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590

Journal Of Economics, Technology, And Business (JETBIS)

Volume 2, Number 9 September 2023

p-ISSN 2964-903X; e-ISSN 2962-9330

THE DECISION OF PASAR JIWA INNOVATION ADOPTION IN THE EARLY

PREVENTION OF MENTAL HEALTH ISSUES AT THE BUBAKAN HEALTH

CENTER, PACITAN REGENCY

Hendro

Harmoko

Kristina Setyowati

Rino Ardhian Nugroho

Universitas Sebelas Maret, Surakarta, Indonesia

Email: hendro.harmoko@student.uns.ac.id

, [email protected]s.ac.id

, rino.nugroh[email protected]s.ac.id

KEYWORDS:

adoption decision;

innovation; community

health center; mental

health.

ABSTRACT

The research method uses a qualitative approach with in-depth interviews

with health workers, patients, and related parties at the Bubakan Health

Center. The results showed that the decision to adopt Soul Market innovations

was influenced by several factors, including awareness about mental health

issues, availability of resources, support from authorities, and perceptions of

the benefits of innovation. The findings of this study indicate that efforts to

prevent early mental health problems require cooperation between authorities,

health workers, and the community. The adoption of Mental Market

innovations can be an effective first step in addressing mental health issues at

the community level. The practical implication of this research is the need to

raise public awareness of mental health issues and increase the support and

resources available in Puskesmas to facilitate the adoption of these

innovations. This research makes an important contribution to the

understanding of early prevention efforts of mental health problems at the

community level, especially in Puskesmas Bubakan, Pacitan Regency, and

can be a reference for the development of more effective early prevention

strategies in the future.

INTRODUCTION

Overall, mental health treatment in Pacitan Regency has not been going well (Yudhastuti et

al., 2019). This is due to the treatment gap between people with mental disorders and puskesmas as

a basic health service unit, which still tends to prioritize the function of curative and rehabilitative

services. In addition to these factors, there are also problems and difficulties in handling mental

disorders, especially at the Bubakan Health Center. This factor is the existence of social stigma for

people with mental disorders. Having a mental disorder is still considered a taboo or even a disgrace

in the family (Yudhastuti et al., 2019). People with mental problems still often get ostracized and

discriminated against, making the healing process difficult for the sufferer himself. Many sufferers

still face social stigma and discrimination due to the relationship between life and social

responsibilities involving people with mental disorders (Burmeister & Marks, 2016). The social

stigma surrounding mental health issues not only affects sufferers but also their families. The social

stigma surrounding mental health issues not only affects sufferers but also their families. Families

with mental disorders will tend to hide the mental illness of their family members to avoid social

stigma, so as not to be isolated from their environment (Pratt et al., 2016). Families with mental

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disorders in rural areas will tend to deal with it in a non-medical way. This is because most people

still believe that mental health disorders are caused by irrational or supernatural things, such as

magic, the entry of evil spirits, and/or because they violate prohibitions and others (Suwarno, 2008).

In addition to the two main issues mentioned above, the problem of community literacy,

especially in rural areas, also influences. Low literacy, in this case, mental health literacy, is still

very influential. This is revealed from the assumption in the community, especially in the Bubakan

Puskesmas work area, that mental health is no more important to getting medical care and treatment

when compared to physical health. Although physical health and mental health are two things that

cannot be separated. Good physical health will be associated with good mental health. Vice versa,

because talking about health holistically, must combine the two (Crepaz-Keay, 2016). Stuart

Geoffrey (Nuryani et al., 2022) also said that people in rural areas have a high risk of mental health

because they consider symptoms of mental disorders to be common. In fact, in some rural

communities, there is still the practice of shackling people with mental disorders using wood or leg

chains, including confinement (Ayuningtyas et al., 2018).

In addition, geographical conditions in the Bubakan Puskesmas work area also affect the

handling of mental health disorders. This is considering that to get to the basic health service center,

namely the Bubakan Health Center, these mental patients need a relatively long time due to hilly

geographical conditions. For this reason, the role of mental health cadres at the Bubakan Health

Center is expected to help ease the burden on patients in overcoming these geographical problems.

