Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.248-254 248 The Effect of Psychoreligy Dzikir Intervention on Self Efficacy and Blood Pressure on Hypertension Adivtian Ragayasa1*, Sylvina Rahmawati2, Emdat Suprayitno3 1Politeknik Kesehatan Surabaya, Surabaya, Indonesia 2Akademi Kebidanan Aifa Husada Madura, Madura, Indonesia 3Fakultas Ilmu Kesehatan, Universitas Wiraraja, Sumenep, Indonesia *Corresponding author: adivtianragayasa@gmail.com ABSTRACT Background: Hypertension is a chronic disease condition that causes impaired self-efficacy and increased blood pressure. One of the non-pharmacological therapies that can do is dzikir or dhikr therapy. Purpose: This study aimed to determine the effect of remembrance therapy on self-efficacy and blood pressure in hypertension. The study was an experimental study using a Randomized Pre Test-Post Test Control Group Design in hypertensive patients receiving psycho religious therapy. The subjects in this study were all hypertensive patients in the working area of the Teja Pamekasan Health Center, as many as 20 people. Methods: The selected sample in this study was some hypertensive patients taken by simple random sampling. Blood pressure measurements were carried out twice before psycho religious therapy and two weeks after psycho religious therapy. Psychoreligious therapy is a series of dhikr and prayer by saying the letter "Al-Fatihah" 7 times, then "Istighfar" 100 times, followed by solawat "Allahumma shall 'ala Muhammad wa Ali Muhammad" as much as 100 (Solawat "Ya sayyidi ya Rasulullah " as much as 1000 times) which does once every day. Mann Whitney U Test analyzed data. Results: The results of calculations using the Mann Whitney U Test statistical test showed a difference in blood pressure at the time of pre and post. The significance values indicate this at pre and post are 0.002 and 0.005. Conclusion: Psychoreligious therapy in remembrance can increase self-efficacy and reduce blood pressure in hypertensive patients in the elderly posyandu in the working area of the Teja Pamekasan Health Center. Keywords: dzikir therapy, hypertension, pshychoreligious Received March 10, 2022; Revised April 1, 2022; Accepted April 29, 2022 DOI: https://doi.org/10.30994/jnp.v5i2.217 The Journal of Nursing Practice, its website, and the articles published there in are licensed under a Creative Commons Attribution-Non Commercial- ShareAlike 4.0 International License. https://thejnp.org/ mailto:adivtianragayasa@gmail.com https://doi.org/10.30994/jnp.v5i2.217 Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.248-254 249 BACKGROUND Hypertension increases systolic blood pressure above 140 mmHg and diastolic blood pressure above 90 mmHg when measured twice at 5-minute intervals with sufficient rest or rest (Indonesia Ministry of Health, 2013). According to the age limit for hypertension patients, it is estimated that 23% of women and 14% of men aged over 65 years suffer from Hypertension (Indonesia Ministry of Health, 2014). The prevalence of high blood pressure in Indonesia became 25.8% of the whole populace of Indonesia (Indonesia Ministry of Health, 2013). Moreover, the second one purpose of dying after stroke is cardiovascular ailment, so this ailment is an ailment that desires to be discovered and endeavored for its treatment, each promotive, preventive, curative, and rehabilitative. High blood pressure may be due to numerous factors, along with lifestyle (smoking, ingesting alcohol), pressure or anxiety, obesity, loss of exercising and heredity (Suprayitno & Wahid, 2019). Stress is associated with high blood pressure due to the fact pressure is a bodily and mental strain which could stimulate the kidneys and launch the hormone adrenaline (Hanefa, 2019). Treatment of high blood pressure does not rely solely on doctors' medications and diets. It's also important to stay relaxed at all times. A calm state is required to activate the parasympathetic nervous system. The parasympathetic nervous system acts on the sympathetic nerves to reduce the body's production of stress hormones (Damayanti et al., 2019). In general, people suffering from illness are followed by feelings of anxiety and an uneasy soul. In addition to taking medicine, praying and dhikr can calm the individual's soul (Suprayitno & Wahid, 2019). As dhikr means remembering, it is a practice associated with other ritual worship. Dhikr can also be said as a form of awareness that a person has in establishing a relationship with the creator. Dhikr has a relaxing power to reduce tension and bring peace of mind. Every dhikr reading contains a profound meaning that can prevent tension (Setiyani, 2018). OBJECTIVE This study aimed to determine the effect of remembrance therapy on self-efficacy and blood pressure in hypertension. METHODS This research is classified as an experimental study using a Randomized Pre Test-Post Test Control Group Design in hypertensive patients receiving psycho religious therapy. The subjects in this study were all hypertensive patients in the working area of the Teja Pamekasan Health