{"id":"https://openalex.org/W7204753555","doi":"https://doi.org/10.53713/nhsj.v6i3.685","title":"Culturally embedded resilience in the diabetes-COVID-19 syndemic: A phenomenological study of older adults in Bali, Indonesia","display_name":"Culturally embedded resilience in the diabetes-COVID-19 syndemic: A phenomenological study of older adults in Bali, Indonesia","publication_year":2026,"publication_date":"2026-08-31","ids":{"openalex":"https://openalex.org/W7204753555","doi":"https://doi.org/10.53713/nhsj.v6i3.685"},"language":"en","primary_location":{"id":"doi:10.53713/nhsj.v6i3.685","doi":"https://doi.org/10.53713/nhsj.v6i3.685","is_oa":true,"landing_page_url":"https://doi.org/10.53713/nhsj.v6i3.685","pdf_url":"https://www.nhs-journal.com/index.php/nhs/article/download/685/365","source":{"id":"https://openalex.org/S4387278499","display_name":"Nursing and Health Sciences Journal (NHSJ)","issn_l":"2798-5059","issn":["2798-5059","2798-5067"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Nursing and Health Sciences Journal (NHSJ)","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://www.nhs-journal.com/index.php/nhs/article/download/685/365","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5019968710","display_name":"Putu Wira Kusuma Putra","orcid":"https://orcid.org/0009-0001-4459-0335","observed_orcids":["https://orcid.org/0009-0001-4459-0335"]},"institutions":[{"id":"https://openalex.org/I4405274866","display_name":"STIKES Bina Usada Bali","ror":"https://ror.org/02h537x90","country_code":"ID","type":"education","lineage":["https://openalex.org/I4405274866"]}],"countries":["ID"],"is_corresponding":false,"raw_author_name":"Putu Wira Kusuma Putra","raw_affiliation_strings":["Nursing Program, STIKES Bina Usada Bali, Badung, Bali"],"raw_orcid":"https://orcid.org/0009-0001-4459-0335","affiliations":[{"raw_affiliation_string":"Nursing Program, STIKES Bina Usada Bali, Badung, Bali","institution_ids":["https://openalex.org/I4405274866"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5024128213","display_name":"Ni Komang Matalia Gandari","orcid":"https://orcid.org/0000-0002-0460-5520","observed_orcids":["https://orcid.org/0000-0002-0460-5520"]},"institutions":[{"id":"https://openalex.org/I4405274866","display_name":"STIKES Bina Usada Bali","ror":"https://ror.org/02h537x90","country_code":"ID","type":"education","lineage":["https://openalex.org/I4405274866"]}],"countries":["ID"],"is_corresponding":false,"raw_author_name":"Ni Komang Matalia Gandari","raw_affiliation_strings":["Nursing Program, STIKES Bina Usada Bali, Badung, Bali"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Nursing Program, STIKES Bina Usada Bali, Badung, Bali","institution_ids":["https://openalex.org/I4405274866"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5066437144","display_name":"Ni Nyoman Suardani","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Ni Nyoman Suardani","raw_affiliation_strings":["Mangusada General Hospital, Badung, Bali"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Mangusada General Hospital, Badung, Bali","institution_ids":[]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5148771151","display_name":"Meriana Barreto Amaral","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210114874","display_name":"National University of East Timor","ror":"https://ror.org/026hhvp67","country_code":"TL","type":"education","lineage":["https://openalex.org/I4210114874"]}],"countries":["TL"],"is_corresponding":false,"raw_author_name":"Meriana Barreto Amaral","raw_affiliation_strings":["Faculty of Medicine and Health Sciences, Universidade Nacional Timor Loro-Sa\u2019e, D\u00edli"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Faculty of Medicine and Health Sciences, Universidade Nacional Timor Loro-Sa\u2019e, D\u00edli","institution_ids":["https://openalex.org/I4210114874"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"6","issue":"3","first_page":"360","last_page":"360"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10793","display_name":"Diabetes Management and