Mental health cadres are scattered in each village as a form of collaboration between the government

and the community. As Alter and Hage explain (La Ode Syaiful Islamy, 2018) collaborative efforts

are approaches to achieve goals flexibly in less time. This collaborative approach, one of which is

through the innovation movement. This innovation aims to provide fast and standard service so that

more severe mental disorders do not occur. Meanwhile, according to (Burmeister & Marks, 2016),

to support social roles as part of a recovery-oriented approach for people with mental disorders, it is

necessary to collaborate across sectors holistically by creating easy access to direct services to

patients through infrastructure improvements (GHAFAR & Cahya, 2023).

In general, mental health development is not only a burden and responsibility of the

government, but also the responsibility of the community. Active community participation is needed

for the success of health development in an area (Arianto & Fitriana, 2013). In line with this

statement and at the same time as an effort to deal with mental health problems in the working area

of the Bubakan Health Center, Tulakan District, an innovation called Puskesmas Sadar Jiwa

abbreviated as PaSar Jiwa has been born. In short, PaSar Jiwa aims to deal with delays in finding

People With Mental Disorders (ODGJ) so that more severe mental disorders do not occur. PaSar

Jiwa is one of the five mental health treatment innovations in Pacitan Regency.

The five innovations are as follows:

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Table 1

Mental Health Service Innovation in Pacitan Regency Until 2021

Organizational Units

Innovation Name

Health Office

Kahur Saji (Sahabat Jiwa Friendly

Residential Room)

Temple Health Center

Posyandu Jiwa Services

Kebonagung Health

Center

Posyandu Jiwa Services

Gondosari Health Center

Soul Promise (No Stigma for People with

Mental Disorders)

Bubakan Health Center

PaSar Jiwa (Puskesmas Sadar Jiwa)

Source: Pacitan District Health Office in 2021

Of the five existing mental health treatment innovations, the author chose the Bubakan Health

Center with PaSar Jiwa Innovation as the research location. This is as information from the

Organizational Section of the Regional Secretariat of Pacitan Regency as the regional coordinator

of the Public Innovation Service Competition, that the PaSar Jiwa innovation is the only innovation

(of the five innovations mentioned above) that has been verified and validated, both in terms of data

completeness, cadre readiness and service coverage to represent Pacitan Regency at the Public

Innovation Service Competition at the East Java Province level in 2021.

The adoption of the PaSar Jiwa innovation has been carried out by the PaSar Jiwa Team in all

working areas of the Bubakan Health Center which include Bubakan Village, Ngile Village, Losari

Village, Kalikuning Village, and Gasang Village. The initiation of PaSar Jiwa innovation in the

Bubakan Health Center work area was carried out starting in 2018. Since then, the process of

adopting PaSar Jiwa innovations has also been communicated through several communication

channels. This communication channel is a medium for disseminating innovation. Two-way

communication between PaSar Jiwa innovators and recipient communities is carried out by

puskesmas through mental health detection service units or directly by going to the field, namely at

Integrated Service Posts through Posyandu cadres, in each hamlet through cadres of Integrated

Development Posts or Posbindu and in schools through School Health Business (UKS) cadres.

The innovation theory developed by (Rogers et al., 2014) is known as a theory that discusses

the decision to adopt innovation. In his book Diffusion of Innovation, (Nuryani et al., 2022) offered

the concept of adoption of innovation accompanied by the speed of a social system in accepting new

ideas offered by innovation. Innovation adoption decision according to (Nuryani et al., 2022), is the

process by which a person or unit of adoption goes through stages in finding and processing

information starting from when the innovation is introduced, then the implementation of the new

idea until there is a certainty to accept or reject the innovation. For the adopter unit, in this case, the

community in the Bubakan Health Center work area who have family members of mental health

patients, that the PaSar Jiwa innovation must have the main characteristic of an innovation, namely

novelty. That is, the PaSar Jiwa innovation must be an idea or practice that can be felt as something

new for the community that is the target of PaSar Jiwa innovation.

