For everyday health and wellbeing, GPs are at the frontline of the healthcare system. They also play an important role in promoting positive behaviour change for both individual patients and the communities in which they live. As the burden of disease in Indonesia is rapidly shifting towards non-communicable diseases (NCDs), the focus of health promotion needs to change also.
Adolescence is the time when many risk factors for adult NCDs commence. Yet in Indonesia and around the world, many GPs are poorly trained around how to engage with adolescent patients. In Yogyakarta, a team of researchers together with 30 practising GPs, 20 medical students and two Yogyakarta schools set out to share knowledge and approaches for preventing NCDs in young people. Knowing that much health literacy is learned in schools, they created an innovative approach to engaging primary and secondary school students.
They first tackled the daunting task of communicating with children and teenagers, particularly through listening to them talk about their health. To do this, an Australia-Indonesia Centre researcher team developed a ‘training for trainers’ program to specifically build on the GPs’ existing skills in communicating with younger patients around healthy behaviour. The importance of listening and the need for confidentiality were emphasized in the program for GPs.
“When we try to get the GPs to communicate with adolescents, it’s really a new thing for them. They don’t know how…. Basically the challenge is adapting their communication skills,” says Associate Professor Mora Claramita from Universitas Gadjah Mada (UGM), who led the program together with Associate Professor Lena Sanci from The University of Melbourne.
Associate Professor Sanci observed that the same challenges recently faced Australian GPs: “There’s not as much appreciation in Indonesia of how psychosocial behaviours effect health, and not as much training around that. Just as in the past, Australia paid very little attention to adolescent health as a concept.”
Together the GPs and medical students researched and designed healthy living learning manuals for use in two existing peer-to-peer health education programs from the Indonesian Ministry of Health – the ‘Dokter Kecil’ (Little Doctor) program in primary schools and the ‘Pos Bindu’ program in secondary schools.
The researchers were incredibly pleased to see the medical students and GPs demonstrate a real commitment to leveraging their influence to promote healthy behaviours and minimise the future burden of NCDs in Indonesia.
For youth, by youth – new peer education resources
The newly developed learning manuals were evaluated and refined through pilot implementation in schools in Gunungkidul region, Yogyakarta, within the Dokter Kecil and Pos Bindu programs. “To date, those programs have been mainly around first aid,” explained Associate Professor Sanci, “but one objective of this study was to see whether we could train the ‘little doctors’ [school students] to promote healthy eating behaviours and encourage non-smoking.”
This shift in focus from first aid and hand washing to healthy eating, exercise and smoking represents the broader shift that is taking place in Indonesia’s public health dialogue. NCDs – which often result from poor diet, a lack of exercise, and smoking – are a fast growing problem, as Indonesia’s improving health system sees less and less illness and death as a result of infectious diseases.
After capturing the thoughts and ideas of the school students around promoting healthy behaviours, researchers and participants developed two student booklets (available free to download, PDFs below). These resources are now helping students to deliver these peer-to-peer programs themselves, with colourful, engaging information and activities around how to avoid NCD risk behaviours such as smoking, lack of exercise and an unhealthy diet – a major cause of obesity and diabetes. It also shows students how they in turn can help their friends and peers be healthier.
Associate Professor Mora Claramita noted, “The students were surprised to see the GPs visit them directly at school and talk with them about how to form a healthy lifestyle. They thought that a doctor only meets patients in a clinic, to cure diseases”.
Looking ahead
This pilot program demonstrated that young peer educators in schools are enthusiastic about communicating with their peers about reducing NCD risk factors through healthy eating and avoiding tobacco smoke. Following its success, the team is hopeful the student program might be scaled up to more schools in the region – and beyond.
“Now that we know how to do this,” Associate Professor Sanci adds, “mental health education is probably the next important thing to tackle in this way.”
Building the skills of the next generation of GPs and medical students to support Indonesia’s adolescents
Associate Professor Claramita also hopes to see the team’s new GP training approach expand nationally. She and her university colleagues (Associate Professor Nur Afrainin Syah, Dr Oryzati Hilman and Dr Fitriana Murriya Ekawati) in partnership with professional colleagues working in primary care settings (Dr Novi Fitri Yani and Dr Diah Prasetyorini) are working passionately for the inclusion of similar adolescent-appropriate NCD prevention material to be incorporated into medical training across Indonesia.
The AIC Health Cluster’s research from the past three years will be presented in Jakarta over two events in Jakarta. On 19 September, the Cluster’s researchers will bring their expertise together at Foundations for our Future: Innovative research for front-line NCD prevention early in life. The following day the Cluster will host a forum for translating research into policy and practice: Youth are our Future: Early-life NCD prevention for a prosperous resilient ‘Golden Generation’. These events will be an opportunity for the AIC to work in partnership with stakeholders from government, NGOs and community organisations to apply research findings and shape policy and practices for NCD prevention among children and adolescents in Indonesia.
