Room of Civil Society Development
DOI: https://doi.org/10.59110/rcsd.687
Volume 4 Issue 4, Year 2025

Family Empowerment for Pressure Ulcer Prevention in Bedridden
Patients at Home in Bababulo Village
Hasifah1*, Maryam Jamaluddin1, Tuty Alawiyah2, Jamila Kasim2, Yuliyanti Setiawati3
1STIKES Nani Hasanuddin Makassar, Makassar, Indonesia
2STIKES Bina Bangsa Majene, Majene, Indonesia
3STIKES Baramuli Pinrang, Pinrang, Indonesia

*Correspondence: hasifajun@gmail.com
ABSTRACT
Pressure ulcers are a common and serious health problem among bedridden patients receiving home care,
often leading to complications that deteriorate their condition. This community service program aimed to
empower families as primary caregivers in preventing pressure ulcers through structured education and
practical mentoring. The intervention involved 30 family caregivers and was implemented in two sessions
consisting of education and hands-on practice, conducted on May 10, 2025, in Bababulo Village, Pamboang
District. Knowledge evaluation was performed using a pre-test and post-test design with 15 structured
questions. The results showed a substantial improvement in family knowledge, with the average score
increasing from 48.3 to 89.5 after the intervention. Participants initially demonstrated limited understanding
of ulcer prevention techniques but became more competent and confident following the sessions. The program
not only improved knowledge and caregiving skills but also strengthened emotional engagement and
collaboration within families. Despite its success, the short training duration and small sample size were
identified as limitations. To ensure sustainability, it is recommended to integrate digital educational
materials, continuous follow-up training, and community support networks. Overall, this initiative provides
an effective and replicable model for family-based empowerment in home care, contributing to enhanced
patient safety and quality of life.
Keywords: Family Empowerment; Caregiver; Pressure Ulcer; Education; Home Care.
Copyright © 2025 The Author(s): This is an open-access article distributed under the terms of the Creative Commons
Attribution ShareAlike 4.0 International (CC BY-SA 4.0)

