臺灣博碩士論文加值系統

ABSTRACT

Background and purpose: Older adults risk experiencing a shrinkage of support, a declining network, social isolation, and feeling lonely, which could negatively affect health and well-being. Nevertheless, the relationship of social capital with health and well-being as well as healthcare utilization is inconsistent. Furthermore, most prior research used a cross-sectional design. Social capital is quite emphasized in the society of Indonesia, especially for older people. Thus, this study aimed to explore the effects of social capital on emotional well-being (happiness and depressive symptoms) and healthcare utilization among older people in Indonesia by longitudinal data.

Method: The study utilized the data from the Indonesian Family Life Survey (IFLS) in the set period of 2007 (wave 4) and 2014 (wave 5). IFLS was a panel survey conducted since 1993, representing 83% of the Indonesian population. The data collection was performed by trained field researchers. This survey measured the aspect of economic, health, and well-being issues. We included participants aged 60 years and above who were followed in Wave 4 and Wave 5 (n = 1374). In study one, social capital, demography, well-being, and health factors predicted the depressive symptoms and happiness determinants. Meanwhile, we used the predictors of social capital and three factors related to Andersen's healthcare utilization model and the utilization of healthcare (healthcare admission/inpatient, outpatient, medical checkup, and posyandu). Generalized estimating equation models were performed in the two studies.

Results: In the first study, older adults participating in arisan (B = -0.63, p < 0.05) and religious programs (B = -0.59, p < 0.01) were significantly related to the scores of depressive symptoms reduction. The effect of religious activities on depressive symptoms would be offset over time. Meanwhile, a higher score of neighborhood trust could increase the possibility of a “very happy” feeling at the intercept (OR = 1.52, p < 0.01). Furthermore, when social participation was defined as none, low or high, low, and high social participation compared to no participation showed protective effects on depressive symptoms at the intercept and at the time slope.
In the second study, social capital was a significant predictor of healthcare utilization. High participation (joining two programs or more) was contributing an essential determinant for access to posyandu (OR = 5.84, p < 0.001) and health checkup services (OR = 1.62, p < 0.05). The higher neighborhood trust was significant with hospital admission (OR = 1.25, p < 0.05).

Conclusion: Social capital significantly predicted positive and negative emotional well-being and healthcare access among older adults. Providing and supporting the program using social capital approaches (such as promoting social activity and neighborhood trust) might be a fundamental choice to enhance older adults’ well-being and health. Social capital support for older adults can be achieved through realizing an age-friendly city or community, advocacy for budget support at national and local levels, and providing public access to enhance interactions among older adults.

ABSTRACT

Background and purpose: Older adults risk experiencing a shrinkage of support, a declining network, social isolation, and feeling lonely, which could negatively affect health and well-being. Nevertheless, the relationship of social capital with health and well-being as well as healthcare utilization is inconsistent. Furthermore, most prior research used a cross-sectional design. Social capital is quite emphasized in the society of Indonesia, especially for older people. Thus, this study aimed to explore the effects of social capital on emotional well-being (happiness and depressive symptoms) and healthcare utilization among older people in Indonesia by longitudinal data.

Method: The study utilized the data from the Indonesian Family Life Survey (IFLS) in the set period of 2007 (wave 4) and 2014 (wave 5). IFLS was a panel survey conducted since 1993, representing 83% of the Indonesian population. The data collection was performed by trained field researchers. This survey measured the aspect of economic, health, and well-being issues. We included participants aged 60 years and above who were followed in Wave 4 and Wave 5 (n = 1374). In study one, social capital, demography, well-being, and health factors predicted the depressive symptoms and happiness determinants. Meanwhile, we used the predictors of social capital and three factors related to Andersen's healthcare utilization model and the utilization of healthcare (healthcare admission/inpatient, outpatient, medical checkup, and posyandu). Generalized estimating equation models were performed in the two studies.

