The Impact of Using the Mental Health Smart Book (BISAA) to

Increase Physical, Psychological, Social, and Spiritual Life Qualities

in the Elderly

Hanik Endang Nihayati, Alfita Nadziir and Rr. Dian Tristiana

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Keywords: Mental health smart book, Quality of life, Elderly.

Abstract: The elderly are at risk of stress because of the physical, psychological, and social changes that they

experience. Intervention is needed to increase the physical, psychological, social, and spiritual life qualities

of the elderly. One of the interventions is stress management, taught through health education by using the

mental health smart book (Buku Pintar Sehat Jiwa Lansia/ BISAA). This study aimed to analyze the effect

of BISAA in increasing the physical, psychological, social, and spiritual qualities in the elderly. A Quasi-

experiment research design was used in this study. The target population were 744 elderly people; the

affordable population were 80 elderly people and the sample comprised of 16 elderly selected by purposive

sampling. The independent variable was health education with BISAA. The dependent variables were the

physical, psychological, social, and spiritual qualities of life. Data were collected using a questionnaire

regarding physical, psychological, social, and spiritual qualities. The study was analyzed using the

Wilcoxon Signed Rank Test and the Mann Whitney U test with a significance level of p≤0.05. The results

from the Wilcoxon Signed Rank Test indicated that physical quality p = 0.014, psychological quality p =

0.011, social quality p = 0.020, and spiritual quality p=0.008. In addition, the statistical test results from the

Mann Whitney U test for physical quality indicated p = 0.028, psychological quality p = 0.012, social

quality p = 0.020, and spiritual quality p = 0.014. Based on these results, it can be concluded that BISAA

can increase the physical, psychological, social and spiritual qualities in elders, the most dominant of which

is the psychological quality. Further research is expected to analyze the effect of BISAA to increase the

environment quality for the elderly.

1 BACKGROUND

The aging process is a process that continues

naturally. The consequence of that process gives rise

to changes in the elderly, including physical,

psychological, and social changes (Azizah, 2011;

Joseph, 2015). Such changes can impact on the

health of the elderly because every change can be a

stressor (a source of stress) that requires elderly

people to adapt (Idris, 2015). When elderly people

suffer from stress, their quality of life deteriorates,

hence there is a need for others to support them and

help them cope with stress. Stress management can

help the elderly by modify various behaviors that are

risky to health and so improve the quality of life

(Edelman & Mandle, 2010).

The World Health Organization (WHO) (2013)

explained that in Southeast Asia, the elderly

population accounts for 142 million people or 18%

of the. It is estimated that by 2050, the elderly

population will have increased three times from this

year (Kemenkes, 2013). According to the National

Socioeconomic Survey (susenas) in 2014, the

number of elderly people in Indonesia reached 20.24

million people or around 8.03% of Indonesia’s total

population (Kemenkes, 2016). The number of

elderly people in Indonesia by 2021 is estimated to

reach 30.1 million people; for these figures,

Indonesia is ranked fourth in the world after China,

India and the United States. By 2050 the number is

expected to increase to more than 50 million people

(Kemenkes, 2013).

According to data obtained from the Surabaya

City Health Office, the number of elderly people in

Nihayati, H., Nadziir, A. and Tristiana, R.

The Impact of Using the Mental Health Smart Book (BISAA) to Increase Physical, Psychological, Social, and Spiritual Life Qualities in the Elderly.

DOI: 10.5220/0008325603790387

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 379-387

ISBN: 978-989-758-336-0

379

East Java in 2013 was 4,210,339 people. The

number of elderly people in Surabaya in 2014 was

228,798 people, compared 217,116 people in 2013.

The number of elderly people in the District of

Tambak Sari in 2014 was 18,584 people. According

to data obtained from the Pacarkeling Community

Health Centre in 2016, the number of elderly people

in the working area of Pacarkeling Community

Health Center was 1,424 people. There were 744

elderly people in Pacarkeling Village and 680

elderly people in Pacarkembang Village. The

number of elderly in RW IX Pacarkeling was 80.

The Basic Health Research Data (Riskesdas) in

2007 indicated that the prevalence of mental

emotional disorders increases with age. In the age

group 55–64 years, the prevalence of emotional

mental disorders is 15.9%. This number increases in

the age group 65–74 years to 23.2% (MOH, 2008).