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The decision to adopt this innovation is important, considering that the sustainability of the

PaSar Jiwa innovation will be determined by the innovators, in this case, doctors, nurses, mental

cadres at the Bubakan Health Center as well as adopters or families of mental health patients as

beneficiaries of the innovation. Adoption decisions made by families of mental health patients can

have an impact on whether or not innovations have been launched by innovators. It is also influenced

by the attributes of innovation as a theory (Nuryani et al., 2022) namely the extent to which

innovation can provide benefits, the extent to which innovation is consistent with the values and

needs of adopters, the degree to which the difficulty of innovation to be understood and used, the

extent to which innovation can be tested gradually and the extent to which an innovation can be seen

and observed by others. Some of these things then become considerations for adopters in deciding

to accept or reject PaSar Jiwa's innovation.

RESEARCH METHODS

The purpose of this study is to analyze the process of decision stages for the adoption of

PaSar Jiwa innovation in the early prevention of mental health problems at the Bubakan Health

Center. The research method contains several things related to the research process, including:

Research Location

The location of PaSar Jiwa Innovation is in the working area of the Bubakan Health Center,

Tulakan District, which includes 5 (five) villages, namely: Bubakan Village, Losari Village, Ngile

Village, Gasang Village, and Kali Kuning Village. PaSar Jiwa innovation is one of several

innovations in handling mental health problems in Pacitan Regency. Of the several innovations in

handling mental health problems that exist, the author chose PaSar Jiwa Innovation because the

innovation has been selected by the local government to represent Pacitan Regency in the East Java

Provincial Public Innovation Service Competition.

Types of Research

In this study, the author used a type of qualitative descriptive research. The reason the author

chose this type is that the author wants to see complete information and phenomena related to the

stages of the decision to adopt PaSar Jiwa innovation at the Bubakan Health Center as a follow-up

to the implementation of the Decree of the Head of the Bubakan Health Center dated October 10,

2019 co,ncerning the PaSar Jiwa Innovation Team.

Research Informants

Informants according to (Sugiyono, 2018) are people who provide information about the facts

of the problem to be researched. The informants in this study were 1 (one) Bubakan puskesmas

doctor, 1 (one) Bubakan puskesmas nurse, 5 (five) cadres of Posbindu PaSar Jiwa, and 5 (five)

families of patients with mental disorders as informants from each village in the Bubakan

Puskesmas work area.

Determination of informants in puskesmas and posbindu, namely doctors, nurses, and

posbindu cadres using purposive sampling techniques, where informants are determined

deliberately because they are considered to know deeply about the problem to be studied.

Meanwhile, the determination of informants in the families of patients with mental disorders uses

accidental sampling techniques, namely informants who are not determined in advance or

coincidentally meet with the author and are directly used as informant samples because the patient's

family is suitable to be used as a source of data. From several patient families or innovation

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adoption units encountered in each of these villages, the author then made a selection to be selected

according to research needs. The choice of accidental sampling technique in family informants of

mental patients was due to the author's limited time in conducting research. In addition to the

author's limited time, this is also influenced by the characteristics of community work at the

research site where most of the patient's family as informants are farming, gardenin,g and freelance

daily labor which is difficult to find at home before evening or evening.

Research Time

The PaSar Jiwa Innovation Adoption Decision Research was conducted from November

2022 to February 2023. The author chose this time because it was considered sufficient to analyze

the PaSar Jiwa Innovation Adoption Decision.

Types of Research Data

The data used in this study include primary data and secondary data. Primary data is data

obtained from direct research subjects using several predetermined instruments. The data collection

is a research process used to answer research questions. Primary data were obtained through

interviews with patients' families, doctors, and nurses as well as mental health cadres at the

Bubakan Health Center who became research informants.

Focus of Research Studies

The focus of the research study is the decision to adopt innovation in mental health services,

starting from the knowledge we know about the innovation, then how the innovation works, and

why innovation is needed. Departing from knowledge about innovation, the analysis of the stages

of innovation adoption decisions is continued at the next stage, namely how to trust innovation, so

that subjects decide to make innovation adoption decisions. If the innovation has been adopted,

then the innovation can be continued. After the decision to adopt the innovation is continued, the

last stage is confirmation of the sustainability or unsustainability of the decision to adopt the

innovation.

