Abstract
After a natural disaster, survivors may undergo psychological and emotional challenges. Some experts argue that such traumatic incidents can also foster posttraumatic growth (PTG). This qualitative descriptive study aimed to explore the progression of PTG and the factors influencing it among natural disaster survivors. Seventy individuals originating from disaster-affected regions in Indonesia between 2006 and 2022 participated in 7 focus groups exploring the impact of natural disasters, the perceived catalysts for change, and the PTG process. Thematic analysis revealed 3 distinct but interconnected stages of PTG: (1) Traumatic experience, characterised by fear, loss, and emotional turmoil; (2) Introspection, marked by reflection, spiritual awakening, and re-evaluation of personal values; and (3) Transformation, demonstrated through strengthened relationships, community solidarity, and proactive coping behaviours. These findings highlight the role of spirituality, social support, and cultural values in facilitating growth. PTG was shaped by individual resilience, community, and institutional support at micro, meso, and macro levels. These insights identify the need for culturally sensitive post-disaster interventions that promote recovery and meaningful growth.
Keywords
Introduction
Natural disasters are large-scale events that can cause death, trauma, and property loss; disrupt services and social networks; deplete community resources; and lead to identifiable physical and mental health effects. 1 Experiencing a natural disaster, such as an earthquake, landslide, flood, or volcanic eruption, can lead to significant stress and anxiety. Natural disasters have both immediate and long-term impacts. 2 Although most people exposed to natural disasters do not develop a clinical disorder, these events can still harm mental health and well-being, contribute to short- and long-term distress and have a substantial mental health burden for individuals and communities. 3
Following such traumatic incidents, survivors are more prone to developing psychological and behavioural issues characterised by persistent reliving of the traumatic event, continuous avoidance of triggers associated with the event, emotional numbing, and ongoing symptoms of heightened arousal. 4 Presently, there is a growing focus on studying mental health challenges post-disaster due to the rising occurrence of disasters and their severe consequences.5,6 It is important to consistently address mental health needs throughout the disaster to potentially avert and mitigate psychological disorders by offering practical, comprehensive, and readily available mental health interventions. 7
Posttraumatic growth (PTG) is a construct describing positive psychological change reported after significant adversity, typically in domains such as meaning, personal strength, and relationships. 8 Over the past 25 years, PTG has been a major focus of research. 9 Recent studies have examined individual and community resilience, and how skills and behaviours develop over time to support recovery after traumatic events.10 -12 Tedeschi and Calhoun 13 introduced the concept of PTG to describe this phenomenon. PTG signifies the emergence of beneficial transformations following traumatic experiences, highlighting the transformative nature of individuals’ responses to such events. These positive changes encompass various aspects, such as altered self-perception, revised interpersonal relationships, and a transformed outlook on life. 14
Tedeschi and Calhoun 13 formulated a framework for PTG, which denotes the favourable psychological changes that take place following challenging life circumstances. Research has quantitatively documented a modest yet positive increase in personal resilience, interpersonal connections, and gratitude for life in various disaster scenarios. 15 However, there is limited research on PTG in the context of natural disasters in Indonesia. Consequently, there is a need for additional studies to substantiate the concept of PTG in this region.
Indonesia has a history of experiencing numerous natural disasters, resulting in significant casualties, leading to social, psychological, and economic impacts.16,17 PTG is a relatively new concept in Indonesia, where, commonly, post-disaster recovery efforts focus on rebuilding infrastructure and addressing economic concerns. 18 Prior studies of PTG narratives highlight trauma as a catalyst for meaning-making and for reframing adversity as an opportunity for personal growth.19,20
Limited qualitative research on PTG in the context of natural disasters in Indonesia exists, despite the country’s history of frequent and severe events. More studies are needed to investigate PTG and its impact on survivors, informing tailored interventions to promote psychological well-being and positive adaptation in the aftermath of disasters. Therefore, this study aimed to explore the development and the factors contributing to PTG among survivors of natural disasters.
Methods
Study Design
A qualitative descriptive approach was employed to explore how survivors of natural disasters in Indonesia make meaning of their experiences and navigate the process of PTG in the aftermath of trauma.
