Addressing Health Illiteracy and Stunting in Culture-Shocked Indigenous Populations: A Case Study of Outer Baduy in Indonesia
Abstract
:1. Introduction
2. Outer Baduy Community
3. Research Methods
3.1. Design
3.2. Participants and Setting
3.3. Data Collection
3.4. Ethical Considerations
3.5. Data Analysis
4. Results
4.1. Factors Associated with Low Health Literacy in the Baduy Community
“If I do not repeat it, I was afraid I will not understand the writing on the card, so I ask Teh Ira”.(Baduy 2)
“We use Baduy as the stunting pilot project site because this tribe emphasizes many prohibitions related to food, related to customs that must not be violated”.(NGO)
“At that time, the Ministry of Social Affairs had food-giving activities in Baduy. We warned that Baduy people only need rice, salted fish, and shrimp paste. Nevertheless, they sent all other foods. Hence, many containers of food came just to be rejected by the Baduy at that time”.(The Government)
“We are ashamed. [The egg] should have been provided by their parents. We are also ashamed because the eggs are provided for stunted children, but their parents eat them”.(Punggawa)
“Well, the target does not like anything like that, ma’am. For example, I want to provide additional food like that, giving eggs or holding a gathering for education and providing additional food like that. The target is in the huma [rice field], in the fields, so there are only 1 or 2. So, it is less effective here because of the people. They do not stay home every day, so they are also busy with their farming activities. Their livelihood is farming, right, ma’am? If they do not farm, they cannot eat because they earn money there; that is how it is”.(Midwife)
“And also looking at the elders’ previous [bad] habits, yes, they have been followed [uncritically by the community], so that is [a sign of] a lack of education, huh”.(Midwife)
“Well, what is interesting about our survey findings is that we divided three areas so there is Inner Baduy, and this is the area where access is difficult, so if we look for it, it is also problematic; there is also little knowledge about health and stunting. That is the characteristic of what is Inner Baduy. However, for Outer Baduy, communication is accessible because their knowledge regarding various kinds of programs has been widely accepted. On the other hand, because it is easy to access, many government, private, or community programs are carried out in the village. This village, so yes, is in the villages of Kaduketuk and then Cijahe and the surrounding areas, and the people are already used to receiving programs”.(Archaeologist)
“Someone once told about stunting, but there was no further follow-up”.(Punggawa)
No, maybe men understand.(Baduy 1)
“If you talk like this [health information about stunting], if you want it to be clear, you have to convey it to a man”.(Baduy 1)
“Don’t know. That’s a man’s business. They held a meeting together. You should talk about this with a man. If there is a community meeting here, all the people who come are men”.(Baduy 1)
4.2. The Impact of Low Health Literacy in the Baduy Community
“His father’s [body] was small, so Sardin’s [body] was small”.(Baduy 1)
“So far, they have completely ignored the data regarding deaths due to snake bites, thinking that they have just given up. This belief [the folk legend that Baduy is immune to snake venom] is just a tactic from kokolot [community elders]. [he actual belief is that] when someone’s life is ended [by snake bites], it is predestined. There’s something [belief] like that. But when medical people come in and all that [health facilities], [they start to believe that] there are things that can be fixed”.(NGO)
“Well, yesterday, we looked at the data from the last few years. Yes, in the last two years and three years, Baduy had a high maternal mortality rate. Yes, up to 4 people per year. Well, this is quite extraordinary. Just one is quite high. Here, it is up to four every year. The child death figure is even higher. There are cases of child deaths, especially neonates. They died when they were born. Well, this case is also quite high. Between 9 and 14 children per year die in Baduy”.(Nurse)
“Sometimes there are things like this, ma’am. For example, the village used to be a tiny population. Even then, they said no matter how badly my child is sick, do not take him to the medical centre. Could you not take him to Rangkasbitung? It is expensive, so where do we get the money to pay the bill? That is the chatter of old people is like”.(Punggawa)
4.3. Strategies to Improve Baduy Community Health Literacy
4.3.1. Developing the Health Literacy of Community Leaders
“The point is that Jaro and Puun also urge the Baduy people to consume nutritious food, but not force it because there is a clash of customs [such as eating healthy but prohibited food] that cannot be forced”.(Midwife)
“We were invited to a community gathering every month. The purpose of the meeting is to provide instructions to the village or the parents; everything is talked about and entrusted to the parents. Only recently has this happened. Violations of various kinds are reported, and then there are instructions, such as if you [want to] eat [certain] food [from outside], you must be careful [that the food contains prohibited or unhealthy items]. It was recently held with the community. Every month, the meeting is held”.(Baduy 1)