But the results are different, if the subjects receiving the innovation after being given

knowledge about the innovation then form negative behaviors or do not adopt the innovation, then

the decision to adopt the innovation is not successfully continued. If the innovation has been

successfully continued, but at the confirmation stage the subject decides not to continue the

decision to adopt the innovation, it is necessary to evaluate the process of implementing the

innovation.

This research a fos focusesve stages of innovation adoption decisions as follows:

1. Knowledge Stage:

a. What subjects know about innovation

- Where subjects get information about innovation

b. Why this innovation is needed

- What subjects need from innovation

c. How innovation works

- What information the subject know about innovation

2. Persuasion Stage:

a. Positive / want (Favorable)

- How subjects respond to the innovations offered

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- Whether the subject is immediately interested in his innovation

b. Negative / not wanting (Unfavorable)

- Whether the subject has ever received information from another party not to trust the

innovation

- What attitudes and opinions are conveyed by the other party to the subject

3. Decision Stage:

a. Innovation Adoption

- Whether the subject accepts innovation

- Whether the subject is seeking additional information from other parties

b. Rejecting innovation

- Whether the subject refuses to follow the innovation

- Whether the subject is influenced by others to reject the innovation

c. Implementation Stage:

- Whether the subject follows the innovation according to the provisions

- Whether subjects follow innovation on an ongoing basis

4. Confirmation Stage:

a. Sustainability of innovation

- Whether subjects benefit from innovation

- Whether the innovation is as expected

- Whether the subject informs the benefits of innovation to others

b. Unsustainable (discontinuance) innovation

- Whether the subject does not benefit from innovation

- Whether the innovation is not as expected

Data collection techniques

The data collection techniques used in this study are as follows:

a. Interview

According to (Sugiyono, 2018) interviews are used to find problems that must be researched

and other things from respondents that are more in-depth. This data collection technique is based

on reports about oneself or at least on personal knowledge or beliefs. The interview is a process

of interaction between the author and informants carried out by exploring information related to

the subject of implementing the PaSar Jiwa innovation adoption decision. There are several steps

for the author in conducting an interview, including:

Conducting interviews with informants related to research, including families of mental

patients, doctors and nurses at community health centers, and cadres assisting mental health

care;

The interview was conducted by recording important points in the research notebook;

The data and records that have been obtained are then analyzed using data analysis

techniques.

b. Observation

Observation is a direct observation technique in the field to obtain an overview of social

events that occur to answer research questions. This data collection technique is used by the

author to increase knowledge and completeness of data. In this study, the observations made by

the author were unstructured observations, that is, observations made without using observation

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guidelines. The author develops observations based on developments that occur in the field

(Hamzah, 2021).

c. Documentation

Documentation is a data collection technique through official documents at the research

location and other sources of scientific papers that contain facts and data related to research.

These facts and data are useful to assist the author in analyzing problems and strengthening

research results and findings. In this documentation study, the author studies PaSar Jiwa's

Service Operational Standards (SOP) and other official documents that support the decision to

adopt PaSar Jiwa's innovation.

Data analysis techniques

The data analysis technique carried out is using an interactive analysis model. The technique

of interactive model data analysis after the data collection process can be explained as follows:

a. data condensation

According to Miles and Huberman (Sugiyono, 2018) what is meant by data condensation is

the process of selecting, focusing, simplifying, abstracting, and or transforming data from

written field notes, interview transcripts, document document,s and other empirical materials to

strengthen data. At the data condensation stage, the author will analyze data based on written

field notes, interview transcripts, documen,ts and observations from other existing phenomena.

The data is then selected which one byith the theme and purpose of the research with the help

of electronic equipment or manual notebooks.

b. display data

After the data condensation process is carried out, the next step is the presentation of the

data. According to Miles and Huberman (Sugiyono, 2018), "the most frequent from display data

for qualitative research data in the past has been narrative text".Ins this opinion, the author will

describe the decision stages of adopting PaSar Jiwa innovations by using narrative tests

accompanied by tables, graphs, images or, the like as needed in presenting data. This is to make

it easier for the author to obtain a systematic picture and to make it easier to determine the next

process flow.

c. Conclusion: drawing/verifying

To answer the problem formulation based on the data that has been presented, the author

will conclude as to whether the decision stage of adopting the PaSar Jiwa innovation is in

accordbylem formulation or not. Therefore, the author only focuses on the stage of the decision

to adopt the innovation.

