p-ISSN 1693-5683; e-ISSN 2527-7146 71 Vol. 19, No. 2, November 2022, pp. 71-77 Research Article Profile of The Use of Traditional Medicines Among Adolescents in SMK Farmasi Teladan Demak Barnabas Bagus Aditya Abadi 1*, Aris Widayati2 1 Master of Pharmacy, Faculty of Pharmacy, Sanata Dharma University, Paingan, Maguwoharjo, Depok, Sleman, Yogyakarta 55282, Indonesia 2 School of Pharmacy, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Jl. Lingkar Selatan, Yogyakarta 55183, Indonesia https://doi.org/10.24071/jpsc.003638 J. Pharm. Sci. Community, 2022, 19(2), 71-77 Article Info ABSTRACT Received: 28-08-2021 Revised: 03-01-2022 Accepted: 23-03-2022 *Corresponding author: Barnabas Bagus Aditya Abadi email: bagus.aabadi@gmail.com Keywords: Adolescents; Indonesia; traditional medicine The use of traditional/herbal medicines is prevalent among Indonesians. However, the description of such use among adolescents is scarce. This study aimed to describe the profile of traditional medicine used by adolescents. This study conducted a descriptive survey as a preliminary study of a proposed research to explore adolescent intentions and behavior in the use of traditional medicines. Respondents were students of SMK Farmasi Teladan Demak. Data were obtained from 78 respondents using a structured interview guideline in Google Forms. Data were analyzed descriptively. The results of this preliminary study show the profiles of traditional medicines usage among adolescents, as follows: 1) 35% of respondents use traditional medicine once a month, 2) 44% of the respondents said the traditional medicine is more harmless than conventional medicine, 3) 96% of respondents showed an interest in "jamu gendong", 4) 86% of the respondent preferred "jamu beras kencur", 5) 79% of respondents use branded traditional medicine for the common cold, 6) 51% of respondents cited the Internet as a source of information about branded traditional medicines, and 7) 78% of respondents purchased branded traditional medicines at pharmacies. This preliminary study identified particular beliefs regarding traditional medicines among adolescents, such as it is safer, natural and practical. The Internet becomes the primary source of information about traditional medicines. The adolescents found it is easy to use traditional medicines, as they can be quickly obtained from a pharmacy. Further research is needed to explore the factors that influence the behavior of using traditional medicine among adolescents. INTRODUCTION In almost all countries, traditional medicine has a role and a long history in medicine. The World Health Organization (WHO) has recorded a significant development in the last two decades of the role of traditional medicine in improving public health status. The WHO has recommended using traditional medicines, including herbs, to prevent and treat disease, especially for chronic diseases (WHO, 2003). Traditional medicine, called herbal medicine by the WHO, includes herbs and products containing plant parts. Herbal medicines can contain natural organic or inorganic active ingredients derived from plants, animals, and mineral materials (WHO, 2019). Many countries have placed traditional medicine in an essential position in health care. In 2018, 64% of the WHO member countries had regulations regarding traditional medicine, including 45 countries in Europe (85% of all countries in Europe) and ten countries in Southeast Asia (91% of all countries in Southeast http://issn.pdii.lipi.go.id/issn.cgi?daftar&1180428136&1&& http://issn.pdii.lipi.go.id/issn.cgi?daftar&1465346481&1&& https://e-journal.usd.ac.id/index.php/JFSK/index https://creativecommons.org/licenses/by/4.0/ https://doi.org/10.24071/jpsc.003638 Research Article Journal of Pharmaceutical Sciences and Community Profile of The Use of Traditional Medicines ... 72 Abadi and Widayati J. Pharm. Sci. Community, 2022, 19(2), 71-77 Asia). In addition, more than 50% of the WHO member countries recognize the vital role of traditional medicine in their health systems (WHO, 2019). Traditional medicine in Indonesia can be grouped into three major groups: "Jamu," "Obat Herbal Terstandar" (OHT), and "Fitofarmaka". The three groups are recognized from scientific evidence availability, i.e., practical experience for "Jamu," pre-clinical trials for OHT, and clinical trials for "Fitofarmaka" (BPOM RI, 2004). The development and utilization of traditional medicine in Indonesia are supported by 30,000 types of plants and animals that can be used as medicine, and 300 of them have been formulated into herbal medicine from generation to generation. Until now, Indonesia already has 23 "Fitofarmaka" products (BPOM RI, 2019). The plants most widely used in the manufacture of herbal medicine include Zingiber officinale, Alpinia