Factors Related to the Knowledge of Physical Disabilities, Individual

Health Service and Public Health Service Practice of General

Practitioners in Primary Health Care

Hari Peni Julianti

, Angela BM Tulaar

, Tirza Z Tamin

, Tanti Ajoe Kesuma

, Endang Ambarwati

Sri Wahyudati

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Diponegoro,

Semarang, Indonesia

Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

hari_peni@yahoo,com

Keywords: Primary Health Care General Practitioner, Knowledge, Practices, Disabilities

Abstract: The purpose of this study was to determine factors related to the level of knowledge about physical

disabilities and the practice of individual health services (IHS) and public health services (PHS) for patient

with physical disabilities of General Practitioner (GP) in Primary Health Care. The design of this study was

cross sectional. Participants of this study were 23 Primary Health Care GP in Wonosobo District. Data were

tested with chi-square, significance level <0.05. Most of the participants were women (65.20%); the average

length of work was 7.48 years, 60.90% worked more than 5 years; 56.0% were civil servants, 34.80% were

BLUD employees, 8.70% were temporary contract employees; 56.50% have a lack of knowledge; 69.60%

lack in IHS practices and 95.70% lack in PHS practices. Gender (Prevalence Ratio (PR) = 3.43, 95% CI =

0.52-22.80, p = 0.19); length of work (PR = 0.20, 95% CI = 0.03-1.21, p = 0.07), employment status (PR =

0.63, 95% CI = 0.12-3.31, p = 0.58) not related to the level of knowledge about physical disabilities. Gender

(PR = 4.67, 95% CI = 0.45-48.26, p = 0.17); length of work (PR = 0.80, 95% CI = 0.13-4.87, p = 0.81),

employment status (PR = 2.50, 95% CI = 0.37-16.89, p = 0.34) not related to IHS and PHS practice. Level

of knowledge (PR = 5.50, 95% CI = 0.78-38.69, p = 0.07) not related to IHS practice. Level of knowledge

(PR = 1.11, 95% CI = 0.90-1.37, p = 0.24) not related to PHS practice. Most of Primary Health Care GP

have a lack of knowledge about physical disabilities; lack in IHS and PHS practices.. There were no

relationship between the level of knowledge and the practice of IHS and PHS.

1 INTRODUCTION

Disability is defined as an individual’s limitation or

loss of opportunities to participate in activities of

daily living as a part of one’s community, due to not

only physical burden or psychological disorders, but

also social barriers. It is also thought that having

disabilities might possess a continuous relationship

between an individual’s physical handicap with their

social environment. At certain times the individual

becomes ‘disabled’, but in other situations, they are

able to function as usual. Therefore, at times when

physical and environmental barriers are removed, it

cannot be said that a person is disabled, because at

these certain times, they are able to carry out their

functions. International Classification of

Functioning, Disability and Health categorize the

four basic components in the concept of disability,

namely impairment, activity and/or limited

participation, individual characteristics, individuals

factors, and environmental factors (Dempsey, 2006;

WHO, 2015).

Indonesia has signed the Convention on the

Rights of Persons with Disabilities (Kemenkes,

2014). The government is obliged to guarantee

access to health services for people with disabilities

including rehabilitation services in primary services

or primary health center (Pusat Kesehatan

Masyarakat – Puskesmas). Therefore, it is

paramount for doctors at primary health center to

have a knowledge about disability and the

238

Julianti, H., Tulaar, A., Tamin, T., Kesuma, T., Ambarwati, E. and Wahyudati, S.

Factors Related to the Knowledge of Physical Disabilities, Individual Health Service and Public Health Service Practice of General Practitioners in Primary Health Care.

DOI: 10.5220/0009088702380241

In Proceedings of the 11th National Congress and the 18th Annual Scientiﬁc Meeting of Indonesian Physical Medicine and Rehabilitation Association (KONAS XI and PIT XVIII PERDOSRI

2019), pages 238-241

ISBN: 978-989-758-409-1

capabilities to manage people with

disabilities. Several measures are needed in order to

manage with disabilities, both in individual health

service (Upaya Kesehatan Perorangan - UKP) and

public health service (Upaya Kesehatan Masyarakat

- UKM). The purpose of this study is to determine

factors related to primary health service doctors’

knowledge about physical disabilities, the practice

of individual health service (IHS) and community

health service (PHS) for individuals with physical

disabilities.

2 METHODS

This is an observational cross sectional study

consisting of 23 doctors from primary health centers

in Wonosobo District. The independent variable

consisted of gender, duration of work, and

employment status, while dependent variable of the

study is the level of knowledge about physical

disability, and practices in individual and public

health efforts in physical disability. Questionnaire

was used as a measuring instrument. The

questionnaire was validated by three experts and was

tested. Data obtained were subsequently tested using

chi-square in order to determine p value and risk

(prevalence ratio), with significance level of <0.05.

3 RESULTS

Research subjects were dominantly

female (65.20%). All subjects had medical education

background, and no subjects with postgraduate or

specialties degree. Mean of work duration is 7.48

years, with a minimum of 1 year, and a maximum 18

years. A percentage of 60, 90% has worked for more

than 5 years. The employment status of the subjects

consisted of 56.0% having the status of civil

servants, 34,80% Badan Layanan Umum Daerah

(BLUD) or regional public service agency

employees, and 8.70% temporary contract

employees. All subjects have never received any

information about disability in medical school and

no experience in attending seminars or courses

related to disability.

