SELF HELP GROUP FOR OLDER PEOPLE WITH HYPERTENSION

AT RUSUNAWA EAST JAKARTA REGION

R. Siti Maryam, Pudjiati, Prayetni, Miskiyah

Nursing Major Health Polytechnic of Jakarta III
Email: maryam.rd76@gmail.com

ABSTRACT

Introduction: Hypertension in Indonesia is increasing from year to year, especially in elderly as a

vulnerable group and is a disease number 3 that cause the death after stroke and tuberculosis. Therefore,
there is need to empower the elderly to improve their potential so that they can solve the problem well.
Self-help group is one of the intervention group through sharing the feelings, encountered problem and
mutual support among them. This study aim is to gain an overview of the effect of the intervention on
the ability of elderly’s self-help groups in dealing with hypertension. Methods: The research method
used quasi-experiment with control group design. This research was conducted in two phases, namely
Phase I: The current development of self-help group that constitute intervention strategies to provide
information to elders about hypertension and how to cope, exercise skills in hypertension, and way of
problem solving ; Phase II: pilot intervention of self-help group to conduct training for the elderly, and
a self-help group meetings. Samples were elderly people who have hypertension. Sampling strategy
used random sampling with the sample size were 44 for the intervention group in Rusun Pulo Gebang
and 42 for the control group in Rusun Jatinegara Kaum and Pulo Gadung. Statistical test used dependent
and independent t-test. Result: There was significant differences in elderly’s average ability in terms
of knowledge about hypertension after self-help group in the intervention group compared with the
control group (pvalue 0.001). Discussion: Self-help group’s intervention generated from this research
can serve as the basis for policy makers and health care managers in order to implement various
interventions related to empowerment of the elderly in the community and can be replicated in different
order of health services both in the community and nursing home.

Keywords: ability of the elderly, high blood pressure, self-help group

INTRODUCTION

Elderly people are particularly vulnerable in society. They are at-risk groups that are more sensitive and
exposed to various risk factors such as economic, social, physical, biological, genetic and lifestyle.
Factors that associated with vulnerability including low socio economic status, unhealthy lifestyle, low
self esteem, powerlessness and inability to take care of themselves. Risk factors that predispose the
occurrence of health problems including environmental, nutrition and sociocultural (Lundy & Janes,
2009). Result of a study of the socio-economic conditions and health of the elderly that Komnas Lansia
carried out in 10 provinces in 2006, found that most diseases suffered by the elderly are joint disease
(52.3%), hypertension (38.8%), anemia (30.7%) and cataract (23%). Such diseases are the main cause
of disability in the elderly so that they become a burden to the family, society and government.

Hypertension is a disease that affects many elderly, marked with blood pressure above normal, generally
do not cause symptoms, so it is often called the silent killer. An estimated 76% of cases of hypertension
in people who have not been diagnosed, in this case the person does not know that he was suffering
from hypertension (Aditama, 2012). According to WHO, the proportion of the people who affected by
high blood pressure because of ageing is 1 of 10 people at age 20-30-year and 5 of the 10 people at the
age of 50 year. Therefore, early detection is important and every adult should know their blood pressure
and keep it within normal level (Danny, 2015).

Profile of Health in Indonesia in 2010 represents an increase of hypertension cases in the form of
primary hypertension who require hospitalization were 19.874 and 955 died, while new cases in 2010
which require were 80.615 outpatients. Riset Kesehatan Dasar (2013) shown that the prevalence of
hypertension in Indonesia that obtained through measurement at age > 18 years was 25.8% and will be
higher in elderly patients. Hypertension is the third leading cause of death (6.8%) for all ages after
stroke (15.4%) and pulmonary tuberculosis (7.5%). In women for the age group 45-54 year that have
hypertension was higher, that is 8.6% than men is 8%.

The higher the incidence of hypertension and its impact, requires the support of all parties, especially
the family as a support system for the client. Family support that carried out in synergy with public
participation can improve the elderly’s ability in addressing the problem, in addition to generating new
intervention strategies for sustainability in health care. One intervention that can be done is through
Self-Help Group (SHG). Self-help group is some people that help each other where they provide
support for each member of the group or mutually beneficial for each member. They share common
problems, share feelings and experiences about the disease and dependency problems (Ahmadi, 2007).