The survey was conducted by researchers at the

Pacarkeling Community Health Centre, Surabaya on

May 10, 2016. The Elderly Visiting Elderly

Integrated Service Post (Posyandu) is more focused

on physical complaints and physical examinations

such as weighing, height measurements, and blood

pressure and does not check mental status. The

results of the preliminary survey supplied physical,

psychological, social, and spiritual quality

questionnaires to 43 elderly people who visited the

Elderly Integrated Service Post (Posyandu) in Seroja

RW IX Pacarkeling Surabaya indicated that there are

no elderly people whose physical, psychological,

social, and spiritual quality are very good.

If the stress on elderly people is not immediately

addressed, it could cause an impact on the elderly in

the form of physical illness, psychological, social,

and spiritual problems. Physical diseases caused or

exacerbated by stress are arteriosclerosis, heart

attacks, cancer, respiratory disorders, bone loss,

nausea, diarrhea, hypertension, and strokes. Sexual

disorders and diabetes mellitus also appear due to

stress (Losyk, 2005; Sukadiyanto, 2010).

Psychological problems in the elderly include

sleeping disorders (insomnia), depression, and even

suicide. Social problems that can arise include the

decline of personal relationships and withdrawal

from others (rather than seeking social support).

Spiritual problems are marked by a decline in

religious beliefs. The impact of stress can ultimately

reduce the quality of life for elderly people (Losyk,

2005).

According to the WHOQOL-SRPB BREF, the

quality of life domain includes five elements:

physical, psychological, social, environmental, and

spiritual (Skevington, 2013). Most researchers

measure quality of life using the physical,

psychological, social and environmental quality

domains. In addition to the four domains, spiritual

quality is very important because individuals who

have good spiritual qualities will live a life in

harmony both as a person and as part of the social

environment and will live peacefully because they

feel close to God. Spirituality is also a reflection of

cultural heritage for the Indonesian nation and is

believed to contain noble values and norms that are

obeyed by society, impacting greatly on life

(Imaddudin, 2015). Improving elderly people’s

quality of life of the enables them to enjoy their old

age with full meaning, happiness, health,

independence, productivity, usefulness, and

prosperity (Kemenkes, 2013).

Stress management can be taught to elderly

people through a variety of media, including via a

book described as the media of elderly mental health

smart book (BISAA). The book contains information

about the elderly, healthy elderly souls, stress, and

stress management. Stress management, which is

easy to apply to the elderly, includes using mini

relaxation, a healthy diet, physical activity, social

support, spiritual practice, and humor. This book

also features the Healthy Elderly Card (KMS) that

can be completed when visiting the Elderly

Integrated Service Post (Posyandu).

Based on the chronology of the problems

described above, the researcher is interested in

conducting research on "The Influence of Elderly

Mental Health Smart Book (BISAA) on Improving

Physical, Psychological, Social and Spiritual Quality

at the Elderly Integrated Service Post (Posyandu)

Seroja RW IX Pacarkeling Surabaya."

2 METHODS

The method used in this research was the Quasi

Experiment with a pre-post test group control

design. The target population were the elderly in

Pacarkeling Surabaya, of which there are 744, and

the reachable population of the elderly in RW IX

Pacarkeling Surabaya amounted to 80 people. The

inclusion criteria in this study were the elderly who

visited the Elderly Integrated Service Post

(Posyandu) Seroja RW IX Pacarkeling Surabaya,

aged 64–74 years, have very bad, bad, moderate or

good physical, psychological, social, and spiritual

qualities, and be able to read. The exclusion criteria

were elderly people with hearing loss.

A purposive sampling technique was used.

Sixteen elderly samples were divided into two

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

380

groups: the treatment and control groups; each group

had a total of eight elderly people. The independent

variable is health education using the elderly mental

health smart book (BISAA). The dependent

variables are the physical, psychological, social, and

spiritual qualities. The instrument used is the SAP

(Counseling Event Unit), Elderly Mental Health

Smart Book (BISAA), which contains about elderly,

healthy soul elderly, stress management, Elderly

Health Card (KMS) and a questionnaire consisting

of two parts: demographic data questionnaire

(gender, age, last education, and marital status) and

valid and reliable physical, psychological, social,

and spiritual quality questionnaires.