4.3.2. Managing Information-Technology-Based Health-Information Groups
“Technology can come in slowly. Cell phones are already in, but if they want to use them, they must go to Outer Baduy, ma’am. In Inner Baduy, they must go outside the village first. Then they are now free to meet their friends”.(Dentist)
“I have all [the midwives’ cellphone numbers]. I have the [cellphone] number of the health personnel and midwives in Cibaleger, in Kariki, I have all the [cellphone] numbers”.(Baduy 1)
4.3.3. Always Present at Least One Health Worker among Residents and Provide an Example of Healthy Living
“Indeed, in the past, I heard that people from Baduy Dalam, for example, were not allowed to use medical services because it has been like that for generations. Nevertheless, now we live in a wider society. So, people from Outer Baduyhave already used modern medicine, right? So sometimes what else can we do if we do not get help”.(Punggawa)
“My intention here is nothing different. I do not sell medicine. I do not sell these or those. I want to help the Baduy people because they do not know where to go. Mr. Jaro said, “Do not leave the Pustu [Subsidiary Health Center]”. No, I will not leave it. If the condition is like this, then that is the condition. So, in the end, that is it. Yesterday, Mr. Jaro’s wife had her feet scalded with hot water. I have taken it to the doctor, there are burns. Then, given ointment, she is healthy now. “It was Mr. Jaro who asked for treatment directly”.(NGO)
4.3.4. Encouraging Collective Reflection When Health Cases Occur
“That is why I say when I go around, “Do not eat cilok [chewy tapioca balls], do not eat noodles, better eat boiled bananas”. This local wisdom has now been lost. The children eat cilok every morning; there are cilok around. Snacks. That afternoon, a lady on a motorbike was picked up by her husband and shouted “cilok…cilok”. The children do not want to eat dinner anymore; why? Because the taste is different, there is already flavouring, and all kinds of things, and a generation of flavouring-addicted people has emerged”.(NGO)
“For example, there was a risky pregnancy, but it turns out that because of a customary problem, she was not allowed to access health services. Finally, after negotiating with the traditional authorities, she was allowed. However, 15 min before arriving at the hospital, the mother died. The mother died on the road. So she died in the ambulance”.(Nurse)
4.3.5. Balancing Gender Communication
5. Discussion
Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Themes | Subthemes | Categories |
---|---|---|
Factors associated with Low Health Literacy | General Illiteracy | Inability to read and dependence on verbal explanations |
Cultural Practices | Prohibitions on certain nutritious foods | |
Accessibility | Remote locations and difficult access for Inner Baduy | |
Time Constraints | Community members busy with farming activities | |
Learning Methods | Imitating elders rather than seeking new health information | |
Program Consistency | Lack of follow-up on health programs | |
Gender Segregation | Different expectations for health literacy between men and women | |
Impact of Low Health Literacy | Fatalism | Acceptance of health conditions as destiny |
High Maternal and Child Mortality | High rates of maternal and neonatal deaths | |
Vicious Circle | Low health literacy leads to poor health maintenance, higher health costs, and further fatalism. | |
Strategies to Improve Health Literacy | Developing the Health Literacy of Community Leaders | Empowering leaders like Jaro and traditional authorities to educate the community |
Managing IT-Based Health-Information Groups | Utilising cell phones and WhatsApp groups for health-information dissemination | |
Presence of Health Workers | Ensuring at least one health worker is always present in the community | |
Encouraging Collective Reflection | Discussing health incidents to learn and prevent future occurrences | |
Balancing Gender Communication | Providing gender-specific health education: nutrition for women and procedural literacy for men |
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Putri, L.D.; Agustin, H.; Bakti, I.; Suminar, J.R. Addressing Health Illiteracy and Stunting in Culture-Shocked Indigenous Populations: A Case Study of Outer Baduy in Indonesia. Int. J. Environ. Res. Public Health 2024, 21, 1114. https://doi.org/10.3390/ijerph21091114
Putri LD, Agustin H, Bakti I, Suminar JR. Addressing Health Illiteracy and Stunting in Culture-Shocked Indigenous Populations: A Case Study of Outer Baduy in Indonesia. International Journal of Environmental Research and Public Health. 2024; 21(9):1114. https://doi.org/10.3390/ijerph21091114
Chicago/Turabian StylePutri, Liza Diniarizky, Herlina Agustin, Iriana Bakti, and Jenny Ratna Suminar. 2024. "Addressing Health Illiteracy and Stunting in Culture-Shocked Indigenous Populations: A Case Study of Outer Baduy in Indonesia" International Journal of Environmental Research and Public Health 21, no. 9: 1114. https://doi.org/10.3390/ijerph21091114