Family support, community cultural traditions, quality of health services on the utilization of health services at Puskesmas in Coastal Areas: A literature study

 Corresponding author: Rahman Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. Family support, community cultural traditions, quality of health services on the utilization of health services at Puskesmas in Coastal Areas: A literature study Rahman 1, *, Lisnawati 2 and A Karlina Askarini Makassau 3 1 Department of Public Health, Public Health Faculty, Halu Oleo University, Indonesia. 2 Hospital Administration Bachelor's Degree Program, Pelita Ibu Health Sciences College, Kendari, Indonesia. 3 Hospital Administration Bachelor's Degree Program, Panakkukang Health Sciences College, Makassar, Indonesia. World Journal of Advanced Research and Reviews, 2025, 26(03), 1806-1817 Publication history: Received on 26 April 2025; revised on 11 June 2025; accepted on 13 June 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.26.3.2332 Abstract Background: Primary health services such as health centers play a strategic role in improving the health status of the community, especially in coastal areas that often experience limited access to health services. However, the utilization of health center services by people in coastal areas is still relatively low and uneven. This phenomenon is influenced by various factors, both in terms of individuals, families, and the socio-cultural environment of the community. This study aims to analyze the relationship between family support, community cultural traditions, and the quality of health services on the utilization of health services in coastal health centers. Methods: This study aims to analyze the relationship between family support, community cultural traditions, and health service quality on the utilization of health services in coastal health centers. Results: The results of this literature study show that the utilization of health services in coastal areas is influenced by three main factors, namely:Family support plays an important role in encouraging individuals, especially the elderly and vulnerable groups, to access health services.People's cultural traditions are still very strong in influencing health behavior. Belief in traditional medicine, myths, and hereditary values is an obstacle in the use of modern health services. The quality of health services such as reliability, empathy, and patient orientation has been proven to have a significant relationship with the level of satisfaction and reutilization of health center services. Conclusion: Based on the results of a literature review of ten scientific articles, it can be concluded that the use of health services in coastal areas is influenced by three main factors, namely family support, community cultural traditions, and the quality of health services. Keywords: Family Support; Community Cultural Traditions; Health Service Quality; Utilization; Health Services 1. Introduction Primary health services such as health centers play a strategic role in improving public health, especially in coastal areas that often experience limited access to health services Ministry of Health of the Republic of Indonesia, 2020 (WHO, 2018.)However, the utilization of health center services by people in coastal areas is still relatively low and uneven. This phenomenon is influenced by various factors, both in terms of individuals, families, and socio-cultural environments Community. (24) World Journal of Advanced Research and Reviews, 2025, 26(03), 1806-1817 1807 Many factors have been declared as challenges in health development such as the environment and facilities that are not supportive, including the inadequate provision of clean water, the lack of good environmental sanitation, the high prevalence of infectious diseases and other infectious diseases, and the still high rate of infant births and deaths. However, what also needs to be addressed as a challenge for the development of the community is the response of the people's behavior in accepting change. Family support is one of the important factors in encouraging individuals to take advantage of health services. The family as the smallest unit in society has a significant influence on health decisionmaking, including the decision to access health centers. Studies show that individuals who receive family support tend to be more active in seeking medical help and undergoing treatment regularly.(2) One of the main obstacles to the acceptance of health programs is the cultural constraints in the community that originally only knew the traditional medical system. The community in the unity of tribes with their own cultural identity is still alive, owning and developing its own medical system as part of their culture in turn.(2) In addition, the cultural traditions of the community also affect health behavior, including in terms of the use of health center services. Trust in traditional medicine, social norms, and views on certain diseases is often an obstacle to the use of modern health services. In some coastal areas, people prefer alternative medicine because it is considered more in line with local cultural values. (3) The quality of health services provided by the health center is also the main determinant in attracting public interest in treatment. Factors such as the competence of medical personnel, the availability of drugs, adequate facilities, and the attitude of health workers affect patient satisfaction and the sustainability of service utilization. (15) Therefore, this study aims to analyze the relationship between family support, community cultural traditions, and the quality of health services on the utilization of health services in coastal health centers. The results of this study are expected to provide recommendations in efforts to improve the coverage and quality of primary health services in coastal areas. 