Wiwit Ciptaningsih Haryanto, Edi Widjajanto, Jack Roebijoso and Harsuko Riniwati
Abstract
Quality of life can determine the length of stay of the patient. The better the quality of life of patients, the higher the level of patient comfort in the hospital. This can affect the incidence of Discharges Against Medical Advice (DAMA) during treatment at the hospital. DAMA was an indicator of the lack of quality of hospital health services. DAMA to patients in general caused by trust/ hope for recovery has begun to disappear. One approach that can raise hopes of healing is through a cultural approach. One of culture that was known in Bolaang Mongondow is Mododuluan. Mododuluan is a form of mutual cooperation and help traditionally bequeathed ancestors. The purpose of this study was to obtain a model of improving the quality of life in the context of controlling the incidence of forced discharges using a cultural approach to the Bolmong community. This research uses quantitative research. The number of respondents was 156 patients. The study was conducted at Datoe Binangkang Bolmong Hospital in August 2019. The research variables were quality of life, DAMA, health insurance and modululuan. Data collection using a questionnaire. Data analysis with SEM analysis using smart PLS. The results obtained that age, education, type of work, LoS, and quality of hospital services are indicators of DAMA. Where the biggest indicator of influence is age. The participation of BPJS and general patients is an indicator of Health Insurance. The biggest indicator of influence is BPJS membership. The ethos of unity (motobatu), ethos of cooperation (Mobobatungan), mutual improvement (Pogogutat) and mutual support as indicators of Mododuluan. The biggest indicator of its influence is the ethos of unity. Physical functions, emotional functions, social functions, psychological welfare dimensions, and environmental dimensions are indicators of quality of life. The most influential indicator is social function. Modululuan culture positively and significantly influences the quality of life and quality of life and modululuan culture positively and significantly influences DAMA. This study also found that the improvement of quality of life through DAMA was strengthened if through modululuan culture and reduced DAMA through quality of life where modululuan was the strongest moderating variable. The conclusion of this study was that mododuluan is the strongest moderating variable to improve quality of life in order to control the DAMA of patients from the hospital. Based on the results of this study, the modululuan must be preserved. Mododuluan can be translated into political, economic, social sectors, and can even be a capital for the community in developing a strong environment, village, sub-district/ city, province and even country. Even in the midst of the industrial revolution 4.0, Mododuluan can reduce tribalism, fanaticism, radicalism and even intolerance.