Data validity

According to Wiliam Wiersma (Sugiyono, 2018) "triangulation is qualitative cross-validation.

It assesses the sufficiency of the data according to the convergence of multiple data sources or

multiple data collection procedures". As the argument goes, triangulation is qualitative cross-

validation and it will assess the adequacy of data according to the intersection of various data

sources. In testing the validity of research data, the author uses triangulation techniques, namely

according to (Sugiyono, 2018) data collection techniques carried out by checking data to the same

source with different techniques. If the data that has been obtained through interviews with

informants and after cross-checking through questionnaires, observations or documentation

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produces different data, further discussions will be carried out with the data source or other parties

to ensure which data is considered correct.

RESULTS AND DISCUSSION

PaSar Jiwa innovation is expected to be able to contribute to the achievement of national

Sustainable Development Goals (SDGs) or sustainable development goals in improving the degree

of mental health in the community, namely SDGs indicator Number 3: "ensuring a healthy life and

supporting welfare for all for all ages". To achieve these sustainable development goals, PaSar Jiwa

takes the role of early prevention of mental health disorders in the community through early

detection efforts. Early detection that has been carried out is expected to prevent people from falling

into severe mental health conditions, suppress suicide cases and reduce t,he budget costs that will

be incurred. This is considering that severe mental disorders have the potential to reduce

productivity which will affect the health and welfare of the community.

Therefore, with the decreasing prevalence of mental illness cases in the community, it is

hoped that the future of public health services at the puskesmas level can contribute to the

sustainable achievement of national SDGs. To find out how the development of mental health

disorder management at the Bubakan Health Center, the following table is presented comparing the

handling of mental health disorders before and after the PaSar Jiwa innovation, as the following

table:

Table 2

Comparison of Mental Health Disorders Management

Before and After PaSar Jiwa Innovation

Handling

Conditions

Before Innovation

After Innovation

Service System

The discovery of

mental health cases

is passive and there

has been no

community

involvement The

Puskesmas program

has not prioritized

the discovery of

mild mental cases

that are the root of

the problem of onset

to severe mental

health cases.

PaSar Jiwa focuses

on cases of mild

mental disorders,

which are detected

early by mental

health cadres to

bring mental health

services and mental

health management

closer to promoting

and preventive

efforts, so that

severemental health

cases and suicide

attempts can be

minimized

Implementers

Doctors and health

workers puskesmas

Doctors and health

workers of

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puskesmas,

involving the role of

PaSar Jiwa cadres:

Posyandu cadres

Posbindu cadres

UKS cadres

The Village Head as

a policy maker at the

village level plays a

role in Community-

Based Health Efforts

involving the role of

the existing Alert

Village

Involvement of

other agencies

in the service

Dr. Darsono

Hospital Pacitan

RSJ Surakarta

Health Office

Dr. Darsono

Hospital Pacitan RSJ

Surakarta

Health Office

Social services

provide

support/stimulants

to some people with

mental disorders

Polri and TNI

(Babinkam and

Babinsa) also

accompany officers

when handling

mental patients in

the field

The Dukcapil Office

facilitates the service

of people with

mental disorders to

obtain an identity

card (KTP)

MSF is a public

service supervisory

institution in the

health sector

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Soul Case

The discovery of

severe mental cases

was 64.6% higher

than that of mild

mental cases by

35.4%.

The discovery of

mild mental cases

was 83.3% higher

than that of severe

mental cases by

16.7%

Source: Narrative matrix of the 2021 public service innovation competition (processed)

Knowledge Stage :

According to (Nuryani et al., 2022) the knowledge stage is the stage where an individual will

learn about the existence of an innovation and seek information about the innovation. Before the

PaSar Jiwa innovation is carried out or accepted by the target, namely people with mental disorders,

the target (as explained by Rogers) must be able to explain what, how, and why the innovation is

processed so that the target or people with mental disorders will find a comprehensive and integrated

understanding of what PaSar Jiwa innovation is.