Center, as many as 20 people. The selected sample in this study was some hypertensive patients taken by simple random sampling. The sample was selected by simple random sampling on patients who voluntarily were willing to become research subjects with an experimental unit of 10 patients per group identified from secondary data at the Teja Pamekasan Public Health Center. Giving informed consent from patients by signing a letter of consent as research subjects to conduct interviews, fill out questionnaires, and measure self-efficacy. The provision of informed consent was based on explaining the aims and objectives of the study to understand the information. Blood pressure measurements were carried out twice before psycho religious therapy and two weeks after psycho religious therapy. Psychoreligious therapy is a series of dhikr and prayer by saying the letter "Al- Fatihah" 7 times, then "Istighfar" 100 times, followed by solawat "Allahumma shalli 'ala Muhammad wa ali Muhammad" as much as 100 (Solawat "Ya sayyidi ya Rasulullah " as much as 1000 times) which is done once every day. Data were analyzed using software (computer software) description of data with mean and standard deviation for normally https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.248-254 250 distributed data. Changes in anxiety and self-efficacy variables were analyzed with the Mann- Whitney U Test. RESULTS Table 1. Frequency Distribution of Gender and Age of Hypertension Patients in the Elderly Posyandu in the Working Area of Teja Pamekasan Health Center in November 2021 Characteristic Group Gender Intervention % Control % Female 6 60% 7 70% Male 4 40% 3 30% Total 10% 100% 10% 100% Age 50 – 60 3 30% 2 20% 61 – 70 6 60% 7 70% 71 – 80 1 10% 1 10% Total 10 100% 10 100% Based on the study results, the sex of hypertension patients in the treatment group mainly was female 6 (60%), and the rest were male as much as 4 (40%). In the control group, it was more significant for 7 (70%), and the rest were for men as much as 3 (30%). The age of hypertensive patients in the treatment group was 61-70 years old (60%), 71-80 years old (10%) and 50-60 years 3 (30%). In the control group, seven were greater, aged 61-70 years (70%), aged 50-60 years were 20%, and the rest were aged 71-80 years were 10%. Table 2. Test Results Differences in Self-Efficacy with Mann-Whitney U Test and Effects Before and After Being Given Psychoreligious Actions in the Form of Remembrance at the Elderly Posyandu in the Work Area of Teja Pamekasan Health Center Self-Efficacy Group Intervention Control Pre Post Pre Post Low 2 0 10 10 20% 0% 100% 100% High 8 10 0 0 80% 100% 0% 0% Total 10 10 10 10 100% 100% 100% 100% Sig Pre 0.004 Sig Post 0.000 Sig 0.008 0.14 https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.248-254 251 Table 3. Test Results of Differences in Systolic Blood Pressure Measurement Variables with Mann Whitney U Test and Effects Before and After Being Given Psychoreligious Actions in the Form of Remembrance at the Elderly Posyandu in the Work Area of the Teja Pamekasan Health Center in November 2021. Mean ±SD Sistole Intervention Control Mean pre ± SD 164 ± 17.68 140 ± 6,77 Mean post ± SD 133 ±9.5 153 ±17,1 Sig. pre 0.002 Sig. post 0.005 Sig. 0.005 0.41 The results of calculations using the Mann Whitney U Test statistical test showed a difference between pre and post. The significance value indicates this at pre and post-time is 0.002 and 0.005 ≤ 0.05, which means that there is a difference before and after being given psycho religious action in the form of remembrance. From the calculation of the difference above, to determine the effect, using the Wilcoxon statistical test, it was found that there was an influence of psycho religious actions in the treatment group. A significance value indicates this in the treatment group of 0.005 ≤ 0.05, which means that there is an effect of decreasing systolic blood pressure. Table 4. Test Results Differences in Diastolic Blood Pressure Measurement Variables With Mann Whitney U Test And The Effect Before And After Being Given Psychoreligious Actions in the Form of Remembrance at the Elderly Posyandu in the Work Area of the Teja Pamekasan Health Center in November 2021. Mean ±SD Diastole Intervention Control Mean pre ± SD 92.8 ±9.19 82.1 ± 10.53 Mean post ± SD 86 ±8.2 89 ±9.4 Sig. pre 0.021 Sig. post 0.519 Sig. 0.286 0.153 The results of calculations using the Mann Whitney U Test statistical test found a difference at the time of pre. There is a significant value of 0.021 < = 0.05, which means a difference before being given psycho religious action in the form of remembrance in the treatment and control groups. At the time of the post, there was no difference. This was indicated by a significance value of 0.519 > = 0.05, which means no difference in the treatment or control groups. From the calculation of the difference above, to determine the effect, using the Wilcoxon statistical test, it was found that there was no effect of psycho religious actions in the treatment group. A significance value indicates this