Cross-Cultural Analysis of the Role of Traditional Medicine in Health Access in Indonesia

This study investigates the contribution of traditional medicine on health care access in Indonesia through a quantitative cross-cultural approach. Utilizing a sample of 350 individuals that is diverse in terms of age, gender, and ethnic background, the study investigates the prevalence and characteristics that impact the use of traditional medicine. The findings show that traditional healing methods are heavily relied upon, especially by elderly people and members of specific ethnic groups. The necessity for culturally responsive healthcare practices is highlighted by the discovery that cultural beliefs are important determinants of health-seeking behaviour. The results add to the growing body of knowledge about the integration of traditional medicine into modern healthcare systems by highlighting the significance of customizing therapies to the many cultural settings found throughout Indonesia.


INTRODUCTION
Indonesia's complicated and nuanced relationship between traditional medicine and contemporary healthcare methods is a reflection of the country's diverse cultural fabric.In Indonesia, traditional medicine is commonly used, especially with young patients.3.4% of children consulted a traditional practitioner and 6.2% of children utilized traditional medicines as a treatment in the last four weeks, according to a national population-based survey carried out in 2014-2015.The primary motivations for seeing a traditional practitioner were for medical treatment (14.8%) and massage (86.8%).Having a birth certificate, which serves as a stand-in for higher economic status, and having low self-rated health were factors linked to the use of traditional medicine.The usage of traditional practitioners was linked to worse self-rated health and younger age [1].
The religious and spiritual aspects of Indonesia also have an impact on the country's healthcare system.Within the current healthcare system, Indonesian doctors are known to work in conjunction with practitioners of traditional, complementary, and alternative medicine (TCAM).The physicians' religious and spiritual beliefs, which impact how they view integrated medical and spiritual care, have an impact on this collaboration [2].
There are some difficulties, though, in incorporating traditional medicine with Indonesia's contemporary healthcare system.Access to medical treatment is still a major problem, especially in rural and isolated places.Providing healthcare services in the nation presents logistical issues due to its large archipelago and uneven population distribution [3].Moreover, there can be considerable regional differences in the quality of healthcare services; for example, Jakarta has a higher human development index than Papua [4].
Indonesia is rapidly modernizing, and as a result, traditional medicine's role is changing.
There is an increasing focus on fusing traditional methods with contemporary healthcare systems.For most people living in rural Indonesia, traditional medicine is their only access to healthcare and is ingrained in their cultural history, being passed down from generation to generation [5], [6].
Using technology to preserve and spread knowledge about traditional medicine is one important advancement.For example, the Usada Hindu Bali app offers users a different option to select the treatment of their choosing by providing knowledge about traditional Balinese medicine [7].By employing traditional medicinal knowledge through technology-based applications, this application not only increases the value of Balinese culture but also enhances the community's health [7].
Modern healthcare systems are not without their difficulties, though.In comparison to the quantity of traditional practitioners, modern healthcare facilities are generally located in rural areas with restricted accessibility.Opting for traditional treatment is often motivated by factors such as high expenses, cultural beliefs, mistrust, and remoteness from contemporary healthcare facilities.
Furthermore, there are proposals for the protection of traditional medical knowledge through intellectual property rights, as it is now acknowledged as intellectual property [5].This is to safeguard the environment and the cultural and economic rights of indigenous people [5].
In Indonesia, traditional medicine has long been a mainstay of healthcare, with its roots in cultural history.To address the wide range of health requirements of the community, it is imperative to comprehend the changing role of traditional medicine as the nation quickly modernizes.
Indonesia's blend of ancient and contemporary medical procedures is a symbol of the country's dynamic cultural environment.The term "traditional medicine" refers to a wide range of indigenous methods that have been passed down through the years and are valued by the various ethnic groups who inhabit the archipelago.Through a cross-cultural analysis that focuses on the function of traditional medicine in healthcare access, this research aims to clarify the complex relationship between culture and healthcare.

Traditional Medicine in Indonesia
Traditional medicine in Indonesia is deeply ingrained in the nation's cultural fabric, representing a diverse array of indigenous healing practices.With roots tracing back through generations, these practices vary across the archipelago's numerous ethnic groups and regions.Javanese jamu, Balinese Usada, and Dayak traditional healing, among others, encapsulate the rich tapestry of traditional medicine [8]- [10].Studies [11]- [13] have documented the therapeutic potential of traditional herbal remedies, emphasizing their historical significance and continuing relevance in addressing various health conditions.

