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Health Behaviors and Clinical Outcomes Among Patients with Myocardial Infarction in Indonesia Herliani, Yusshy Kurnia; Matchim, Yaowarat; Kritpracha, Charuwan
Jurnal NERS Vol 10, No 2 (2015): Vol. 10 Nomor 2 Oktober 2015
Publisher : Universitas Airlangga

Introduction: Health behaviors are necessary for preventing possible cardiac events and maintaining health for MI patients. In addition to health behaviors, measuring clinical outcomes is a critical element for optimizing treatment and monitoring the risk factors of a cardiac event. The aims of this study were to (1) describe health behaviors and clinical outcomes among patients with myocardial infarction (MI) in Indonesia; and (2) investigate the relationship between their health behaviors, clinical outcomes, and other selected variables. Method: Sixty hospitalized MI patients participated in this descriptive correlational study. Data were analyzed using descriptive and correlational statistics. Results: The majority of MI patients in this study had a moderate level of total health behaviors, exercise behaviors, dietary behaviors, and stress management. Interestingly, most of the patients had a high level of medication adherence, and smoking cessation. Also, their blood pressure (BP) and body mass index (BMI) of MI patients were at the normal level. In contrast, more than half the patients had a high level of fasting blood glucose and total cholesterol, and a low level of HDL. Moreover, nearly half of the patients presented a high level of LDL, and triglyceride. Exercise behaviors have a negative relationship with total cholesterol, and LDL. Interestingly, gender showed a positive relationship with total health behaviors, and smoking cessation. In addition, monthly incomes show a positive relationship with exercise behavior, and dietary behaviors. The number of times hospitalized appeared to have a positive relationship with systolic BP. Surprisingly, MI treatments showed a positive relationship with total health behaviors, smoking cessation, and BP. Discussion: In conclusion, cardiac rehabilitation should involve health behaviors and clinical outcomes to prevent recurrent cardiac events and maintain health for MI patients.Keywords: Myocardial infarction, Health behaviors, Clinical outcomes

Dietary Behaviors among Patients with Type 2 Diabetes Mellitus in Indonesia Aklima, Aklima; Kritpracha, Charuwan; Thaniwattananon, Ploenpit
Nurse Media Journal of Nursing Vol 3, No 1 (2013): (JUNE 2013)
Publisher : Department of Nursing, Faculty of Medicine, Diponegoro University

Purpose: To describe the dietary behaviors among patients with Type 2 Diabetes Mellitus(T2DM) in Indonesia.Method: Sixty patients with T2DM who met the inclusion criteria were selected from fourvillages of the Banda Raya Community Health Centre in Banda Aceh, Indonesia. Patientsâ€™dietary behaviors were measured by the Self-Management Dietary Behaviors Questionnaire(SMDBQ). The SMDBQ was modified from the previous study with adequate reliability(Chronbachâ€™s alpha was .82).Result: The subjects who participated in this study were middle aged adults (53 years). Morethan half of the subjects in this study were female (76.7%). All of the subjects were Muslim.More than one-third had an education level of senior high school (38.3%). The majority of thesubjects had no experiences with any previous educational program or counseling programrelated to dietary behaviors (86.7%). The results showed a moderate level of dietary behaviorsof patients with T2DM in Aceh, Indonesia.Conclusions: The dietary behaviors among Type 2 diabetic patients in Aceh, Indonesia wereat a moderate level. Regarding dietary behaviors scales, almost all items were at a moderatelevel. However, recognizing and consuming the amount of calorie needs was at a low level.Further research is needed in terms of dietary self-management by using an interventionapproach to improve the dietary behaviors of diabetic patients.Key words: Type 2 diabetes mellitus, dietary behaviors.

