Maintaining and promoting wellness of elderly in rural areas of Indonesia – an action research study

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Ageing and problems related to the aged are increasingly reported not only in developed countries, but also in developing countries such as Indonesia. However, despite increases in the numbers of elderly people, ageing has not yet been identified as an important policy issue in Indonesia. Existing government programs for the elderly are limited in terms of funds and resources and tend to be sectoral, centralised and specifically targeted. Health service delivery is primarily interventionist with limited consideration of early intervention and preventative care and programs are not implemented equitably to all regions in Indonesia. A dearth of research on needs of elders in Indonesia, especially in rural areas such as Gowa district in South Sulawesi, making it difficult to identify existing services and programs and highlight support required to meet existing and future needs. The aim of this study was to investigate programs and services needed to support elders in Indonesia and specifically in Gowa district to maintain and enhance quality of life. This study employed an action research approach wherein staff engaged in elderly health (N=21) consisting of nurses, midwives and other health professionals from community health centres (Puskesmas), formed an action research group (ARG). ARG members engaged in a critical change agenda over a 12-month timeframe from March 2010 until May 2011. This study was divided into three stages consisting of a total of four action research cycles. The first stage consisting of one cycle, preliminary investigation, involved collection of baseline data using a survey instrument. The second stage involved development of comprehensive intervention strategies. There were two action cycles in this stage, establishing action research group (Action Cycle Two) and group empowerment in Action Cycle Three. The final stage occurred after the ARG had developed strategies and implemented new practice change. In this stage, there was one action cycle (Action Cycle Four) where participants decided to continue taking action to maintain and promote wellness of the elderly in their community. Data from the preliminary study showed that health care programs for the elderly existed in every Puskesmas; however, there was variation largely due to funding, human resources and facilities. The preliminary study revealed that staff in the elderly health program of practice focussed on curative interventions with little or no health promotion and education activities. The preliminary study provided baseline data for ARG members to discuss service gaps potentially impacting on quality of life for older people in the community. Through critical reflections, ARG members identified three major themes that the group discussed, namely; context of programs and services, current practice, and factors influencing service delivery. The ARG identified existing needs in order to improve their practice including a need for more training related to their task. Subsequently, three education sessions were provided by the Provincial Health Office related to the elderly health program, and one session delivered by the researcher and a colleague. During stage two, ARG members continued to meet, sharing an emerging sense of empowerment. In action cycle two, ARG members discussed barriers and potential strategies to enhance practice. In action cycle three, ARG members conceptualised agreed methods to address service gaps. This study confirmed that staff in the elderly health program played a central role in promoting and maintaining wellness of elderly people. The ARG members found regular meetings helped them better understand their practice, and the model of care utilised and provided opportunities to share experiences in implementing the elderly health program. Although practice change impact on and in the program was not measured, participants reported that their practice moved away from engaging in curative tasks towards the inclusion of health promotion and education activities. Ongoing educational preparation for staff working in community settings, such as within elderly health programs, is one recommendation from this study. Moreover, to provide better health care services, teamwork is needed in delivering comprehensive health services for the elderly in integrated health posts (Posyandu).