The knowledge stage has three indicators, namely knowledge indicators of the existence of an

innovation, knowledge indicators about how to use an innovation correctly, and knowledge

indicators about the functioning principles that underlie how and why innovation can work. From

the statements of informants above if associated with theory (Nuryani et al., 2022), then at this stage

of knowledge has the characteristics of innovation implementers and decision-making units or

innovation adopters, namely families of people with mental health disorders, each of which is

influenced by socioeconomic variables, individual variables and communication behavior variables.

In the knowledge indicator of the existence of an innovation, this is influenced by individual

variables where both the implementer of the innovation and the adopter of the innovation each have

the same knowledge that the innovation in addition to solving mental health problems, is also an

effort to save medical costs. However, in terms of behavioral variables, communication,

socialization or counseling about PaSar Jiwa carried out by innovation implementers has not reached

all communities or is still lacking. This is also felt by innovation adopters.

In the knowledge indicator of how to use an innovation correctly, this is influenced by

individual variables that according to the implementation of the innovation procedurally in the

management of mental health treatment has run well. However in terms of communication behavior

variables, where the intensity of the performance of mentoring mental health patients through

communication in the field is still minimal due to limited mental health human resources coupled

with having other administrative workloads.

In the indicator of knowledge about the principles of functioning that underlie how and why

innovation can work, this is influenced by individual variables where in carrying out innovation

adoption, PaSar Jiwa innovation implementers are guided by the terms of reference as a guide for

the entire innovation implementation team. Meanwhile, in terms of communication behavior

variables, the objectives and functions of PaSar Jiwa in terms of reference as a guide for assisting

have been well arranged.

Based on the results of the analysis of the discussion above, it is known that at this stage of

unification, it is only influenced by individual variables and communication behavior variables.

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Meanwhile, the knowledge stage in the decision to adopt PaSar Jiwa innovation is not influenced by

socioeconomic variables.

Persuasion Stage :

At this stage of encouragement or persuasion, the individual begins to interact psychologically

with the innovation. Before the innovation is accepted by the target or people with mental disorders,

the target as explained (Rogers & Singhal, 2003) must be able to determine the behavior of the

innovation, namely whether individuals tend to be positive or want (favorable) or even negative or

not want (unfavorable) the innovation.

If associated with the theory (Rogers & Singhal, 2003) about the decision to adopt innovation,

the analysis at the stage of encouragement or persuasion will see the characteristics of the

implementer of innovation and the decision-making unit or adopter of innovation, namely families

with mental health disorders, each of which is influenced by:

a. Variable relative profit. This variable is to measure the comfort factor, and satisfaction or

something that is considered beneficial. For the adopter of innovation, PaSar Jiwa greatly affects

the quality of life of patients and the lives of others, so this innovation is very profitable and

provides satisfaction to adopters.

b. Compatibility variables. This variable to measure an innovation is consistent with existing values

and adopter needs. For the adopter of innovation, PaSar Jiwa is not directly adopted because of

doubts about the innovation. However, due to the need to immediately find a solution for healing

for patients or their families, the PaSar Jiwa can be accepted in the decision to adopt innovation.

c. Variable complexity. This variable is influenced by the level of difficulty of innovation. For

innovation implementers and innovation adopters, this does not affect both. Given the innovation

of PaSar Jiwa, it is very easy to adapt and even replicate. In addition, PaSar Jiwa is also low cost,

the instrument is easy to learn, and only requires trained cadres.

d. Variable trialability. This variable is influenced by the degree to which innovations can be piloted

gradually. For innovation implementers and innovation adopters, this is by what innovation

implementers do, namely that the introduction of innovation to each village is carried out through

socialization or counseling in stages starting from the Bubakan Health Center to the hamlet level

by involving regional leaders and stakeholders. So that makes it easier for adopters to accept or

understand.

e. Observability/observation variables. This variable is influenced by the level of innovation if seen

or observed by others, i.e. the easier a person sees the results of innovation, the more likely they

are to adopt. For innovation adopters, this can be proven by following the assistance from cadres

and seeing the changes that occur in patients so that innovation adopters or patient families can

accept the PaSar Jiwa innovation. The biggest encouragement is due to a change in patient

attitudes compared to before participating in assistance from PaSar Jiwa innovation

implementers.