Review: Anxiety and Quality of life in Patients with Myocardial Infarction Panthee, Bimala; Kritpracha, Charuwan
Nurse Media Journal of Nursing Vol 1, No 1 (2011): (JUNE 2011)
Publisher : Department of Nursing, Faculty of Medicine, Diponegoro University

Obejctive: Anxiety and reduced Quality of Life (QoL) are commonly reported in patients with myocardial infarction (MI) for long years and has a great interest to improve patientsâ€™ quality of life. Almost all of the patients with MI will have anxiety to some level. Persistent anxiety for long period has detrimental effect on quality of life. Therefore this study is aimed to find out the effect of anxiety on quality of life of patients with MI.Methods: Published literatures were searched using individual or combination of keywords: anxiety, quality of life and myocardial infarction in following databases: PubMed, CIHNAL, Proquest, and Google Scholar. The full texts were obtained from the journal homepage using Prince of Songkla University and those that could not be accessed from this University were obtained from the University of Tokyo network. Papers which were not accessible from these two networks were excluded from the review.Results: Majority of studies found that patients with MI reported high level of anxiety persisting over months to years affecting QoL. Some studies showed that anxiety was associated with complications and all of the study showed that anxiety was associated with decreased quality of life. Different studies measured anxiety and quality of life differently which might have affect the results of the studies and most of the studies did not consider it and lack to correlate the level of anxiety in each dimension of QoL is noted. High level of anxiety was correlated with the poorer quality of life. Therefore, the researcher should note that which level of anxiety the patient is suffering from because mild anxiety is helpful to focus attention; to learn the stressful situation and solve the problems to protect him/her by themselves. Moderate level of anxiety reduces the patientâ€™s concentration but facilitates to seek information and solve problems with assistance. Severe anxiety results in difficulties in thinking and reasoning and disturbs physiological functioning. Therefore, it is equally important to consider the correlation between mild, moderate anxiety to QoL.Conclusion: Anxiety affects negatively in QoL in patients with MI. Identification of the level of anxiety can help plan effective nursing management of MI patients.

Development of Family-Based Dietary Self-Management Support Program on Dietary Behaviors in Patients with Type 2 Diabetes Mellitus in Indonesia: A Literature Review Aklima, Aklima; Kritpracha, Charuwan; Thaniwattananon, Ploenpit
Nurse Media Journal of Nursing Vol 2, No 2 (2012): (DECEMBER 2012)
Publisher : Department of Nursing, Faculty of Medicine, Diponegoro University

Background: WHO statistics show that Indonesia has the fourth highest number of diabetes sufferers. The International Diabetes Federationâ€Ÿs 5th estimated that in 2011 there were 71.4 million people in South East Asia region were suffering with DM Purpose: To develop a family-based dietary self-management support program to improve dietary behaviors in patients with T2DM. Method: A literature review was conducted by reviewing articles related evidence-based practices. Only articles in the English and Indonesian languages were reviewed. The search found eleven published experimental studies related to the topic. Result: Even though dietary self-management has benefits for patients with diabetes, many studies have found that these patients often have difficulty in establishing or maintaining an effective program to self-manage their dietary behaviors. Lack of family support is one factor that often seems to be related to such failures. Family participation in a diabetes education program also had positive psychosocial impacts. Otherwise, another study found that family might not always have a positive impact on self-management. Therefore, this review recommends that development of a family-based support program could be a positive factor in helping to improve dietary self-management behaviors in patients with T2DM. Self-management theory by Funnell and Andersonâ€Ÿs work (2004) can guide the development of a program with the goal of empowering individuals and families in improving the patientâ€Ÿs dietary behaviors. The program consists of: (1) reflecting on current and/or past self-management experiences by listening to the patient about their dietary behaviors, (2) discussing the emotions and feelings of the patients, (3) engaging the patient in improving their situation by active listening and helping the patient reflect on their problems and identifying effective strategies, (4) providing information about dietary management and problem-solving strategies, and (5) goal-setting and action planning by assisting the patient to write the goals and action plan on a specially prepared form. All of these sessions would involve the patientâ€Ÿs family. Follow-up visits may be needed to evaluate the dietary behaviors of patients. Conclusion: The collaboration of patients, family and health care professionals can have a positive impact on the dietary self-management behaviors of patients with T2DM. Further study is needed, as there is a growing awareness of the important role in diabetes management of integrating family support into routine diabetes management. Key words: Type 2 diabetes mellitus, dietary behaviors, self-management, and family support.