2. Methods The method used in writing this research is a literature review study. Literature review is a scientific study that focuses only on one specific topic. This study aims to analyze various sources of literature selected so that it becomes a conclusion and can become a new idea. This research uses sources of journal literature and scientific articles that have been previously published online through Google Scholar and SINTA using several keywords related to family support, community cultural traditions, quality of health services in the utilization of health services. From the results of selecting articles, 10 articles were obtained that were in accordance with the research inclusion criteria. World Journal of Advanced Research and Reviews, 2025, 26(03), 1806-1817 1808 3. Results and discussion Table 1 Literature Review NO Researcher Name Research Title Research Objectives Research Methods Research Results Conclusion 1 Anisa Mutiara et. al.(2023) Tradition of Coastal Community Beliefs Regarding the Health of Pregnant Women in Belawan I Village, Medan Belawan District The purpose of this research is to explore the traditions of coastal communities in traditional pregnancy, childbirth and postpartum care, utilizing existing health care This research is an explorative research with a qualitative approach, which explores and examines information about the habits or customs of the community related to pregnancy, childbirth and postpartum care in terms of efforts to deal with problems and prevention efforts with the factors that affect them. The results of the study show that the tradition of the Coastal Community in Belawan I Village, Medan Belawan District, who are already and are pregnant, still believes in it, both prohibited and recommended. In the tradition of pregnant women in the environment, they do several things, including using a single garlic, jeriango, hedgehog thorns knotted in hair as a tree, drinking cooking oil to facilitate childbirth, avoiding sugarcane water and coconut water because it interferes with fetal development and so on. In the tradition during pregnancy, things that are done include wearing a stick, prohibiting behavior outside of maghrib, and challenging certain foods, the reasons found regarding these taboos are symbolic to show people's concern during pregnancy. They do not object to the existence of this tradition and are burdened in carrying it out because they believe that what their ancestors did was done for generations. In addition to tradition, the role of midwives and health centers is an alternative in childbirth assistance and pregnancy examinations. 2 Nurulsiam S. Salasim et. al. (2021) The Relationship between Service Quality and Inpatient Satisfaction Level at Pasir Panjang Health Center, Kupang City This study aims to determine the relationship between service quality and the satisfaction level of inpatients at the Pasir Panjang Health Center, Kupang City in 2019. This type of research is an analytical survey with a crosssectional study approach. The sample of this study amounted to 118 inpatients obtained through simple random sampling using the probability sampling method. Data collection was carried out with 42 items of questionnaires on health service quality and patient satisfaction The results of the study showed that there was a relationship between the dimensions of tangible evidence, reliability, responsiveness, assurance and empathy and the level of satisfaction of inpatients at the Pasir Panjang Health Center, Kupang City in 2019. There is a relationship between the dimension of tangible evidence, the dimension of reliability, the dimension of responsiveness, the dimension of assurance and the dimension of empathy with the level of satisfaction of inpatients at the Pasir Panjang Health Center, Kupang City in 2019. World Journal of Advanced Research and Reviews, 2025, 26(03), 1806-1817 1809 NO Researcher Name Research Title Research Objectives Research Methods Research Results Conclusion 3 Resta Mutiara Yudha et, al. (2024) The relationship between the quality dimension of health services and the reuse of inpatient services at the UPTD of the Bojonggambir Health Center, Tasikmalaya Regency The purpose of the research is to determine the relationship between the quality dimension of health services and the reutilization of inpatient services at the UPTD Bojonggambir Health Center, Tasikmalaya Regency. Types of quantitative research with analytical methods and cross sectional design. The sample in this study was 105 people obtained by purposive sampling technique, data was collected using observation and questionnaires The dimensions of effective service quality, safety, patient-oriented, timely, efficient, fair, integrated include good and mostly reuse inpatient services. There is a relationship between the dimensions of effectiveness, safety, patientoriented, timely, efficient, fair and integrated, with the patient-oriented dimension variable as the dominant variable related to the reuse of inpatient services. 