Gethok Tular: A Source of Self-Care Knowledge for Older Women with Hypertension in Rural Areas

ISSN 2354-8428 e-ISSN 2598-8727 JURNAL KEPERAWATAN KOMPREHENSIF COMPREHENSIVE NURSING JOURNAL Vol. 11 No. 1, January 2025 Published by : Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat JURNAL KEPERAWATAN KOMPREHENSIF VOL. 11 NO. 1 Bandung January 2025 ISSN 2354-8428 e-ISSN 2598-8727 154 p-ISSN : 2354 8428 | e-ISSN: 2598 8727 Jurnal Keperawatan Komprehensif Volume 11 Issue 1 January 2025 Research Article Gethok Tular: A Source of Self-Care Knowledge for Older Women with Hypertension in Rural Areas Rosiana Eva Rayanti1 │ Rivaldy Alfrets Werfete2 │ Galuh Ambar Sasi3 │ Marsela Riska Raswandaru4 1,2,4Department Nursing Program, Faculty of Medicine and Health Sciences, Satya Wacana Christian University, Salatiga City, Central Java,50711, Indonesia 3History of Education, Faculty of Teacher Training and Education, Satya Wacana Christian University, Salatiga City, Central Java, 50711, Indonesia *contact Received : 15/12/2024 Revised : 27/12/2025 Accepted : 30/01/2025 Online : 31/01/2025 Published : 31/01/2025 Abstract Aims: This study explores the role of gethok tular (oral tradition) in promoting self-care management among elderly Javanese women with hypertension in rural areas, where access to health information remains limited despite existing education programs. Methods: This study employed a qualitative ethnographic approach conducted between January and June 2022. Data were collected through in-depth interviews and observations involving five elderly women in Ngrawan Village, Semarang Regency. To ensure triangulation, additional insights were gathered from midwives and posbindu (integrated healthcare posts for non-communicable diseases) cadres. The participants were Javanese women aged 60 years or older, born and residing in Ngrawan Village, diagnosed with hypertension for more than two years, and actively participating in posbindu activities. Content analysis was used to interpret the data. Results: Gethok tular facilitates the informal exchange of hypertension-related knowledge, particularly during interactions at posbindu sessions. Despite limited understanding of hypertension, participants practiced self-care by staying active, attending checkups, and using herbal remedies like soursop and avocado leaves to manage symptoms. Conclusion: The gethok tular tradition offers a culturally relevant method for disseminating health information and improving selfcare practices in rural communities. This approach holds potential for integration into community-based health programs. Keywords: Gethok Tular, Hypertension, Older women, Rural Community, Self-Care INTRODUCTION Hypertension remains one of the most prevalent non-communicable diseases globally. The prevalence of hypertension is higher in low-income countries compared to high-income countries(1). Indonesia, a developing country, has seen a continuous increase in hypertension prevalence. Data https://doi.org/10.33755/jkk from Indonesia’s Ministry of Health reported that 25.8% of the population had hypertension in 2013, increasing to 34.1% in 2018(2). In Central Java, the fourthhighest province in hypertension prevalence, the situation is alarming. In 2023, healthcare services for hypertension in Semarang, the capital of Central Java, showed a higher proportion of female This is an open access article under the CC BY-SA license 155 p-ISSN : 2354 8428 | e-ISSN: 2598 8727 patients, with 205,318 cases (63.8%), compared to male patients, who accounted for 116,402 cases (36.2%)(3). Elderly individuals, particularly women, represent the group most affected by hypertension which is primarily attributed to physiological changes such as reduced vascular elasticity, compounded by the hormonal change’s women experience postmenopause, including decreased estrogen levels that help regulate blood pressure (4). Older women exhibit a higher prevalence of hypertension compared to men. In 2018, 36.9% of older women in Indonesia were hypertensive, compared to 31.3% of men. In Central Java, these figures were 40.17% for women and 34.83% for men (5). In Ngrawan Village, Semarang Regency, 17 older women had hypertension, compared to only five men. Several factors contribute to this disparity, including physiological, social, economic, and educational factors. Socially, older women often face diminished societal roles, leading to isolation and stress, which can elevate blood pressure (6,7). Economically, the loss of income in old age hinders their ability to meet healthcare needs. Low education levels further limit their knowledge of hypertension management such as periodic medical checkup, leaving many unaware of their condition until symptoms become severe(8). Self-care behaviors in older women with hypertension are strongly influenced by their level of knowledge misconceptions about health—such as believing they are healthy if they can perform daily activities—affect their willingness to seek medical care. Other barriers include the cost of treatment, distance to healthcare facilities, and perceptions of healthcare provider attitudes (9). As a result, many older women resort to self-medication using herbal remedies such as avocado leaves (10), bay leaves(11), tomatoes (12) and ginger (13,14). The use of medicinal plants in rural Indonesia is a longstanding tradition passed down https://doi.org/10.33755/jkk Jurnal Keperawatan Komprehensif Volume 11 Issue 1 January 2025 through generations, predominantly practiced by women aged 55–64(15). As a result, rural communities, particularly older adults, tend to trust herbal remedies for treatment. Among 281 individuals with hypertension Ngadirojo Community Health Center, Wonogiri Regency, commonly used plants for blood pressure reduction include celery, noni, ground cherry (Physalis angulata), soursop leaves, bilimbi, and garlic because of their affordability, ease of cultivation, and accessibility(16). Posbindu (integrated healthcare posts for non-communicable diseases) have been implemented (17). The implementation of Posbindu in Indonesia faces challenges in hypertension screening and risk factor identification due to limited-service coverage, program complexity, overlap with other non-communicable disease initiatives, and resource constraints(18). Expanding hypertension management in rural communities requires culturally relevant approaches to encourage regular health screenings. A study in China on elderly individuals with hypertension found a correlation between social support and hypertension management, highlighting the need for a community-based approach(19). Traditional practices like gethok tular, an oral tradition of sharing information, play a significant role in knowledge dissemination among Javanese in rural communities (20). Older women often exchange experiences and health tips while waiting for medical check-ups at posbindu (21). This practice and herbal remedies highlight the importance of integrating cultural traditions into health education strategies. 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