Self-help group is the group's activities with empowering its members to resolve their own problems.
Through participation in group, the member feel more open, more useful, and more empowered to
make decision so as to reduce the burden on families, loneliness and guilt (Mok, 2004). Magura (2007)
stated that SHG can reduce the symptoms of the disease, lowering the crisis and hospitalization, improve
social skills and extending social networks, and increasing healthy behaviors and perception of good
health.

Some of the results of other relevant research was research of Sudja and Meirina (2014) found
significant differences in knowledge, attitudes and behavior of pre-elderly before and after intervention
psychoeducation models. Al-Kandari (2011) found that the frequency and strength of contact with
friends or people who matter are associated with lower somatic symptoms and blood pressure, in which
social support and social networks have a profound effect on the lives of the elderly to improve physical
and psychological function. Through the intervention of the elderly, it is expected from self-help group
that they are able to maintain their health on their own in order to reach healthy, active and productive
old age.

METHOD
Research design was a quasi-experimental research with nonequivalent pretest-posttest with control
group. This study was conducted by comparing the group with self-help group intervention as the
intervention group with the group without self-help group intervention as the control group. This design
used two measurement, before and after treatment.

Sampling of intervention group method based on random sampling. Sampling were done in three
Rusunawa. Rusunawa is subsidized apartment or vertical housing that provided by the province
government. Rusunawa that was chosen for the research were Rusunawa Pulo Gebang as for the
intervention group and Rusunawa Jatinegara Kaum and Pulo Gadung as for the control group. The
sample size for intervention group was 44 elderly and for the control group was 42. So the total was 86
elderly. This sample was obtained from clinical database and KPLDH (Ketuk Pintu Layani Dengan
Hati) team with the age group of 45-59 year (pre-elderly) and ≥ 60 (elderly). The intervention group
did pre-test and health education activities related to health development and maintenance of
hypertension in the elderly as well as things that must be considered by the elderly. The group activity
was carried out once a week for one month. The first meeting of the self-help group activities include
sharing experiences about the treatment of hypertension that conducted so far (written in elderly’s
workbook). The second meeting, the carried out activities was to share experiences on the appropriate
input of hypertension of another elderly and facilitators, discussions related to the type of herbal therapy
in hypertension and how to make and practice of deep breath relaxation. The third meeting was to share
experiences and try herbal therapy in hypertension and practice acupressure to treat high blood pressure.
The fourth meeting activities was to share the experiences of doing at least 2 acupressure points, breath
relaxation and then perform post-test. The control group did pre-test and measuring blood pressure and
then did post-test and measuring blood pressure again. The group given a leaflet related to hypertension
prevention. This research involved students as enumerators and nurses in KPLDH Rusunawa in data
collection and coordination during the implementation of the study.
RESULT

Based on characteristic of the elderly shown that the intervention and control groups had similar
characteristics, the majority of pre-elderly age is 45-59 years old, female, married, with elementary
level of education. In both groups were nearly equal in a history of hypertension, long-suffering around
1-5 years, taking prescribed antihypertensive medication and perform routine control of blood pressure,
never received any health education or counseling on hypertension compared to the intervention group.
Both groups own most of Hand Phone and can operate it.

The characteristic of hypertension before intervention between groups shown that the intervention
group consists of nearly mostly of moderate hypertension that range of 160-179 mmHg for systolic and
100-109 mmHg for diastolic. While the control group consists of mostly of mild hypertension that range
of 140-159 mmHg for sistolic and 90-99 mmHg for diastolic. In both groups there were changes in the
types of hypertension after intervention of self-help groups that his blood pressure into the normal range
of 120-139 mmHg for systolic and 80-89 mmHg for diastolic in 30 older people. And the changes in
blood pressure of hypertension is becoming severe and mild hypertension.

The result of the equality test analysis shown that there was no difference for all variables between
intervention and control groups (p value > 0.05). Thus all the variables between the two groups was
similar.

