THE EFFECT OF BABY MASSAGE ON THE SLEEP QUALITY IN BABY AGED 3 - 9 MONTHS IN SUMBAKELING VILLAGES
Mamlukah 1 Mamlukah 1 , Isti Kumalasari 2
3. The Difference in the Level of Depression Before and After Music Therapy
After conducting study on depressed patients at the Psychiatric Polyclinic of Majalengka District General Hospital in 2018, there was a statistically significant difference between before and after music therapy with a p value = 0.02 (p £ 0,05). The mean level of depression before music therapy was 25.1875 and it decreased to 15.1250. This showed a significant difference between before and after music therapy. Thus, it can be concluded that music therapy had an effect on decreasing the level of depression.
According to a study conducted by Vita Sry Sulastri (2011) entitled "Effect of music therapy on the change in the level of depression among the elderly at PSTW of Budi Luhur Unit, Kasongan, Bantul Yogyakarta" the results of statistical test using Paired t-test showed the t value of 2.530 at df of 11 with a significance level of (p = 0.028). The result of the t-test showed a p value of less than 0.05 (0.028 <0.05) so that the hypothesis was accepted. Thus it can be concluded that there was an effect of music therapy on the change in the level of depression among the elderly at PSTW of Budi Luhur Unit, Kasongan, Bantul Yogyakarta.
This study results are in line with a study conducted by Nadirawati & Novita Chindy Permana (2017) entitled "Effect of Popular Music Therapy on Depression among the Elderly at the Tresna Werdha Karitas Social Institution". Statistical tests obtained (p value; α = 0.05) and the mean score of depression before the provision of popular music therapy was 7 with a
156 of depression was 4.44 with the standard deviation of 1.548 which meant there was a significant difference between before and after music therapy.
Basically depressed patients are relatively easy to treat, but patients who have been properly diagnosed and obtain adequate therapy are still very few because it requires relatively expensive costs. However, the management ofdepression can also use an easily found technique, namely music. According to Djohan (2009: 240) music therapy is a therapeutic activity that uses music as a medium to improve, maintain, and develop mental, physical and health emotions. (in Rusanto, 2010).
One type of effective music therapy for depressed patients is pop music. Pop music in general is a type of music that is easy to listen and has commercial lyrics. In the lyrics, pop music is easily understood by listeners, the lyrics raised by the pop songwriters and the vocalists can be enjoyed immediately, such as love theme, even related to religious manner because of the simplicity of the accords and the lyrics. So it is not surprising that pop bands always invite audience members excessively at each performance (Nugraha in Didik, 2008 : 18).
Pop music is classified into light music. People who like light music will have distinctive personality traits and problems that put pressure on relationships, independence, identity and society. Pop music consistently expresses specific themes for its fans to feel connected with the song and to help them reducing emotionally alone feelings. In particular, it is expected that they will be characterized as cooperative, social, not hasty in making decisions, responsible, accepting other people and their groups, and have self-confidence in their academic abilities (Fitriana Dilfia, 2010).
One of the efforts to overcome depression is to listen to popular music since popular music has the power to improve, maintain, and develop the physical, mental, emotional, social and spiritual health of patients. Therefore healthcare providers are expected to try to apply popular music therapy as an alternative medical treatment. The goal is not only to overcome current problems, but also prevent the recurrence of depression in the future.
CONCLUSIONS AND RECOMMENDATIONS Conclusions
Based on the study results and discussion on "Effect of Music Therapy on the Decrease in the Level of Depression among Depressed Patients with Depression at Psychiatric Polyclinic of Majalengka District General Hospital in 2018" there are some conclusion as follows:
1. The mean score of the pre-test on the level of depression among depressed patients at Psychiatric Polyclinic of Majalengka District General Hospital before providing music
157 was 15 and the highest depression score was 45.
2. The mean score of the post-test on the level of depression among depressed patients at Psychiatric Polyclinic of Majalengka District General Hospital after providing music therapy was 15.1250 with the standard deviation of 7.36546. The lowest depression score was 9 and the highest depression score was 30.
3. Music therapy had a significant effect on the decrease in the level of depression among depressed patients at Psychiatric Polyclinic of Majalengka District General Hospital in 2018. This was evidenced by the results of the Wilcoxon statistical test analysis with a confidence level of 95% (a= 0.05) which obtained p value of 0.000. Thus p value was <
a (0.000 < 0.05). Since the significance value was smaller than a, then Ho was rejected and Ha was accepted.