Education","score":0.7856000065803528,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10793","display_name":"Diabetes Management and Education","score":0.7856000065803528,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11761","display_name":"Resilience and Mental Health","score":0.04960000142455101,"subfield":{"id":"https://openalex.org/subfields/3203","display_name":"Clinical Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10168","display_name":"COVID-19 and Mental Health","score":0.03220000118017197,"subfield":{"id":"https://openalex.org/subfields/3203","display_name":"Clinical Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/type-2-diabetes","display_name":"type 2 diabetes","score":0.8880000114440918},{"id":"https://openalex.org/keywords/older-adults","display_name":"older adults","score":0.9980000257492065},{"id":"https://openalex.org/keywords/balinese-culture","display_name":"Balinese culture","score":0.6800000071525574},{"id":"https://openalex.org/keywords/tri-hita-karana","display_name":"Tri Hita Karana","score":0.8960000276565552},{"id":"https://openalex.org/keywords/dietary-management","display_name":"dietary management","score":0.8410000205039978},{"id":"https://openalex.org/keywords/physical-activity-during-pandemic","display_name":"physical activity during pandemic","score":0.7940000295639038},{"id":"https://openalex.org/keywords/treatment-adherence","display_name":"medication adherence","score":0.8119999766349792},{"id":"https://openalex.org/keywords/chronic-disease-self-management","display_name":"chronic disease self-management","score":0.8640000224113464},{"id":"https://openalex.org/keywords/deficit-narratives","display_name":"deficit narratives","score":0.7590000033378601},{"id":"https://openalex.org/keywords/bali","display_name":"Bali","score":0.4650000035762787}],"concepts":[{"id":"https://openalex.org/C2779797386","wikidata":"https://www.wikidata.org/wiki/Q7662290","display_name":"Syndemic","level":3,"score":0.6895999908447266},{"id":"https://openalex.org/C2779343474","wikidata":"https://www.wikidata.org/wiki/Q3109175","display_name":"Context (archaeology)","level":2,"score":0.5309000015258789},{"id":"https://openalex.org/C156325361","wikidata":"https://www.wikidata.org/wiki/Q1152864","display_name":"Grounded theory","level":3,"score":0.5174999833106995},{"id":"https://openalex.org/C13200473","wikidata":"https://www.wikidata.org/wiki/Q2747831","display_name":"Reflexivity","level":2,"score":0.5056999921798706},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.503000020980835},{"id":"https://openalex.org/C139265228","wikidata":"https://www.wikidata.org/wiki/Q5283089","display_name":"Distress","level":2,"score":0.41929998993873596},{"id":"https://openalex.org/C55958113","wikidata":"https://www.wikidata.org/wiki/Q169480","display_name":"Indigenous","level":2,"score":0.41690000891685486},{"id":"https://openalex.org/C137176749","wikidata":"https://www.wikidata.org/wiki/Q4105337","display_name":"Psychological resilience","level":2,"score":0.41679999232292175},{"id":"https://openalex.org/C190248442","wikidata":"https://www.wikidata.org/wiki/Q839486","display_name":"Qualitative research","level":2,"score":0.4156999886035919},{"id":"https://openalex.org/C144024400","wikidata":"https://www.wikidata.org/wiki/Q21201","display_name":"Sociology","level":0,"score":0.40299999713897705},{"id":"https://openalex.org/C113470044","wikidata":"https://www.wikidata.org/wiki/Q6056506","display_name":"Interpretative phenomenological analysis","level":3,"score":0.35670000314712524},{"id":"https://openalex.org/C547328371","wikidata":"https://www.wikidata.org/wiki/Q132196","display_name":"Karma","level":3,"score":0.3458000123500824},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.34540000557899475},{"id":"https://openalex.org/C75630572","wikidata":"https://www.wikidata.org/wiki/Q538904","display_name":"Applied psychology","level":1,"score":0.32269999384880066},{"id":"https://openalex.org/C3017944768","wikidata":"https://www.wikidata.org/wiki/Q1450463","display_name":"Poison