of prescription-only antihypertensive medication on these platforms. MATERIALS AND METHODS: This qualitative document analysis comprehensively assessed three online marketplaces in Indonesia in May 2019. Five top products in each online marketplace were identified and reviewed. An in-depth analysis was performed to obtain detailed information about the products (e.g., ingredients), indications, and customers' comments. Selected antihypertensive medications (captopril, amlodipine, and valsartan) were searched for. The data were analyzed thematically. RESULTS: The search results showed that more than 5000 products were available in each online marketplace and that all of the top products offered in these platforms were traditional medicines. Some products specifically claimed to be effective for lowering blood pressure (e.g., "the solution for hypertension without complications"). Morinda citrifolia (noni) and Allium sativum (garlic) were ingredients found in all three platforms, mainly in combination with other herbal medicines. The prescription-only antihypertensive medications offered and could be purchased through online marketplaces reviewed. However, information about dosage forms, indications, side effects, and contraindications of these medications was rarely provided on these platforms. CONCLUSION: Indonesian online marketplaces provide a wide range of products for the treatment of hypertension, particularly traditional medicines. Given the increasing trends of online shopping, providing objective and adequate information for customers is essential. Regulations for the purchase of prescription-only medicines, such as antihypertensive medications, should be strengthened.

Potential use of a "Blood Pressure Action Sheet" for Indonesian patients with hypertension living in rural villages: a qualitative study.

PURPOSE: The aim of the study was to obtain feedback on the layout, content, and potential use of a blood pressure (BP) action sheet, a purpose-designed written resource for Indonesian patients with hypertension. METHODS: Telephone interviews were conducted with 13 health professionals, 12 community health workers, and 12 patients in rural Yogyakarta, Indonesia, to explore their impressions of the BP action sheet, how the sheet might affect management of hypertension, and suggestions for improvement. RESULTS: Participants felt that the sheet presented useful information about achieving the target BP and managing hypertension. The use of the sheet could be optimized by engaging community health workers to help explain the information and to provide assistance around the stated actions for hypertension management. A more attractive design and inclusion of more details were suggested. Both patients and health care workers expressed interest in using the sheet. CONCLUSION: The BP action sheet has potential as a useful resource for patients with hypertension by providing information, recording target BP, and facilitating patient-centered communication. Use of the BP action sheet might provide an effective low-cost way for health professionals and community health workers to encourage patients to achieve their target BP.

Access to medicines for hypertension: a survey in rural Yogyakarta province, Indonesia.

INTRODUCTION: Obtaining an adequate supply of medicines is an important step in facilitating medication adherence. This study aimed to determine (1) how people with hypertension in rural villages in Indonesia obtain their supply of anti-hypertensive medications, (2) the type of hypertension medication taken and (3) factors associated with where and how people obtain their medicines supplies. METHOD: Data pertaining to people with hypertension (age ≥45 years) were collected from eight rural villages in the Bantul district, Yogyakarta province, Indonesia, using a researcher-administered questionnaire. RESULTS: Of 384 participants, 203 (52.9%) obtained anti-hypertensive medications from public or private healthcare services. The most common way was by purchasing these medicines without prescription in community pharmacies (n=64, 17%). The medicines obtained this way included captopril, amlodipine, nifedipine, and bisoprolol. One-hundred and nineteen (15%) participants obtained their medicines at no cost by visiting public healthcare services such as community health centres (n=51), the Integrated Health Service Post for the Elderly (n=53), and the public hospitals (n=15). Direct dispensing from clinicians was reported by participants who visited a doctor (n=15), midwife (n=23) or nurse (n=21). Having access to an adequate medication supply (ie for an entire 30 days) was reported by 40 (10.4%) participants, who obtained the medication from a community health centre (n=18), public hospital (n=4), community pharmacy (n=5), private hospital (n=2), or multiple sources (n=11). A higher formal education level was associated with obtaining medicines from multiple sources rather than from the public or private provider only. Living near a community health centre and having government insurance were associated with obtaining medicines from the public health service. Age, gender, employment, presence of other chronic diseases, and knowledge about hypertension were not significantly associated with how participants obtained their medications. CONCLUSION: These Indonesian participants obtained their anti-hypertensive medications from various sources; however, the inadequate supplies found in this study could compromise both short- and long-term management of hypertension. Direct dispensing, non-doctor prescribing, and self-medication with anti-hypertensive medications indicate the current complex healthcare system in Indonesia. This study also shows some challenges involved in managing patients with chronic diseases such as hypertension in resource-poor settings. It provides important findings for quality improvement practices that should be considered to improve the health lifespan in populous countries such as Indonesia.

Factors affecting self-reported medication adherence and hypertension knowledge: A cross-sectional study in rural villages, Yogyakarta Province, Indonesia.

