The Relationship of Education Level and Economic Status with The Use of Scraping on The Elderly Based on Transcultural Nursing

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INTRODUCTION
Complementary nursing and alternative medicine have been widely used by the community, one of which is scrapings. According to the National Center of Complementary and Alternative Medicine, complementary and alternative therapies are treatments that consist of various medical practices and products that are not part of conventional medicine (Indriani, 2019). The World Health Organization (WHO) states that 75-80% of the world's population has undergone non-conventional treatment. Nonconventional treatment is a treatment that can use traditional methods such as scrapings. The minister of health of republic Indonesia explained that traditional medicine is one of the efforts to treat other ways outside of medicine and or nursing, which are widely used by the community in overcoming health problems (RI, 2003). In Asia, the use of conventional medicine is also in great demand. Several countries such as Vietnam, China, Cambodia, and Indonesia have almost the same conventional treatment, one of which is scraping, as it is called in Indonesia. In Vietnam, they call scraps Cao Gio, Cambodia calls them Goh Kyol, and in China, they call scraps Gua Sha but the Chinese use jade as a scraping tool (Triratnawati, 2010).
According to Efendi and Makhfudli (2009) scraping is a traditional method of pressing and sliding a blunt object such as a coin or spoon repeatedly on the skin's surface until a red patch appears. The survey results on research by Didik (2004) scrapings, and 64% believed scrapings were very useful for colds and muscle pain. According to research conducted by Suryani and Sianturi (2013), scrapings are believed to be effective in curing symptoms of unwell in the elderly who experience physical changes as an effort to handle when they are not feeling well because the method is easy, effective. and does not require much money. However, using scrapings that are carried out continuously will cause an addiction effect so that existing health services are not used effectively by the elderly. Only now, scraping is a treatment method that has yet to have a specific policy regarding its use, although studies show that scrapings do not have a severe impact. However, using scrapings on the elderly will pose a risk to health due to physiological changes (Supadmi, 2013).
According to the World Health Organization (WHO), in 2020, the world's population aged 60 years and over will reach 900 million people. In Southeast Asia, the elderly population is 8% or around 142 million people. 13.06% of the total population of East Java. This figure tends to increase compared to the previous year, which was 12.64%. This shows that East Java is an area with a population structure towards an aging population. It was also stated that the highest elderly population in East Java province based on the highest order was in the Regencies of Magetan, Pacitan, Ponorogo, and Lamongan, followed by Tuban.
Efforts to improve the health status of the elderly can be influenced by various factors, including cultural and social culture. This is in accordance with the transcultural nursing theory by Leininger and R McFarland (2002), which examines nursing care based on cultural similarities and differences. The dimensions of the cultural and social structure in theory proposed by Leininger include economic and educational factors. An ethnographic study by Suryani and Sianturi (2013) showed that economic and cultural factors influenced the selection of scrapings to treat colds in a farming community in Sleman Yogyakarta. In a study conducted by Permasatasari, L. I., Lukman, M., (2014) District, Tuban Regency. The collecting and processing of data used an instrument, namely the education and economics questionnaire. Data management is done using a scoring technique. Then the scoring data was analyzed to see the relationship between the problems discussed using the Pearson correlation test.

RESULT
This study's demographic characteristics described respondents' characteristics, including gender, age, occupation, religion, and ethnicity. The education level of the elderly  Table 2 shows, the most of respondents had low educational level (60%, n=25).
The economic status of the elderly  Table 3 shows that from 42 respondents, more than some respondents have a low economic status (59.5%, n=59.5).
The use of scraping on elderly Based on the table 4, it shows that from 42 respondents, more than half respondents used scrapings (62%, n=26). There was a respondent (2.3%) who had a medium and low level of education in using scrapings, two respondents (5%) having a moderate level of education and a moderate frequency of using scrapings, and most respondents (22%, n=9) have an education level. and followed by a high frequency of scrapings.

