Citra Puspa Juwita¹, Desy Simanjuntak²

Author:

¹Physiotherapy Program, Faculty of Vocational Studies, Universitas Kristen Indonesia

Corresponding Author:

²Medical Faculty, Universitas Kristen Indonesia, Email: desy.simanjuntak@uki.ac.id

Abstract

Background of the study: Health care professionals are professionals who can be at the forefront of being able to promote physical activity so that immunity is maintained. Purpose: For this reason, it is necessary to know how the perceptions and attitudes of health care professionals towards the behavior of promoting physical activity.

Methods: This study used a quantitative approach with cross sectional analytic design. The study population was doctors, nurses, and  physiotherapists in seven developing provinces in Indonesia, with a sample size of 400. Data collection used primary data with an online questionnaire containing statements with Likert scale answers that had been tested for feasibility. Chi square test will be used in testing the hypothesis of the study.

Results: There is a relationship between perceptions of the promoting behavior of physical activity of Health care professionals in Indonesia (p value= 0.01) and good perceptions will support promoting behavior 2.4 times better than those with less perceptions (OR = 2.397). There was no significant relationship between attitudes and physical activity promoting behavior among Health care professionals during the COVID-19 pandemic.

Conclusion: Good perceptions will support 2.4 times the occurrence of physical activity promoting behavior among Health care professionals.

Keywords: Perception; Attitude; Behavior; Promoting; Covid-19.

Received on 10^th May 2021, Revised on May 19^th 2021, Accepted on 28^th May 2021 DOI:10.36678/IJMAES.2021.V07I02.007

INTRODUCTION 

Non-communicable diseases, including heart disease, stroke, cancer, diabetes and chronic lung disease are collectively responsible for nearly 70% of all deaths worldwide. Nearly three-quarters of all deaths are due to infectious diseases, and 82% of the 16 million people who die prematurely, or before reaching the age of 70, occur in low- and middle-income countries¹. In Indonesia, the trend of
non-communicable diseases are diabetes mellitus, hypertension, and obesity in 2018 has increased from 2013^2,3.

Promoting by education to the public for regular and appropriate physical activities, must become a culture for health care professionals. The Covid-19 pandemic which has been going on for one year continues to haunt people’s lives, so to prevent transmission, they must comply with the health protocol. In addition to fulfilling the health protocol, people need to maintain their immunity in order to maintain their health^4,5. The immunity of the human body is influenced by daily physical activities^6,7.

health care professionals consisting of doctors, nurses, midwives, physiotherapists, nutritionists and others can be at the forefront in providing promotional efforts to patients and the community
in delivering correct and appropriate education so that with continuous efforts, it can minimize the incidence of disease^8,9,10.

Health care professionals who have behaviors that support promotional efforts will determine the success rate of the Clean and Healthy Living Community Movement Program (GERMAS). Behavior is generally associated with perceptions and attitudes^11,12. Based on the above background, the purpose of this study is to determine the behavior of health care professionals in carrying out the promotion of physical activity during the Covid-19 pandemic.

METHODOLOGY

This study used a quantitative approach with analytic design cross sectional. The study population was doctors, nurses and physiotherapists in seven developing provinces in Indonesia as many as 195.917³⁸, with a sample size of 400. Data collection used primary data with an online questionnaire containing statements with Likert scale answers that had been tested for validity and reliability. Chi square test will be used in testing the hypothesis of the study.

RESULTS

Most respondents were nurses (67.2%). The majority of respondents came from DKI Jakarta Province with the largest age being 26-45 years (70%). The most recent level of education of
respondents was bachelor / degree in applied education, amounting to 47.7% followed by Diploma (35.1%). Health care professionals including doctors, nurses and physiotherapist in Indonesia are dominated by nurses. The promotive
behavior of physical activity on good Health care professionals is 70% and 30% less. Data processing begins by looking at the normality of the data, namely by using the test of normality Kolmogorov-Smirnov, it was found that the data was
not normal (p <0.05). The results of the chi square show that the perception of Health care professionals on physical activity is 90% good and 10% less. In the variable of attitudes towards promotive behavior, physical activity of
Health care professionals obtained good results, namely 93% positive attitudes and only 7% with negative attitudes. Perceptions and attitudes towards promotive behavior of physical activity among Health workers.