The Effect of Dietary and Exercise Self-Management Support Program on Dietary Behavior Exercise Behavior and Clinical Outcomes in Muslim Patients with Poorly Controlled Type 2 DM in a Community Setting in Indonesia Pamungkas, Rian Adi; Chinnawong, Tippamas; Kritpracha, Charuwan
Nurse Media Journal of Nursing Vol 5, No 1 (2015): (JUNE 2015)
Publisher : Department of Nursing, Faculty of Medicine, Diponegoro University

Purpose: The objective of this study was to examine the effect of dietary and exercise self-management support program on the dietary behavior, exercise behavior, and clinical outcomes of Muslim patients with poorly controlled type 2 DM in Indonesia. Methods: This study was a quasi-experimental, two group, pre-test and post-test design. The experimental group received the dietary and exercise self-management support program and usual care, whereas the control group only received the usual nursing care.Result: 35 subjects in the experimental group and 35 subjects in the control group completed the program, respectively. The findings indicated that there are significantly differences in dietary behavior (p=.00), exercise behavior (p=.00) and clinical outcomes: fasting blood glucose (FBG) (p=.00), cholesterol total level (p=.01) and systolic blood pressure (p=.00) between the experimental group and control group. However, for the BMI status (p=.84) and diastolic blood pressure (BP) (p=.32) were no significant differences between two groups. Conclusion: The dietary and exercise self-management support program was effective for improving the dietary behavior, exercise behavior, FBG, and total cholesterol level for individuals with poorly controlled type 2 diabetes mellitus. Further studies should be replicated using larger groups over a longer time frame.

Cardiac Rehabilitation Enhancing Programs in Patients with Myocardial Infarction: A literature Review Ahyana, Ahyana; Kritpracha, Charuwan; Thaniwattananon, Ploenpit
Nurse Media Journal of Nursing Vol 3, No 1 (2013): (JUNE 2013)
Publisher : Department of Nursing, Faculty of Medicine, Diponegoro University

Background: Cardiac rehabilitation (CR) is a process that involves a multidisciplinary team of health professionals in order to optimize the status of patientsâ€™ physical, psychological, social, and vocational well being. The CR program has been proven to influence health outcomes in patients with cardiac diseases, particularly myocardial infarction (MI) and stable angina. However, patientsâ€™ compliance with cardiac rehabilitation programs remains a challenge.Purpose: The purpose of this study is to review and identify interventions that enhance cardiac rehabilitation behaviors in MI patients.Method: A literature review was conducted by analyzing related research reports published since 2000 to 2012. Only English language articles were included.Result: There were 10 experimental studies and 2 meta-analysis studies. Interventions widely used to enhance cardiac rehabilitation behaviors in MI patients were self-efficacy and self management derived programs. These programs involved interventions that enhance cardiac rehabilitation behaviors, including training exercise, behavioral change, education and psychological support, and lifestyle changing strategies. None have reported the use of culturally tailored intervention. Four phases of cardiac rehabilitation were accepted as each phase represents a different aspect of care: inpatient care, early post discharge period, exercise training, and long term follow up. Critical factors for patients in maintaining an optimum health condition after a cardiac event are, in order, status of patientâ€™s physical, psychological, social, and vocational well being.Conclusion: Cardiac Rehabilitation program has been shown to improve quality of life and decrease mortality in MI patients. The development of culturally specific interventions to increase cardiac rehabilitation behaviors will provide a significant improvement for cardiac patientâ€™s care that ultimately results in better health outcomes. Health care professionals should be involved in CR programs in order to enhance patientsâ€™ performance in CR behaviors; moreover, further study is also needed to examine the existing intervention studies to improve the CR program.Keywords: cardiac rehabilitation, attendance, behaviors, outcomes, secondary prevention and myocardial infarction (MI).

