Lathifah Hanum

In Indonesia, intergenerational co-residence in later life is widely regarded as a normative arrangement, yet older adults’ own motivations for and reservations about living with their adult children remain underexamined. This study explored how older Indonesian adults perceive co-residence with their adult children and what considerations shape their preferences. Using a vignette-based qualitative design, we conducted semi-structured interviews with 20 older adults (aged 60 to 78) who were themselves living in multigenerational households. Data were analysed using a hybrid inductive-deductive thematic analysis. When responding to the vignette, most participants (13 of 20) expressed a preference against prioritising co-residence, despite all currently living with an adult child. A recurring motivation was their wish not to become a burden on their children and to preserve their independence. Five factors shaped these perspectives: financial circumstances, relationship quality, filial responsibility, health-related housing suitability, and marital status. By showing that older adults embedded in a strongly pro-co-residence culture nonetheless voice reservations about it and prioritise not becoming a burden on their children, this study challenges the assumption that normative co-residence reflects older adults’ own preferences and suggests that concerns about autonomy and dependency shape later-life living arrangements beyond individualistic Western settings.

Approximately 70% of older adults in Indonesia live in multigenerational households with their adult children, yet little is known about how adult children experience co-residence. This study developed and validated the Indonesian Intergenerational Co-Residence Scale for Adult Children (IICS-AC), addressing the absence of instruments that systematically capture these experiences. Item generation drew on a systematic review and in-depth interviews with 30 adult children, followed by expert evaluation through the Delphi method. Data were collected from 408 adult children across 25 provinces and analysed using confirmatory factor analysis (CFA). The results supported a refined four-factor, 31-item structure: filial responsibility, parent-child relationship, marital status, and financial circumstances, with acceptable model fit indices (RMSEA = 0.057, CFI = 0.918, TLI = 0.911, SRMR = 0.046). The four-factor structure was further supported by comparison against alternative one-factor and higher-order models. Subscales demonstrated strong internal consistency, although test-retest analysis indicated weaker temporal stability over a one-month interval. Initial validity evidence was obtained through convergent, discriminant, and criterion validity analyses, with the total score showing positive correlations with life satisfaction and negative correlations with depression. The IICS-AC offers a contextually relevant tool for assessing adult children’s experiences of intergenerational co-residence in Indonesia, with potential applications for research, practice, and policy, while further work is needed to establish its stability over time.

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Indonesia’s growing older population and the persistence of intergenerational co-residence highlight the need for context-specific assessment tools. Yet, there remains a gap in published instruments that evaluate these experiences for older adults and their adult children. This study investigated whether valid and context-specific questionnaires could be developed to assess these experiences through expert consensus. An initial pool of 119 items for older adults and 127 items for adult children was generated from in-depth interviews exploring motives for co-residence. The items addressed domains including filial responsibility, family relationships, marital status, financial circumstances and health-related considerations. For older adults, this included relationship quality with family members and housing suitability, while for adult children, it included parent-child relationships and adaptability to health and household conditions. The Delphi method was then used, with experts in family studies and geropsychology evaluating the clarity and relevance of these items across two rounds. The process refined the instruments, in the form of questionnaires, to 84 items for older adults and 82 items for adult children. The resulting instruments are the first context-specific tools designed for assessing intergenerational co-residence in Indonesia, offering a resource for researchers and practitioners to study family living arrangements.

Despite widespread use in social research, the vignette development often lacks systematic frameworks linking empirical evidence to narrative construction. This methodological gap is particularly problematic when studying sensitive topics across cultural contexts, where scenarios must balance realism with authenticity. This study presents a three-phase framework for developing and validating generation-specific vignettes through participatory stakeholder collaboration, using Indonesian intergenerational co-residence decisions as a methodological case study. The framework integrates: (1) translation of systematic review findings into vignette components reflecting key decision-making factors; (2) participatory scenario construction with real-time collaborative revision; and (3) two-stage validation through focus groups (n = 6 older adults; n = 6 adult children) and individual interviews (n = 4) assessing multidimensional reflection, balanced engagement, and clarity. Results demonstrated differential validation outcomes across generations: the older adults’ vignette required no revisions and elicited practical problem-solving responses, whereas the adult children’s vignette underwent modifications to clarify parental motivation, sibling proximity, and narrative sequence. Both vignettes successfully prompted consideration of interacting factors–health, finances, kinship, emotions, and cultural expectations–validating their capacity to elicit complex decision-making processes. The validated framework offers researchers a replicable, evidence-based approach for developing culturally grounded vignettes. While demonstrated through family co-residence research in Indonesia, the three-phase process provides transferable guidance for studying sensitive topics requiring stakeholder-validated scenarios across diverse populations and research contexts.