Participants
A total of 70 survivors of natural disasters participated in this study. Participants ranged in age from 29 to 65 years, with the sample being predominantly female (77%). The majority had a high school education (57%), while others had junior secondary or higher education. Their socio-economic background was generally modest, reflected in the fact that most were homemakers (67%) or farmers (33%), occupations typical of the rural and peri-urban areas where the disasters occurred. These demographic characteristics provide important context for understanding the sociocultural and economic environment in which PTG emerged. The study used purposive sampling, selected because PTG requires survivors who have lived experience of trauma severe enough to disrupt core beliefs, consistent with PTG theoretical foundations (Tedeschi & Calhoun). Inclusion criteria were:
(1) adults aged ≥18 years; (2) direct exposure to a significant natural disaster; (3) ability to recall the event; (4) at least 6 months post-disaster to allow psychological processing; and (5) residence in West Sumatra or Yogyakarta during the defined disaster periods. Exclusion criteria were individuals <18 years, those without direct exposure to a significant natural disaster, inability to recall the event, less than 6 months post-disaster, or living outside West Sumatra or Yogyakarta during the defined disaster periods.
These 2 provinces were selected because they represent diverse types of high-impact natural disasters in Indonesia: West Sumatra, with recurrent earthquakes and large-scale landslides (2009, 2022) and Yogyakarta, with one major earthquake (2006) and a high-impact volcanic eruption (2010). West Sumatra (Earthquake & Landslides, 2009; 2022), the magnitude 7.6 earthquake in 2009 (killed 1117 people; widespread destruction of homes, schools, and community infrastructure), and was followed by recurrent landslides affecting rural and mountainous areas with high mortality risk, bereavements, displacement, and economic disruption. Yogyakarta had Earthquake in 2006; Merapi Mount Eruption in 2010, and in 2006 earthquake with Magnitude 6.3; >5700 deaths; over 150 000 injuries. In 2010, during the Merapi eruption, pyroclastic flows, ashfall, displacement of >350 000 residents, long-term relocation, and destruction of agricultural livelihoods. These events were characterised by intense trauma exposure, uncertainty, and prolonged recovery, key contexts in which PTG tends to emerge.
Together, these locations allowed us to examine PTG across different disaster typologies, intensities, and recovery timelines. Both provinces also have documented large-scale casualties, infrastructural damage, and psychosocial impact, making them rich contexts for examining PTG. Pragmatic reasons were clarified: long-standing collaborations with local health centres and community leaders enabled ethical, safe access for survivors.
To recruit participants for the study, initial contact was made with influential community members, including community leaders and healthcare professionals at public health facilities. Subsequently, invitations for participation were extended to individuals through these networks. The participants were then organised into groups of 10 to 12 individuals. A series of focus group discussions (FGDs) was conducted, comprising 7 groups.
Focus Group Discussions
FGDs were conducted in the hall of local government office, to gather participants’ perspectives, insights, and understanding, with a focus on exploring PTG and related factors (see Table 1 for the FGD guide). Participants were encouraged to freely express their thoughts during the discussions, with groups facilitated by experienced researchers (MM and SA). All discussions were conducted sensitively, taking into account the potential for triggering traumatic memories and distress. The FGDs were conducted in a blend of local dialects to ensure a comfortable environment in which participants could share openly. The facilitators maintained a respectful, friendly, and empathetic approach throughout the sessions. Written informed consent was obtained from all participants beforehand, and all FGDs were recorded and transcribed. Analysis of the transcripts indicated data saturation at Focus Group 7, with no new content or themes emerging. Table 1 summarises the focus group interview guide under each category related to disaster impact, PTG, adaptation, and support systems.
Interview Guide: Disaster Impact and Recovery.
Data Analysis
Thematic analysis involves systematically reviewing qualitative data to identify recurring patterns and construct a descriptive narrative of the phenomenon under study. This approach allows for a nuanced understanding of complex experiences to provide insights. 21 The analysis process commenced with transcribing the survivors’ interview responses. The transcripts were reviewed for accuracy and subsequently proofread by a speaker fluent in the transcribed language to ensure linguistic clarity and fidelity. To facilitate analysis and reporting, the data were translated into the Indonesian language (Bahasa Indonesia). 22 To preserve meaning and ensure translation accuracy, back translation was undertaken: the Indonesian transcripts were independently translated back into the original dialects by a bilingual translator, with discrepancies reviewed and resolved among the research team. 23 This process facilitated conceptual equivalence and reliability of the translated data.