Recommendations
1. For Educational Institutions
Educational institutions are expected to add references, especially those related to the needs of students in conducting studies.
2. For the Hospital
After the completion of this study, the hospital is expected to be able to apply the use of music therapy to depressed patients at Psychiatric Polyclinic of Majalengka District General Hospital to reduce their depression levels.
3. For Patients and Families
Patients are intended to more control their depression levels so that they can return to the community as a whole with family assistance as the therapist.
4. For Further Researchers
To increase the number references and time of study to obtain more accurate and effective study results.
REFERENCES
Amelia, D., & Trisyani, M. (2015) Terapi Musik Terhadap Penurunan Tingkat Depresi. (4) 38-125.
Chan, F,M. (2011). Effects of music on depression in older people: a randomised controlled Trial (21) 776-783.
Damayanti, R. (2014). Efektifitas Terapi Musik Klasik Terhadap Penurunan Tingkat Halusinasi Pada Pasien Halusinasi Dengar di RSJ Tampan Provinsi Riau, 1 (2).
Erkkila, J et al. (2011). Individual music therapy for depression : randomised controlled trial, 199, 132-139.
Fauziah W, (2015), pengaruh teknik relaksasi nafas dalam terhadap penurunan tekanan darah pada lanjut usia (Lansia) dengan hipertensi di wilayah kerja UPTD Puskesmas Panyingkiran Kabupaten Majalengka Tahun 2015, Skripsi, Majalengka, STIKes YPIB Majalengka.
158 Penyandang Tunadaksa di Balai Besar Rehabilitasi Sosial Bina Daksa Prof. Dr.
Soeharso, Tesis, Surakarta, Universitas Muhammadiyah Surakarta.
Ilmu dalam selembar kertas, 2011,
https://thefuturisticlovers.wordpress.com/2011//10/20/keperawatan-jiwa-konsep-dasar- klien-dengan-depresi/, 20 Oktober, 2011.
Jiwa Sehat Menurut WHO, 2018 http://www.referensimakalah.com/2012/12/jiwa sehat- menurut-who.html, 12 Desember 2018.
Kaplan & Sandock. (2010) Buku Ajar Psikiatri Klinis : EGC.
Keliat, B.A. (2011). Manajemen Kasus Gangguan Jiwa. Jakarta.
159 THE RAISE OF M-HEALTH STARTUP UTILIZATION IN INDONESIA
AS A NEW HEALTH COMMUNICATION MEDIA IN DIGITAL ERA Gemasih Pintanine1, Evi Martha1
1Health Promotion Department of Faculty of Public Health Universitas Indonesia, D Building 1st Floor Kampus Baru UI Depok 16424, Indonesia
Abstract
Introduction: The high number of internet penetration and smartphone user recently make mobile health startups are beginning to rise. It offers many advantages by digitalizing healthcare to promote a healthy life and health education. However, despite its potential utilization for positive effects on health outcomes, the mobile health startup still under-regulated and supervision
Method: The paper consisted of a literature study, data collection, and analysis using articles from a number of databases published in various research journals, articles, government reports, company websites related to mobile health
Results: There is no specific guidelines and policy regarding the mobile health startup related to the content, ethics, privacy and security issues as WHO recommended already Recommendation: The government should lead the positive vibes of digitalizing healthcare of mobile health startup by performing a specific policy and guidelines to make the reliable yet trustable source of digital health platforms so it can be used widely
Keywords: mobile health; health startup; digital health
Introduction
The fast-growing information and communication technology (ICT) sector which, over the last decade, has resulted in many people in Indonesia now relying on mobile communication devices in their daily lives. Indeed, the role of the Internet in healthcare services is an important aspect of the digital age. Digital age also offers the potential to transform every facet of daily life, from reshaping how people make decisions, enhancing customer experiences, and creating new business models to optimize value chains for unprecedented levels of efficiency (Das, 2016)
The digital age enables people to easily find virtually any type of information, including health information. To facilitate this, fast access to accurate and borderless information is essential, particularly through mobile devices and especially smart phones triggered by the number of internet users in Indonesia that growing so rapidly and could be utilized for healthcare purposes as shown in figure 1:
160 Figure 1. the number of Internet user in Indonesia (Asosiasi Penyelenggara Jasa
Internet Indonesia, 2018)
Out of recognition of the need of the Indonesian people to access healthcare services digitally, the rise of several startup companies are greatly responded. Startup, which is defined as “a creator of vertical innovation and not horizontal innovation, refers to new technology that has not been created before is, a startup aims to create a monopoly in a niche market, and then expand to new markets” (Thiel, 2014). In Indonesia, many sectors have been raised by the presence of technology startups, people now could easily and more comfortably purchase goods with e-commerce assistance, or go to other locations more quickly using online transportation, and get an easily method payment or soft loan through the services presented by financial technology startups. The advancement of those technologies startup has also penetrated into various other fields, including the health care sectors.