4 Dedek Safitri et al. (2022) The relationship between the quality of health services and the satisfaction of BPJS users at the Inderapura Health Center, Pancung District, South Pesisir Regency The purpose of this study is to determine the relationship between the quality of health services at the health center and the satisfaction of patients using BPJS using five dimensions, namely reliability, responsiveness, assurance, empathy and physical evidence The method used in this study is a quantitative research with a descriptive analysis design with a cross sectional approach. Cross-sectional research examines an event at a time at a time. This study aims to determine the relationship between the quality of health services and the satisfaction of BPJS users at the Inderapura Health Center, Pancung Soal District, South Pesisir Regency in 2022 The results of this study showed that there was no relationship between service quality to the physical evidence dimension (tangible) p-value (0.117) > 0.05, the responsiveness dimension of p-value (0.456) > 0.05 and the dimension of assurance (assurance) pvalue (0.577) > 0.05. And there is a relationship between service quality to the reliability dimension of pvalue (0.014) < 0.05, and the dimension of empathy (emphaty) p-value (0.043) < 0.05. The conclusion in this study is that there is no relationship between quality and physical evidence dimensions, responsiveness and assurance and patient satisfaction, and there is a meaningful relationship between service quality, reliability and empathy and BPJS patient satisfaction. It is hoped that the health center can maintain and be able to improve the quality of health services that are already good, and it is also expected to conduct periodic surveys of the quality of health services and patient satisfaction, especially in the five dimensions 5 Feny Widiyastuty et al. (2023) Socio-Cultural Relations with the Utilization of Services This study aims to analyze socio-cultural relations with the use of This study is a quantitative research with a cross sectional design. The research population is all families in Entikong District. A research The results of statistical analysis showed that there was a socio-cultural relationship with the use of services at the Entikong The conclusion of the results of this study is that there is a relationship between socioculture and the use of services at the Entikong World Journal of Advanced Research and Reviews, 2025, 26(03), 1806-1817 1810 NO Researcher Name Research Title Research Objectives Research Methods Research Results Conclusion at the Entikong Health Center health services at the Entikong Health Center. sample of 250 families was selected using a proportional random sampling technique. The research was conducted in Entikong District in September – November 2022. Health Center. (pvalue=0.000, 95%CI 1.6474.680). Increased understanding of diseases and their treatment can reduce public trust in health myths. Health Center. The high public trust in the myth of diseases and the tradition of medicine inherited from ancestors prevents people from taking advantage of treatment at the Health Center. 6 Raihan Melisa Lubis and Sulistiawati (2022) Factors Affecting the Utilization of Coastal Public Health Services in Indonesia Able to summarize what factors affect the utilization of health services on the coast of Indonesia The method of this study is to use Systematic Review. The literature criteria are to collect literature sources from scientific journals or scientific papers through a comprehensive search from 3 indexed journal bases Google Scholar, Medline/Pubmed, and Open Science Framework/OSF The results of the study show that there are 5 main categories of risk factors that are widely researched, namely demographics, social circumstances, attitudes/beliefs, family income sources, and resources. In the demographic variable, a significant factor with the utilization of health services is gender. In the factors that affect the use of services, there are 5 main categories of risk factors that are widely researched, namely demographics, social circumstances, attitudes/beliefs, family sources of income, and resources. In demographic variables, and gender are significant factors with the use of health services. Education, tradition and social support are the most significant factors in the variables of social circumstances. 7 Rahman et, al. (2024) The relationship between the perception of health and illness and the use of health services in rural coastal communities in the working area of the Kapoiala Health Center and the Soropia Health Center, Konawe To find out the relationship between the healthy perception of sick and the use of health services in coastal rural communities of Konawe Regency. The type of research used is quantitative descriptive with a cross-sectional study approach, namely looking for the relationship between the perception of healthy illness and the utilization of health services in coastal rural communities of Konawe Regency. The number of The results of the statistical test showed that the value of ÿ (0.942) > 0.05 which means that there was no significant relationship between the perception of being sick and the utilization of coastal rural public health services in Konawe Regency. Of the 442 people who used health service facilities There was no significant relationship between the perception of health and illness and the use of health services in rural coastal communities. Therefore, the Health Office needs to consider policies regarding the placement, workload analysis and equitable distribution of health