Data were analysed using Braun and Clarke’s 24 6-phase reflexive thematic analysis. First, transcripts were transcribed verbatim and repeatedly reviewed for familiarisation. Second, inductive coding was conducted manually, with codes emerging organically from the data. Third, codes were clustered into potential themes based on shared meaning. In the fourth phase, themes were refined for coherence and distinctiveness. Fifth, themes and subthemes were clearly defined and named. Finally, findings were synthesised into a narrative, supported by illustrative quotes.
Rigour and Trustworthiness
To enhance the trustworthiness of the study, the research team met regularly to review and refine the analysis, to debrief and have ongoing discussions and consensus-building. Furthermore, member checking was conducted by presenting the preliminary analysis to 1 participant to validate the interpretations and ensure alignment with their experiences. Feedback from the participant led to some revisions and supports the credibility of the findings. This is an important element in qualitative research, as member checking provides credibility to the data. 25 While not a whole community forum, this individual feedback served as an important validation step.
Ethical Approval and Consideration
This study received ethical approval from the Ethics Committee in Padang (Approval No. LB 02.02/5.7/206/2022). FGDs were conducted between August and September 2022. Participation was entirely voluntary, and confidentiality was strictly maintained throughout the research process. While no participants reported (or the team observed) distress during the discussions, the team remained attentive to any possible signs of discomfort. Participants were informed of the availability of support services and relevant community resources should they experience emotional distress at any point during or after the study. Written informed consent was obtained from all participants after they received a full explanation of the study’s purpose, procedures, and their rights.
Results
Participants had 2 distinct characteristics. Firstly, 30 survivors had experienced a disaster approximately 6 months prior to the interview. Secondly, 40 survivors had experienced a disaster between 2006 and 2010. In this study, participants were predominantly female (77% of the sample), with an age range of 29 to 65 years. The majority (57%) had a high school education level, while 67% identified as homemakers and 33% as farmers. From the FGD topics, the authors identified 3 main themes with several sub-themes (See Table 2).
Themes, Subthemes and Quotes of Survivors Show the Post-Traumatic Growth Stages.
The results showed that survivors progressed through 3 interconnected stages in their journey of post-disaster growth: Stage 1: Traumatic Experience, Stage 2: Introspection, and Stage 3: Transformation. Each stage involved distinct psychosocial processes, with both individual and community-level influences.
Stage 1: Traumatic Experience
This theme showed that the natural disaster triggered psychological distress as the first stage of the process after the disaster had happened. Traumatic experience was described as the feeling of shock and acute stress, fear, loss and grief, the sense of guilt and disillusionment. Survivors described experiencing shock and acute stress, with 1 participant recalling, “I was still in shock. . .I couldn’t believe it happened so fast. We had to run in the dark, crying and screaming.” (FGD2-P4). Many also reported fear and hypervigilance, as the trauma left them in a state of heightened alertness: “Now, every time I hear thunder or heavy rain, my heart races. I keep thinking another landslide is coming.” (FGD3-P3), or the feeling of fear for the unknown or unexplainable (FGD1).
Profound loss and grief were evident in some responses, such as “My house was destroyed. . .but worse, I saw my neighbour’s house collapse with their children inside.” (FGD6-P4), and for some participants, families were injured in front of them (FGD5). Additionally, the traumatic experience was not only expressed in fear or loss, but some survivors expressed anguish over their survival, while others perished. “I wonder why I survived, and others didn’t. It’s not easy to carry that." (FGD10-P4). There was also disappointment in human behaviour, as one noted, “Some people became selfish. . .even those helping us asked for something in return. It hurt to see that.” (FGD7-P4). These emotional reactions illustrate the initial impact phase, where trauma was internalised but not yet processed, leaving survivors in a state of profound distress or concern.
Stage 2: Introspection
Following the disaster, survivors entered a phase of deep reflection, trying to make sense of what had happened by reevaluating their past actions and beliefs. This period was marked by a search for meaning, with many participants turning to spirituality and faith for comfort, regardless of their religious affiliation. One survivor shared, “After the disaster, I began praying more. It brought peace. I felt closer to Allah.” (FGD5-P10). Another viewed the disaster as a divine test: “Disaster is a test from God. . .it made me more pious.” (FGD7-P5). Alongside this spiritual awakening, many experienced a renewed appreciation for life, recognising what truly mattered. “We lost everything. . .but we’re alive. That’s a blessing. Life matters more than things.“ (FGD2-P10). The crisis also strengthened family bonds and personal values, as priorities shifted: "Even if we don’t have food, we stay together. That’s what matters most now." (FGD6-P9). Moreover, community support had an important role in healing, as noted consistently, "My neighbours and the volunteers helped a lot. It made me feel that we are not alone.” (FGD1-P2). Throughout this stage, survivors began to reframe their experiences, integrating the trauma into a narrative of healing, faith, and connexion.
