Analisis dan Pengembangan Instrumen Faktor-Faktor Perilaku Mencari Pelayanan Kesehatan Pada Lanjut Usia yang Menderita Diabetes Mellitus
NURULLYA RACHMA, Prof. Intansari Nurjannah, S.Kp, MN.Sc.,PhD, Ema Madyaningrum, S.Kep, Ns., M.Kes., Ph.D, Dr. dr. Probosuseno, Sp.PD-Kger (K), SE., MM
2026 | Disertasi | S3 Kedokteran Umum
Latar belakang: Lansia yang menderita DM rentan mengalami masalah kesehatan, termasuk depresi, cemas, gangguan kognitif, dan penggunaan obat yang tidak tepat. Kondisi ini berdampak pada kemampuan lansia mengelola penyakit. Perilaku mencari pelayanan kesehatan merupakan faktor penting dalam pengelolaan DM, namun sampai saat ini belum tersedia instrumen yang secara khusus mengukur faktor-faktor yang mempengaruhi perilaku tersebut pada lansia dengan DM.
Tujuan : Mengembangkan instrumen faktor-faktor perilaku mencari pelayanan kesehatan pada lansia yang menderita DM.
Metode : Penelitian dilakukan di tiga Puskesmas di Kota Semarang, pada bulan Maret 2023 sampai Februari 2026, serta menggunakan desain multi-method. Tahap pertama meliputi survei untuk mengidentifikasi masalah kesehatan dan pada perilaku mencari pelayanan kesehatan, wawancara mendalam dengan lansia DM, dan focus group discussion (FGD) dengan pelaksana program kesehatan lansia untuk mengidentifikasi faktor-faktor yang mempengaruhi perilaku tersebut. Tahap kedua adalah pengembangan instrumen berdasarkan Andersen’s Behavioral Model melalui proses penyusunan item, expert review, uji keterbacaan, uji coba instrumen, analisis diskriminasi item, Explanatory factor analysis (EFA) dan confirmatory Factor Analysis (CFA), serta pengujian reliabilitas. Analisis data kuantitatif menggunakan statistik deskriptif dan regresi logistik berganda untuk mengidentifikasi faktor-faktor yang berhubungan dengan rutinitas kunjungan ke fasilitas pelayanan kesehatan. Analisis data kualitatif menggunakan Directed Content Analysis.
Hasil: Hasil survei menunjukkan 8,6% lansia dengan DM terindikasi depresi, 22,6% mengalami cemas, 88,7% fungsi intelektual masih utuh, dan 18,?rpotensi mengalami pemberian obat yang tidak tepat. Faktor yang mempengaruhi perilaku mencari pelayanan kesehatan meliputi faktor predisposisi, enabling, dan kebutuhan. Penelitian berhasil mengembangkan instrumen yang terdiri dari 21 item yang terbagi dalam empat faktor, yaitu motivasi internal dan dukungan psikososial, kebutuhan fisik-psikologis akibat DM, aksesibilitas dan kualitas pelayanan, dan persepsi kebutuhan kesehatan mental. Hasil uji diskriminasi item menunjukkan nilai corrected item-total correlation berkisar antara -0,089 sampai 0,459. EFA menghasilkan struktur awal lima faktor dengan nilai eigenvalue 9,746; 6,088; 3,498; 2,868; dan 2,079, yang terdiri dari 28 item dengan loading faktor 0,53-0,99. Selanjutnya dikonfirmasi menjadi empat faktor melalui CFA. Model akhir menunjukkan kecocokan yang baik (CFI= 0,992; TLI = 0,0,990; RMSE = 0,042. Nilai composite reliability (CR) berkisar antara 0,801 - 0,995, menunjukkan reliabilitas konstruk yang baik.
Kesimpulan: Instrumen yang dikembangkan layak sebagai alat ukur untuk mengidentifikasi faktor-faktor perilaku mencari pelayanan kesehatan pada lansia yang menderita DM. Diharapkan instrumen dapat digunakan pada pelayanan kesehatan primer, sebagai instrumen untuk mengidentifikasi faktor-faktor yang mempengaruhi pemanfaatan pelayanan kesehatan oleh lansia yang menderita DM.
Kata kunci: perilaku mencari pelayanan kesehatan, pengembangan instrumen, lanjut usia, Diabetes Mellitus
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Background: Older adults with diabetes mellitus (DM) are susceptible to multiple health issues, such as depression, anxiety, cognitive impairment, and inappropriate medication use. These conditions can negatively impact diabetes self-management and health-seeking behavior. Although health-seeking behavior is a critical determinant of diabetes management, there is currently no instrument specifically designed to measure the factors influencing health-seeking behavior among older adults with DM.
Objective: To develop an instrument that measures the factors influencing health-seeking behavior among older adults with diabetes mellitus.
Methods: This multi-method study was conducted at three primary healthcare centers (Puskesmas) in Semarang City, Indonesia, from March 2023 to February 2026. The first phase included a survey to identify health problems and health-seeking behavior, in-depth interviews with older adults with DM, and focus group discussions (FGDs) with healthcare providers responsible for older adult health programs to identify factors influencing health-seeking behavior. The second phase involved instrument development based on Andersen's Behavioral Model through item generation, expert review, readability testing, pilot testing, item discrimination analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability testing. Quantitative data were analyzed using descriptive statistics and multiple logistic regression to identify factors associated with routine visits to healthcare facilities. Qualitative data were analyzed using directed content analysis.
Results: The survey findings revealed that some older adults with DM experienced mental health problems, including depression, anxiety, cognitive impairment, and inappropriate medication use. The factors influencing health-seeking behavior were categorized into predisposing, enabling, and need factors. The study successfully developed an instrument consisting of 21 item a cross four factors: internal motivation and psychosocial support; physical and psychological needs associated with diabetes; accessibility and quality of care; and perceptions of mental health needs. The item discrimination test results indicated that the corrected item-total correlation values ranged from -0.089 to 0.459. An Exploratory Factor Analysis (EFA) initially suggested a five-factor structure with eigenvalue of 9.746; 6.088; 3.498; 2.868; and 2.079, comprising 28 items with factors loading ranging from 0.53-0.99. Which was subsequently confirmed as a four-factor structure through Confirmatory Factor Analysis (CFA). The final model demonstrated a good fit (CFI = 0.992; TLI = 0.990; RMSE = 0.042). Composite reliability (CR) values ranged from 0.801 to 0.995, indicating good construct reliability.
Conclusion: The developed instrument is appropriate as an measurement tool to identify factors influencing health-seeking behavior among older adults with DM. It is anticipated that this instrument can be employed in primary healthcare settings as a tool to identify factors affecting healthcare utilization by older adults with DM.
Keywords: health-seeking behavior; instrument development; older adults; Diabetes Mellitus
Kata Kunci : Perilaku mencari pelayanan kesehatan, pengembangan instrumen, lanjut usia, Diabetes Mellitus