The study was conducted over three weeks. The

pre-test used physical, psychological, and spiritual

quality questionnaires using door to door collection

for the treatment and control group the day before

the health education mental health smart book

(BISAA) was given to the elderly pariticpants.

Intervention was held once a week as many as 3

times of treatment group meeting at Elderly

Integrated Service Post (Posyandu) Seroja RW IX

Pacarkeling Surabaya. Subsequently a post-test was

conducted using a physical, psychological, social,

and spiritual quality questionnaire for both groups

through door to door collection one week after the

third meeting. The collected data were analyzed

using the Wilcoxon Signed Rank Test and the Mann

Whitney U test with p≤0.

3 RESULTS

3.1 Respondents’ Demographic

Characteristics

Table 1 shows that females dominated both the

treatment and control groups. In the treatment group

there were six female respondents (75%) and in the

control group there were five female respondents

(62.5%). Half (four) of the respondents in both

groups were aged 60–64 (50%). Three (37.5%)

respondents in each group had an elementary school

and senior high school education background. Most

elderly respondents (five) in both groups were

married (62.5%).

3.2 Measured Variables

3.2.1 Physical Qualities

Table 2 indicates that physical quality was moderate

for most (five or 62.5%) respondents before the

intervention was provided to the treatment group.

The pre-test in the control group showed that many

(three or 37.5%) elderly respondents had medium

and good physical qualities. Following the

intervention, most elderly respondents (five or

62.5%) had good physical qualities while most of

the respondents in the control group had moderate

physical condition (five or 62.5%).

Table 1: Demographic Characteristic Data of the

Respondents.

Data Category

Treatment

Grou

Control

Grou

f % f %

Sex

Male 2 25 3 37.5

Female 6 75 5 62.5

Total 8 100 8 100

Age

–

64 4 50 4 50

–

69 2 25 1 12.5

–

74 2 25 3 37.5

Total 8 100 8 100

Education

Did not go

to School 0 0 0 0

Elementary

School 3 37.5 3 37.5

Junior High

School 2 25 2 12.5

Senior High

School 3 37.5 3 37.5

Undergraduate

Stud

0 0 0 0

Total 8 100 8 100

Marital

Status

Unmarrie

0 0 0 0

Marrie

5 62.5 5 62.5

Widowe

3 37.5 3 37.5

Total 8 100 8 100

Table 2: Physical Quality Distribution of the

Respondents.

Physical

Treatment Control

Pre-Test Post-Test Pre-Test Post-Test

f % f % f % f %

Very

0 0 0 0 0 0 0 0

0 0 0 0 2 25 0 0

Moderate 5 62.5 1 12.5 3 37.5 5 62.5

Goo

3 37.5 5 62.5 3 37.5 3 37.5

Very

Goo

0 0 2 25 0 0 0 0

Total 8 100 8 100 8 100 8 100

The Impact of Using the Mental Health Smart Book (BISAA) to Increase Physical, Psychological, Social, and Spiritual Life Qualities in the

Elderly

381

From Table 3 it can be seen that physical

qualities in the treatment group, after being provided

with health education using the elderly mental health

smart book (BISAA), mostly increased to six (75%).

The results of the analysis using the Wilcoxon

Signed Rank Test in the treatment group obtained a

sig value (2-tailed) of p = 0.014, so p <0.05. These

results indicate that there is a difference between the

physical quality before and after being given health

education by the elderly mental health smart book

(BISAA) in the treatment group.

In the control group, most (six or 75%) of the

respondents did not indicate a difference in the

physical quality between the pre-test and post-test

results. The statistical test results using Wilcoxon

Signed Rank Test in the control group obtained a sig

value (2-tailed) of p = 0.157 so p> 0.05. These

results indicate that there is no difference in physical

quality between the pre-test and post-test in the

control group.

Statistical test results using the Mann Whitney U

Test sig (2-tailed) value was p = 0.028 so p <0.05.

These results indicate that there is a difference

between the physical quality of the treatment group

and the control group.