control","level":2,"score":0.32030001282691956},{"id":"https://openalex.org/C2779998236","wikidata":"https://www.wikidata.org/wiki/Q223270","display_name":"Loneliness","level":2,"score":0.31929999589920044},{"id":"https://openalex.org/C77805123","wikidata":"https://www.wikidata.org/wiki/Q161272","display_name":"Social psychology","level":1,"score":0.31130000948905945},{"id":"https://openalex.org/C102944935","wikidata":"https://www.wikidata.org/wiki/Q4953701","display_name":"Bracketing (phenomenology)","level":2,"score":0.31049999594688416},{"id":"https://openalex.org/C2778652608","wikidata":"https://www.wikidata.org/wiki/Q1752840","display_name":"Salutogenesis","level":4,"score":0.302700012922287},{"id":"https://openalex.org/C194943564","wikidata":"https://www.wikidata.org/wiki/Q1129049","display_name":"Participant observation","level":2,"score":0.3021000027656555},{"id":"https://openalex.org/C73282008","wikidata":"https://www.wikidata.org/wiki/Q1759895","display_name":"Coping (psychology)","level":2,"score":0.2994000017642975},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.29420000314712524},{"id":"https://openalex.org/C89623803","wikidata":"https://www.wikidata.org/wiki/Q12184","display_name":"Pandemic","level":5,"score":0.28690001368522644},{"id":"https://openalex.org/C31957729","wikidata":"https://www.wikidata.org/wiki/Q5282877","display_name":"Distancing","level":5,"score":0.2867000102996826},{"id":"https://openalex.org/C134362201","wikidata":"https://www.wikidata.org/wiki/Q317309","display_name":"Mental health","level":2,"score":0.2838999927043915},{"id":"https://openalex.org/C138496976","wikidata":"https://www.wikidata.org/wiki/Q175002","display_name":"Developmental psychology","level":1,"score":0.2827000021934509},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.26919999718666077},{"id":"https://openalex.org/C2780444219","wikidata":"https://www.wikidata.org/wiki/Q341045","display_name":"Mindfulness","level":2,"score":0.2660999894142151},{"id":"https://openalex.org/C70410870","wikidata":"https://www.wikidata.org/wiki/Q199906","display_name":"Clinical psychology","level":1,"score":0.2567000091075897},{"id":"https://openalex.org/C2777673361","wikidata":"https://www.wikidata.org/wiki/Q5281228","display_name":"Disadvantage","level":2,"score":0.2547999918460846},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.25440001487731934}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.53713/nhsj.v6i3.685","doi":"https://doi.org/10.53713/nhsj.v6i3.685","is_oa":true,"landing_page_url":"https://doi.org/10.53713/nhsj.v6i3.685","pdf_url":"https://www.nhs-journal.com/index.php/nhs/article/download/685/365","source":{"id":"https://openalex.org/S4387278499","display_name":"Nursing and Health Sciences Journal (NHSJ)","issn_l":"2798-5059","issn":["2798-5059","2798-5067"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Nursing and Health Sciences Journal (NHSJ)","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.53713/nhsj.v6i3.685","doi":"https://doi.org/10.53713/nhsj.v6i3.685","is_oa":true,"landing_page_url":"https://doi.org/10.53713/nhsj.v6i3.685","pdf_url":"https://www.nhs-journal.com/index.php/nhs/article/download/685/365","source":{"id":"https://openalex.org/S4387278499","display_name":"Nursing and Health Sciences Journal (NHSJ)","issn_l":"2798-5059","issn":["2798-5059","2798-5067"],"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Nursing and Health Sciences Journal (NHSJ)","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":1.0,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7204753555.pdf","grobid_xml":"https://content.openalex.org/works/W7204753555.grobid-xml"},"referenced_works_count":31,"referenced_works":["https://openalex.org/W3096909987","https://openalex.org/W3120967903","https://openalex.org/W3192517516","https://openalex.org/W3217392569","https://openalex.org/W4210351174","https://openalex.org/W4225723699","https://openalex.org/W4288056383","https://openalex.org/W4288070455","https://openalex.org/W4308374264","https://openalex.org/W4310038313","https://openalex.org/W4365140148","https://openalex.org/W4380681949","https://openalex.org/W4386142991","https://openalex.org/W4386469522","https://openalex.org/W4