Contribution of Social Support to Health Belief

in Patients with Chronic Renal Failure

Sulis Mariyanti, Safira Tias Rangganis and Aziz Luthfi

Department of Psychology, Faculty of Psychology, Universitas Esa Unggul, Jakarta, Indonesia

Keywords: Social Support, Health Belief, Patients, Chronic Renal Failure, Adulthood.

Abstract: The number of patients with chronic renal failure is increasing every year. Various therapeutic treatments that

must be undertaken and the risk if not doing treatment can cause stress for patients. Patients with chronic renal

failure are required to comply with doctor's advice and can develop confidence that they will be healthy or in

other words have health beliefs. One factor that contributes to one's health beliefs is social support. The

purpose of this research was to determine the contribution of social support to health belief in patients with

chronic renal failure. The design of this research is quantitative correlational, with a purposive sampling

technique. The sample of this research were 100 patients with chronic renal failure. Social support was

measured with 36 valid items and the reliability coefficient (α) = 0.920 and the health belief were measured

with 25 items and the reliability coefficient (α) = 0.848. The results showed that social support had a positive

significant influence on health belief with a sig (p) = 0,000 (p <0.05). Social support contributed 16.4% to

health belief. Patients with chronic renal failure had more negative health beliefs (51%). Male patients have

higher health beliefs than females.

1 INTRODUCTION

Currently, health issues are a concern in Indonesia.

Based on the 2018 Rikesdas data, Indonesia has

experienced an increase in the development of non-

communicable diseases caused by the lifestyle

adopted by the community (Rossa, 2018). According

to AIA Healthy Living Index research in 2018,

healthy living activities undertaken by the Indonesian

people in 2016 were 4.0% and decreased in 2018 by

3.6%. In his research explained that the most

influential lifestyle is the lack of a person doing

physical movements such as sports and also consume

healthy food because it is considered complicated,

expensive and also a waste of time ("Research:

Indonesia's Lowest Healthy Life Index in the Asia

Pacific, "2018). This causes an increase in the

development of non-communicable diseases one of

which decreases kidney function. According to data

from the Ministry of Health 2018, chronic renal

failure ranks second as a disease that incurs a lot of

costs and life-threatening in Indonesia with growth of

almost 100% within a year, this development is

greater than other non-communicable diseases

("Potret Sehat Indonesia dari Riskesdas 2018”, 2018).

In 2018 there were 43,000,000 patients with chronic

renal failure ("Potret Sehat Indonesia dari Riskesdas

2018", 2018).

The chronic renal failure for the body, among

others, as a regulator of blood volume and

composition, formation of red blood cells, helps

maintain acid-base balance, regulates blood pressure,

expulsion of foreign components and regulates the

number of electrolyte concentrations in extracellular

fluid (Zurmeli, Bayhakki and Utami, 2006).

Meanwhile, along with increasing age and doing

unhealthy lifestyles, such as having a diet that is high

in fat and carbohydrates, lack of drinking and not

doing exercise can cause decreased organ function in

the body including kidney function (Alam, S., &

Hadibroto, I., 2007).

The chronic renal failure is a condition where the

body fails to maintain metabolism and fluid and

electrolyte balance, causing uremia (Zurmeli,

Bayhakki, & Utami, 2006). chronic renal failure is

usually caused by several diseases both from kidney

disease itself and other diseases such as diabetes and

hypertension (Tandra, 2018). In Tandra (2018),

chronic renal failure can occur gradually and also

occur suddenly. chronic renal failure that occurs

gradually usually has unclear initial symptoms so that

patients feel it when it is said to be the final stage

Mariyanti, S., Rangganis, S. and Luthﬁ, A.

Contribution of Social Support to Health Belief in Patients with Chronic Renal Failure.

