Perceived and Objective Quality of Life Among Pregnant Women: Mixed-Methods Research on Chronic Energy Deficiency

Authors

Fitri Apriyanti , Diah Wulandari , M. Nizar Syarif Hamidi

DOI:

10.29303/jppipa.v11i5.11252

Published:

2025-05-25

Issue:

Vol. 11 No. 5 (2025): May

Keywords:

Chronic energy deficiency, Pregnancy, Maternal Health, Quality of life

Research Articles

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How to Cite

Apriyanti, F., Wulandari, D., & Hamidi, M. N. S. (2025). Perceived and Objective Quality of Life Among Pregnant Women: Mixed-Methods Research on Chronic Energy Deficiency. Jurnal Penelitian Pendidikan IPA, 11(5), 909–919. https://doi.org/10.29303/jppipa.v11i5.11252
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Abstract

Chronic Energy Deficiency (CED) in pregnant women is a substantial public health issue in Indonesia.  This research examines the divergence between objective and subjective quality of life in pregnant women with CED in Kampar District, Riau Province.  A sequential explanatory design with mixed methodologies was used.  The quantitative phase included 150 pregnant women with chronic energy deficiency (mid-upper arm circumference <23.5 cm) from 10 community health centers (out of 31 in Kampar District), selected using a strategy that guarantees a blend of urban and rural regions.  Evaluations included WHOQOL-BREF, anthropometric assessments, and clinical exams.  The qualitative phase included comprehensive interviews and focus group discussions with 30 intentionally chosen individuals.  Data integration was executed by joint display analysis. Quantitative results indicated poor objective quality of life scores: physical domain: 54.3±12.7; psychological: 58.6±11.4; social: 64.2±13.8; environmental: 52.1±10.9.  Nonetheless, 73% of interviewees regarded their quality of life as "good" or "excellent."  Qualitative analysis revealed four themes: "normalization of adversity" (CED seen as typical during pregnancy), "family sacrifice" (prioritization of familial needs), "social support as resilience" (help from family and community), and "spiritual coping" (religious beliefs as a source of strength).  Key determinants affecting the disparity in quality of life were social support (β=0.432, p<0.001), psychological resilience (β=0.387, p<0.001), healthcare access (β=0.256, p<0.05), and health literacy (β=0.198, p<0.05). Despite unfavorable objective health indicators, pregnant women with CED in Kampar District maintain good perspectives of quality of life, facilitated by robust social support, cultural normalization, and spiritual coping strategies.  Effective therapies must amalgamate biological strategies with psychological assistance, taking into account local cultural factors.  Programs must fulfill dietary requirements while concurrently enhancing community support structures and advancing health literacy to reconcile the disparity between objective health status and subjective well-being.

References

Ahmed, T., Hossain, M., & Sanin, K. I. (2012). Global burden of maternal and child undernutrition and micronutrient deficiencies. Annals of Nutrition & Metabolism, 61 Suppl 1, 8–17. https://doi.org/10.1159/000345165

Al-Mutawtah, M., Campbell, E., Kubis, H.-P., & Erjavec, M. (2023). Women’s experiences of social support during pregnancy: a qualitative systematic review. BMC Pregnancy and Childbirth, 23(1), 782. https://doi.org/10.1186/s12884-023-06089-0

Bedaso, A., Adams, J., Peng, W., & Sibbritt, D. (2021). The relationship between social support and mental health problems during pregnancy: A systematic review and meta-analysis. Reproductive Health, 18(1), 162. https://doi.org/10.1186/s12978-021-01209-5

Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., Onis, M., Ezzati, M., Grantham-McGregor, S., Katz, J., Martorell, R., Uauy, R., Maternal, & Group, C. N. S. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427–451. https://doi.org/10.1016/S0140-6736(13)60937-X

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. https://doi.org/10.1191/1478088706qp063oa