Health Access in Indonesia
Access to healthcare in Indonesia is marked by a complex interplay of geographical, economic, and cultural factors.Geographical disparities pose challenges to rural populations, limiting their access to modern healthcare facilities [14]- [16].Economic constraints further compound these challenges, disproportionately affecting vulnerable populations.Additionally, cultural beliefs and practices influence health-seeking behaviors, with some communities relying more heavily on traditional healing methods [17]- [19].Understanding these factors is crucial for designing interventions that enhance overall health access.

Cultural Factors Influencing Health-Seeking Behavior
Cultural factors play a pivotal role in shaping individuals' health-seeking behaviors [20]- [22].The Health Belief Model and the Theory of Planned Behavior [23] provide frameworks to understand how cultural perceptions, beliefs, and norms influence healthcare decisions.Studies in Indonesia [24]- [26] have underscored the significance of cultural factors in determining the preference for traditional medicine over modern healthcare, highlighting the need for a nuanced understanding of these dynamics.

Integration of Traditional Medicine into Modern Healthcare
Globally, there is a growing recognition of the potential benefits of integrating traditional medicine into modern healthcare systems.The World Health Organization [27], [28] emphasizes the importance of incorporating traditional medicine into national health strategies, particularly in countries with rich traditional healing practices.Successful integration models from countries like China and India provide insights into the positive outcomes of a harmonious coexistence of traditional and modern healthcare [29]- [32].However, the process of integration requires careful consideration of cultural sensitivities and effective collaboration between traditional healers and modern healthcare practitioners.

Current Research Landscape
Existing studies in Indonesia have predominantly focused on either traditional medicine or modern healthcare practices.Few have taken a holistic approach to understanding the coexistence of these systems.This research aims to fill this gap by providing a comprehensive cross-cultural analysis, examining how traditional and modern healthcare practices interact within the diverse cultural contexts of Indonesia.

METHODS
This study uses a quantitative approach to conduct a cross-cultural analysis of the role of traditional medicine in health access in Indonesia.A cross-sectional study design will be used to collect data at a single point in time, which allows for examination of relationships between variables and assessment of prevalence and patterns.

Study Population and Sample
The target population consists of individuals from different ethnic groups and regions in Indonesia.Using stratified sampling techniques, participants will be selected to ensure representation from various cultural backgrounds.The sample size will be determined using statistical power calculations to achieve a level of confidence in the findings.Stratification will allow for a more in-depth understanding of traditional medicine practices in specific cultural contexts, a total of 350 samples are involved in this study.

Data Collection
The main data collection method will be a structured survey conducted through online and offline channels.The survey instrument will be developed based on the research objectives and will include sections on demographic information, health-seeking behavior, cultural beliefs, and utilization of traditional and modern health care.The survey will undergo pilot testing to refine the questions and ensure clarity.
In addition, qualitative data may be collected through in-depth interviews or focus group discussions to provide deeper context and insights into the cultural nuances associated with healthcare choices.

Data Analysis
Descriptive statistics were used to summarize the demographic characteristics of the sample and provide an overview of the prevalence of traditional medicine use.Inferential statistical methods, including regression analysis, and simultaneous analysis of variance, were used to explore relationships between variables.These analyses helped identify significant associations and patterns in the data.Comparative analysis is conducted to assess variations in traditional medicine practices among different ethnic groups.Statistical tools will be used to highlight similarities and differences in health-seeking behaviors with SPSS.

Descriptive Results
Demographic analysis revealed a diverse research population (n=350) representing various age groups, genders, and ethnic backgrounds.Approximately 60% of the participants identified with traditional cultural practices, while the remaining 40% reported a more westernized lifestyle.The prevalence of traditional medicine use was significant, with 75% of respondents indicating some level of involvement.Of these, 45% reported using traditional medicine regularly, indicating a substantial reliance on traditional healing practices.

Influence of Culture on Health Seeking Behavior
Regression analysis showed a statistically significant relationship (p<0.001) between cultural beliefs and health-seeking behaviors.Participants with stronger cultural ties were 1.5 times more likely to choose traditional medicine over modern healthcare, emphasizing the profound impact of cultural factors.
Regression analysis tests showed variation in the use of traditional medicine across different age groups (χ2 = 24.6,p < 0.05) and ethnicities (χ2 = 36.2,p < 0.001).Younger participants (18-30 years old) showed a preference for modern healthcare, with only 30% relying on traditional medicine.In contrast, individuals over 50 years old, especially from certain ethnic backgrounds, showed a higher propensity towards traditional medicine (60%).

Socioeconomic Status and Health Access
Simultaneous test analysis showed significant differences in health access associated with socioeconomic status (F(2, 997.) = 12.3, p 0.000).Participants with lower socioeconomic status reported higher use of traditional medicine and faced greater barriers to accessing modern healthcare services.