Based on the results of the analysis above, it is known that the characteristics at the stage

of encouragement or persuasion of PaSar Jiwa innovation are influenced by four variables

(Awaludin & Sukmono, 2020), namely relative profit variables, compatibility variables,

trialability variables, and observability variables. There is only one variable that does not affect

that is the complexity variable or the variable caused by the level of difficulty of innovation.

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Decision Stage :

According to (Rogers & Singhal, 2003) at this stage, individuals decide whether to accept or

reject an innovation. If the innovation can be used partially, then this innovation will be accepted

faster because usually want to try the innovation first in the situation and then decide to accept the

innovation. However, rejection of innovation can also occur. According to (Rogers & Singhal, 2003)

there are two types of rejection, namely first is active rejection where the individual tries innovation

and thinks he will adopt the innovation but in the end, he rejects the innovation. The second is

passive rejection, where the individual does not think at all about adopting innovation.

It can be explained that one of the things that influenced the decision to accept the PaSar Jiwa

innovation was that PaSar Jiwa became a solution or solution for the community, especially adopters

or families who have mental health patients where most of them have felt confused in caring for and

caring for patients or their family members. Meanwhile, if it is associated with the theory (Rogers

& Singhal, 2003) about the decision to adopt innovation, the analysis at this decision stage, will be

seen in two variables, namely accepting or rejecting innovation. Based on the results of the

discussion above, at this stage, it is known that each of the implementers and adopters of innovation

has decided to accept innovation. This happens because PaSar Jiwa innJiwa'sion has been used

partially, therefore innovation can be accepted faster because the adopters of innovation have tried

first and then decided to accept the innovation.

Implementation Stage:

According to (Rogers & Singhal, 2003) at the implementation stage, an innovation is tried to

be used, although at this stage there is still uncertainty about the expected impact of an innovation

even though the decision to adopt the innovation has previously been taken.

From the adopter's statement, it is known that PaSar Jiwa's innovation has been well

implemented. It is hoped that the officers can be added and the services can be further developed so

that the handling of mental health problems in the community can be handled properly. Meanwhile,

if it is related to the theory (Rogers & Singhal, 2003) about the decision to adopt innovation, the

analysis at this implementation stage explains that PaSar Jiwa innovation has been tried to be

implemented, but at this stage, there is still a possibility or uncertainty of the impact of the

implementation of the innovation. Although at the previous stage, both implementers and adopters

of innovations have already decided to accept innovations.

Confirmation Stage :

According to (Rogers & Singhal, 2003) at this stage of confirmation, the sustainability of

innovation will depend on individual support and attitude, while discontinuity is the attitude of

rejecting innovation after adopting it. This unsustainability can occur in two ways, namely first: the

individual rejection of innovation to seek other innovations (replacement discontinuance) and

second: unsustainability due to dissatisfaction with the results of the decision to adopt innovations

or it can also be because innovations do not meet needs so that there is no benefit from the

innovation.

From both statements, it is known that the adopters of the PaSar Jiwa innovation have each

confirmed that the impact of following the innovation has proven to help patients recover by being

able to move again. Meanwhile, if it is associated with the theory (Rogers & Singhal, 2003) about

the decision to adopt innovation, the analysis at this confirmation stage, will be seen in two variables,

namely sustainability and discontinuity (discontinuance) of innovation. Based on the results of the

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discussion above, it is known at this stage that both implementers and adopters of innovation have

jointly confirmed to continue innovation. This is demonstrated through statements and support from

implementers and adopters of innovation.