Hypothesis test between two categorical variables which is appropriate to use for abnormal data is chi
square. The results of the chi square show that there is a relationship between perceptions of the promoting  behavior of physical activity of Health care professionals in Indonesia (p value= 0.01) and that good perceptions support promoting behavior 2.4 times better than those with less perceptions (OR = 2.397); so that the first hypothesis can be accepted, namely that there is a relationship between perceptions and promoting behavior of physical activity in Health care professionals during the Covid-19 pandemic.

The chi square results on attitudes toward physical activity promoting behavior among Health care professionals obtained p value 0.481, greater than 0.05, so the hypothesis is rejected. There was no significant relationship between attitudes and physical activity promoting behavior among Health care professionals during the Covid-19 pandemic.

DISCUSSION

In 2018 the lack of physical activity in Indonesia was 33.5%. The Covid-19 pandemic that has hit Indonesia since March 2020 has established health protocols, one of which is physical distancing and avoiding crowds, so that people will be less physically active than before the pandemic^13,14,15.

Efforts to increase physical activity is to promote physical activity so that people can be motivated^16,17,18. Through the promotion of physical activity, it can support the target of the
Healthy Community Movement Program (GERMAS) according to the 2020-2024 Mid-Term Development Plan, namely increasing health promotion and community empowerment with strategic target indicators of increasing active Pos PelayananTerpadu from 60% to 85%, Pos Bina Terpadu (Posbindu) active by 100%, and reduce the number of people who do not do physical activity less than 33.5% to 30%¹⁹.

Promoting behavior of physical activity among Health care professionals is dominated by good behavior, which is 70%. This figure is still relatively large because as a Health care professional in Indonesia it is obliged to provide promotional efforts to patients or the community as a stage in carrying out professional duties, be it
as a doctor, nurse, and physiotherapy^20,21. Research in the city of Addis Ababa, Ethiopia, on 442 Health care professionals from 7 government hospitals consisting of doctors (135.34.9%), nurses (218.56.3%), and physiotherapists (34.8.8%) have filled questionnaire.

The results showed that the provision of promotive/professional counseling was low in the hospital, so it is necessary to determine a strategy to increase the provision of promotive/counseling on physical activity in hospital regulations²².
Another study in Saudi Arabia, that out of 206 primary Health care professionals surveyed, 58.1% reported health awareness promotion programs
carried out in hospitals and 64.6% reported that the health promotion system in hospitals needs to be improved²³.

A different result carried out in Saudi Arabia also is that the majorities of primary care staff is quite
enthusiastic in promoting physical activity among patients and reveal that they regularly discuss and advise on the benefits of physical fitness. However,
there are several factors that hinder the promotion of physical activity, such s i) lack of time, ii) lack of educational materials for patients, iii) lack  of proper training and protocols for healthcare professionals, iv) lack of patient cooperation, and v) lack of financial incentives²⁴.

Health care professionals have good perceptions and attitudes. Most of them have good perceptions and attitudes towards physical activity. 90% of Health care professionals’ perception of physical
activity is good and 10% is not good. Attitudes of Health care professionals towards physical activity were 93% positive and 7% negative.

The last education of respondents in this study is at least a diploma 3 which has technical learning outcomes so that Health care professionals have good perceptions and attitudes about physical activity. There is a significant difference in the opinion of health professionals regarding the perceived level of physical activity among the
general population and observe the majority of respondents have a positive attitude that health promotion and encouragement of physical activity play a key role in primary care²⁴.