galanga, Curcuma longa, Curcuma zanthorrhiza, Elettaria cardamomum, Morinda citrifolia, Phaleria macrocarpa, Strobilanthes crispa, Andrographis paniculata, Aloe vera, etc. (Direktorat Jenderal Hortikultura, 2014). Commonly, traditional medicine is considered more harmless to be used than conventional medicine. Most people think that the side effects of traditional medicine are minimum (Abdel-Qader et al., 2020; Bayisa et al., 2014). Riskesdas 2018 data provide a clear picture that more than 50% of the Indonesian population have used traditional medicines or herbal medicines, both in dosage forms produced by pharmaceutical companies and home-made (Balitbangkes Kemenkes RI, 2019). More than 65 million people are aged between 10 and 24 years in Indonesia, representing around 28% of the population (WHO, 2017). The WHO defines adolescents as those in a transitional stage between childhood and adulthood or ten to 19 years (WHO, 2020). Through the Minister of Health Regulation (PMK) No. 25 of 2014, the Indonesian government limits adolescents as a population in the age range of ten to 18 years (Kementrian Kesehatan RI, 2014). Adolescents in advancing to maturity experience three stages of adjustment: early adolescence, middle adolescence, and late adolescence. During this development period, adolescents experience several changes, specifically biological changes, including morphology and physiology related to reproductive capacity, psychosocial changes, and growth speedup, which are part of physical changes (Soetjiningsih, 2010). During their development, adolescents experience various conditions that make them feel uncomfortable with complaints or illnesses. Common complaints and diseases in adolescents include anemia, diarrhea, asthma, back and neck pain, skin disorders such as acne (Collaboration, 2016), obesity (Özdemir, 2015; Suandi, 2010), constipation (Thea et al., 2020), and headache (Vaičiūnas and Šmigelskas, 2019). Other disorders that commonly occur, especially in young women, are menstrual disorders (Februanti et al., 2020; Gray, 2013), abdominal pain, and vaginal discharge (Gupta et al., 2020). Referring to the complaints and illnesses experienced by adolescents during their developmental period and their role as the nation's next-generation, research into the use of traditional medicines among adolescents is imperative. This study aimed to describe the profile of traditional medicine used among adolescents in Indonesia. This research is a preliminary study, which will be used as the source for further research on the factors that influence the intention and behavior of adolescents in using traditional medicines. METHODS This preliminary study is a descriptive survey to explore the initial data on the profile of traditional medicines used among adolescents. The data obtained in this preliminary study will be used as a reference for the development of instruments and a conceptual framework for further research that will explore the factors that influence adolescent intentions and behavior in the use of traditional medicines. Ethical clearance has been obtained from The Health Research Ethics Committee – Stifar Yayasan Pharmasi Semarang with No.286/AHW- SW/KEPK/STIFAR/EC/IX/2021 under the main research protocol titled The Intention of Using Traditional Medicines Among Adolescents: A Review of the Theory of Planned Behavior. The population of this preliminary study was all students in grades X, XI, and XII at SMK Farmasi Teladan Demak, which was 78 students. The inclusion criteria were those who were registered as students of the SMK Teladan Farmasi Demak and willing to fill out the structured online interview guidelines using Google form voluntarily. In this preliminary study, the sample size is the same as the population because the entire population meets the inclusion criteria. The instrument used in this study was a simple structured online interviews guideline containing sets of questions, i.e., the respondent's characteristics and the profile of traditional medicines usage. The structured interview Journal of Pharmaceutical Sciences and Community Profile of The Use of Traditional Medicines... Research Article 73 Abadi and Widayati J. Pharm. Sci. Community, 2022, 19(2), 71-77 guideline contains 48 questions. There are six questions related to demographic data, 19 questions related to the use of traditional medicines, 19 questions about types of traditional medicines used, one question about the importance of using traditional medicines, one question about the source of information of traditional medicines, one question about the benefits of using traditional medicine, and one question about the reasons for using traditional medicines. The structure of the questions was conducted by referring