The Relationship between Education Level and The Use of Scraping
Then, two respondents (5%) have a high level of education, but the frequency of scraping is low. Two other respondents (5%) have a high level of education and a moderate frequency of scraping, and six respondents (14%) have a high level of education and frequency of scraping. Analysis using Spearman Rho statistical test p=0.007 (p=value <0.05). These results indicate that Hypothesis 1 is accepted. There is a relationship between the level of education and the use of scrapings on the elderly. The value of r = 0.472. It can be interpreted as a strong and positive relationship between the level of education and scrapings on the elderly. Based on table 6, four respondents (9.9%) had low economic status and scraping frequency. Six other respondents (14%) had low economic status, but the frequency of scrapings is in the moderate category.

The Relationship between Economic Level and Utilization of Scraps
A total of 15 respondents (36%) had low economic status, but the frequency of scrapings is in the high category.
Then, five respondents (12.1%) had high economic status but low use of scrapings. One respondent (2%) had a high economic status but was low in the use of scrapings, and the remaining respondents (26%, n=11) had high economic status and were followed by a high frequency of scrapings.
Analysis using Spearman Rho statistical test obtained p = 0.071 (p-value <0.05). These results show that H1 is rejected, meaning there is no relationship between economic factors and the use of scrapings on the elderly. The value of r = -0.09 can be interpreted as having no significant relationship between economic factors and the use of scrapings on the elderly. The results showed a relationship between educational factors and the use of scrapings on the elderly. This is in line with Sari and Prastianty research (2017), which states that the educational factor is significant for the Jambi Malay tribe with education or knowledge of various experiences in overcoming a health problem. Leininger and R McFarland (2002), suggests that health behavior is shaped by various factors that work together. The higher an individual's education, the individual's belief can be supported by scientific evidence that is rational and can adapt to a culture that is in accordance with his health condition.

DISCUSSION
According to Nugroho (2000), the higher the individual's education is expected to be able to carry out something important for himself and their community.
The category of 'moderate education level' in this research was the respondents who graduated from junior high school or equivalent also respondents who graduated from high school or equivalent. The results show that 31 respondents graduated from junior high school or the equivalent, and 16 graduated from high school or the equivalent. Respondent code no.1 has a high education level: he graduated from college but still uses scrapings to help relieve unwell feelings. According to Mubarak and Chayatin, 2009), the level of education can affect awareness of the importance of health for oneself and the environment, which can encourage the need for health services. The elderly with higher formal education will have higher knowledge than the elderly with lower education levels. Supardi, Jamal and Loupatty (2012), stated that the number of educated people who did not finish high school/equivalent was 1.17 times higher than the population who graduated from high school/equivalent.
Education is one of the supporting factors in the use of scrapings. Education is not only knowledge and learning outcomes but also experiences gained from the surrounding culture and habits. People choose the treatment method of using scrapings because it is obtained from previous people's experiences and the community's habits, so using scrapings becomes a suggestion for the elderly to get rid of feeling unwell.
Factors in the theory of transcultural nursing that are more strongly related to using scrapings in the The study's results showed no relationship between the education factor and the use of scraping on the elderly. Family income can determine the health status of the family. Good family income can affect maintaining cleanliness and subsequent handling based on family income. Meanwhile, low-income families can only meet their needs in health facilities according to their abilities (Kemenkes, 2017).
However, this does not apply to families with good incomes but have many family members whose living expenses are covered. According to Leininger and R McFarland (2002), people will take advantage of the material resources they have to pay for their illness to recover quickly.
The results showed that 25 respondents had low economic status and 17 had high economic status, even though they both had high scores on using scrapings. It can be said that economic factors are not related to the use of scrapings on the elderly. No matter the high or low economic status of the elderly, they still use scrapings to relieve the mild symptoms of their disease. Economic factors do not guarantee that the elderly choose a medication treatment. It is evident that even respondents with high economic status also use scrapings as a treatment method.

CONCLUSION
It can be concluded that the education factor is related to the use of scrapings by the elderly (p-value = 0.007), while the economic factor is not related (p-value = 0.071). Further research needs to be done to examine the effects of scrapings on the health of the elderly.