3.2.2 Psychological Qualities

Table 4 indicates that most respondents (five or

62.5%) in the treatment group demonstrated

moderate psychological qualities before the

intervention. In the control group, half (four or 50%)

demonstrated moderate psychological qualities.

After the intervention, half (four or 50%) of

respondents in the treatment group demonstrated

very good psychological qualities, while the post-

test results in the control group showed that many

respondents had moderate and good psychological

qualities with three (37.5%) respondents for each.

Table 5 indicates that after being given

intervention, the psychological qualities of elderly

respondents increased to seven (87.5%). The results

of the statistics test using the Wilcoxon Signed Rank

Test in the treatment group obtained a sig value (2-

tailed) of p = 0.011 so p <0.05. These results

indicate that there is a difference between

psychological qualities before and after the delivery

of health education using the elderly mental health

smart book (BISAA) with the treatment group.

In the control group, most participants (five or

62.5%) showed that the psychological qualities

Table 3: Data Result of the Pre-test and Post-test in

Physical Quality.

Respon-

dent

Treatment Control

Pre-Test Post-Test Pre-Test Post-Test

1 Moderate Goo

Moderate

2 Moderate Goo

Moderate Moderate

3 Moderate Goo

Goo

4 Moderate Moderate Moderate Moderate

5 Good

Very

Goo

Good Good

6 Good

Very

Goo

Moderate Moderate

7 Goo

Goo

8 Moderate Goo

Moderate

Wilcoxon

Signed

Ran

p = 0.014 p = 0.157

Mann

Whitney

U Test

Post-Test p = 0.028

Table 4: Psychological Quality Distribution of the

Respondents.

Psycho-

logical

Treatment Control

Pre-Test Post-Test Pre-Test Post-Test

f % f % f % f %

Very

0 0 0 0 0 0 0 0

0 0 0 0 1 12.5 0 0

Moderate 5 62.5 1 12.5 5 62.5 5 62.5

Goo

3 37.5 4 50 2 25 3 37.5

Very

Goo

3 37.5 4 50 2 25 3 37.5

Total 8 100 8 100 8 100 8 100

Table 5: Data Result of the Pre-test and Post-test in

Psychological Quality.

Respon-

dent

Treatment Control

Pre-Test Post-Test Pre-Test Post-Test

1 Moderate

Very

Goo

Moderate Bad

2 Moderate Goo

Moderate Moderate

3 Good

Very

Goo

Moderate Good

4 Moderate Moderate Ba

5 Moderate Goo

Goo

6 Moderate Goo

Moderate

7 Good

Very

Goo

Good Good

8 Good

Very

Goo

Moderate Moderate

Wilcoxon

Signed

Ran

p = 0.011 p = 0.564

Mann

Whitney

U Test

Post Test p = 0.012

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

382

between the pre-test and post-test did not change.

Statistical test results using the Wilcoxon Signed

Rank Test, in the control group, obtained a sig value

(2-tailed)of p = 0.564 so p> 0.05. The results show

that there was no difference in the psychological

quality between pre-test and post-test in the control

group. The statistical test results used the Mann

Whitney U Test sig (2-tailed) with a value of p =

0.012 so p <0.05. These results indicate that there is

a difference between the psychological qualities of

the treatment group and the control group.

3.2.3 Social Qualities

Table 6 indicates that five (62.5%) elderly

respondents demonstrated moderate social qualities

before being provided with intervention in the

treatment group and the same result was indicated in

the pre-test in the control group. After the

intervention was given, results for the the treatment

group indicated that half (four or 50%) of

responbdents had good social qualities while, in the

post-test for the control group, most (five or 62,5%)

indicated moderate social qualities.

From Table 7, it is evident that six (75%) eldely

respondents indicated an increase in social qualities

following the intervention. The results of the

statistics analysis using the Wilcoxon Signed Rank

Test for the treatment group obtained a sig value (2-

tailed) of p = 0.020 so p <0.05. These results

indicate that there is a difference between social

qualities before and after the health education was

delivered, using the elderly mental health smart

book (BISAA) for the treatment group.

In the control group, most respondents (six or

75%) indicated no change in psychological qualities

between the pre-test and post-test. Statistical test

results using the Wilcoxon Signed Rank Test in the

control group obtained a sig value (2-tailed) of p =

0.157 so p> 0.05. These results indicate that there is

no social quality difference between the pre-test and

post-test in the control group.