1. Introduction
Pressure ulcers are a significant health problem that frequently affect patients who
experience long-term immobility, both in hospitals and home-care settings. Clinically, they
are defined as localized injuries to the skin and underlying tissue, typically occurring over
bony prominences because of prolonged pressure or shear forces (Mervis & Phillips, 2019).
These ulcers not only cause severe pain but can also lead to serious complications such as
infection and prolonged hospitalization, which have a substantial impact on patients’ quality
of life (Henkel Ferro et al., 2020). According to the World Health Organization (WHO, 2022),
the global incidence of pressure ulcers remains high, particularly among older adults and
individuals with chronic conditions. In Indonesia, this problem has become an increasing
public health concern due to its high prevalence and the considerable burden it places on
both patients and healthcare systems. Data from the Ministry of Health indicate that pressure
ulcers are among the most common complications in hospitalized patients, with incidence
rates ranging from 15% to 20% in various hospitals.
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This condition not only extends the length of the hospitalization but also increases the
overall cost of treatment, with an estimated additional cost of reaching 70% of the total cost
of patient care. In this context, the role of the family becomes essential as they perform
important nursing tasks such as repositioning, maintaining skin hygiene, and identifying
early signs of pressure ulcers (Armanda et al., 2022; Spike, 2018). Families often act as key
enablers in maintaining patient well-being and adherence to preventive care routines,
although their caregiving roles may involve complex ethical and emotional challenges.
However, many families lack the knowledge and skills necessary to carry out these
responsibilities effectively and often experience emotional strain and caregiver burden while
providing long-term care (Brodaty & Donkin, 2009).
Family empowerment through structured education and skills training is recognized
as an effective strategy for enhancing the quality of home-based care (Arifin et al., 2024;
Effendy et al., 2022). The empowerment process involves increasing awareness of proper care
practices, strengthening emotional resilience, and providing families with the competencies
needed to manage patients’ health effectively. Through training, caregivers can learn
essential techniques such as correct patient repositioning, maintaining skin hygiene, and
recognizing early warning signs of pressure ulcers (Gupta & Addison, 2020; Mościcka et al.,
2022). Engaging families in care planning and decision-making also fosters emotional
connection, shared responsibility, and long-term commitment to treatment plans, which
collectively contribute to better health outcomes (Pusa et al., 2019).
Recent studies support the effectiveness of educational interventions in increasing
caregivers’ knowledge and practical ability. Kristanto and Atmojo (2021) found a significant
improvement in family knowledge and skills related to pressure ulcer prevention after
structured education and mentoring, while Zuniga et al. (2024) emphasized the importance
of the drill-and-practice method in strengthening behavioral change. These findings affirm
that empowering caregivers is not merely about transferring knowledge but about
developing confidence, responsibility, and sustained engagement in caregiving practices.
Furthermore, empowerment facilitates the development of better interpersonal and
communication skills among family members, transforming them from passive caregivers
into active partners in the patient’s healing process. Education-based empowerment
initiatives should therefore be integrated into community health strategies to ensure that
patients receive comprehensive, quality care at home. Structured interventions, such as
training on repositioning, skin care, and patient monitoring, can substantially improve
caregiver confidence and independence (Boyko et al., 2018; Ziegler et al., 2023).
Unlike previous community service efforts that focused primarily on institutional or
hospital-based prevention, this program highlights the importance of home-based family
empowerment. Such a participatory and contextual approach is expected to serve as a
sustainable model for community engagement. By strengthening the capacity of families as
caregivers, this initiative aims to reduce the incidence of pressure ulcers, enhance patient
comfort, and improve the overall well-being of both patients and their caregivers. This
understanding can also serve as a reference for health workers and policymakers in
developing family-centered, community-responsive intervention programs in the future.
2. Method
This community service used a pre-experimental design with a one-group pre-test and
post-test approach to evaluate the improvement of family caregivers’ knowledge regarding
the prevention of pressure ulcers. The activity applied an educational and participatory
method, emphasizing the active involvement of family members as partners in the caregiving

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process. The main objective was to empower families by increasing their understanding,
practical skills, and awareness related to home-based care for bedridden patients.
The program was conducted in Bababulo Village, Pamboang District, involving 30
participants who served as primary caregivers, including spouses, children, and parents of
bedridden patients. Participants were selected purposively based on their direct role in
providing care and their willingness to participate. The activity took place on May 10, 2025,
and lasted for approximately two hours, which consisted of one hour of educational delivery
and one hour of direct mentoring and practice carried out at the patients’ homes.
Before the intervention, the implementation team carried out an initial assessment
through observation and brief interviews to identify the conditions of patients, the
caregivers’ initial level of knowledge, and the potential risk factors that could contribute to
pressure ulcers such as immobility, nutrition, and hygiene. The educational session included
interactive lectures, demonstrations, and discussions, focusing on the understanding of
pressure ulcer causes, early signs, and preventive measures such as repositioning,
maintaining skin cleanliness, and ensuring adequate nutrition. To enhance understanding,
the team provided visual aids and printed educational materials during the activity.
During the mentoring stage, the caregivers were guided to apply the preventive
techniques directly at home under the supervision of the team, who provided feedback and
encouragement to build confidence in practice. After the mentoring, a post-test questionnaire
was administered to measure the improvement in knowledge after the intervention. The
questionnaire consisted of 15 multiple-choice questions covering definitions, risk factors,
symptoms, and prevention techniques. The instrument was validated by nursing experts
prior to use. The pre-test and post-test results were analyzed using descriptive statistics,
which included mean scores, frequency, and percentage, to identify changes in knowledge
levels among the participants.
Ethical considerations were observed throughout the program. All participants were
informed about the objectives, procedures, and voluntary nature of the activity. They were
also assured that all personal data and responses would remain confidential. This structured
and participatory approach not only measured the educational effectiveness of the
intervention but also fostered collaboration between caregivers and health workers in
improving the quality of home-based patient care.
3. Result
The community service program was implemented to improve the knowledge and
awareness of family caregivers in preventing pressure ulcers through targeted education and
mentoring. Evaluation was carried out using pre-test and post-test instruments consisting of
15 multiple-choice questions covering definitions, risk factors, early signs, and preventive
measures of pressure ulcers.
Before the educational session, caregivers’ knowledge was generally low. The average
pre-test score was 48.3 out of 100, with 73 percent of participants scoring below 60. Only four
participants (27 percent) had previously heard of pressure ulcers, but they were unfamiliar
with effective prevention techniques. This result indicates that most caregivers lacked
sufficient understanding of basic home-care practices for bedridden patients.
After the educational intervention, a significant increase in knowledge was recorded.
The average post-test score increased to 89.5 out of 100, and 87 percent of participants
achieved scores above 80. All participants were able to mention at least three appropriate
prevention techniques, such as patient repositioning, skin hygiene maintenance, and