Review: Self-management Support Program on Dietary Behaviors in Patients with Type 2 Diabetes Mellitus Primanda, Yanuar; Kritpracha, Charuwan
Nurse Media Journal of Nursing Vol 1, No 1 (2011): (JUNE 2011)
Publisher : Department of Nursing, Faculty of Medicine, Diponegoro University

Background: Dietary behaviors are the cornerstone in diabetes management. Diabetes self-management support program in which patients play an active role to determine their health care is an important strategy to improve dietary behaviors in type 2 diabetes mellitus (T2DM) patients. Its elements which contribute to the successfulness of the program need to be identified.Purpose: To review and identify the elements of self-management support program to improve dietary behaviors in T2DM patients.Method: An integrative review was conducted. Relevant studies published in English language during last 10-year, measured dietary behaviors in T2DM patients, and retrieved from CINAHL and PubMed were included.Results: 13 experimental studies and 3 meta-analysis studies were reviewed. Goal setting and action planning combined with other strategies (brief counseling and problem solving) seemed more effective to improve dietary behaviors. Either trained lay people or clinicians could lead the program although clinician-led programs were common. Contents and materials of the education vary across the studies. The effects on dietary behaviors could be detected in short term duration of program (<6 months). Continuing follow-up was essential element which face-to-face follow-up as the most common strategy. The utilization of technology such as telephone-call and internet based follow-up might provide more benefits for patients.Conclusion: Diabetes self-management support program is effective to improve dietary behaviors in T2DM patients. Further research is needed to test the effectiveness of goal setting strategy and technology utilization for follow-up strategy such telephone call in Indonesian T2DM population.Keywords: self-management, dietary behaviors, type 2 diabetes mellitus

Quality of life among Indonesian family caregivers caring for dependent older persons with type 2 diabetes mellitus in the community: A cross-sectional, correlational study Siregar, Rinco; Kritpracha, Charuwan; Chinnawong, Tippamas; Latour, Jos M.
Belitung Nursing Journal Vol. 11 No. 1 (2025): January - February
Publisher : Belitung Raya Foundation, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.3683

Background: The global prevalence of older adults with diabetes has increased, and family caregivers in Indonesia play a critical role in managing diabetes and providing personal care. However, caregiving can be complex and challenging, often negatively affecting caregivers' quality of life (QoL). Objective: This study aimed to develop and test a hypothesized causal model of QoL among Indonesian family caregivers who care for dependent older persons with type 2 diabetes mellitus (T2DM) in 2024. Methods: A cross-sectional, correlational study was conducted with 270 family caregivers recruited from five Community Health Centers. Data were collected using various scales: the Center for Epidemiologic Studies Depression Scale, the Zarit Burden Interview, the Duke University Religion Index, the Perceived Knowledge on T2DM Care Scale, the Family-Carer Diabetes Management Self-Efficacy Scale, the Multidimensional Scale of Perceived Social Support, and the Quality-of-Life Index. Descriptive statistics and Partial Least Squares Structural Equation Modeling (PLS-SEM) were used for analysis. Results: The final model explained 89.1% of the variance in the quality of life (QoL) of family caregivers (R² = 0.893, Adjusted R² = 0.891), with 66% predictive relevance. Depression symptoms had the strongest negative direct effect on QoL, followed by caregiver burden. Self-efficacy and perceived knowledge had positive direct effects, while social support showed no significant direct effect. Indirect effects revealed that social support and self-efficacy positively influenced QoL through depression symptoms. The total effect (TE) analysis confirmed that depression symptoms had the strongest negative effect on QoL (TE = -0.744, p <0.001), while social support (TE = 0.443, p <0.001) and self-efficacy (TE = 0.413, p <0.001) had positive effects. Conclusion: Reducing depression symptoms and caregiver burden, strengthening social support, and promoting self-efficacy could significantly improve the QoL of family caregivers who care for older persons with T2DM. Nursing practice should address caregivers' physical and emotional needs, provide education, foster social support, and support caregiver mental health.

