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Integrated care: Health Promotion Hospital Model to Improve Family Support for Patients with Chronic Disease

  • Rina Kurniawati ,
  • Mahendro Prasetyo Kusumo ,


Background:  One of the strategies to hold down such economic burden is to improve health promotion services. Family involvement can be used to increase the success in health promotion program. Family involvement in chronic disease management is associated with successful chronic disease treatment.The aim of this study is designing health promotion hospital model to improve family support for patients with chronic disease.

Method: This qualitative study was conducted through four focused group discussion (FGD) and six in-depth interview. The data were collected from June-October 2021. The analysis used in this study is Miles and Huberman qualitative data analysis. The analysis was carried out starting from data collection, data reduction, data presentation, and drawing conclusions.

Result: From the transcript of four FGDs and six interviews, a family-based health promotion model was obtained. The family-based health promotion model to increase family support for chronic disease patients in hospitals is formed from eight (8) elements, namely: 1) Health literacy, 2) The preferred method is peer-led discussion, group discussion, 3) Social media using WhatsApp Groups, 4) Forming groups involving families, 5) Involving community leaders, 6) Relaxing and entertaining activities, 7) Effective communication, and 8) Nurse engagement.

Conclusion: The health promotion hospital model to increase family support for patients with chronic diseases consists of: Supporting the patient's family to increase the patient's knowledge about the disease and how to treat it. Peer-led discussion, group discussion, and face-to-face meeting along with giving of leaflet with materials as desired by the patients and their family are the education methods preferred by the patients and their family.