Stage 3: Transformation
The third stage showed a marked transformation among the survivors, where the initial emotional response gradually gave way to a sense of growth. Through reflection, they began to find meaning from their experience, reshaping their perspectives and actions in ways that resonated with PTG. This was not just about personal recovery, but also encompassed changes in all aspects of the neighbourhood, including trust in the community leader, information sharing, and the development of new knowledge and/or skills. The community’s concern and care for the survivors’ well-being were evident, as identified in the volunteers’ and university responses (FGD1), the local government’s maintenance of health service access (FGD2), and the provision of temporary shelters and houses (FGD6 & FGD1).
Survivors also realised that the support is not permanent (FGD3); they need to be aware and build or cope in more constructive ways. There was a sense of community solidarity, as neighbours who once struggled now stood together. “After the earthquake, our neighbourhood became stronger. We help each other without being asked." (FGD5-P4). Acts of mutual aid were identified as automatic: “The support is automatic now. When someone’s house collapsed, we worked together to rebuild it.” (FGD4-P6). Alongside this collective strength came personal resilience and acceptance: “This is part of life. We can’t control disasters, but we can prepare and support each other." (FGD3-P8). Additionally, there was empowerment and forward-thinking. Survivors were taking charge of their future as illustrated, “I learned about disaster mitigation from the volunteers. Now I help teach others." (FGD1-P5). Lessons from the past also informed subsequent actions: “In building houses now, we make sure to follow safe construction standards.” (FGD3-P3). These showed the attitude that reflected how the survivors not only endured the events but also how they felt stronger, wiser, and more connected. The trauma, once a source of despair, had become a catalyst for resilience, future preparedness, and hope.
Table 2 presents the findings in a hierarchical format, beginning with the overarching theme, followed by the sub-themes, and supported by illustrative participant quotes.
Discussion
The aim of this research was to investigate PTG and the factors influencing its development among natural disaster survivors in two Indonesian provinces. Using a 3-stage process of PTG: traumatic experience, introspection, and transformation, this study reveals an adaptive and contextually embedded process of PTG that aligns with PTG theory. 13 This highlights culturally specific nuances in the Indonesian setting and describes positive change after adversity.
The first stage, Traumatic experience, captured the psychosocial aftermath immediately following the natural disaster. Survivors recounted shock, fear, helplessness, and grief. These findings reflect the foundational stage of PTG development as conceptualised by Tedeschi and Calhoun, 13 in which trauma disrupts core beliefs and challenges. Consistent with past studies, this initial experience is a psychological symptom and a prerequisite for growth. 9 Interestingly, this stage also revealed negative social factors such as opportunism and egoism (eg, perceived selfishness) among some survivors, supporting findings from the disaster literature, which often exposes both prosocial and antisocial behaviours. 26 The Traumatic Experience stage reflected acute psychological disruption characterised by shock, fear, guilt, and moral disillusionment. At this stage, individual differences, such as previous exposure to disasters, personal coping styles, and religious orientation, heightened or reduced emotional turmoil. Limited initial access to support services amplified distress for some, whereas the rapid response of volunteers and health personnel helped others regain physical and emotional stability. This aligns with literature demonstrating that unmet basic needs and unaddressed trauma reactions prolong intrusive rumination and impede progress towards growth.
In the second stage, Introspection, survivors began a process of meaning-making. Religious beliefs played a central role, serving as a coping mechanism and a source of transformative insight. In line with Seyed Bagheri et al 27 and Pearce et al, 28 our study confirms that spirituality, particularly within the Islamic faith, provides a framework for interpreting adversity as divine will, fostering acceptance, and encouraging gratitude. This internalisation of spiritual meaning aligns with Goodwin and Kraft 29 conceptualisation of religiosity as a form of culturally embedded therapy. Participants reflected on the fragility of life, the insignificance of material possessions, and the strength of familial bonds, central values that emerged through rumination and cognitive restructuring. 30 These reflective processes echo the PTG domains proposed by Tedeschi et al, 31 particularly enhanced appreciation of life and improved relationships. During the introspection stage, survivors engaged in deliberate rumination and meaning-making. Spiritual and cultural frameworks played a dominant role in this cognitive shift, with many interpreting the disaster as a divine test. Psychological factors such as openness to reflection, emotional regulation, and family cohesion shaped whether introspection led to adaptive processing or remained stuck in distress. Access to supportive conversations with community leaders, health workers, and volunteers provided emotional scaffolding and validation, helping survivors frame their experience in more constructive terms. This stage illustrates the interplay between internal cognitive processes and external sources of emotional and informational support.