Psychometric properties of the Indonesian version of the Quality of Life Index (QLI-I) among family caregivers of dependent older persons with type 2 diabetes mellitus Siregar, Rinco; Kritpracha, Charuwan; Chinnawong, Tippamas; Latour, Jos M.
Belitung Nursing Journal Vol. 11 No. 4 (2025): July - August
Publisher : Belitung Raya Foundation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33546/bnj.3929

Background: The quality of life (QoL) of family caregivers supporting older persons with functional dependence due to Type 2 Diabetes Mellitus (T2DM) is a growing concern. Accurately assessing caregiver well-being requires culturally appropriate, valid, and reliable instruments. However, such tools remain limited in the Indonesian context. Objective: This study aimed to translate the Quality of Life Index (QLI) into Indonesian and evaluate the psychometric properties of the Indonesian version (QLI-I) among family caregivers of dependent older persons with T2DM. Methods: Brislin’s back-translation method was used to ensure linguistic and conceptual equivalence in the translation process. Content validity was assessed by a panel of five experts. Psychometric evaluation was conducted on a purposive sample of 394 family caregivers recruited from eleven community health centers in Medan, Indonesia. Construct validity was examined using confirmatory factor analysis (CFA), while convergent validity and construct reliability (CR) were analyzed to assess measurement accuracy. Results: The Indonesian version of the Quality of Life Index (QLI-I) demonstrated strong construct validity, with standardized factor loadings ranging from 0.707 to 0.870. CFA indicated an acceptable model fit based on the following indices: Root Mean Square Error of Approximation (RMSEA) = 0.067, ratio of chi-square to degrees of freedom (CMIN/df) = 2.779, Comparative Fit Index (CFI) = 0.906, Incremental Fit Index (IFI) = 0.906, Goodness of Fit Index (GFI) = 0.814, and Tucker-Lewis Index (TLI) = 0.898. Composite Reliability (CR) values were high across all domains: Health/Functioning (HF) = 0.957, Family (FA) = 0.876, Social/Economic (SE) = 0.924, and Psychological/Spiritual (PS) = 0.922. Average Variance Extracted (AVE) values met the recommended threshold for each domain: HF = 0.633, FA = 0.586, SE = 0.605, and PS = 0.627. All constructs demonstrated acceptable discriminant validity, confirming the distinctiveness of each domain. Conclusion: The QLI-I is a valid and reliable instrument for assessing the QoL of family caregivers of dependent older persons with T2DM. Its use in clinical and community settings can support nurses and healthcare professionals in identifying caregiver needs and developing culturally appropriate, evidence-based interventions to enhance caregiver well-being.

Correlation between Coping Strategies and Quality of Life among Myocardial Infarction Patients in Nepal Panthee, Bimala; Kritpracha, Charuwan; Chinnawong, Tippamas
Nurse Media Journal of Nursing Vol 1, No 2 (2011): (DECEMBER 2011)
Publisher : Department of Nursing, Faculty of Medicine, Universitas Diponegoro

Objective: To examine the correlation between coping strategies and quality of life (QoL) among patients with myocardial infarction (MI) Method: A descriptive correlational design was used to examine the relationship between coping strategies and QoL among 88 patients with MI who were older than 18 years, 2 months after the initial diagnosis of MI. QoL was assessed using the cardiac version of the Quality of Life Index. Coping strategy was assessed using Jalowiec Coping Scale. Problem-focused coping and emotion-focused coping were also compared in male and female patients.Results: Problem-focused coping was significantly positively associated with overall QoL (r = .41, p = <.01), particularly the health and functioning dimension (rs = .39, p = <.01) and socio-economic dimension (rs = .46, p = <.01) but not with psychological & spiritual and family dimension. Men used more problem-focused coping strategies than women. The problem-focused coping score was significantly different between men and women (t = 4.9, p <.05).Conclusion: The results revealed that patients who used more of problem-focused coping had better QoL than patients who used less problem-focused coping. Educating patients to enhance the use of appropriate coping strategies may be useful to promote the QoL of Nepalese patients with MI. Key words: Coping, quality of life, myocardial infarction

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