A person’s perception affects their behavior towards something, someone who has good perceptions generally has good behavior. The results of the chi square show that there is a relationship between perceptions of the promotive behavior of physical activity of health care professionals in Indonesia with a p value of 0.01 and that good perceptions will support promotive behavior 2.4 times better than those with less perceptions (OR = 2.397). Health professionals’ perception of physical activity is important because it will influence behavior in promoting physical
activity^25,26.

Chi square results on attitudes towards promotive behavior of physical activity among health care professionals obtained p value 0.481 greater than 0.05, so that there is no significant relationship between attitudes and promotive behavior of physical activity among Health care professionals during the Covid-19 pandemic. Positive attitudes affect behavior expected^7,28,29. This result is different from previous studies where a positive attitude does not necessarily affect behavior, as in previous studies on hygiene behavior, it was found that the result of bivariate analysis was that there was a relationship between knowledge and hygiene behavior (p value 0.032) and there is no relationship
between attitude and food processor hygiene behavior (p value 0.562)³⁰.

An observational analytic study with
a cross-sectional study of 126 respondents from all high schools / equivalent in South Siberut District showed that 53.2 percent of adolescents had an
attitude that did not support premarital sexual behavior and there was no relationship between adolescent attitudes towards premarital sexual behavior³¹.

Attitudes that are not related to the promotive behavior of physical activity can be due to the Covid-19 pandemic. Promotional efforts made by Health care professionals in health services will of course require longer time than treatment alone, health services are not optimal because during the pandemic, minimal interaction is attempted so that no Covid-19 transmission occurred ^32,33.

The level of stress on health care professionals during the pandemic also increases so that attitudes and behaviors are not related, because there is anxiety that Health care professionals will be infected with Covid-19 or can transmit it to family members^{34,35,36,37,38}.

CONCLUSION

In accordance with the objectives of the study, based on the results and discussion the conclusions good perceptions
will support 2.4 times the occurrence of physical activity promotive behavior among health care professionals and There is no significant relationship between attitudes and promotive behavior of physical activity in Health care
professionals during the COVID-19 pandemic. Suggestions for further research are to use a different approach from this study so that the reasons for perceptions and attitudes towards promoting behavior in physical activity can be explored deeper.

Conflicts of Interest: The authors declare that there is no competing interest in publishing this article.

Fund for the study: This study was fully funded by Universitas Kristen Indonesia.