World Journal of Advanced Research and Reviews, 2025, 26(03), 1806-1817 1811 NO Researcher Name Research Title Research Objectives Research Methods Research Results Conclusion Regency, Southeast Sulawesi Province, Indonesia, 2023 samples in this study is 535 people. (Puskesmas), there were 320 respondents (72.40%) who had a healthy perception of being sick in the good category and 112 respondents (27.60%) who had a healthy perception of being sick in the bad category. Meanwhile, of the 93 respondents who did not use health service facilities, there were 73 respondents (78.49%) who had a healthy perception of being sick in the good category and 20 respondents (21.51%) who had a bad perception. workers so that the workload of officers is not too high and can provide maximum health services and increase public knowledge by conducting health promotion or providing health education to the public about the services available at the Health Center. 8 Sunik Cahyawati et al. (2021) Factors Related to the Utilization of Integrated Health Service Centers for the Elderly . The purpose of this study is to determine the relationship between the use of health centers on attitudes, family support, the role of cadres, and the distance of access to health services for the elderly The method used was quantitative with a cross sectional design, a sample of 121 respondents, namely the elderly aged 60 years and above. This study obtained a significant relationship between the attitude of the elderly with a p-value (0.001), family support with a p-value (0.00), and the role of cadres with the use of elderly health service centers while the distance to the posyandu was not significantly related to the p-value (0.513). Family support and the role of cadres are needed to support the interest and readiness of the elderly in building a positive attitude towards the Health Center, the distance to health service places is not a problem. There is a relationship between the attitude of the elderly, family support, and the role of cadres in the utilization of Puskesmas while there is no relationship between the distance of access to health service places and the use of Puskesmas. 9 Susy K. Sebayang et, al. (2021) Behavior of Seeking Coastal Public Health Services in Aims to find out the behavior of seeking coastal public health Data from cross-sectional surveys of metabolic syndrome and mental health conducted More than half of coastal communities in Banyuwangi Regency go to health services About half of the community members in coastal Banyumas Regency access World Journal of Advanced Research and Reviews, 2025, 26(03), 1806-1817 1812 NO Researcher Name Research Title Research Objectives Research Methods Research Results Conclusion Banyuwangi, Indonesia: CrossSurvey Results services in Banyumas Regency. in coastal communities in Banyumas Regency were used for the analysis. Participants who were randomly selected from the list of members of the Family Welfare Development Group (PKK) were asked to be interviewed at the relevant village office. for treatment and 7 out of 10 people go to health services. to seek health for their family members. Women are more likely than men to visit health services when they or their family members are sick. Private doctors are more popular than health centers. Private midwives are the most popular service for antenatal care (ANC) and childbirth. Although there was no clear increase in healthcare utilization over time, we found that contraceptive utilization increased over time health services for themselves and 7 out of 10 people access them for their family members. Private practice midwives are the most in-demand service for ANC and childbirth. The use of health services needs to be further improved in coastal communities, especially for men's health. 10 Rifqi Abdul Fattah et, al. (2025) Factors influencing the utilization of health services in Indonesia's national health insurance system – cross-sectional study This study aims to identify the factors that affect the utilization of health services in Indonesia This study analyzes crosssectional survey data collected by the "Equity and Health Care Financing in Indonesia" (ENHANCE) Study. The Andersen model of health service use behavior was adopted as a framework to understand the utilization of health services in Indonesia. Sociodemographic variables are categorized into predisposing factors, supporting factors, and need factors. Outcome measures include the utilization of primary and secondary health services. A multilevel logistic regression model was run to Of the 31,864 individuals included in the ENHANCE survey, about 14% had used outpatient services in the past month. Less than 5% of the study population had visited a hospital for inpatient care and about 23% used maternal and child health services in the past 12 months. Age, gender, and selfassessed health are the main determinants of health service utilization. No significant differences were found in primary care utilization among people with different insurance statuses, but people who received This study shows that the distribution of health service utilization in Indonesia is largely even because predisposing factors (age and gender) and health needs are found to greatly affect the utilization of various types of health services. However, enabling factors such as health insurance status were also found to be related World Journal of Advanced Research and Reviews, 2025, 26(03), 1806-1817 1813 NO Researcher Name Research Title Research