Digital health startup companies in Indonesia try to enhance the delivery of healthcare services and access to health-related experience through the innovation by utilizing the growth of technology and information’s development in responding the high number of smartphone users in Indonesia. In recent years, mobile health application startups in Indonesia have been dominated by consumer health portals and telehealth platform by mobile technologies. The mobile health or mHealth itself defined by the World Health Organization (WHO) as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices”(WHO, 2011) The innovations offer complementary methods for physicians and patients to gather and exchange knowledge and interact effectively, where “mHealth is an emerging and rapidly growing sector that has the potential to play a part in the transformation of healthcare and increase its quality and efficiency, as well as to create new businesses”(Comission European, 2014) , The objective of this paper is to explore the needs in the utilization of mobile health startups along within the challenges to be encounter with in Indonesia.
Methods
42 55 63 82 88,1 110,2 132,7 143,26
0 50 100 150 200
2010 2011 2012 2013 2014 2015 2016 2017
Number of Internet users in Indonesia
(in millions)
161 The paper consists of a literature review and data collection of a number of databases (i.e., ProQuest, EBSCOhost, SAGE, Science Direct, and Google Scholar) to retrieve publications related to digital healthcare and mobile health applications. The search for relevant literature was limited to articles published between 2000 and 2017.
“Mobile health” was the main keyword used, followed by “digital health.” The study also gathered information and relevant findings from secondary data published in various research journals, articles, government websites, government reports, and company websites.
Results and discussion
According to Tech in Asia, an online startup community in Asia, there were more than 1,740 health startup companies in Asia in 2017, approximately 80 of which were established in Indonesia. This number, along with the growth of health information and technologies and internet penetration in Asia, suggests strong potential for the digitization of healthcare services. However, Indonesia take the second highest growth of health startups among Southeast Asian countries as shown in figure 2:
Figure 2. Health startups in Southeast Asia (Tech in Asia, 2017).
Many types of startups now are created to deliver the unique experience of the healthcare delivery systems especially in Southeast Asia countries, most of them were growing in five specific ways as followings (Ng, 2017): Consumer health portals, E- commerce platforms, Telehealth solutions, Practice-management products, and data aggregation platform. Indonesia now has more than 143 million internet users in 2017 and the smartphones user in Indonesia entered 50.08% with an average duration of internet usage is 1-3 hours per day. The most utilization internet purpose in health area are for seeking health information and consultation with health practitioners (Asosiasi Penyelenggara Jasa Internet Indonesia, 2018). Some of the mobile health application has been downloaded more than 1.o00.000 times in Google play store platform, and it will be keep growing in a few years, which could reflect how big the digitalize healthcare are growing now.
0 100 200
Indonesia Malaysia Myanmar Philippines Singapore Thailand Vietnam
Health Startups In South East Asia
162 The digital health startups have been transformed into many forms of mobile health application while in terms of types of mobile health application that mostly used by people based on its utilization’s purposes (Boulos, 2014) could be described in Table 1 below:
Table 1 Range of Mobile Health ApplicationBoulos, 2014) No Type of mobile health
application
Definition
1 Application for medical provider
Target audience are the healthcare workers, including physicians, nurses and assistants.
Because of its functions it is not easily operated by non-health professionals
2 Specialty or disease-specific application
Providing a high technology to cover a broad spectrum of general medical knowledge, such as mobile diagnostic visual tests, 3 Medical education and teaching Used by medical professionals in training,
such as students and residents, 4 Apps for patients and the
general public (including health and fitness apps)
This current popular application aid patients in managing chronic disease, lifestyle management, smoking cessation and even self-diagnosis.
According to Indonesia’s Digital Healthcare Services Penetration Survey in 2016 (Daily Socialid, 2017), there are three most popular digital healthcare startups in 2017, those are Dokter.ID, Klik.Dokter and Alodokter (Daily Socialid, 2017) , all these startups offer at least three popular contents such as diseases symptom information, health tips and news, and online consultation. Adding the unique experience, the user could search what exactly the specific information they actually really need by typing the keyword directly in the application, or they also could find the information by looking up the categories offered by the application, such as kind of diseases, pregnancy, nutrition, and wellness.