Table 1. The comparison of elderly’s ability on hypertension before and after intervention
with self-help group among groups

Variable Group N Mean SD P value

Knowledge Intervention
Before 44 5.11 2.15 0.188
After 44 5.77 2.51
Difference mean 0.66
Control
Before 42 5.26 1.74 0.000
After 42 6.98 1.42
Difference mean 1.72
Attitude Intervention
Before 44 20.66 3.63 0.429
After 44 21.30 4.74
Difference mean 0.64
Control
Before 42 20.19 3.10 0.013
After 42 21.79 2.31
Difference mean 1.6
Behavior Intervention
Before 44 17.11 5.25 0.167
After 44 18.48 5.59
Difference mean 1.37
Control
Before 42 18.00 4.62 0.153
After 42 19.19 4.42
Difference mean 1.19

The analysis shown that there was significant difference in the control group that have knowledge to
taking care before and after the intervention of self-help group (p = 0.000) with the difference in the
average value was greater in the control group compared to the intervention group. While the
intervention group found no significant difference in knowledge to taking care in the elderly (p = 0.188).
The result of the analysis of the attitudes of hypertension in the elderly found significant difference in
the attitude control group before and after intervention self-help group (p = 0.013) with the difference
in the average value of most of the control group. Likewise, the behavior of hypertension, found no
significant difference in the behavior of both groups before and after intervention self-help groups (p
value > 0.05) with the difference in the average value most in the intervention group.

Table 2. Analysis of elderly’s ability on hypertension

after the intervention of self-help group among intervention and control groups

Variable Group N Mean SD 95% CI P

value
Knowledge Intervention 44 0.66 3.27 -2.208 – 0.097 0.001
Control 42 1.71 1.89 -2.198 – 0.088
Attitude Intervention 44 0.64 5.29 -2.970 – 1.052 0.065
Control 42 1.60 3.96 -2.958 – 1.041
Behavior Intervention 44 1.36 6.44 -2.361 – 2.707 0.244
Control 42 1.19 5.29 -2.350 – 2.696

The analysis shows that there are differences in elderly hypertension’s knowledge between the
intervention group and the control group after the intervention of self-help group (p = 0.001).

DISCUSSION
The result shown that the characteristics of the elderly in the intervention and control groups were pre
elderly age (45-59 year) more than elderly and female gender dominate both groups. Both groups have
a history of hypertension and regularly checked blood pressure as well as having handphone facilities
as communication device.

The research of Maryam (2015) there was a significant relationship between a history of hypertension
by blood pressure control (p value = 0.018) in which this result stating that the elderly who have a
family history of hypertension will perform regular blood pressure control. This result were the same
with the opinion of Jaya (2009) in Evadewi (2013) and Smelzter (2002) which said that individual with
hypertension’s history in the family tend to have a greater likelihood of hypertension compared to
individuals who do not have hypertension’s history. This is part of the primary hypertension where the
cause of hypertension is not known like herediter.

Most of the control group had ever received any health education or counseling on hypertension
compared to the intervention group. This is in accordance with the opinion of Notoatmodjo (2007)
which says that the provision of effective health education can influence the improvement of knowledge
of individuals or groups that follow.

The analysis shown that there was significant difference in the average ability of the elderly in terms of
knowledge to taking care hypertension after self-help groups in the intervention group compared with
the control group. Formed self-help groups and activities to share experiences, health counseling and
coping skills elderly hypertension can increase knowledge about hypertension. This is consistent
opinion that sharing knowledge and coping skills can help the members of the group to choose a suitable
strategy for them (Silverman, 2002). Tremblay and Gutberlet (2010) also revealed the involvement of
a person in the group is an empowerment process that provides an opportunity to work with others,
learn decision-making skills and problem solving as well as manage the resources available in the
community

The program can run because of support all parties, from the health center, the KPLDH team of
Rusunawa in cooperation with ‘Kader Kesehatan’ to identification and collection of data related to the
elderly and to communicate about self-help group formed. This is reinforced which indicated that some
activities can be done at the meeting agenda in self-help groups such as the announcement of events,
statements feeling (may be positive or negative) at a previous meeting, the opening of the meeting by
the facilitator, the disclosure feelings of group members, discussion, and question and answer session,
ended with the closing in which there is a reward and suggestions or criticism (Sugarman, 1998 in
Andriany, 2009). Moon (2011) suggests that the use of self-help groups can teach someone to
understand others through sharing experiences, providing an opportunity to meet regularly, mutual
support and exchange coping skills with one another.