DOI: 10.5220/0009567100970102

In Proceedings of the 1st International Conference on Health (ICOH 2019), pages 97-102

ISBN: 978-989-758-454-1

(Alam, S., & Hadibroto, I., 2007). In Tandra (2018),

when it is in its final stages that the kidneys have a

GFR below 15ml / min of normal function, actions

such as hemodialysis or kidney transplantation will be

performed. But if kidney function is still in stages 1

to 4, the condition of the kidney can be prevented by

severing lifestyle changes such as electrical

imbalance control, control of hypertension and on a

high-calorie, low-protein diet that is scheduled by the

doctor and also sports (Tandra, 2018).

According to Tandra (2018) said that there are still

patients with chronic renal failure who do not follow

the doctor's recommendations, especially in

undergoing diet and exercise. This was also stated by

a specialist consultant kidney, Aida Lydia who said

that many patients also do not take medication and

control to the doctor routinely so that it can trigger

complications and dialysis (Purba, 2019). Whether or

not the patient follows the doctor's recommendations

such as a control to the doctor routinely, does not

undergo diet and exercise and does not take

medication regularly is thought to be caused because

the patient has a negative health belief.

According to Rosenstock (Janz & Becker, 1984)

said that health belief is a belief or assessment of

behavior related to health. Assessments are obtained

through a cognitive process from information

obtained through the environment or through an

assessment process through individual experiences.

In the results of Nugraha & Nurhayati's research

(2011), stated that patients with chronic renal failure

in Al Ihsan Regional Hospital have negative health

beliefs that are characterized by irregularity in taking

medication and inconsistent dieting. The results of

interviews with patients who are suspected of having

positive health beliefs are subject M, a 60-year-old

female patient who has chronic renal failure and has

a history of diabetes. The subject said that following

the doctor's advice was not easy especially for dieting

but the subject continued to follow the doctor's advice

because he was sure his condition would improve

besides the subject was also afraid if not following the

doctor's advice his condition worsened because the

subject knew his illness was quite severe. Unlike the

56-year-old subject L, a patient who experienced

chronic renal failure and had a history of diabetes. He

does not have confidence that the existing treatment

can make it better. In addition, children from the

subject also do not support to follow the advice of

doctors. The subject did not get support so that made

the subject less motivated to carry out the treatment.

According to Rosenstock (Janz & Becker, 1984) and

based on interviews above one of the factors that

influence health beliefs are supported.

Sarafino (2002), states that social support refers to

providing comfort to others, caring for them or

appreciating them. Sarafino (2002), also said that

social support can make a patient not stressed in

dealing with his illness, makes someone able to

overcome the problem and can see the good side of

the problem he is facing. In addition, social support

makes a person stronger, more able to live a healthy

lifestyle and make others feel cared for and needed so

that someone will be encouraged to exercise, eat

healthy, not smoke and not drink alcohol. In Smet

(1994), when someone is supported by the

environment, everything will feel easier. If someone

gets social support from the environment it will make

the individual feel calm, cared for, loved, self-

confidence and competence arise (Smet, 1994). Thus

high social support is characterized by getting

attention and care coming from people around, there

are other people who support in any condition, there

is help in the form of material, physical or

psychological coming from people around, directed

about treatment, advised to follow doctor's advice,

have a place to tell stories, accompanied when going

to the hospital, have someone who can be trusted to

give advice or advice, and have a group of friends

who can provide a sense of togetherness among group

members. With the high social support from the

surrounding environment can make patients chronic

renal failure feel stronger, more excited, more

motivated to carry out treatment, patients feel cared

for, given affection from the surrounding environment,

facilitated to follow treatment because it is facilitated,

patients get the right information both from medical

personnel or the surrounding environment, there are

always other people who always provide assistance

and this is thought to make patients feel happy, happy

because someone who supports it encourages patients

to believe whatever is said by others including doctors

and families if patients follow the advice given will be

healthier and ready to follow the recommended

treatment such as taking medication regularly,

consistent in diet, doing exercise and control to the

doctor regularly. Meanwhile, low social support will

make patients chronic renal failure feel uninspired, not

motivated to carry out treatment, feel less cared for and

given affection from the surrounding environment, it is

difficult to follow a healthy lifestyle because there are

no supporting facilities, also feel alone This is thought

to cause the patient to be unsure of the advice given by

the doctor and not follow it because he feels it will not

make him healthier.