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nutritional management. This improvement demonstrates that the educational materials
were effective and easy to understand for participants from various educational
backgrounds.
Aspect
Pre-Test
Post-Test
Average Score
48.3
89.5
Participants Scoring Below 60
11 (73%)
0 (0%)
Participants Scoring Above 80
0 (0%)
13 (87%)
Participants Mentioning at Least Three Prevention
4 (27%)
30 (100%)
Techniques
Participants’ active engagement during discussions reflected high motivation and
enthusiasm to learn about patient care. Many shared their personal experiences and asked
clarifying questions, indicating that the educational and participatory method successfully
encouraged interaction and learning. During the implementation, the program team
conducted both counseling sessions with family caregivers and practical demonstrations on
pressure ulcer prevention in bedridden patients at their homes. These activities illustrated
the integration of education and hands-on mentoring that characterized the empowerment
model applied in this program.

a) Counseling and education session with
family caregivers.

b) Practical session on pressure ulcer
prevention conducted during home-based
mentoring.

Figure 1. Educational and mentoring activities conducted during the family
empowerment program in Bababulo Village
4. Discussion
4.1 Program Success
The findings of this study indicate that the educational intervention was highly
effective in enhancing caregivers’ knowledge, awareness, and confidence in preventing
pressure ulcers. The substantial increase in post-test scores demonstrates that the materials
and methods were relevant, comprehensible, and well-adapted to participants’ learning
needs. This improvement confirms that carefully structured educational programs can
effectively bridge gaps in caregivers’ understanding and skills, particularly in the context of
home-based patient care.
This result is consistent with the work of Aiman, Saddique, and Jabeen (2024), who
found that targeted education and systematic training significantly improve both nursing
knowledge and clinical practice in pressure ulcer prevention. Similarly, in this program,