Objectives This study assessed medication adherence and hypertension knowledge, and their predictive factors, in people with hypertension, living in rural communities in Indonesia. Methods Data were acquired from 384 people living in eight rural villages via a researcher-administered questionnaire, a validated adherence scale, and a standardized hypertension knowledge survey. Multivariate analysis was used to identify the predictors of adherence and knowledge. Results Fifty-nine (15%) participants had good hypertension knowledge (score ≥ 8 out of 10). Compared to participants with poor knowledge, these participants had higher formal education (odds ratio = 2.7, 95% confidence interval = 1.5-4.7), and lived closer to a community health center (odds ratio = 1.8, 95% confidence interval = 1.0-3.3). Knowledge gaps about the need for long-term medication, hypertension complications, and the target blood pressure were identified. Good hypertension knowledge predicted good adherence to medication (odds ratio = 7.1, 95% confidence interval = 3.3-15.2). Only 42 (11%) participants were considered to have good adherence. Reasons for intentional nonadherence were beliefs that medicines should be taken only when symptoms are evident, limited access to healthcare services, and a preference using traditional medicines. Conclusion Strategies for addressing knowledge gaps and misconceptions about hypertension medication are needed, particularly for people with a low educational level and those living some distances from healthcare facilities.

Understanding untreated hypertension from patients' point of view: A qualitative study in rural Yogyakarta province, Indonesia.

Objectives This study aimed to explore perspectives about hypertension from patients who do not take anti-hypertensive medications. Factors that shape their perspectives as well as patients' expectations were also canvassed. Method Individual, face-to-face interviews were conducted with 30 people (≥45 years old) living in rural villages, diagnosed with hypertension, who had not taken any anti-hypertensive medications for at least one year. Interviews were audiotaped, transcribed verbatim and thematically analysed. Results Four themes emerged: (1) alternative medicines for managing high blood pressure; (2) accessing health care services; (3) the need for anti-hypertensive medications; and (4) existing support and patients' expectations. Reluctance to take anti-hypertensive medications was influenced by patients' beliefs in personal health threats and the effectiveness of anti-hypertensive medications, high self-efficacy for taking alternative medicines, the lack of recommendation regarding hypertension treatment, and barriers to accessing supplies of medicines. Conclusion Despite their awareness of being diagnosed with hypertension, patients undervalued visiting a health professional to control their high blood pressure. Health strategies need to consider patients' beliefs, concerns and expectations. Providing an accessible, affordable and adequate supply of hypertension medication is also key to any programs designed to optimise hypertension management.

Self-medication among people living with hypertension: a review.

Background: Self-medication is commonly practised by patients, underpinned by health beliefs that affect their adherence to medication regimens, and impacting on treatment outcomes. Objectives: This review explores the scope of self-medication practices among people with hypertension, in terms of the scale of use, types of medication and influencing factors. Method: A comprehensive search of English language, peer-reviewed literature published between 2000 and 2014 was performed. Twenty-seven studies met the inclusion criteria; 22 of these focused on complementary and alternative medicines (CAMs). Results: Anti-hypertensive medications are listed among the 11% of products that patients reportedly obtain over-the-counter (OTC) for self-medication. On average, 25% of patients use CAMs, mostly herbs, to lower blood pressure. Recommendations by family, friends and neighbours are the most influential factors for self-medication with CAMs. Faith in treatment with CAMs, dissatisfaction with conventional medicine and the desire to reduce medication costs are also cited. Most (70%) patients with hypertension take OTC medicines to treat minor illnesses. The concurrent use of anti-hypertensive medications with analgesics and herbal medicines is commonly practised. The sociodemographic profile of patients engaging in self-medication differs markedly in the articles reviewed; self-medication practices cannot be attributed to a particular profile. Low disclosure of self-medication is consistently reported. Conclusion: This review highlights a high proportion of people with hypertension practise self-medication. Further studies are needed to assess the impact of self-medication with OTC and anti-hypertensive medications on hypertension treatment. Health professionals involved in hypertension management should be mindful of any types of self-medication practices.

A Community Health Worker-Based Program for Elderly People With Hypertension in Indonesia: A Qualitative Study, 2013.

INTRODUCTION: Hypertension is prevalent in the elderly, but treatment is often inadequate, particularly in developing countries. The objective of this study was to explore the role of a community-based program in supporting patients with hypertension in an Indonesian rural community. METHODS: A qualitative study comprising observation and in-depth interviews was conducted in an Integrated Health Service Post for the Elderly (IHSP-Elderly) program in Bantul district (Yogyakarta province). Eleven members of IHSP-Elderly program (ie, hypertensive patients), 3 community health workers (CHWs), and 1 district health staff member were interviewed to obtain their views about the role of the IHSP-Elderly program in hypertension management. Data were analyzed using thematic analysis. RESULTS: CHWs played a prominent role as the gatekeepers of health care in the rural community. In supporting hypertension management, CHWs served members of the IHSP-Elderly program by facilitating blood pressure checks and physical exercise and providing health education. Members reported various benefits, such as a healthier feeling overall, peer support, and access to affordable health care. Members felt that IHSP-Elderly program could do more to provide routine blood pressure screening and improve the process of referral to other health care services. CONCLUSION: CHWs have the potential to liaise between rural communities and the wider health care system. Their role needs to be strengthened through targeted organizational support that aims to improve delivery of, and referral to, care. Further study is needed to identify the key factors for effective CHW-based programs in rural communities and the incorporation of these programs into the health care system.