The final stage, Transformation, demonstrated tangible shifts in survivors’ behaviours and perspectives. These included strengthened community solidarity, engagement in mutual aid, readiness to support others, and lifestyle changes, such as adopting safer housing practices and participating in public education efforts. This behavioural embodiment of internal change marks a transition from reflection to action, moving from survival to hope. Survivors’ willingness to teach others about disaster preparedness and volunteer in community efforts parallels Tedeschi and Calhoun’s concept of “new possibilities” and post-trauma prosocial behaviour. 13 Additionally, the roles of university volunteers, informal community leaders, and government relief efforts supported this transformation, demonstrating that systemic and interpersonal support are crucial in fostering and sustaining PTG. Transformation involved behavioural and relational changes, such as mutual aid, strengthened family and community ties, and proactive engagement in disaster preparedness. This stage reflects the integration of cognitive growth into daily life. Long-term support systems, including continued psychosocial outreach, reconstruction programmes (such as earthquake-resistant housing), and equitable access to health services, reinforced survivors’ sense of agency and security. For many, learning new skills (eg, disaster mitigation) or contributing to community rebuilding became expressions of empowerment. Thus, transformation was not only internal but also shaped by social, community, and policy-level structures that enabled sustained growth
The survivors’ progression across the 3 stages of PTG was shaped not only by internal cognitive and emotional processes but also by ecological factors operating at the micro, meso, and macro levels. At the micro level, personal values such as spirituality, gratitude, and family cohesion strongly influenced meaning-making during the Introspection stage. Participants’ reflections such as feeling closer to God, appreciating survival, and prioritising loved ones, illustrate the pivotal role of internal beliefs and emotional resources in reframing traumatic experiences.
At the meso level, community structures played a central role. Support from neighbours, volunteers, local leaders, and health workers provided emotional support, information, and practical assistance, facilitating survivors’ movement from distress to transformation. Mutual aid, collective reconstruction efforts, and community solidarity, as repeatedly described in participants’ narratives, functioned as catalysts for hope, agency, and shared resilience.
At the macro level, governmental and institutional responses shaped long-term recovery trajectories. Participants highlighted free access to healthcare, administrative support, and the construction of earthquake-resistant housing as critical to restoring safety and stability. Conversely, delays in reconstruction and perceived inequities in aid allocation also influenced their ability to progress towards positive adaptation. These policy-level factors formed the broader context in which individual and community recovery unfolded.
This study supports the distinction between resilience and PTG. While resilience reflects the capacity to withstand adversity, PTG involves a transformative shift that redefines one’s worldview and core values. Resilience may maintain pre-trauma functioning, but PTG enhances it through struggle, rumination, and reflection.
The findings of this study contribute to the expanding body of PTG literature by demonstrating that the Indonesian experience of growth is deeply embedded in collectivist and spiritual worldviews. Similar to Tedeschi and Calhoun’s 13 Conceptualisation, growth arises through cognitive restructuring and meaning-making, yet in this context, spiritual surrender, communal belonging, and mutual aid play central roles. This aligns with research in other collectivist cultures Seyed Bagheri et al 27 where faith-based interpretations of suffering strengthen resilience and moral renewal. Furthermore, the transformation stage observed here extends the PTG model by integrating collective resilience and social capital concepts highlighted in emerging studies on community-level PTG.32,33
Importantly, this study differentiates PTG from resilience, supporting the view that resilience enables survival, whereas PTG transforms meaning and purpose. 34 The observed interplay among faith, family, and community cohesion highlights culturally specific pathways to growth that are often overlooked in Western frameworks of PTG. Thus, this research contributes novel insight into how Islamic and communal values guide emotional processing and recovery, enriching global PTG discourse with evidence from an underrepresented sociocultural context.