From Nugraha and Nurhayati's (2011) research on

the correlations between health belief and compliance

behavior in patients with chronic renal failure in Al

ICOH 2019 - 1st International Conference on Health

Ihsan Regional Hospital, which says that there is a

low relationship between health belief and

compliance behavior, which means that the more the

patient is convinced of his illness, the more the

patient's adherence to the doctor's recommendations

was also high. In addition, Khotimah Research (2014)

states that there is a correlation between family

support and health care provider support for

adherence to ARV therapy. Patients who get low

family support are proven to have a 6 times greater

risk for undisciplined taking medication than those

who get high family support. Based on the description

above, is there any influence of social support on the

health beliefs of patients with chronic renal failure

2 METHODS

This study uses quantitative research methods that are

non-experimental. This study is included in a causal-

comparative study with simple linear regression with

the aim of the study to determine the effect of social

support on health beliefs. The sample in this study

amounted to 100 patients with chronic renal failure in

Jakarta with the characteristics of a sample having a

partner, living with family and not having dialysis.

Retrieval of data in this study using a questionnaire

using a Likert scale.

Social support measurement tools are adapted

based on measuring tools made by Gidion (2010)

based on Sarafino (2002) theory. Researchers made

modifications by adding 10 items so that the initial

number of items was 60 items. After the validity test,

26 items have been dropped so that they have a total of

34 items. The reliability in this item amounted to 0.920.

While the measure of health belief is adapted from

Widyaningsih (2018) based on Rosentrock's theory (in

Janz & Becker, 1984). Researchers made

modifications by adding 12 items so that the initial

number of items was 40 items. After the validity test,

15 items have been dropped so that they have a total of

25 items. The reliability in this item amounted to 0.848.

3 RESULT

Table 1: Description of gender.

Age Frequency Precentage (%)

Early Adulthood 24 24%

Middle Adulthood 40 40%

Late Adulthood 36 36%

Total 100 100%

Most of the respondents were male, 53% and female

were 47%.

Table 2: Description of age’s respondents.

Gender Frequency Percentage(%)

Male 53 53%

Female 47 47%

Total 100 100%

Most of the respondents were middle adulthood

40%, early adulthood 24% and late adulthood 36%.

Table 3: Normality Test Result.

Variable Kolmogorof-Smirnov

Social Support 0,103

Health Belief 0,127

Kolmogorov-Smirnov One-Sample normality test

results obtained the probability of social support

0.103 and health belief 0.127.

Table 4: Simple Linear Regression.

Score Social Support and Health Belief

Konstanta B +0,308

Sig. (2-tailed)

0,000

100

The results of simple linear regression tests that

have been carried out in table 4 of the ANOVA results

can be seen that the value of sig. (p) 0,000 (p <0.05),

which means that there is an influence of social

support for health belief in patients with chronic renal

failure. Besides that, the constant value of B is

+0.308, which means that social support has a

positive influence on health belief, so the hypothesis

in this study is accepted. If social support is high, it

will be followed by high health beliefs.

Table 5: Categorization of Social Support.

Score Category Frequency Percentage

X ≥ 105,02 High 51 51%

X ˂ 105,02 Low 49 49%

Total 100 100%

Most respondents who have high social support as

much as 51% and low social support are 49%.

Contribution of Social Support to Health Belief in Patients with Chronic Renal Failure

Table 6: Categorization of Health Belief.

Score Category Frequency Percentage

X ≥ 77,59 Positif 49 49%

X ˂ 77,59 Negatif 51 51%

Total 100 100%

Most respondents who have negative health

beliefs of 51% and positive health beliefs are 49%.