Questionnaire of knowledge about physical

disability is a questionnaire with open questions

consisting of 5 questions about understanding, cases

diagnosis, management, individual health service

(IHS) and public health service (PHS) and referral to

physical disabilities. Knowledge about physical

disability is stated as good if the research subjects

get more or equal to 70 and are declared less if they

get less than 70. The results showed that 56.50 % of

research subjects had a lack of knowledge about

physical disabilities. Questionnaire on the practice of

IHS is a questionnaire with open questions

consisting of 3 questions whether or not serving

patients with physical disabilities, what cases are

served and whether or not to make a referral. The

questionnaire about the practice of PHS is a

questionnaire with open questions consisting of 3

questions whether or not the practice of HIS, have

been carried out on persons with physical

disabilities, what cases are handled and referrals that

have been made. The practice of individual health

efforts and public health efforts are declared good if

they score more or equal to 70 and declared less if

they get less than 70. The results showed that

69.60% of research subjects had poor practice in

HIS and 95.70% of research subjects had poor PHS

practices.

Statistical analysis showed that the gender,

duration of work and employment status of the

subjects were not related to the level of knowledge

about physical disabilities. The gender, duration of

work, employment status was not related to practices

in IHS. In addition, the gender, duration of work,

employment status were not related to practices in

PHS. Statistical analysis also showed there was no

relationship between the level of knowledge with

IHS and PHS practices. The relationship between

gender, length of work, employment status with the

level of knowledge and practice of IHS and PHS,

level of knowledge and HIS, PHS practice are

detailed in table 1.

4 DISCUSSIONS

This research shows that 56.50% subjects lack

knowledge about Physical Disability. Knowledge

about physical disability consisting of 5 questions

about understanding, cases diagnosis, management

of individual health service (IHS) and public health

service (PHS) and referral is stated as good if the

research subjects get more or equal to 70 and are

declared less if they get less than 70 (Notoatmodjo,

2012).

Subjects lacking knowledge about disability

was unable to define the definition of physical

disability, cases diagnosis, management of HIS, PHS

and referral. Subjects who have knowledge about

physical disabilities are lacking is caused by the

inadequate information about physical disabilities

during medical school, having never attended

Factors Related to the Knowledge of Physical Disabilities, Individual Health Service and Public Health Service Practice of General

Practitioners in Primary Health Care

239

training or seminars about physical

disabilities. Subjects with favourable knowledge

about physical disability were able to define

disability in terms of definition, diagnosis and

referral. This subject received information about

physical disability superficially from the health

department and online media.

Table 1: Relationship between subjects gender, duration of

work, and employment status with level of

knowledge about physical disability and practice of IHS

and PHS, level of knowledge and HIS, PHS practice.

No Variable RP

95%

Confidence

Interval

value

1 Gender - Level of

knowledge

Duration of work -

Level of knowledge

Employment status

- Level of

knowledge

3.43 (0.52-

22.80)

0.20 (0.03-

1.21)

0.6 3 (0.12-

3.31)

0.19

0.07

0.58

2 Gender – HIS

practice

Duration of work -

IHS practice

Employment status

- IHS practices

4.67 (0.45-

48.26)

0.80 (0.13-

4.87)

2.50 (0.37-

16.89)

0.17

0.81

0.34

3 Gender – PHS

Practices

Duration of work -

PHS practice

Employment

status - PHS

practices

1.07 (0.94-

1.23)

1.08 (0.93-

1.25)

1.08 (0.93-

1.27)

0.46

0.41

0.37

4 Level of knowledge

- IHS practice

5.50

(0.78-38.69)

0.07

5 Level of knowledge

- PHS practices

1.11

(0.90-1.37)

0.24

It is found that subjects who lacks in IHS and

PHS practice were 69.60% and 95.70%

respectively. Most subjects lacks ability to practice

IHS as a result of not having patients with

disability. Subjects with favourable ability in IHS

practice was caused by having patients with physical

disability patients and are able to make diagnoses,

management such as treatment of bed ulcers and

make referrals. Most of the research subjects lack

practice in PHS for people with physical disabilities

as a result of no experience in PHS for people with

physical disabilities. A considerably small number

of subjects with favourable PHS practices were

found to be experienced delivering general health

promotion and counselling, not specifically for

patients with physical disabilities.

An individual’s knowledge and behavior is

influenced by predisposing factors namely gender,

age, level of education, economic status,

experience; enforcing factors such as peer

exposure; enabling actors namely legal aspects and

access (Green, 1984; Notoatmodjo 2012).

The

results of this study are that gender, duration of

work, and employment status is not related to the

level of knowledge about physical disability and

practise in IHS and PHS to individuals with

disabilities. There was no relationship between the

level of knowledge and the practice of IHS and PHS.

Most subjects lack adequate information about

physical disabilities and were inexperienced in IHS

and especially PHS for individuals with physical

disabilities. Therefore this study shows that gender,

duration of work and employment status were not

the factors correlated with a clinician’s knowledge

and practise in IHS and PHS. The results of

Aulagnier M, et all study show that 8.2% of the GP

reported discomfort in treating people with physical

disability (Aulagnier, 2005). General practitioner

reported less experience with the disabled patients

and no medical training about disabilities

(Aulagnier, 2005).

5 CONCLUSIONS

It was determined that 56.50% of Public Health

Center (Puskesmas) doctors lack knowledge about

physical disabilities; with 69.60% and 95.70% lack

individual health services and public health service

practice respectively. There were no factors related

to the level of knowledge about physical disability,

and practices in individual health and public health

service. There was no relationship between the level

of knowledge and the practice of IHS and PHS.

Training on physical disability is needed by

Puskesmas doctors to increase knowledge and

practice both in the IHS and PHS.

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Aulagnier M, Verger P, Ravaud JF, Souville M, Lussault

PY, Garnier JP, Paraponaris A. 2005. General

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Medicine and Rehabilitation Association

240

Dempsey, Nankervis K. 2006. Community disability

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Practitioners in Primary Health Care

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