387033642","https://openalex.org/W4387765562","https://openalex.org/W4389795291","https://openalex.org/W4395013170","https://openalex.org/W4399830656","https://openalex.org/W4400057270","https://openalex.org/W4401758960","https://openalex.org/W4401905113","https://openalex.org/W4402363525","https://openalex.org/W4402958225","https://openalex.org/W4407859234","https://openalex.org/W4409988880","https://openalex.org/W4412440155","https://openalex.org/W4414967937","https://openalex.org/W4416844581","https://openalex.org/W7117551987","https://openalex.org/W7118373064"],"related_works":["https://openalex.org/W7161061602","https://openalex.org/W4387806330","https://openalex.org/W4389782830","https://openalex.org/W4319334850","https://openalex.org/W7171615576","https://openalex.org/W7061090149","https://openalex.org/W4407773376","https://openalex.org/W4413439076","https://openalex.org/W7008256851","https://openalex.org/W4380681949"],"abstract_inverted_index":{"The":[0,139],"COVID-19\u2013diabetes":[1],"mellitus":[2],"(DM)":[3],"syndemic":[4,111,170],"disproportionately":[5],"threatened":[6],"older":[7,23,51],"adults":[8,25,52],"with":[9,26,81,119,128],"Type":[10],"2":[11],"DM":[12],"globally.":[13],"This":[14],"study":[15,44],"investigates":[16],"the":[17],"culturally":[18,176],"embedded":[19,177],"resilience":[20,195],"mechanisms":[21],"enabling":[22],"Balinese":[24,121],"long-standing":[27],"T2DM":[28,55],"to":[29,103],"maintain":[30],"complication-free":[31],"status":[32],"during":[33],"this":[34,169],"crisis,":[35],"directly":[36],"challenging":[37],"dominant":[38],"deficit":[39],"narratives.":[40],"A":[41],"descriptive":[42],"phenomenological":[43],"grounded":[45],"in":[46,58,70],"Husserlian":[47],"principles":[48],"recruited":[49],"ten":[50],"(aged":[53],"56\u201370;":[54],"\u226520":[56],"years)":[57],"Badung":[59],"Regency,":[60],"Bali,":[61],"utilizing":[62],"purposive":[63],"sampling.":[64],"Bilingual":[65],"researchers":[66],"conducted":[67],"in-depth":[68],"interviews":[69],"participants\u2019":[71],"preferred":[72],"languages.":[73],"Data":[74],"were":[75],"analyzed":[76],"employing":[77],"Colaizzi\u2019s":[78],"seven-step":[79],"method,":[80],"methodological":[82],"rigor":[83],"ensured":[84],"through":[85],"reflexive":[86],"bracketing":[87],"and":[88,133,159],"biweekly":[89],"peer":[90],"debriefing.":[91],"Analysis":[92],"revealed":[93],"four":[94],"interconnected":[95],"themes":[96],"illustrating":[97],"a":[98,150,163,174,181],"trajectory":[99],"from":[100],"psychological":[101],"distress":[102],"disciplined":[104],"self-management:":[105],"(1)":[106],"spiritually":[107],"mediated":[108],"acceptance":[109],"of":[110],"threat;":[112],"(2)":[113],"dietary":[114],"management":[115,205],"integrating":[116,198],"biomedical":[117,136,160],"guidance":[118],"traditional":[120],"Usada":[122],"practices;":[123],"(3)":[124],"adapted":[125],"physical":[126],"activity":[127],"strict":[129],"pandemic":[130],"protocol":[131],"adherence;":[132],"(4)":[134],"consistent":[135],"treatment":[137],"compliance.":[138],"Tri":[140],"Hita":[141],"Karana":[142],"(THK)":[143],"philosophy":[144],"underpinned":[145],"all":[146],"themes,":[147],"functioning":[148],"as":[149,173,193],"cohesive":[151],"cultural":[152],"framework":[153],"that":[154],"seamlessly":[155],"integrated":[156],"psychological,":[157],"behavioral,":[158],"domains":[161],"into":[162,202],"unified":[164],"self-management":[165],"ecosystem.":[166],"Resilience":[167],"within":[168],"context":[171],"emerged":[172],"dynamic,":[175],"process":[178],"rather":[179],"than":[180],"fixed":[182],"individual":[183],"trait.":[184],"Healthcare":[185],"systems":[186],"must":[187],"prioritize":[188],"THK-informed,":[189],"strength-based":[190],"nursing":[191],"programs":[192],"proactive":[194],"infrastructure,":[196],"systematically":[197],"indigenous":[199],"health":[200,210],"philosophies":[201],"chronic":[203],"disease":[204],"strategies":[206],"for":[207],"future":[208],"global":[209],"emergencies.":[211]},"counts_by_year":[],"updated_date":"2026-10-28T10:33:24.094632","created_date":"2026-09-01T00:00:00"}