Statistical test results using the Mann Whitney U

Test sig (2-tailed) value were p = 0.020 so p <0.05.

These results indicate that there is a difference

between the social qualities of the treatment group

and the control group.

3.2.4 Spiritual Qualities

Table 8 indicates that half of the respondents (four

or 50%) in the treatment group had good spiritual

qualities before being given intervention and before

the pre-test in the control group. Following the

intervention, most (five or 62.5%) respondents’

spiritual qualities in the treatment group were very

good, while the post-test in the control group

indicated that many (three or 37.5%) of elderly

Table 6: Social Quality Distribution of the

Respondents.

Social

Treatment Control

Pre-Test Post-Test Pre-Test Post-Test

f % f % f % f %

Very

0 0 0 0 0 0 0 0

0 0 0 0 1 12.5 0 0

Moderate 5 62.5 1 12.5 5 62.5 5 62.5

Goo

3 37.5 4 50 2 25 3 37.5

Very

Goo

0 0 3 37.5 0 0 0 0

Total 8 100 8 100 8 100 8 100

Table 7: The Data Result of the Pre-test and Post-test

in Social Quality.

Respon-

dent

Treatment Control

Pre-Test Post-Test Pre-Test Post-Test

1 Moderate Goo

Goo

2 Moderate Goo

Moderate Moderate

Goo

Moderate Moderate

4 Moderate Moderate Moderate Moderate

5 Moderate Goo

Moderate Moderate

6 Good

Very

Goo

Bad Moderate

7 Good

Very

Goo

Good Good

8 Good

Very

Goo

Moderate Good

Wilcoxon

Signed

Ran

p = 0.020 p = 0.157

Mann

Whitney

U Test

Post-Test p = 0.020

Table 8: The Spiritual Quality Distribution of the

Respondents.

Spiritual

Treatment Control

Pre-Test Post-Test Pre-Test Post-Test

f % f % f % f %

Very

0 0 0 0 0 0 0 0

1 12.5 0 0 1 12.5 1 12.5

Moderate 3 37.5 0 0 3 37.5 3 37.5

Goo

4 50 3 37.5 4 50 3 37.5

Very

Goo

0 0 5 62.5 0 0 1 12.5

Total 8 100 8 100 8 100 8 100

The Impact of Using the Mental Health Smart Book (BISAA) to Increase Physical, Psychological, Social, and Spiritual Life Qualities in the

Elderly

383

respondents have moderate and good spiritual

qualities.

Table 9 indicates that after being given

intervention in the treatment group, the spiritual

qualities of all (eight or 100%) elderly people were

good. The results of the statistics test using the

Wilcoxon Signed Rank Test in the treatment group

obtained a sig value (2-tailed) of p = 0.008 so p

<0.05. These results indicate that there is a

difference between the spiritual qualities before and

after being given health education by the elderly

mental health smart book (BISAA) in the treatment

group.

In the control group most (seven or 82.5%)

respondents’ spiritual qualities between the pre-test

and the post-test did not change. The results of the

statistical test using the Wilcoxon Signed Rank Test

in the control group, obtained a value of sig (2-

tailed) at p = 0.317 so p> 0.05. These results indicate

that there is no difference in the psychological

qualities between pre-test and post-test in the control

group.

The statistical test results using the Mann

Whitney U Test sig (2-tailed) value was p = 0.014 so

p <0.05. These results indicate that there is a

difference between the psychological quality of the

treatment group and the control group.

4 DISCUSSION

4.1 Physical Qualities

Table 2 indicates that most treatment group

respondents’ physical qualities were moderate

before being provided with health education with

the media of elderly mental health smart book

(BISAA) as they sometimes have the ability to

perform daily activities, and have enough energy

and ability to carry out an activity. The pre-test in

the control group showed that many respondents had

moderate and good physical qualities, as they often

have enough energy to perform the activity and

sometimes feel satisfied.

After being given health education using the

elderly mental health smart book (BISAA), it was

determined that regarding the physical qualities of

the treatment group, most (75%) experienced

improvement, such as being more able to perform

daily activities, have enough energy to carry out the

activity, getting along with others, and satisfied by

sleep. The post-test regarding physical qualities in

the control group indicated that the majority of

respondents (75%) did not change or remain the

same as they often had enough energy to perform the

activity and were sometimes satisfied with their

sleep.