  1. S. Bernell and S. W. Howard, “Use Your Words Carefully: What Is a Chronic Disease?,” Front. Public Heal., vol. 4, pp. 1–4, 2016, doi: 10.3389/fpubh.2016.00159.
  2. World Health Organization, “Preventing Chronic Disease a Vital Investment,” Geneva, 2005. [Online]. Available:
  3. A. Afshari et al., “Health promoting hospitals: a study on educational hospitals of Isfahan, Iran,” Heal. Promot. Perspect., vol. 6, no. 1, pp. 23–30, 2016, doi: 10.15171/hpp.2016.04.
  4. A. Paramita, L. Kristiana, and A. Y. Kristanto, “Analisis Biaya Kesehatan Kegiatan Promosi Kesehatan Dan Pemberdayaan Masyarakat Di Tingkat Puskesmas Dalam Menyukseskan Gerakan Masyarakat Hidup Sehat,” Bul. Penelit. Sist. Kesehat., vol. 21, no. 3, pp. 163–171, 2018, doi: 10.22435/hsr.v21i3.407.
  5. M. P. Kusumo and W. Kusumawati, “Barriers to Understanding Health Education in Patients with Diabetes Mellitus (DM) in Yogyakarta: Qualitative Study Mahendro,” Unnes J. Public Heal., vol. 11, no. 1, pp. 14–22, 2022.
  6. R. K. Dewi, Nuryadi, and C. Sandra, “Identifikasi Pelayanan Promotif pada Fasilitas Kesehatan Tingkat Pertama Program Jaminan Kesehatan Nasional,” e-Jurnal Pustaka Kesehat., vol. 4, no. 2, pp. 307–315, 2016.
  7. A. Afshari, L. Ahmadi Ghahnaviye, M. Khezeli, and S. Shahrbanoo Daniali, “Health Promotion Perception Among Health-Care Providers Working in Educational Hospitals of Isfahan, Iran: A Qualitative Study,” J. Educ. Health Promot., vol. 8, no. July, pp. 1–6, 2019, doi: 10.4103/jehp.jehp.
  8. Peraturan Menteri Kesehatan RI Nomor 44 Tahun 2018 tentang Penyelenggaraan Promosi Kesehatan Rumah Sakit. Indonesia: Kementerian Kesehatan Republik Indonesia, 2018.
  9. D. Garcia-Huidobro and T. Mendenhall, “Family Oriented Care: Opportunities for Health Promotion and Disease Prevention,” J. Fam. Med. Dis. Prev., vol. 1, no. 2, pp. 1–6, 2015.
  10. A. A. Lee, J. D. Piette, M. Heisler, M. R. Janevic, K. M. Langa, and A. M. Rosland, “Family members’ experiences supporting adults with chronic illness: A national survey,” Fam. Syst. Heal., vol. 35, no. 4, pp. 463–473, 2017, doi: 10.1037/fsh0000293.
  11. M. P. Kusumo, J. Hendrartini, Z. M. Sufro, and F. S. T. Dewi, “Theater performing art: A strategy to improve self-efficacy and social support in patient with type 2 diabetes mellitus (T2DM),” J. Glob. Pharma Technol., vol. 12, no. 6, pp. 70–76, 2020.
  12. A. M. Rosland and J. D. Piette, “Emerging Models for Mobilizing Family Support for Chronic Disease Management: A Structured Review,” Chronic Illn., vol. 6, no. 1, pp. 1–18, 2015, doi: 10.1177/1742395309352254.
  13. World Health Organization, Standards for Health Promotion in Hospitals. Barcelona, Spain: World Health Organization, 2004.
  14. M. Liljeroos, S. Ågren, T. Jaarsma, and A. Stromberg, “Dialogues between nurses, patients with heart failure and their partners during a dyadic psychoeducational intervention: A qualitative study,” BMJ Open, vol. 7, no. 12, pp. 1–9, 2017, doi: 10.1136/bmjopen-2017-018236.
  15. M. P. Kusumo, J. Hendrartini, Z. M. Sufro, and F. S. Tetra, “Theater Performing Arts (TPA): Community Empowerment to Improve Blood Glucose Control Behavior in Yogyakarta,” vol. 18, no. 4, 2020, doi: 10.5812/ijem.103106.Research.
  16. M. Doull, A. M. O’Connor, V. Welch, P. Tugwell, and G. A. Wells, “Peer support strategies for improving the health and well-being of individuals with chronic diseases,” Cochrane Database Syst. Rev., vol. 2017, no. 6, pp. 2017–2020, 2017, doi: 10.1002/14651858.CD005352.pub2.
  17. C. L. Dennis, “Peer support within a health care context: A concept analysis,” Int. J. Nurs. Stud., vol. 40, no. 3, pp. 321–332, 2003, doi: 10.1016/S0020-7489(02)00092-5.
  18. S. E. P. Munce et al., “Online peer support interventions for chronic conditions: A scoping review protocol,” BMJ Open, vol. 7, no. 9, pp. 1–4, 2017, doi: 10.1136/bmjopen-2017-017999.
  19. N. Kaufman, “Peer-to-Peer Support Helps People Improve Their Chronic Condition Therapy Outcomes,” Canary Health, 2021. (accessed Nov. 12, 2021).
  20. J. M. Frantz, “A peer-led approach to promoting health education in schools: The views of peers,” South African J. Educ., vol. 35, no. 1, pp. 1–7, 2015, doi: 10.15700/201503070006.