Table 7: Description of Health Belief base on Gender.

Gender

Negative Positive Total

Male

26 27 53

Female

25 22 47

Total

51 49 100

Asymp. Sig. (2-tailed)

Pearson Chi-Square

0,680

Male respondents more have positive health

beliefs and female have negative health beliefs. But

Chi-Square results obtained sig = 0.680 (p> 0.05)

which means there are no correlations between health

beliefs with the sex of the respondent.

Table 8: Description of Health Belief Base on Age.

Age

Negative Positive Total

Early Adulthood

13 11 24

Middle Adulthood

21 19 40

Late Adulthood

17 19 36

Total

51 49 100

Asymp. Sig. (2-tailed)

Pearson Chi-Square

0,573

Respondents of late adulthood more have positive

health and early adulthood and middle adulthood

more have low health beliefs. Chi-Square results

obtained sig = 0.573 (p> 0.05) which means there are

no correlations between health beliefs with the age of

the respondent.

4 DISCUSSION

In this study statistical tests with simple linear

regression obtained sig values. (p) 0,000 (p <0.05)

and the regression coefficient is +0.308 which means

the hypothesis is accepted. These results indicate that

there is a positive influence of social support on

health belief in patients with chronic renal failure.

Based on the value (R2) shows a result of 0.164 which

means that social support has a significant influence

that is 16.4%, while the rest is influenced by other

factors. The results of the linear regression equation

show the value of Y = 45.195 + 0.308x, meaning that

when social support increases by 1 then health belief

will also increase by 0.308, and vice versa if social

support decreases then health belief also decreases by

the same amount.

The results of this research are in line with

research previously conducted by Maulana (2015),

whose research results say that there is a positive and

significant influence of social support with healthy

dietary behavior in early adult women, which means

that the higher the social support, the higher the score

for healthy diet behavior. Other research was also

carried out by Irnawati, Siagian, & Ottay (2016), the

results of his study showed that social support had a

positive influence on medication adherence for

tuberculosis patients. The results of the study show

that social support influences healthy dietary

behavior and medication adherence including health

belief behavior.

A patient with chronic renal failure who gets high

social support will feel cared for, get affection, get the

right information about his illness so that makes the

patient feel happy and happy because he is taken care

of so that he is more motivated and enthusiastic in

undergoing his treatment, the patient also does not

feel alone and is stronger in fighting the disease. So

that patients have confidence that the benefits

obtained when doing treatment, believe the risks if

not doing treatment, know that the disease will be

more severe, believe the treatment can make health

conditions improve, adhere to treatment such as

regularly taking medication and a healthy diet, and

seeking information regarding his illness.

Conversely, if a patient with chronic renal failure gets

low social support, he will feel alone in dealing with

his illness, feel alienated from his environment, feel

sad so that he is not motivated and enthusiastic about

taking medication because there is no support from

his environment, and makes patients less confident

about their healthy development, they are not sure

that they will be healthier if they take medication,

they are not sure of the risks that will occur if they do

not take medication, and they are not ready to take

advice from their doctor, do not regularly take

medication and do not comply with the doctor's

recommended diet.

Sarafino (2011), said that social support can make

patients not stressed in dealing with their illnesses,

make someone able to overcome their problems,

make someone see the good side of the problem he is

facing, besides social support, makes a person

stronger, more lead a lifestyle healthy and make

others feel cared for and needed so that someone will

be encouraged to exercise, eat healthy, no smoke and

ICOH 2019 - 1st International Conference on Health

100

no drink alcohol or in other words believe in a healthy

lifestyle.

Based on the results of health belief categoriza-

tion, there are 51 people in the negative category.