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participants not only deepened their theoretical understanding but also demonstrated better
practical competence in essential care activities such as patient repositioning, maintaining
skin integrity, and identifying early warning signs. This suggests that knowledge-based
interventions can directly translate into improved caregiving practices, reinforcing the
critical link between education and preventive care.
From a theoretical standpoint, the findings reflect the essence of empowerment theory
as articulated by Hickmann, Richter, and Schlieter (2022), who describe empowerment as a
dynamic process that strengthens individuals’ autonomy, self-efficacy, and active
participation in health-related decisions. Within this program, caregivers were not treated as
passive recipients of information but rather as partners in the caregiving process. Through
participatory learning and mutual dialogue, they developed a stronger sense of
responsibility and ownership in managing patient care. This transformation embodies the
principle of empowerment, where individuals are supported to make informed decisions
and assume active roles in improving health outcomes.
The improvement observed among participants also reflects a clear development in
health literacy, which, as Vamos et al. (2020) argue, extends beyond understanding health
information to include the ability to apply, communicate, and act upon it in daily life.
Through interactive discussions, visual materials, and real-time mentoring, caregivers not
only enhanced their comprehension but also demonstrated the capacity to make informed
health decisions and translate knowledge into practical care behaviors. This finding is further
supported by Visscher et al. (2018), who found that community-based health literacy
interventions consistently lead to improvements in preventive behavior and self-care
practices.
The implementation of the mentoring component at the patients’ homes further
reinforced this learning process. Conducting sessions within the caregivers’ own
environment allowed them to connect theoretical understanding with real caregiving
experiences, facilitating experiential learning. This observation is consistent with Bahtiar et
al. (2022), who emphasized that home-based educational activities enhance knowledge
retention and strengthen the transfer of learning into daily caregiving routines. In addition
to these cognitive and behavioral outcomes, Young (2020) highlighted that family members
of patients with pressure ulcers often experience psychological distress, anxiety, and feelings
of guilt during the caregiving process. Therefore, educational programs that emphasize
empowerment and empathy, as implemented in this study, can also help reduce caregivers’
emotional burden by promoting confidence and a sense of shared responsibility in patient
care.
Overall, the success of this program lies in its ability to combine conceptual
understanding, hands-on practice, and emotional engagement in a holistic educational
model. By integrating the principles of empowerment and health literacy, the intervention
not only improved caregivers’ knowledge but also fostered sustainable behavioral change
and a deeper commitment to patient well-being. When caregivers are empowered through
participatory education, they become confident, capable, and compassionate partners in care,
contributing to improved quality of life for both patients and their families.
4.2 Challenges and Limitations
Despite the overall success of the program, several challenges were identified during
its implementation. One of the main limitations was the short duration of the educational
sessions, which provided limited time for participants to fully internalize and practice the
preventive care techniques. The program was conducted in only two hours, which may have

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restricted deeper engagement, reflection, and skill reinforcement among caregivers.
Additionally, variations in participants’ educational backgrounds and learning capacities
affected the level of understanding and consistency in applying the knowledge gained. Some
caregivers required additional explanation or demonstration to grasp medical concepts
related to pressure ulcer prevention. These observations are consistent with the findings of
Taylor, Mulligan, and McGraw (2021), who identified that differences in educational
preparation, resource access, and contextual support often hinder the implementation of
evidence-based pressure ulcer prevention practices in community settings.
These findings are also in line with the results of Rafiei, Vanaki, Mohammadi, and
Hosseinzadeh (2021), who identified similar challenges among family caregivers involved in
pressure injury prevention. Their scoping review highlighted that caregivers often face
barriers such as inadequate training opportunities, limited health communication with
professionals, and the absence of structured educational support. The authors emphasized
that family caregivers play an essential role in implementing prevention guidelines but
require ongoing guidance and empowerment to do so effectively. The present findings align
with this perspective, suggesting that brief, one-time training may be insufficient to address
the diverse needs and experiences of family caregivers in home-care settings.
Environmental and contextual factors also contributed to the challenges encountered.
Limited physical space, competing household responsibilities, and time constraints due to
caregiving duties occasionally interfered with the practice components of the program. These
factors highlight the importance of designing flexible and adaptable training models that
accommodate the realities of caregivers’ daily lives.
To address these challenges, future programs should consider integrating digital and
technology-based learning resources to supplement face-to-face sessions. According to
Cardoso et al. (2018), the use of educational technologies can facilitate continuous learning
and provide caregivers with accessible materials that reinforce practical knowledge. Such
tools enable caregivers to revisit the content as needed, allowing for independent and
sustained learning beyond the initial training. The integration of video tutorials, interactive
modules, and mobile learning platforms can enhance engagement and ensure that
educational benefits are maintained over time.
In summary, the challenges identified in this program underscore the need for longerduration, multi-session training models supported by flexible learning technologies.
Continuous follow-up, combined with accessible digital materials, can strengthen
knowledge retention and bridge the gap between theoretical understanding and consistent
caregiving practice.
4.3 Recommendations and Implications
The results of this program provide valuable insights for improving future communitybased family empowerment initiatives. Addressing these challenges through structured and
technology-supported education can ensure both scalability and sustainability of family
empowerment efforts. Building upon the achievements and challenges identified, several
recommendations can be proposed to enhance both the educational process and its long-term
impact.
Future programs should adopt a multi-phase training model that includes pre-training
assessments, interactive learning sessions, and post-training supervision. This structure
allows for continuous monitoring of caregivers’ progress and creates opportunities for
reflection and reinforcement of key concepts. Establishing periodic follow-up or refresher