to several references that report similar research (Februanti et al., 2020; Oktaviani et al., 2020; Sari Dewi et al., 2019). The instrument was validated with content validity by expert judgment. A language comprehension test was also conducted with several students who had similar characteristics to the study population. The structured interviews guideline was distributed to respondents using a Google Form link. The link was formatted for sending the response once only. The data were analyzed descriptively. The frequency and percentage were calculated. RESULTS AND DISCUSSION Respondent's characteristics Respondents in this study were categorized into several characteristics, i.e., gender, age, the highest level of education, and the expenses per month. Of the 78 respondents who were given the online survey, all completed and returned the responses, giving a response rate of 100%. As shown in Table 1, the 78 respondents are aged between 14-18 years with a dominant age of 17 years of 35%. A total of 88.5% of respondents are female. The number of respondents with expenses less than or equal to 300 thousand rupiah reached more than 70%. The profiles of traditional medicines usage As shown in Table 2, the use of herbal medicines by respondents in this study is sporadic. About one-third of them used traditional medicines every two weeks to once a month only, generally if they had any health complaints. The two dominant reasons for using herbal medicines stated by respondents in this study are that herbal medicines are more harmless than conventional medicines and reflect the habits of their parents and family. Low prices are not the main reason of teenagers in this study to use herbal medicines. The 78 respondents who gave answers regarding the use of traditional/ herbal medicine, it was found that 96% of respondents used "jamu gendong" which is sold by seller- women either walking or by bicycle door to door. Currently, "jamu gendong" is available in Polyethylene Ethylene Terephalate (PET) plastic bottles sold in supermarkets or traditional markets. The PET herbal medicine is used by 71% of respondents in this study. On the other hand, herbal medicine named "Jamu Godog", a particular type of traditional medicine is made by boiling herbs in the water, is less popular among adolescents. Respondents in this study used "jamu" sold by the seller-women door-to-door and/or the plastic bottle version. Herbal medicines called "Beras Kencur" and "Kunyit Asem" were the most popular "Jamu" bought by respondents in this study. The use of branded traditional medicines The branded traditional medicines used among the respondents were predominantly for common colds, as shown in Table 3. Other health complaints include motion/travel sickness, diarrhea, sore throat, and menstrual pain. Most respondents have used the Internet to obtain information about traditional medicines. In addition, they also sought information from their parents. Pharmacies are the most preferred place to purchase traditional medicines, besides kiosks and groceries. Generally, "Jamu" is very popular as a particular type of traditional medicine among Indonesians, as found in this study. The behavior of using traditional medicines seems to not depend on gender (Abdel-Qader et al., 2020; Jabbar et al., 2017; Medisa et al., 2020; Oktarlina et al., 2018; Oktaviani et al., 2020; Wardania and Muhlis, 2020) although more adolescent girls were involved in this study. Using traditional medicines is commonly based on the perception that natural materials are less harmful than synthetic compounds (Abdel-Qader et al., 2020; Bayisa et al., 2014; Wardania and Muhlis, 2020; Welz et al., 2018). Furthermore, traditional medicines can be easily obtained either from their backyard as the herb plants or the neighbor kiosks or groceries as a product (Wardania and Muhlis, 2020). People's experience in using traditional medicines is also a prominent reason to do so in the future for similar health complaints (Welz et al., 2018). Again, natural material is a particular attraction for people to use traditional medicines (Sari Dewi et al., 2019). Research Article Journal of Pharmaceutical Sciences and Community Profile of The Use of Traditional Medicines ... 