REFERENCES

1. WHO.(2018). Non communicable diseases. Geneva: https:// www.who.int/news-room fact-sheets/detail/noncommunicabl cable-diseases diunduh pada 20 Agustus 2020.
2. Ministry of Health Indonesia. (2019). “LaporanNasionalRiskesdas 2018,” Badan Penelitiandan Pengembangan Kesehatan.
3. Welis, W., & Rifki, M. S. (2013). Gizi Untuk Aktifitas Fisik dan Kebugaran. Padang: Sukabina Press.
4. Kara, E. (2020). Coronavirus (COVID-19) Pandemic: Immunity and Exercise Intervention. International Journal of Applied Exercise Physiology, 9(10), 97-104.
5. Froberg, A. (2020). How children and young people can stay physically active during the novel coronavirus pandemic while take into account safety measures and precautions. Health Promotion Perspectives, 10(4), 295-299.
6. Tiksnadi, B. B., Sylviana, N., Cahyadi, A. I., & Undarsa, A. C. (2020). Olahraga Rutin untuk Meningkatkan ImunitasPasien Hipertensi Selama Masa Pandemi COVID-19. Indonesian Journal of Cardiology, 112-119.
7. Sukendra, D. M. (2015). Efek Olahraga Ringan Pada Fungsi Imunitas Terhadap Mikroba. Jurnal Media Ilmu Keolahragaan Indonesia, 57-65.
8. Fahra, R. U., Widayati, N., & Sutawardana, J. H. (2017). Hubungan Peran Perawat Sebagai Edukator dengan Perawatan Diri Pasien Diabetes Melitus Tipe 2 di Poli Penyakit Dalam Rumah Sakit Bina Sehat Jember. NurseLine Journal, 61-72.
9. Ismy, J., & Liansyah, T. m. (2016). Peran dokter keluarga dalam tatalaksana kasus. Jurnal kedokteran syiah kuala, 40-43.
10. Black, B., Ingman, M., & Janes, J. (2016). Physical Therapists’ Role in Health Promotion as Perceived by the Patient: Descriptive Survey. Phys Ther, 1588-1596.
11. Shiddiq, S., Wahyu, A., & Muis, M. (2014). Hubungan persepsi k3 karyawan dengan perilaku tidak. Mkmi, 110-116.
12. Agiviana, A. P., & Djastuti, I. (2015). Analisis Pengaruh Persepsi, Sikap, Pengetahuan Dantempat Kerja Terhadap Perilaku keselamatankaryawan. Dipone-goro Journal Ofmanagement, 4(3), 1-9.
13. Nurhadi, J. Z., & Fatahillah. (2020). Pengaruh Pandemi Covid-19 Terhadap Tingkat Aktivitas Fisik Padamasyarakat Komplek Pratama, Kelurahan Medan Tembung. Jurnal Health Sains, 1(5), 294-298.
14. Sekulic, D., Blazevic, M., Gilic, B., Kvesic, I., & Zenic, N. (2020). Prospective Analysis of Levels and Correlates of Physical Activity during COVID-19 Pandemic and Imposed Rules of Social Distancing; Gender Specific Study among Adolescents from Southern Croatia. Sustainability, 12(10); 1-13.
15. Puccinelli, P. J., Costa, T. S., Seffrin, A., Lira, C. A., Vancini, R. L., Nikolaidis, P. T., Andrade, M. S. (2021). Reduced level of physical activity during COVID-19 pandemic is associated with depression and anxiety levels: an internet based survey. BMC Public Health, 21; 1-11
16. National Health System. (2021). NHS. Retrieved April 29; 2021 from https:// www.nhs.uk/live-well/exercise/ exercise-health-benefits.
17. Pinto, B. M., & Papandonatos, G. D. (2013). A Randomized Trial to Promote Physical Activity Among Breast. Health Psychology, 32(6); 616-626.
18. Silva, J. M., Rezende, M. U., Spada, T. C., Francisco, L. d., Farias, F. E., Silva, C. A., Ciolac, E. G. (2017). Educational program promoting regular physical exercise improves functional capacity and daily living physical activity in subjects with knee osteoarthritis. BMC Musculoskeletal Disorder, 18(1); 1-8
19. Tholstrup, L., Kaplan, M., Drake, A., Gao, Z., Nichols, D., & Zhao, J. (2014). Promoting Physical Activity in the School Environment. Clinical Practice in Pediatric Psychology, 2(3); 350-361.
20. Ministry of Health Indonesia. (2020). Peraturan Menteri Kesehatan Republik Indonesia Nomor 21 Tahun 2020 Tentang. Jakarta: Kepala Biro Hukum dan Organisasi Sekretaris Jenderal Kementerian Kesehatan.
21. Ministry of Health Indonesia. (2015). Peraturan Menteri Kesehatan Republik Indonesia Nomor 65 Tahun 2015 Tentang Standar Pelayanan Fisioterapi. Jakarta: Menkes RI.