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sessions is also essential to maintain motivation and ensure the consistent application of
preventive care practices among family members.
Collaboration with community health workers and local health cadres should be
strengthened to facilitate ongoing mentoring and monitoring. These actors can serve as
facilitators who bridge the gap between families and healthcare professionals, providing
regular support and evaluation. Strengthening such partnerships also aligns with the
empowerment perspective described by Hickmann, Richter, and Schlieter (2022), which
views empowerment as a relational process built upon shared responsibility and collective
engagement.
The integration of educational technology should be prioritized to increase accessibility
and engagement in learning. As highlighted by Cardoso et al. (2018), technology-based
learning tools can improve caregivers’ ability to acquire and retain knowledge by offering
flexible and self-paced learning opportunities. Digital resources such as video
demonstrations, online platforms, and mobile applications can create interactive and
supportive learning environments, like the participatory web-based education models
developed by Ryu and Pratt (2025). These tools are particularly useful for caregivers with
limited time or logistical constraints, enabling continuous learning and practical application
of care techniques.
From both theoretical and practical perspectives, this study reaffirms the
interconnectedness of empowerment and health literacy. Effective family education
programs should not only transfer information but also strengthen caregivers’ capacity to
interpret, apply, and evaluate health-related knowledge within their daily routines. This
reflects the concept proposed by Vamos, Okan, Sentell, and Rootman (2020) that health
literacy represents a process of lifelong learning and participation. Policymakers and health
institutions can leverage these findings to design scalable caregiver training models and
integrate family empowerment into community health strategies. Ultimately, by combining
participatory education, digital innovation, and local engagement, family empowerment
programs can foster a more resilient and compassionate home-care ecosystem that supports
both patient safety and overall family well-being.
5. Conclusion
The findings of this community service program demonstrate that family
empowerment through education and mentoring is an effective approach to prevent
pressure ulcers in bedridden patients at home. The intervention significantly improved
caregivers’ knowledge, awareness, and confidence in performing preventive care. The
average knowledge score increased from 48.3 to 89.5, indicating that the educational
materials and participatory approach were well understood and successfully applied in
practice.
In practical terms, this program highlights the importance of involving family
members as active partners in home-based patient care. By enhancing caregivers’
competence and motivation, families become more capable of maintaining patient comfort
and safety. The program also illustrates that community-based educational initiatives can
strengthen family engagement and contribute to sustainable improvements in caregiving
quality, particularly for patients requiring long-term care.
For future implementation, it is recommended to extend the training duration and
incorporate digital educational media to support continuous learning and accessibility.
Regular follow-up sessions, peer support groups, and collaboration with community health

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cadres are also essential to ensure sustainability and long-term impact. Broader adoption of
similar empowerment-based programs may serve as a model for improving health literacy
and caregiving quality in other communities, ultimately enhancing patient well-being and
family resilience.
6. Acknowledgements
The authors would like to express their deepest gratitude to all parties who contributed
to the implementation of this community service activity. Special thanks are extended to the
families and caregivers in Bababulo Village, Pamboang District, for their active participation
and cooperation throughout the program.
We also extend our sincere thanks to the local health cadres and village officials for
their support and assistance in ensuring the smooth implementation of this activity. Our
highest appreciation goes to the academic institution STIKes Bina Bangsa Majene and the
community service teams from STIKES Gema Insan Akademik and STIKES Nani
Hasanuddin Makassar for their dedication, guidance, and commitment in delivering
Education to improve the quality of care for bedridden patients at home.
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