CONCLUSION

Based on the discussion and research results in the previous chapter, the research conclusions

of the Decision to Adopt Mental Market Innovation in Conducting Early Prevention of Mental

Health Problems at the Bubakan Health Center in Pacitan Regency based on theory (Rogers &

Singhal, 2003) are as follows:

According to theory (Rogers & Singhal, 2003), before going to the stage in the communication

channel of innovation diffusion, it always begins with a consideration of the conditions or

background that trigger innovators in giving birth to an innovation. In the context of this PaSar Jiwa

innovation, the background is contained in the variables felt needs/problems or needs/problems that

exist in the work area of the Bubakan Health Center. These needs or problems are treatment gaps

and social stigma. Of the need to solve problems, the Bubakan Health Center initiated the birth of

PaSar Jiwa Innovation through the Decree of the Head of the Bubakan Health Center regarding the

PaSar Jiwa Innovation Team. Therefore, as the implementers of innovation, doctors, nurses, and

mental cadres then opened the communication channel to the community in 5 (five) villages in the

Bubakan Health Center work area.

At the knowledge stage as a theory (Rogers & Singhal, 2003), it has three indicators, namely:

1) Knowledge indicators of the existence of an innovation. This indicator is influenced by two

variables, namely individual variables and communication behavior variables. On individual

variables, both implementers and adopters of each innovation have the same knowledge that the

innovation is not only solving mental health problems but also an effort to save medical costs. While

on the variable of communication behavior, there is still socialization or counseling about PaSar

Jiwa that has not reached all communities. This is also felt by innovation adopters. 2) Knowledge

indicators of how to properly use an innovation. This indicator is influenced by individual variables

that the mental health management procedure has been running well. However in terms of

communication behavior variables, the intensity of mentoring performance for mental health

patients in the field is still minimal due to limited mental health human resources, let alone still

having other administrative workloads. 3) Indicators of knowledge of the principles of functioning

underlying how and why an innovation can work. This indicator is influenced by individual

variables, where PaSar Jiwa innovation implementers are guided by the terms of reference as guia

de in carrying out functions for the entire innovation team in terms of passisting

Next is the second stage, namely the stage of encouragement or persuasion. At this stage, the

characteristics of PaSar Jiwa innovation are influenced by four variables, namely: 1) Relative profit

variable: This variable measures the comfort factor, and satisfaction or something that is considered

profitable. For innovation adopters, PaSar Jiwa can affect the quality of life of patients so this

innovation is very profitable and provides satisfaction to adopters. 2) Compatibility variable: This

variable measures the consistency of existing values as well as the needs of adopters. The need to

find solutions for the recovery of patients or families of people with mental health disorders is an

impetus for innovation adopters in the decision to adopt these innovations. 3) Trialability variable:

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This variable is influenced by the degree to which innovations can be piloted gradually. For

implementers and adopters of innovation, this is by the introduction of innovation to each village

through gradual socialization starting from the Bubakan Health Center to the hamlet level. So that

makes it easier for adopters to accept innovation. and 4) Observability variable: This variable is

influenced by the level of innovation if seen or observed by others. For innovation adopters, this can

be proven by following assistance from cadres and seeing changes that occur in patients so that

innovation adopters have the incentive to accept the PaSar Jiwa innovation. The biggest

encouragement is due to a change in patient attitudes when compared to before participating in PaSar

Jiwa innovation assistance. At this stage of encouragement, there is only one variable that does not

affect that is the complexity variable or the variable caused by the level of difficulty of innovation.

This is because PaSar Jiwa innovation has no difficulty in adoption.

The third stage is the decision stage. At this stage, both parties, both PaSar Jiwa innovation

implementers and adopters have jointly decided to adopt the innovation because of the benefits and

benefits in it. This PaSar Jiwa innovation has also been used partially, therefore innovation can be

accepted faster because the adopters have tried innovations after that decided to accept the

innovation. The fourth stage is the implementation stage. At this stage, the PaSar Jiwa innovation

has been tested to be implemented, although there is still a possibility or uncertainty of the impact

of the implementation of the innovation.

The final stage is the confirmation stage. At this stage, both implementers and adopters of the

innovation have jointly ensured the sustainability of the PaSar Jiwa innovation. By the results of

previous discussions, both parties decided to continue this innovation. The continued use of

innovation is proven by the support and attitudes of implementers and adopters of innovation. In the

previous stage, namely the implementation stage, both implementers and adopters of the innovation

were supported by decisions that had been taken based on encouragement or persuasion and

knowledge at the previous stage.

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