Objectives Research Methods Research Results Conclusion examine the factors associated with each type of healthcare utilization. subsidized premiums under JKN received primary care from public health facilities and were less likely to receive primary care from private health facilities. Compared to people who pay JKN insurance premiums on their own, those who are uninsured and those whose premiums are subsidized to visit public and private hospitals World Journal of Advanced Research and Reviews, 2025, 26(03), 1806-1817 1814 3.1. Family Support Based on the results of the literature table, family support plays an important role in encouraging the use of health services by individuals, especially in the context of coastal areas that still have limited access and facilities. The family acts as a source of motivation, mentoring, and decision-making in accessing health services. The study by and emphasizes the importance of family support for service-seeking behaviors, particularly for older groups and coastal communities. This support includes assistance to health facilities and strengthening positive attitudes towards health center services. (Cahyawati, 2020) (Lubis, 2024) (8) (11) Family support is an important factor in health-related decision-making, especially in the context of the nuclear family such as husband, wife, children, and parents. The form of family support can be in the form of emotional support (motivation and attention)(Indriani, 2021), Information support (knowledge of the importance of health services), Instrumental support (assistance in the form of transportation, costs, etc.), Decision support (joint decision to access health services). Individuals who receive support from their families will be more motivated to use health services, including health centers. (3) According to the family system theory by Wright and Leahey (2009), the family is an interdependent system, where individual decisions and actions are influenced by all family members. In the context of health, the family plays the role of a companion, decision-maker, and provider of emotional and material resources. This is in line with Andersen's health behavior model which identifies enabling factors such as family social support as determinants of health service utilization. Cahyawati's research shows that there is a significant relationship between family support and the use of health services by the elderly. Supported seniors tended to have a positive attitude and accessed health centers more often and also found that families who actively accompanied their family members had a major influence on the decision to seek medical attention, especially in remote areas.(2020) (1) Family support in the form of reminders of examination schedules, transportation assistance, and psychological support has been shown to increase the regularity of visits to health facilities. In coastal communities, where infrastructure and economic constraints are major challenges, the role of the family is increasingly crucial. Family support has an important role in determining whether a person utilizes health services, including health centers. This support can be in the form of emotional, informational, financial, and decision-making support. Family support not only strengthens the decision to seek treatment, but also serves as a bridge in overcoming geographical and financial access barriers. Therefore, interventions involving families can increase the effectiveness of health care programs. 3.2. Community Culture Based on the results of the literature review, local traditions and cultural values also shape public health behavior. Belief in traditional medicine, myths about diseases, and certain prohibitions and taboos are factors that hinder the use of formal health services. For example, research by shows that people still hold to ancestral medicine traditions such as the use of amulets or the prohibition of certain foods during pregnancy. Nonetheless, this tradition does not completely reject modern services, but rather is complementary. Therefore, a culture-based promotive and educational approach is needed to increase acceptance of modern health services. (Mutiara, 2023) (12). In addition, people's culture, such as traditional beliefs, norms, and social values, greatly influences people's perception of diseases and treatments. Many people in certain areas prefer alternative medicine or shamans to health centers for hereditary beliefs. Community culture encompasses the traditional beliefs, values, norms, customs, and practices embraced by a particular community. Culture can influence the way people view diseases and how they choose treatment methods. Culture plays an important role in determining how individuals view health and illness. Leininger's theory of Transcultural Nursing emphasizes that cultural beliefs profoundly influence health behaviors and treatment decisions. Meanwhile, the theory of planned behavior (Ajzen, 1991) explains that subjective norms – which in this context refer to cultural values – are the main determinants of behavioral intentions. Mutiara researched traditional practices during pregnancy in the coastal communities of Belawan. They found that belief in amulets, dietary abstinence, and the use of cooking oil to facilitate childbirth became a barrier to the use of formal health services. However, they also mentioned that services such as pregnancy check-ups at health centers are starting to be accepted as a complement to traditional practices.(2023)(12)