Patients who have negative health beliefs will be less

sure of the risk of the disease, not ready to face

treatment and do not believe in the benefits of

treatment. In Nugraha & Nurhayati's (2011) research

results, it was stated that kidney failure patients in Al

Ihsan Regional Hospital had negative health beliefs

marked by not believing that kidney failure was a

dangerous disease, lacking confidence that patients

were able to follow the doctor's recommendations,

and lacking confidence that the disease can pose

medical risks. Health belief in Rosenstock (1974),

makes patients think that they have a serious illness

and must be cured, makes a person motivated that he

can live healthily, make someone try to avoid the

disease. Other than that. In addition, Sarafino (2011)

also said that individuals who were convinced of the

consequences of their illness, both medically,

psychologically and socially, the greater the belief

that the threat of these consequences would approach

them. This belief makes individuals encouraged to

make health recommendations such as a healthy diet

because of the many benefits gained.

One that affects one's health belief according to

Rosentrock is gender. The results of cross-tabulation

between sex and health beliefs showed a sig of 0.680

which means that there was no influence of health

beliefs with the gender of the patient chronic renal

failure. This is in line with research Hayati (2011),

which says that sex does not indicate compliance with

taking medication in pulmonary tuberculosis patients.

From cross-tabulation data with health beliefs, it is

stated that more women have negative health beliefs

than men. According to Korin, et al (2017), women

pay more attention to their health before being

exposed to the disease, while men pay more attention

to their health after being exposed to the disease. This

is because women's mindsets that change after living

a healthy lifestyle remain affected by the disease. The

results of Ulum, Widyawati, & Kusnanto (2014)

stated that men were more obedient to undergo

diabetes treatment of diabetes 2 because the number

of respondents in the study was more dominant.

Besides gender, according to Rosenstock (1974),

another demographic factor that affects health beliefs

is age. The cross-tabulation between age and health

belief shows sig. (p) as much as 0.573 (p> 0.05)

which means that there is no relationship between age

and health beliefs of patients with chronic renal

failure. According to WHO (2003), said that age and

sex have no relationship with patient compliance

following the doctor's advice in several places. In

addition, Hayati (2011) also said that there was no

relationship between age and adherence to the taking

of tuberculosis patients in pulmonary tuberculosis

patients. From cross-tabulation data between age and

health belief shows that in the early adult and middle

age groups more negative health beliefs and in the late

adult group more patients who have positive health

beliefs. This is in line with the statements of

Budiman, Khambri & Bachtiar (2013), who said that

age can affect one's motivation to adopt a healthy

lifestyle, the more age the higher the level of one's

compliance with medication or therapy.

The findings in this study are social support in this

study is high but patients have low health beliefs, it is

allegedly because it is influenced by the age factor of

the respondents. Where respondents in this study

more middle adulthood, which in theory (Hurlock,

2003), said that in middle adulthood both men and

women are having an increasingly warm relationship

with their environment but this period is also a

transition period from middle adulthood to old age

and at that time physical health began to decline but

someone has not been able to accept it.

5 CONCLUSION

Based on research that has been done, it can be

concluded that there is an influence of social support

on health belief in patients with chronic renal failure

with sig (p). 0,000 (p <0.05). With the results of the

linear regression equation, Y = 45.195 + 0.308x

shows the coefficient of variable (x) of +0.308 which

means that social support has a positive effect on

health belief which means the hypothesis is accepted.

It states that the higher the social support the more

positive the patient's health beliefs chronic renal

failure, and vice versa the lower the social support,

the lower the health beliefs owned by the patient's

chronic renal failure. Based on the R2 value shows a

result of 0.164 or 16.4%, which means social support

has an influence of 16.4% on the patient's health

belief in chronic renal failure.

From the results of this study more patients

chronic renal failure who had negative health beliefs

by 51% compared to positive. From the results of the

cross-tabulation shows that there is no relationship

between sex on one's health belief, but the data shows

that men have more positive health beliefs because

the number of respondents in this study is dominated

by men. This research also shows that age has no

correlations with the health beliefs of patients with

chronic renal failure

Contribution of Social Support to Health Belief in Patients with Chronic Renal Failure

101

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