Results: In the first study, older adults participating in arisan (B = -0.63, p < 0.05) and religious programs (B = -0.59, p < 0.01) were significantly related to the scores of depressive symptoms reduction. The effect of religious activities on depressive symptoms would be offset over time. Meanwhile, a higher score of neighborhood trust could increase the possibility of a “very happy” feeling at the intercept (OR = 1.52, p < 0.01). Furthermore, when social participation was defined as none, low or high, low, and high social participation compared to no participation showed protective effects on depressive symptoms at the intercept and at the time slope.
In the second study, social capital was a significant predictor of healthcare utilization. High participation (joining two programs or more) was contributing an essential determinant for access to posyandu (OR = 5.84, p < 0.001) and health checkup services (OR = 1.62, p < 0.05). The higher neighborhood trust was significant with hospital admission (OR = 1.25, p < 0.05).

Conclusion: Social capital significantly predicted positive and negative emotional well-being and healthcare access among older adults. Providing and supporting the program using social capital approaches (such as promoting social activity and neighborhood trust) might be a fundamental choice to enhance older adults’ well-being and health. Social capital support for older adults can be achieved through realizing an age-friendly city or community, advocacy for budget support at national and local levels, and providing public access to enhance interactions among older adults.

TABLE OF CONTENTS

ACKNOWLEDGEMENT iii
ABSTRACT iv
TABLE OF CONTENTS v
LIST OF FIGURES vii
LIST OF TABLES viii
CHAPTER 1 1
INTRODUCTION 1
A. Background 1
B. Study Purpose 4
C. Research Hypotheses 5
CHAPTER 2 6
LITERATURE REVIEW 6
A. Social Capital 6
1. Definition and theoretical explanations 6
2. Social capital (structural and cognitive) and health issues 8
3. Social Capital in Indonesia 9
B. Depressive symptoms 10
1. Definition 10
2. Factors related to depressive symptoms 11
C. Happiness 13
1. Theoretical explanations 13
2. Related factors toward older adults’ happiness 14
D. Health care utilization 15
1. Healthcare utilization behavioral model 15
2. Healthcare utilization in the older population 17
3. Social capital (structural and cognitive facet) and healthcare utilization for older people 18
4. Healthcare system and healthcare utilization of older adults in Indonesia 21
E. Research gaps 25
CHAPTER 3 28
METHODS 28
A. Data and sample 28
B. Study 1: Effects of social capital on Indonesian older adults’ psychological well-being 30
1. Conceptual framework 30
2. Data and sample 32
3. Measures 32
4. Analysis 37
C. Study 2: Social capital effects on older adults’ health care utilization 38
1. Conceptual framework 38
2. Data and sample 39
3. Measures 40
4. Analysis 45
D. Ethical considerations 45
CHAPTER 4 46
RESULTS AND DISCUSSION 46
A. Study one: Social capital effect on the psychological well-being of older adults in Indonesia 46
1. Results of study one 46
2. Discussion of study one 53
B. Study two: Social Capital and the various access to healthcare among older adults in Indonesia 58
1. Result of study two 58
2. Discussion of study two 65
CHAPTER 5 70
CONCLUSION 70
Acknowledgment 73
References 74



LIST OF FIGURES

Figure 1. Phase 5 of the behavioral model of healthcare use (cited: Andersen, 2008) 17

Figure 2. The Indonesian health system structure (cited: Kadar et al., 2013) 22

Figure 3. Conceptual framework of the determinant factor of emotional wellbeing 32

Figure 4. Conceptual framework of healthcare utilization determinant factor 38

Figure 5. Older adults’ participation in 2007 and 2014 setting 50




LIST OF TABLES

Table 1. Definition of variables in study 1 35
Table 2. Definition of variables in study two 44
Table 3. Characteristics of participants aged 60 years and older in the periods of 2007 (wave 4) and 2014 (wave 5) 47
Table 4. Determinant of depressive symptoms scores (CESD) and happiness (very happy feeling) among older adults in Indonesia 52
Table 5. Associated factors of depressive symptoms and happiness among Indonesian older adults using GEE (social participation in three categories).…..54
Table 6. Characteristics table of older adults (n = 1,374) 60
Table 7. Factors of posyandu visit among Indonesian older adults 61
Table 8. Factors of health checkup visit among Indonesian older adults 62
Table 9. Factors of outpatient visit among Indonesian older adults 63
Table 10. Factors of hospital admission among Indonesian older adults 64

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