22. Ministry of Health Indonesia. (2019). Peraturan Menteri Kesehatan Republik Indonesia Nomor 4 Thaun 2019 tentang Standar Teknis Pemenuhan Mutu Pelayanan Dasar Pada Standar Pelayanan Minimal Bidang Kesehatan. Jakarta: Menkes RI.
23. Teferi, G., Kumar, H., & Singh, P. (2017). Physical Activity Prescription for Non-Communicable Diseases: Practices of Healthcare Professionals in Hospital Setting, Ethiopia. IOSR Journal of Sports and Physical Education, 4(1); 54-60.
24. Altamimi, S., Alshoshan, F., Shaman, G. A., Tawfeeq, N., Alasmary, M., & Ahmed, A. E. (2016). Health promotion practices as perceived by primary healthcare professionals at the Ministry of National Guard Health Affairs, Saudi Arabia. Qatar Medical Journal, 4; 1-9.
25. Al-Ghamdi, S., Alajmi, M., Gonaim, A. A., Juhayyim, S. A., Qasem, S. A., & Tamimi, I. A. (2017). Perceptions and Attitudes of Primary Healthcare Providers in Riyadh City, Saudi Arabia, towards the Promotion of Physical Activity. International Journal of Medical Research & Health Sciences, 6(11); 1-13.
26. Albert, F. A., Crowe, M. J., O, A. E., Aduli, M., & Aduli, B. S. (2020). Physical Activity Promotion: A Systematic Review of. Int. J. Environ. Res. Public Health, 17(12); 1-36.
27. Rice, E. L., & Klein, W. M. (2019). Interactions Among Perceived Norms and Attitudes About Health-Related Behaviors in U.S. Adolescents. Health Psychology, 38(3); 268-275.
28. Mouton, A., Mugnier, B., Demoulin, C., & Cloes, M. (2014). Physical Therapists’ Knowledge, Attitudes, and Beliefs About Physical Activity: A Prerequisite to Their Role in Physical Activity Promotion? Journal of Physical Therapy Education, 28(3); 120-127.
29. Berge, J. M., MacLehose, R., Eisenberg, M., Laska, M. N., & Neumark-Sztainer, D. (2012). How significant is the significant other’? Associations between significant others’ health behaviors and attitudes and young adults’ health outcomes. International Journal of Behavioral Nutrition and Physical Activity, 9; 9-35.
30. Korkmaz, A. G., Kartal, A., Ozen , C. I., & Kostu, N. (2017). The relationship between attitudes toward aging and health-promoting behaviours in older adults. International Journal of Nursing Practice, 23(6).
31. Mulyani, R. (2014). Pengetahuan, sikap dan perilaku hygiene pengolahan makanan. Jurnal ilmiah Keperawatan, 10(1).
32. Yolanda, R., Kurniadi, A., & Tanumihardja, T. N. (2019). Faktor-Faktor Yang Berhubungan Dengan Sikap Remaja Terhadap Perilaku Seksual Pranikah Di Kecamatan Siberut Selatan, Kepulauan Mentawai Tahun 2018. Jurnal Kesehatan Reproduksi, 10(1).
33. Singh, D. R., Sunuwar, D. R., Shah, S. K., Kark, K., Sah, L. K., Adhikari, B., & Sah, R. K. (2021). Impact of COVID-19 on health services utilization in Province-2 of Nepal: a qualitative study among community members and stakeholders. BMC Health Services Research, 21; 1-14.
34. Raphael, J., Winter, R., & Berry, K. (2021). Adapting practice in mental healthcare settings during the COVID-19 pandemic and other contagions: systematic review. BJPsych Open, 7(2), 1-13.
35. Kafle, K., Shrestha, D. B., Baniy, A., Lamichhane, S., Shahi, M., Gurung, B., Budhathoki, P. (2021). Psychological distress among health service providers during COVID-19 pandemic in Nepal. PLoS One, 16(2); 1-12.
36. Litam, S. D., & Balkin, R. S. (2020). Moral Injury in Health-Care Workers During COVID-19 Pandemic. Traumatology: An International Journal.
37. Scherer, Y. Li, Felix N.  L. &Kuper, H.(2021). Prevalence of depression, anxiety and posttraumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS One 16 (3); 1-19.
38. Ministry of Health Indonesia (2019). Badan PPSDM Kesehatan Informasi SDM Kesehatan. (Kementerian Kesehatan Republik Indonesia) Retrieved Agustus 21, 2020 from http://bppsdmk. kemkes.go.id/ info_sdmk/info/index?rumpun=9.

Citation

Citra Puspa Juwita, Desy Simanjuntak.
Behavior of health care professionals to promoting of physical activity in the
pandemic Covid-19. June 2021; ijmaes; 7 (2); 1026-1033.