Activities in self-help groups have been agreed and implemented in a sustainable manner through the
workbook. The workbook must be filled with positive and negative behaviors related to the efforts made
to control blood pressure and how to cope when problems or symptoms of hypertension appear. It is
expected that by filling this workbook, it can become a habit that is continuous and into a healthy
lifestyle. This is in accordance with the opinion of Pender (2002) which states that if the behavior was
integrated with health promotion in lifestyle, it can produce a positive health experience throughout life.

Experience the good health throughout life became one of the purposes of the implementation of the
SHG as is to be expected after attending this event will increase healthy behaviors and perceptions about
the healthy state in which the client will accepted disease, treatment should be done, better coping
mechanisms and disease management, improve the quality of life and sense to maintain health, higher
self esteem, accept the problem without blaming, more creative and taking the time to be with family
more (Magura, 2007).

CONCLUSION AND RECOMMENDATION

Based on the research that both groups have a history of hypertension and regularly check blood
pressure as well as having handphone facilities as a device of communication and most of the control
group had ever received any health education or counseling on hypertension compared to the
intervention group. The officer of Puskesmas and Rusunawa is expected to enhance and sustain the
activities that carried out during ‘Posyandu Lansia’ or Class of Hypertension by providing health
education or counseling on hypertension treatment that focuses on the skills or practices; control of
blood pressure with a 'pave the way’' for those who do not come to ‘Posyandu Lansia’ or Class of
Hypertension; and take the benefit of Mobile Phone to form the Whats App (WA) group as a media to
remind each other to come when the activities were scheduled and the sharing of knowledge and
positive or negative experiences.