74 Abadi and Widayati J. Pharm. Sci. Community, 2022, 19(2), 71-77 Table 1. Respondent’s Characteristics of The Preliminary Study of Traditional Medicines Usage Among Students of SMK Farmasi Teladan Demak Characteristics Frequency Percentage (%) N = 78 Gender Male 9 11.5 Female 69 88.5 Age (Years old) 14 2 3 15 13 17 16 25 32 17 27 35 18 11 14 Class X 27 34.6 XI 30 38.5 XII 21 29.9 Expenses per-month < Rp. 100,000, - 20 26 Rp. 100,000 - Rp. 200,000 21 27 Rp. 200,000 - Rp. 300,000 17 22 Rp. 300,000 - Rp. 400,000 11 14 > Rp. 400,000 9 12 Table 2. The Profiles of Traditional Medicines Usage Among Students of SMK Farmasi Teladan Demak The frequency of use Percentage (%) N = 78 Once a month 35 Twice a week 32 If needed for health problem 28 Once a week 17 Irregular 14 Everyday 3 Reasons of use Percentage (%) N = 78 More harmless 44 No particular reason 32 Family members 31 Minimum side effect 15 Cheaper 6 Type of “jamu” Percentage (%), N = 78 Use Not use “Jamu Gendong” 96 4 “Jamu” in plastic bottle 71 29 “Jamu Godog” 8 92 Perceived benefit of using traditional medicine Percentage (%) N = 78 Improve health 77 Journal of Pharmaceutical Sciences and Community Profile of The Use of Traditional Medicines... Research Article 75 Abadi and Widayati J. Pharm. Sci. Community, 2022, 19(2), 71-77 Cure the symptoms 19 Do not have any benefits 4 Table 3. Health complaints, sources of information, and place to obtain branded traditional medicines among students of SMK Farmasi Teladan Demak The health complaints treated using branded traditional medicines Percentage (%) N = 78 Yes No Common Cold 79 21 Cough 73 27 Motion / travel sickness 68 32 Diarrhea 64 36 Sore throat 54 46 Menstrual syndrome 48 52 Place to obtain branded traditional medicines Percentage (%) N = 78 Pharmacy 78 Kiosks 35 Drug store 29 Others 15 Minimarket 6 Online shop 4 Source of information for branded traditional medicines Percentage (%) N = 78 Internet 51 Parents 44 TV advertisement 42 Teacher 31 Social media (Instagram, WhatsApp, Facebook, etc.) 31 Friends 27 Besides, the literature has clearly shown that the behavior of using medicines for self- medication, including using traditional medicines, is influenced by family members, especially the mothers. In fact, medicines stored in the household are used interchangeably between family members (Widayati, 2013). All of those reasons mentioned above have also become the causes of adolescents in this study regarding taking traditional medicines. Generally, "Jamu" or herbal medicines have been used empirically for preventive and curative (Tilaar and Widjaja, 2014). However, most people tend to take more active health- seeking when they encounter health symptoms (Widayati, 2012). Perhaps, an elderly group has more willingness to take medication for health prevention. Also, patients with chronic disease usually take alternative medication, including using herbal medicines. Herbal medicines for weight-loose are also common among the female population (Abdel-Qader et al., 2020; Welz et al., 2018). Uniquely, adolescents in this study are also using traditional medicines occasionally when they suffered health complaints. Although herbal medicines can be prepared at home as hand-made products, adolescents in this study preferred to obtain traditional products from the pharmacy. The pharmacy is quite popular among people who willing to take traditional medicine products (Oktaviani et al., 2020; Sari Dewi et al., 2019). In addition, herbal stores are also another option to purchase herbal/traditional medicine products (Wardania Research Article Journal of Pharmaceutical Sciences and Community Profile of The Use of Traditional Medicines ... 76 Abadi and Widayati J. Pharm. Sci. Community, 2022, 19(2), 71-77 and Muhlis, 2020). The choices of where to obtain herbal medicines can be based on easy access and other practical reasons. Typically, family members become sources of information for self-medication, including traditional medicines (Wardania and Muhlis, 2020; Welz et al., 2018; Widayati, 2013). Other sources of information can also be accessed, for example, printed media (Sari Dewi et al., 2019). Currently, the use of the Internet to access health information is extensive (Ariyanti, 2016; Azizah and Irhandayaningsih, 2019). Adolescents are the group of the population as the highest users of the Internet. Young people in this study showed a significant preference in using the Internet to seek information about traditional medicines. However, it should be noted that critical thinking is required when seeking information provided through the Internet since not all of the information, including information regarding traditional medicines, are reliable (Dirjen Aptika, 2016). CONCLUSIONS This preliminary study elicited profiles of traditional medicines used among adolescents. Beliefs about using traditional medicines that emerged are natural and accessible. Information from the Internet is more prominent instead of the family member's influence. This study also implies that adolescents are much confident in using traditional medicines to deal with their health problems. Therefore, further research is urgent to explore which factors influence the behavior of using traditional medicines among adolescents. 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