Carr, A. J., Gibson, B., & Robinson, P. G. (2001). Measuring quality of life: Is quality of life determined by expectations or experience? BMJ (Clinical Research Ed), 322(7296), 1240–1243. https://doi.org/10.1136/bmj.322.7296.1240

Christian, P., Lee, S. E., Donahue Angel, M., Adair, L. S., Arifeen, S. E., Ashorn, P., Barros, F. C., Fall, C. H. D., Fawzi, W. W., Hao, W., Hu, G., Humphrey, J. H., Huybregts, L., Joglekar, C. V, Kariuki, S. K., Kolsteren, P., Krishnaveni, G. V, Liu, E., Martorell, R., & Black, R. E. (2013). Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries. International Journal of Epidemiology, 42(5), 1340–1355. https://doi.org/10.1093/ije/dyt109

Creswell, J. W., & Clark, V. L. P. (2017). Designing and conducting mixed methods research. Sage publications.

Felce, D., & Perry, J. (1995). Quality of life: Its definition and measurement. Research in Developmental Disabilities, 16(1), 51–74. https://doi.org/10.1016/0891-4222(94)00028-8

Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs-principles and practices. Health Services Research, 48(2), 2134–2156. https://doi.org/10.1111/1475-6773.12117

Fisher, J., Mello, M., Patel, V., Rahman, A., Tran, T., Holton, S., & Holmes, W. (2012). Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: A systematic review. Bulletin of the World Health Organization, 90(2), 139 –149. https://doi.org/10.2471/BLT.11.091850

Gebre, B., Biadgilign, S., Taddese, Z., Legesse, T., & Letebo, M. (2018). Determinants of malnutrition among pregnant and lactating women under humanitarian setting in Ethiopia. BMC Nutrition, 4, 11. https://doi.org/10.1186/s40795-018-0222-2

Girma, S., Fikadu, T., Agdew, E., Haftu, D., Gedamu, G., Dewana, Z., & Getachew, B. (2019). Factors associated with low birthweight among newborns delivered at public health facilities of Nekemte town, West Ethiopia: A case control study. BMC Pregnancy and Childbirth, 19(1), 220. https://doi.org/10.1186/s12884-019-2372-x

Harna, H., Rahmawati, R., Asrul, A., & Sapang, M. (2024). Prevalence and determinant factors of Chronic Energy Deficiency (CED) in pregnant women. AcTion: Aceh Nutrition Journal, 9, 65. https://doi.org/10.30867/action.v9i1.1443

Karimi, M., & Brazier, J. (2016). Health, Health-Related Quality of Life, and Quality of Life: What is the Difference? PharmacoEconomics, 34(7), 645–649. https://doi.org/10.1007/s40273-016-0389-9

Kazemi, F., Nahidi, F., & Kariman, N. (2016). Assessment Scales, Associated Factors and the Quality of Life Score in Pregnant Women in Iran. Global Journal of Health Science, 8(11). https://doi.org/10.5539/gjhs.v8n11p127

Lagadec, N., Steinecker, M., Kapassi, A., Magnier, A. M., Chastang, J., Robert, S., Gaouaou, N., & Ibanez, G. (2018). Factors influencing the quality of life of pregnant women: A systematic review. BMC Pregnancy and Childbirth, 18(1), 455. https://doi.org/10.1186/s12884-018-2087-4

Lipoeto, N. I., Masrul, N., & Nindrea, R. D. (2020). Nutritional contributors to maternal anemia in Indonesia: Chronic energy deficiency and micronutrients. Asia Pacific Journal of Clinical Nutrition, 29(Suppl 1), 9– 17. https://doi.org/10.6133/apjcn.202012_29(S1).02

Mortazavi, F., Mousavi, S. A., Chaman, R., & Khosravi, A. (2014). Maternal quality of life during the transition to motherhood. Iranian Red Crescent Medical Journal, 16(5), 8443. https://doi.org/10.5812/ircmj.8443