  21. M. Sustersic, A. Gauchet, A. Foote, and J. L. Bosson, “How best to use and evaluate Patient Information Leaflets given during a consultation: a systematic review of literature reviews,” Heal. Expect., vol. 20, no. 4, pp. 531–542, 2017, doi: 10.1111/hex.12487.
  22. A. L. Barik, R. A. Purwaningtyas, and D. Astuti, “The Effectiveness of Traditional Media (Leaflet and Poster) to Promote Health in a Community Setting in the Digital Era: A Systematic Review,” J. Ners, vol. 14, no. 3, p. 76, 2019, doi: 10.20473/jn.v14i3.16988.
  23. S. Hassan, A. Elhameed, and R. R. Alam, “Burden of Caring for Chronic Diseases and Family Caregivers Health Status Relationship between Burden of Caring For Older Adult Patients with Chronic Diseases and Family Caregivers ... Relationship between Burden of Caring For Older Adult Patients with Ch,” no. January 2016, 2019.
  24. A. E. Arrey, J. Bilsen, P. Lacor, and R. Deschepper, “Spirituality / Religiosity : A Cultural and Psychological Resource among Sub-Saharan African Migrant Women with HIV / AIDS in Belgium,” pp. 1–22, 2016, doi: 10.1371/journal.pone.0159488.
  25. C. T. Siregar, S. Z. Nasution, R. A. Ariga, Lufthiani, D. Tanjung, and I. A. Harahap, “The role and function of family caring for family members with chronic disease in medan,” AIP Conf. Proc., vol. 2342, no. April, 2021, doi: 10.1063/5.0045438.
  26. A.-M. Rosland, “Sharing the Care : The Role of Family in Chronic Illness,” Calif. Heal. care Found., no. August, pp. 1–27, 2009.
  27. A. Marques, T. Santos, J. Martins, and M. G. De Matos, “The association between physical activity and chronic diseases in European adults The association between physical activity and chronic diseases in,” vol. 1391, no. November, 2017, doi: 10.1080/17461391.2017.1400109.
  28. M. P. Kusumo, Y. S. Prabandari, and F. S. T. Dewi, “Measuring the Knowledge, Attitude and Practice of Patients With Diabetes Mellitus—The Design and Development Process,” Int. Q. Community Health Educ., no. June, 2021, doi: 10.1177/0272684X211022173.
  29. “How Can Nurses Contribute to Patient Engagement?,” American Sentinel College of Nursing & Health Sciences at Post University, 2012. (accessed Nov. 03, 2021).
  30. S. Miller-Hoover, “Patient Engagement Is Everyone’s Responsibility,” AMN Healthcare, Inc, 2016. (accessed Nov. 03, 2021).
  31. H. Trisnowati, “Pemberdayaan Masyarakat untuk Pencegahan Faktor Risiko Penyakit Tidak Menular ( Studi pada Pedesaan di Yogyakarta ) Community Empowerment to Prevent Risk Factors of Non Communicable Diseases ( Case in A Rural Communities of Yogyakarta ),” vol. 14, no. 1, pp. 17–25, 2018.
  32. M. Stellefson, S. R. Paige, B. H. Chaney, and J. D. Chaney, “Evolving Role of Social Media in Health Promotion : Updated Responsibilities for Health Education Specialists,” 2020.
  33. M. N. K. Boulos, D. M. Giustini, and S. Wheeler, “Instagram and WhatsApp in Health and Healthcare : An Overview Instagram and WhatsApp in Health and Healthcare : An Overview,” Futur. Internet, vol. 8, no. 37, pp. 1–14, 2016, doi: 10.3390/fi8030037.
  34. A. A. C. Pereira, J. R. Destro, M. P. Bernuci, L. F. Garcia, and T. F. R. Lucena, “Effects of a whatsapp-delivered education intervention to enhance breast cancer knowledge in women: Mixed-methods study,” JMIR mHealth uHealth, vol. 8, no. 7, 2020, doi: 10.2196/17430.
  35. A. C. Sartori, T. F. R. Lucena, C. T. Lopes, M. P. Bernuci, and M. U. Yamaguchi, “Educational Intervention Using WhatsApp on Medication Adherence in Hypertension and Diabetes Patients: A Randomized Clinical Trial,” Telemed. e-Health, vol. 26, no. 12, pp. 1526–1532, 2020, doi: 10.1089/tmj.2019.0305.
  36. “Patient-clinician communication in hospitals: Communicating for safety at transitions of care,” 2016. [Online]. Available:

How to Cite

Rina Kurniawati, & Mahendro Prasetyo Kusumo. (2023). Integrated care: Health Promotion Hospital Model to Improve Family Support for Patients with Chronic Disease. Bali Medical Journal, 12(1), 753–760.




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