Background: Overweight and obesity are growing public health concerns globally for which innovative prevention and care delivery efforts are required. We recently developed a web-based training program to improve the quality of health professionals’ weight management counseling of adolescents in Indonesia. Having previously confirmed its acceptability, this study aimed to measure the effectiveness of the program through a randomized controlled trial. Methods: We recruited 64 primary healthcare professionals from 17 provinces across Indonesia who were randomized to participate in a 4-week online training program (intervention group [IG, n = 32] or a waitlist control group [CG, n = 32]). Using active learning approaches, the training program focused on adolescent development, psychosocial assessment, motivational interviewing (MI), and parent engagement. Participants in each arm were asked to record two counseling sessions with adolescents. These were objectively rated by trained psychologists using a validated tool, and also by qualitative assessment of counseling quality. In both groups, the first recorded counseling session occurred before the training. The second recording took place after the training for IG participants, but not for CG participants. Results: IG participants demonstrated significant improvements in their knowledge and counseling skills (p<0.001, t-test). This included improvements in introductory remarks, quality of psychosocial assessment, and MI skills. There was no change in the extent of parental involvement. The MI training successfully oriented the counseling sessions towards a more collaborative and participatory conversation for supporting behavioral change. Conclusion: This novel online training program improved the knowledge and counseling skills of Indonesian primary healthcare professionals. Greater emphasis on engaging parents and more guidance on conducting telehealth counseling may improve parental involvement in future iterations.

Background: Primary care provides an important context to engage adolescents and their families in healthy lifestyles with the goal of reducing future behaviour-related health problems. Developing a valid tool to assess health professionals’ skills in behavioural change counselling is integral to improving the quality of clinical care provided to adolescents in Indonesia. Methods: This work was nested within a project to develop a training program to enhance the behaviour-change counselling of adolescents and their parents by Indonesian primary care professionals. Initial item development was based on the content of the training module and the domain structure of the Behavioral Change Counselling Index (BECCI), a commonly used tool to assess counselling quality in healthcare settings. Expert panels were used to test content validity, while face validity was assessed by a group of trained psychologists. Inter-rater agreement was calculated prior to tests of construct validity and reliability, which involved psychologists rating 125 audio-taped counselling sessions between the health professional and adolescent patients, together with a parent. Results: An initial 13-item tool was developed using a 1–5 Likert scale. Validity and reliability testing resulted in the decision to use a 14-item tool with a 0–3 Likert scale. The scale was found to have a Cronbach’s α coefficient of 0.839 (internal consistency), and there was strong inter-rater agreement (0.931). Conclusion: The assessment tool known as the Adolescent Behavioural Change Counselling Assessment Tool, is a valid and reliable instrument to measure Indonesian health professionals’ behavioural-change counselling skills with adolescent patients. The tool provides an evaluation framework for future interventions that aim to improve health professionals’ skills in addressing adolescent behaviour-related health problems.

Background: Obesity is a growing public health and clinical concern, worldwide. In many countries, including Indonesia, health professionals lack the capacity to promote behavior change around obesity prevention and management, especially with adolescents for whom a wider set of communication skills are required. This study describes the theoretical basis, approach to development of content, use and satisfaction of an internet-based educational intervention designed to improve the quality of health professional weight management counseling with adolescents in Indonesia. Methods: This study is part of an exploratory sequential mixed methods design which was undertaken from 2020 to 2022. Following a needs analysis, an internet-based training resource was developed, informed by constructive alignment theory and active learning principles. Using both synchronous and asynchronous approaches over a four-week pilot study, a weekly interactive session was held online, using multifaceted training materials housed on a website (https://ramahremaja.id). The training resource was then tested in a two-arm study involving health professionals from 17 of 34 provinces across Indonesia. Results: Sixty-four primary health professionals were recruited for the two-arm study. The completion rate for reviewing all materials and assignments on the website was 72% and the online meeting participation rate was 78%. Participants were highly positive about the clarity of the training material and the appropriateness of the delivery methods. The main challenges related to poor internet literacy and interrupted internet connectivity. Conclusion: Designed to support weight management in adolescents, this internet-based training program shows potential for enhancing Indonesian health professional behavior-change counseling skills.

Many older adults in Indonesia live with their children. This study examined the relationship between the quality of the relationship that elderly parents may have with their children living with them and any effects on psychological well-being. Relationship quality encompasses positive and negative aspects. This study employed convenience sampling and to reach 102 elderly participants. A measure of positive and negative social exchanges was used to measure the relationship between elderly parents and their children. Ryff’s Scale of Psychological Well-Being was utilized to measure the psychological well-being of the subjects. We used descriptive statistics, Pearson correlation coefficient, an independent t-test, and one-way analysis of variance (ANOVA) to assess the statistics produced. The primary results showed no correlation between the positive qualities of the relationship and psychological well-being (r = 0.092, p > 0.01). However, the negative qualities of the relationship were negatively correlated with psychological well-being (r = −0.335, p < 0.01). Thus, negative qualities of relationships with their children were found to be more impactful on psychological well-being than positive qualities in elderly parents who maintain coresidence with their children. This means that the greater the lack of sympathy, intrusion, failure to provide needed help, and rejection/neglect from the child, the worse the psychological well-being of the elderly parent.