Mubarak (2007) describes health education as a

dynamic process of behavior change. Stress

management can improve physical qualities because

of stress management strategies that conduct mini

relaxation, healthy diet, and physical activity

(Edelman & Mandle, 2010).

Mini relaxation can concentrate the mind so that

the blood vessels can become more elastic.

Circulation will be smoother so that the body

becomes relaxed and warm; the work of the heart

will feel lighter, which certainly affects the workings

of other organs to improve physical qualities

(Handoyo, 2004).

A healthy diet makes it is possible for the body

to obtain good nutrition to improve physical

functions and improve physical quality (Swarth,

2006). Scientists state that an active lifestyle and

regular exercise can help prevent or delay the onset

of illness and disability, increase appetite, help with

the recovery of old diseases, increase energy,

balance, immunity, and flexibility, thus improving

physical quality (Hutapea, 2005).

In the treatment group there were elderly people

whose physical qualities were the same as they were

before intervention was given. This is because the

elderly were not paying enough attention when the

Table 9: Data Result of the Pre-test and Post-test in

Spiritual Quality.

Respon-

dent

Treatment Control

Pre-Test Post-Test Pre-Test Post-Test

1 Moderate Goo

Goo

2 Good

Very

Goo

Moderate Moderate

3 Moderate Very Moderate Moderate

4 Ba

Goo

5 Moderate Good Good Good

6 Good

Very

Goo

Bad Bad

7 Goo

Ver

Moderate Moderate

8 Good

Very

Goo

Good

Very

Goo

Wilcoxon

Signed

Ran

p = 0.008 p = 0.317

Mann

Whitney

U Test

Post-Test p = 0.014

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

384

intervention was given, and one of the elderly people

had an elementary school educational background so

was unable to absorb and understand the health

education provided. In the control group there were

elderly people whose physical quality increased

even though they did not receive intervention. This

is because the elderly have an awareness in

maintaining their physical health and actively follow

the elderly integrated service post (Posyandu) and

avoid foods that can worsen their health condition.

4.2 Psychological Qualities

Table 4 determines that most respondents had

moderate psychological qualities before being given

health education through the elderly mental health

smart book (BISAA), such as sometimes accepting

their body appearance, having negative feelings

(loneliness, despair, anxiety, and depression), and

having positive feelings (happy and cheerful). The

pre-test in the control group showed that half of the

respondents had moderate psychological qualities

such as having positive feelings (happy and

cheerful), sometimes feeling satisfaction.

After being given the health education through

elderly mental health smart book (BISAA), it was

determined that most respondents (87.5%) in the

treatment group the result is psychological quality in

treatment group found that their psychological

qualities, with indicators such as frequently

accepting body appearance, never having negative

feelings (loneliness, despair, anxiety, depression),

frequently having positive feelings (happy and

cheerful) and frequently demonstrating the ability to

concentrate. The post-test of psychological qualities

in the control group showed the majority (62.5%)

did not change; some had positive feelings (happy

and cheerful) and sometimes they were satisfied

with themselves.

Mubarak (2007) describes health education as a

dynamic process of behavior change. Stress

management can improve psychological quality

because of stress management strategies linked to

carrying out mini relaxation, healthy diet, physical

activity, and humor (Edelman & Mandle, 2010).

Mini relaxation can calm the mind, feeling,

psychology, form mental resilience, accelerate

healing and stress relief (depression), to improve

psychological qualities (Handoyo, 2004). According

to Swarth (2006) a healthy diet allows the body to

obtain good nutrition that can improve the health

conditions of the elderly to overcome stress and

develop psychological qualities.

Physical activity can release endorphins from the

brain, resembling the effects of morphine.

Endorphins prompt feelings of comfort. Physical

exercise also creates mental and emotional relief that

helps a person cope and prevent stress to improve

psychological qualities (Swarth, 2006).

In addition, individuals who have high levels of

humor are known to cope better with stress, establish

relationships with people around them, and are

physically healthier. When an individual can cope

well with stress, then feelings of disappointment or

sadness that may arise as a result of a mismatch of

expectations with reality are reduced, therefore

individuals have good psychological qualities

(Hardianti, 2014).