REFERENCES
Aditama, T.Y. (2012). Masalah Hipertensi di Indonesia. Diakses dari http://www.depkes.go.id/
tanggal 27 Februari 2017.
Ahmadi, K. (2007). What is a self-help group?. Diakses dari http://www.psychcentral.com tanggal 2
September 2013.
Al-Kandari. (2011). Relationship of Strength of Social Support and Frequency of Social Contact with
Hypertension and General Health Status Among Older Adult in the Mobile Care Unit in
Kwait. J. Cross-Cult Gerontol, 26:175-187.
Andriany, M., Sahar, J.,& Widyatuti. (2009). Self-help group dalam mengatasi masalah
perkembangan remaja puteri di SMK X. Karya Ilmiah Akhir. Depok: FIK Universitas
Indonesia.
Avis, M., Elkan R., Patel S., Walker BA., Ankti N., & Bell C. (2008). Ethnicity and Participation in
Cancer Self Help Group. Psycho-oncology, 17, 940-947.
Black, J.M.,& Hawks, J.H.(2014). Keperawatan Medikal Bedah. Edisi 8. Buku 2. Singapore: Elsevier.
Danny, S.S. (2015). Pentingnya Deteksi Dini Hipertensi. Diakses dari https://sindonews.com/ tanggal
27 Februari 2017.
Evadewi, P.K.R., & Sukmayanti, L.M.K. (2013). Kepatuhan mengonsumsi obat pasien hipertensi di
Denpasar ditinjau dari kepribadian tipe A dan B. Jurnal Psikologi Udayana, Vol. 1 No. 1, 32-
42 (Online Journal.unud.ac.id).
Flores, YG., Hinton L., Barker JC., Franz CE., & Velasquez A. (2009). A Case Study of the Ethics of
Care of a Latino Caregiver of an Elderly Parent with Dementia. Health Care for Women
International, 30 : 1055-1072.
Goudel, C. (2000). Strategy for Self Help Group of People with Disabilities in Developing Countries.
Diakses dari www.aifo.it/self-help.doc. tanggal 12 Mei 2010.
Kemenkes RI. (2014). Pokok-pokok Hasil Riskesdas Indonesia Tahun 2013. (Buku 1). Jakarta:
Balitbangkes.
Kemenkes RI. (2014). Riskesdas dalam Angka Indonesia Tahun 2013. (Buku 2). Jakarta: Balitbangkes.
Komisi Nasional Lanjut Usia. (2010). Profil Penduduk Lansia di Indonesia 2009. Jakarta.
Kozier, B J., Erb, G., Berman, AJ., & Snyder. (2004). Fundamental of Nursing : Concepts, Process and
Practice. 7th ed. Upper Saddle River : Pearson Education, Inc.
Lopez-Hartman, M., Wens, J., Verhoeven, V., & Remmen, R. (2011). The effect of caregiver support
interventions forinformal caregivers of community-dwelling frail elderly :a systematic
review. International Journal of Integrated Care, Vol 12,1-16.
Lundy, K.& Janes, S. (2009). Community Health Nursing. Caring for the Public’s Health. (Second
Edition). Canada: Jones and Barlett Publishers.
Magura, S., Knight, E.L., Vogel, H.S. Mahmood, D.,Laudt, A.B. (2007). Mediator of Effectiveness in
Dual-Focus Self-Help Groups, diakses dari. http://www.ncbi.nlm.gov/pmc/articles tanggal 2
September 2013.
Maryam, R.S., Hartini, T., & Rosidawati. (2015). Hubungan minum obat anti hipertensi dengan
melakukan tekanan darah rutin pada lansia. Jurnal Proteksi Kesehatan. Vol.4 No.1. April
2015.
Mok, B. H. (2004). Self Help Group Participation and Empowerment in Hong Kong. Journal of
Sociology and Social Welfare, Vol. XXXI, No. 3, 153-168.
Moon, E. A. (2011). Caring for the Caregiver : Investigating Stress through Communication in an
Alzheimer’s Support Group. A Thesis. Faculty of San Diego State University.
Notoatmodjo, S. (2007). Promosi Kesehatan dan Ilmu Perilaku. Jakarta: Penerbit Rineka Cipta.
Pender, N.J., Murdaugh, C.L., & Parsons, M.A. (2002). Health Promotion in Nursing Practice.
(Fourth Edition). New Jersey: Prentice Hall.
Shaji, S. (2009). All About Self Help Group (SHG). www.nri.worldwide.com. diperoleh 12 Mei 2010.
Silverman, P. (2002). The Self Help Group Sourcebook :Your Guide to Community and Online
Support Group. 7th ed. Deville, NJ : Saint Clare’s Health Service.
Smeltzer, B. (2002). Buku Ajar keperawatan Medikal Bedah. Jakarta: Penerbit EGC.
Sudja, N., & Meirina. (2014). Intervensi Psikoedukasi Meningkatkan Kemampuan Pralansia dalam
Penanganan Hipertensi. Jurnal Ners. Vol. 9, No.1. Hal. 66-73.
Tremblay, C., & Gutberlet, J. (2010). Empowerment Through Participation : Assessing the Voice of
Leader from Recycling Cooperatives in Sao Paulo, Brazil. Community Development Journal
Advance, 19, 2010.
White, B.J. (2002). Promoting Wellness and Recovery Through Self help Group.
www.selfhelpgroups.org. diperoleh 24 Juni 2010.

Bionote
R. Siti Maryam is a lecturer since 2003 and graduated for community nursing specialist in Nursing
Faculty in University of Indonesia. Almost all of her researchs was focus on elderly in community
setting. The paper about The Correlation between Education Degree and Activity Daily Living with
Dementia among Elderly at Nursing Home have publicated on Jurnal Kesehatan Reproduksi, Vol.6,
No.1, April 2015. ISSN 2087-703X. The research about balance exercise have been appreciated by the
Ministry of Law and Human Right for Intellectual Property Right “VCD Physical Balance Exercise” in
2014.