Online medical consultations that purposely to get medical advice or any health information directly from the practitioners or specialists through online platforms is a promising approach to the challenge of improving access to specialty care. This service offers a rapid, direct, and documented communication pathway and tries to fill the gap between practitioners and patients especially in the digital age. As a result, online medical consultation has the potential to enable cost-effective and convenient care for patients while improving access to and coordination of specialty care across the system and may
163 offer an appealing new modality for a rational appropriation of healthcare services (Vimalananda et al., 2015). The most important related with the mHealth utilization is to personalized medicine, empowering the patient/citizen by providing bigger responsibility in the management of their own health condition. The best health communication approaches are designed to match the unique characteristics, interests, and cultural orientations of intended target audiences, which means that effective interventions must be strategically designed for clearly segmented, homogeneous groups of people (Kreps
& Neuhauser, 2010) while over the last decades, health communication mostly designed with one-size-fits-all messages that are not specifically relevant to individual characteristics, so that the need to create a health communication to be more
‘‘personalized’’ and ‘‘unique’’ is now urgently required to enhance the interactivity of communication in a digital age, and it could be done by using mHealth technologies.
On the other side, there is still challenges of mHealth to address with especially in Indonesia, there is the lack of studies that validate and evaluate their impact on wellbeing and health of the patient, the user of the mHealth possibly get the overloaded information, and some of the information quality provided, somehow, still questionable since some of the information provided does not include a scientifically nor valid source and the users do not check the credibility of information (Vanden Birgit, 2016). There is also a concern of security, uneven quality of information on the Internet, varied laws and regulations, and lack of a clear message have led many a user to shy away from the process (Mittman & Cain, 2001). It is important for user to know that they get the reliable and valid health information from a trustable source and the need of specific policy to supervise and regulate the content of health information in the digital platform in Indonesia.
WHO described at least four barriers in terms of mobile health implementation especially in South-East region (WHO, 2011)
1. Policy: related to health information security, patient confidentiality, standardized metrics and content, which now is being important considering the growth of mobile health in Indonesia
2. Knowledge: The lack of knowledge concerning the possible applications of mHealth was a key barrier reported. It is important to know the ongoing need of mobile health to keep stakeholders especially government get the well informed of trends and developments
3. Technical expertise: technical expertise was only reported as a barrier by the South- East Asia Region, reflected that there is still the gaps regarding the qualified personnel to deal with the mobile health and Indonesia need to deal with this matter properly 4. Operating cost: The lack of evidence of the cost-effectiveness of mHealth initiatives
become one of the top four barriers by almost all WHO regions. It becomes a challenge yet the opportunity for Indonesia to explore regarding this issue
The best practice of mobile health guidelines is coming from The American Heart Association (AMA), Healthcare Information Association and Management System Society and digital health non-profit DHX that create a collaboration of a non-profit
164 mobile health application guidelines and assessment writing called Xcertia (O’Reilly, 2018). This guidelines and assessment will create a trustworthy resource to support consumer and clinician choice of mobile health application based on for assessment in four vital areas (see in Table 2):
Table 2 Xcertia guidelines of mobile health apps vital areas
No Area Description
1 Operability Whether a mobile health application installs, loads and runs in a manner that provides a reasonable user experience
2 Privacy Whether the application protect the user information, including protected health information, in full compliance with all applicable laws, rules and regulations
3 Security Whether the application is protected from external threats
4 Content Whether the information provided in the mobile health application is current and accurate
The proper regulations and guidelines that legally supervise the operations of mobile health application are needed to prevent any possibilities mal administrative or problem happens in the future and to ensure the quality of services provided including the information, content, operating procedures and medical personnel involved since there is about 80% of the most popular health applications available on Android do not comply with standards intended to prevent the misuse and dissemination of their users’ data (Papageorgiou et al., 2018)
Conclusion
The high growth of mobile health application development and utilization in Indonesia that triggered by the high number of the smartphone and internet user should be an opportunity to improve health access. Nowadays, mobile health startups are becoming the possible solution to address the healthcare issues in the digital era. The rapid growth of health startups followed by the great enthusiasms by the people of Indonesia that currently engaged with mobile devices strongly. Ministry of Health should collaborate with Ministry of Communication and Informatics to lead the digitalize healthcare as a possible solution to reach as many as possible people to get an online access health information and medical advice including disease prevention cooperate with health startup companies.