In the treatment group there were elderly people

whose psychological qualities were the same before

and after the intervention. This is because they were

not paying enough attention during the intervention

and had elementary school background, so had less

ability to absorb the health education provided. In

the control group there was an elderly person whose

psychological quality increased, despite not

receiving intervention. This is because the elderly

person was aged between 60 and 64 and had a life

partner, therefore the psychological quality was

good and his high school educational background

meant that he could understand various problems

that could interfere with his psychological qualities

and know how to handle them. Furthermore, there

are elderly people in the control group who

experienced a degradation in psychological qualities

because they were often worried about their health

condition; they are 74 years old and feel lonely

because they do not have spouse or are widowed and

live alone.

4.3 Social Qualities

Table 6 indicates that social qualities before the

health education intervention using the elderly

mental health smart book (BISAA) in group of

treatment and pre-test in control group were mostly

moderate. Respondents were sometimes satisfied

with interaction from others and sometimes satisfied

with the support given by a friend.

After being given health education using elderly

mental health smart book (BISAA), it was found that

social qualities in the treatment group had increased

for 75% of the sample, relating to satisfaction in

interacting with others and often feeling satisfied

with the support given by friends. The post-test of

social qualities in the control group indicated there

was no change in the results.

The Impact of Using the Mental Health Smart Book (BISAA) to Increase Physical, Psychological, Social, and Spiritual Life Qualities in the

Elderly

385

Stress management can improve social qualities

because stress management strategies seek to

provide social support. Social support can be

obtained by telling stories and talking about

problems regarding the social environment with

others, such as family, friends, and close relatives.

Therefore they obtain suggestions and gain good

advice, support, and assistance without criticism,

ultimately improving social qualities (Edelman &

Mandle, 2010).

In the treatment group there were elderly people

whose social quality category was the same as

before the intervention. This is because the elderly

people were not paying enough attention during the

intervention and they had an elementary school

educational background so had less ability to absorb

the provided health education. Furthermore, in the

control group there were elderly people whose

psychological qualities increased, although they did

not recieve any intervention. This is because the

elderly respondents’ personalitieare likely to gather

and interact with other elderly people.

4.4 Spiritual Quality

Table 8 indicates that before being given the health

education using the elderly mental health smart book

(BISAA), half of the respondents in the treatment

group had good spiritual qualities, such as often

feeling that worship activities would help his life be

better, hoping and believing God would help with

his life, and amazement about God's creation. The

pre-test in the control group showed that half of the

respondents also had good spiritual qualities.

After being given health education using the elderly

mental health smart book (BISAA), it was

determined that the spiritual quality in the treatment

group all experienced improvement, and took part in

activities such as worshipping every day, often

feeling that the worship activities helped to improve

life, always hoping and believing that God will

support life, and always feel amazed by God’s

creation. A post-test of the spiritual qualities in the

control group showed that the majority of

respondents (82.5%) did not change, and took part in

activities such as worshipping every day, often

feeling that the worship activities helped to improve

life, always hoping and believing that God will

support life, and always feel amazed by God’s

creation.

Mubarak (2007) describes health education as a a

dynamic process of behavior change. Stress

management can improve spiritual qualities because

one of the stress management strategies is to

participate in spiritual practice by being closer to

God Almighty through the practice of worship such

as prayer, fasting, praying, and attending recitation

(Edelman & Mandle, 2010).

In the control group there were elderly people

whose spiritual qualities increased despite not

receiving intervention. This is because some elderly

personalities are always obedient to God and

continually participate in worship.

5 CONCLUSIONS

Health education using the elderly mental health

smart book (BISAA) has an influence on the

improvement of physical, psychological, social and

spiritual qualities in the elderly, and most

significantly with psychological qualities.

Health officers can conduct health education at

the Elderly Integrated Service Post (Posyandu) with

the elderly mental mealth smart book (BISAA) to

help improve the physical, psychological, social, and

spiritual qualities of the elderly. Future researchers

could identify the influence of the elderly mental

health smart book (BISAA) on the improvement of

environmental qualities in the elderly.

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