in the treatment group of 0.286 > = 0.05, which means that there is no effect of decreasing diastolic blood pressure in the treatment group. For more details, see the blood pressure table. https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.248-254 252 DISCUSSION The study results prove an effect of psycho religious therapy in the form of remembrance on self-efficacy. This indicated by the results of calculations in the treatment group that ten hypertensive patients had a post-self-efficacy category higher than pre. The results of this study form the basis that psycho religious therapy with the remembrance of prayer can use to increase self-efficacy. Dhikr has a relaxing power to reduce tension and bring peace of mind. Each recitation of dhikr contains a profound meaning that can prevent tension (Pertiwiningrum & Kamalah, 2021). Every dhikr reading contains the meaning of an acknowledgment of trust and belief only in Allah SWT. Individuals who have high spirituality have a strong belief only in Allah, and this belief can lead to solid control and direct the individual in a positive direction (Anggraieni & Subandi, 2014). This study's results found differences between the treatment and control groups on the self-efficacy variable. After doing psycho-religious action in the form of remembrance in the treatment group, there was a 100% effect. In line with research conducted by Kumala et al. (2017) regarding the effectiveness of dhikr training in increasing mental calm in patients with hypertension, the results showed that there were differences in the level of mental calm in research respondents after being given dhikr relaxation training. The results of the different Wilcoxon rank test scores of Z = -2.673 and p = 0.008 (p <0.05) showed a significant difference in mental calm in the research respondents between before and after giving dhikr training. The average score of peace of mind on the respondents between before and after the dhikr training showed an increase from 78.56 to 98.33. These results indicate that dhikr training affects increasing mental calm and reduces the blood pressure of control respondents (Kumala et al., 2017). The study results prove that there is an effect of lowering blood pressure after psycho religious actions in the form of remembrance are carried out (Kumala et al., 2017). The results of this study form the basis that psycho religious therapy in the form of remembrance can reduce blood pressure on the condition that it is practiced every time, either after worship or when there is no activity (Annisafitri, 2020). Dhikr functions as a beta-blocker drug (beta-receptor blocker) in the work of the sympathetic nerves (Purnika & Roesmono, 2019). Dhikr, on the other hand, can make the brain wave flow into alpha waves when a person becomes very creative and highly reclusive so that every time the brain thinks (works), it produces biochemical reactions that react more strongly than others, depending on the emotional intensity of the mind and body (biology) closely connected (Aini & Astuti, 2020). Thoughts give rise to emotions that evoke chemical reactions. Some reactions are beneficial, and other reactions are impaired (Suprayitno & Huzaimah, 2020). This is in line with the research intending to reduce the use of drugs in treating hypertension and normalizing blood pressure. In this study, there were 40 respondents divided into two groups, namely the intervention group of 20 people and the control group of 20 people. The study results prove that there is an effect of lowering blood pressure after psycho religious actions in the form of remembrance is carried out. The results of this study form the basis that psycho religious therapy in the form of remembrance can reduce blood pressure on the condition that it is practiced every time, either after worship or when there is no activity. In general, people suffering from illness are followed by feelings of anxiety and an uneasy soul (Hakim & Ananingtyas, 2020). In addition to taking medicine, praying and dhikr can calm the individual's soul. As dhikr means remembering, it is a practice associated with https://thejnp.org/ Journal Of Nursing Practice https://thejnp.org/ ISSN: 2614-3488 (print); 2614-3496 (online) Vol.5 No.2. April 2022. Page.248-254 253 other ritual worship. Dhikr can also be said as a form of awareness that a person has in establishing a relationship with the creator (Setiyani, 2018). CONCLUSION Psychoreligious therapy in the form of remembrance can increase self-efficacy and reduce blood pressure in hypertensive patients in the elderly posyandu working area of Teja Pamekasan Health Center. ACKNOWLEDGMENTS The authors would like to thank the participants of this study. CONFLICTS OF INTEREST There is no conflict of interest. REFERENCES Aini, L., & Astuti, L. (2020). PENGARUH TERAPI RELAKSASI DZIKIR TERHADAP PENURUNAN TEKANAN DARAH PADA PENDERITA HIPERTENSI. Jurnal Kesehatan: Jurnal Ilmiah Multi Sciences, 10(01), 38–45. Anggraieni, W. N., & Subandi, S. (2014). 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