Although this study did not specifically evaluate clinical treatment pathways, participants repeatedly referred to forms of recovery assistance that indirectly shaped their PTG process. Formal services, such as free access to health care, psychological counselling provided through community health centres, and trauma-healing activities facilitated by volunteers and university teams, helped reduce immediate distress, enabling survivors to move from the “traumatic experience” stage into early introspection. Evidence shows that psychosocial support lowers post traumatic stress disorder symptoms and enhances cognitive processing, which are prerequisites for PTG development (Seyed Bagheri et al., 2020). In this study, participants described trauma-healing games for children, emotional debriefing, and informational guidance provided by volunteers, which contributed to stabilising emotions and restoring a sense of safety. These interactions supported survivors’ capacity to reflect, make meaning, and eventually transition into transformative growth.
This study has several limitations. Most participants were female homemakers. Future research should include a more diverse set of participants, including men and younger survivors, to capture a broader spectrum of PTG experiences. Because data were based on retrospective accounts of disasters occurring up to 15 years prior, recall bias may have influenced the depth or accuracy of some reflections. We also cannot be certain whether the interviewed individuals are genuinely experiencing PTG. For participants from 2006, it is difficult to confirm whether their reported experiences of PTG remain directly related to the original traumatic event, rather than being influenced by other life events such as the loss of a loved one or subsequent trauma. This highlights the need for a well-defined protocol or clear inclusion criteria to accurately identify participants who are truly undergoing PTG.
This qualitative descriptive approach limits the generalisability of findings beyond the studied communities. Whilst this research offers a new perspective based on the Indonesian context of natural disasters; a grounded theory design could have been strengthened the proposed propositions. Longitudinal research is needed to examine how PTG evolves and how institutional recovery efforts sustain or hinder long-term transformation.
Study Implication
This research has an impact on developing an intervention and on how to provide support to disaster victims. Interventions should be tailored to the local cultural context, incorporating spirituality as a core element of coping strategies and promoting holistic recovery. Health professionals can strengthen mental health services by integrating spiritual practices, collaborating with religious leaders, and embedding a spiritual component into therapy sessions. Policymakers are encouraged to prioritise immediate disaster response and long-term physical and psychological rehabilitation for survivors. In addition, educational institutions should equip students who act as agents of change with programmes that foster cognitive resilience, critical thinking, and community engagement, enabling them to contribute meaningfully to disaster preparedness and recovery efforts.
Conclusion
This study provides a comprehensive understanding of PTG among survivors of natural disasters in Indonesia, revealing a gradual multidimensional process that unfolds across 3 interconnected stages: traumatic experience, introspection, and transformation. Survivors initially experienced marked distress but, over time, found meaning in suffering and cultivating PTG embedded in spiritual practice, gratitude, and family bonds, with progress shaped by individual values (micro), community supports (meso), and broader policy environments (macro). Fostering PTG among survivors of natural disasters requires not only timely material aid but also sustained psychosocial support that aligns with survivors’ cultural, spiritual, and communal contexts. By supporting introspection and enabling transformation, post-disaster interventions can help survivors not only recover but also grow.
In addition, this study provides a novel, culturally informed framework of PTG that transcends individual coping to encompass community and systemic dimensions of recovery. By mapping the evolution from trauma to transformation through the lenses of spirituality, social cohesion, and government response, it highlights how PTG is co-constructed through shared cultural and institutional processes in Indonesia.
Footnotes
Acknowledgements
The authors would like to thank the study participants for sharing their experiences and insights. Appreciation is also extended to the Faculty of Nursing, Universitas Andalas, for their institutional support, and to the Universitas Andalas Research Institute for funding through the Research Collaboration Scheme (Grant No. T/25/UN.16.17/PT.01.03/KO-RKI-A (Mitra)/2022).
Ethical Considerations
This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from Faculty of Medicine Research Committee Universitas Andalas (Approval No. LB 02.02/5.7/206/2022). All procedures involving human participants were reviewed and approved prior to data collection to ensure the protection of participants’ rights, safety, and well-being.
Consent to Participate
All written informed consent forms were signed prior to the initiation of data collection to ensure participants’ voluntary participation and understanding of the study.
Author Contributions
Conception and design: HM, HS, LS, AFP, SA, DB.
Acquisition of data: HM, HS, LS, AFP, SA, DB.
Analysis and interpretation of data: HM, HS, LS, MM, DP, SA, VL, MC.
Drafted and/or revised the article: HM, HS, LS, MM, DP, SA, RK, VL, MC.
Approved the submitted version for publication: All authors.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study has been partially funded by Universitas Andalas Research Institute through the Research Collaboration Scheme, number T/25/UN.16.17/PT.01.03/KO-RKI-A (Mitra)/2022.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.*