Nguyen, P. H., DiGirolamo, A. M., Gonzalez-Casanova, I., Young, M., Kim, N., Nguyen, S., Martorell, R., & Ramakrishnan, U. (2018). Influences of early child nutritional status and home learning environment on child development in Vietnam. Maternal & Child Nutrition, 14(1), 12468. https://doi.org/10.1111/mcn.12468

Niehof, A. (1988). Traditional Medication at Pregnancy and Childbirth in Madura (Indonesia (ed.)). Springer Netherlands. https://doi.org/10.1007/978-94-009-2713-1_12

Purba, F. D., Hunfeld, J. A. M., Iskandarsyah, A., Fitriana, T. S., Sadarjoen, S. S., Passchier, J., & Busschbach, J. J. V. (2018). Quality of life of the Indonesian general population: Test-retest reliability and population norms of the EQ-5D-5L and WHOQOL-BREF. PloS One, 13(5), 197098. https://doi.org/10.1371/journal.pone.0197098

Rahman, A., Surkan, P. J., Cayetano, C. E., Rwagatare, P., & Dickson, K. E. (2013). Grand Challenges: Integrating Maternal Mental Health into Maternal and Child Health Programmes. PLOS Medicine, 10(5), 1001442. https://doi.org/10.1371/journal.pmed.1001442

Riskesdas. (2018). Laporan nasional Riskesdas 2018. Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan RI; Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan RI. Retrieved from https://layanandata.kemkes.go.id/katalog-data/riskesdas/ketersediaan-data/riskesdas-2018

Shrestha, V., Paudel, R., Sunuwar, D. R., Lyman, A. L. T., Manohar, S., & Amatya, A. (2021). Factors associated with dietary diversity among pregnant women in the western hill region of Nepal: A community based cross-sectional study. PloS One, 16(4), 247085. https://doi.org/10.1371/journal.pone.0247085

Tang, A. M., Chung, M., Dong, K. R., Bahwere, P., Bose, K., Chakraborty, R., Charlton, K., Das, P., Ghosh, M., Hossain, M. I., Nguyen, P., Patsche, C. B., Sultana, T., Deitchler, M., & Maalouf-Manasseh, Z. (2020). Determining a global mid-upper arm circumference cut-off to assess underweight in adults (men and non-pregnant women. Public Health Nutrition, 23(17), 3104–3113. https://doi.org/10.1017/S1368980020000397

Utomo, A., Mcdonald, P., Utomo, I., Cahyadi, N., & Sparrow, R. (2019). Social engagement and the elderly in rural Indonesia. Social Science & Medicine, 229, 22–31. https://doi.org/10.1016/j.socscimed.2018.05.009

Victora, C. G., Christian, P., Vidaletti, L. P., Gatica-Domínguez, G., Menon, P., & Black, R. E. (2021). Revisiting maternal and child undernutrition in low-income and middle-income countries: Variable progress towards an unfinished agenda. Lancet (London, England), 397(10282), 1388–1399. https://doi.org/10.1016/S0140-6736(21)00394-9

Wati, E. K., Murwani, R., Kartasurya, M. I., & Sulistiyani, S. (2024). Determinants of chronic energy deficiency (CED) incidence in pregnant women: A cross-sectional study in Banyumas, Indonesia. Narra Journal, 4(1), 742. https://doi.org/10.52225/narra.v4i1.742

WHOQOL. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychological Medicine, 28(3), 551–558. https://doi.org/10.1017/s0033291798006667

Yulia, C., Rosdiana, D. S., Muktiarni, M., & Sari, D. R. (2024). Reflections of well-being: Navigating body image, chronic energy deficiency, and nutritional intake among urban and rural adolescents. Frontiers in Nutrition, 11, 1346929. https://doi.org/10.3389/fnut.2024.1346929

Author Biographies

Fitri Apriyanti, Universitas Pahlawan Tuanku Tambusai

Diah Wulandari, Universitas Gadjah Mada

M. Nizar Syarif Hamidi, Universitas Pahlawan Tuanku Tambusai

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