H5J (Hypnotic 5 Fingers) Mobile Application For Reduce Anxiety Problems Chemotheraphy Patient

Introduction: Chemotherapy as a therapy for cancer patients has several effects, one of which is anxiety. Anxiety can be reduced by using relaxation techniques. One of these relaxation techniques can be done with five finger hypnosis. These efforts can be modified in accordance with the 4.0 industrial revolution by using digital technology. Objective: The purpose of this study was to develop H5J (Mobile Application Hypnotic 5 Fingers) to reduce anxiety problems in chemotherapy patients. Methods: The application was developed through two stages, the first was carried out by creating application content and sophisticated systems by technology experts. Furthermore, in the second stage, a perception test was performed in the fields of mental, medical surgical nursing and information technology expert. Then, 100 patients with chemotherapy were assessed in Jember Regency Malang Regency, East Java, Indonesia using a learning media questionnaire, and Intraclass Correlation Coefficients (ICC) test. The H5J Mobile application contains menu content that provides information about non-pharmacological relaxation therapy material relaxation distraction in the form of five-finger hypnosis (hypnosis guide and five-finger hypnosis wave) in industrial era 4.0. Results: The statistical analysis showed the value of 0.875, while the average of 3 assessors was 0.964> 0.5 (high stability). Furthermore, from the diligence results, 86.78% of the patients stated that the application was very suitable for use, while 13.22% commented that it was feasible.


Introduction:
Cancer is one type of noncommunicable disease that has the highest mortality rate in addition to cardiovascular disease, respiratory disease and diabetes mellitus (Warganegara, 2016). This disease has many negative impacts on human life in terms of physical, psychological, social and spiritual, so that it has an impact on the quality of life of patients. The prevalence of cancer in various countries also shows an increase in cases. The American Cancer Society predicts that there will be 4,600 new cancer diagnoses and 600,000 cancer deaths (Siegel R., 2017). According to the Basic Health Research (Riskesdas) in 2018, the prevalence of cancer in Indonesia reached 1.79 per 1000 population, up from 2013 (KEMENKES, 2018).
Chemotherapy is one of the therapies for cancer patients at this time. In general the patient forms an emotional response consisting of questions, anxiety and depression (Haris, Syahruddin, Susanto, & Kekalih, 2015). Anxiety can be caused because patients will face chemotherapy as an effort to treat cancer (Pratiwi, Widianti, & Solehati, 2017). Anxiety can be reduced by using relaxation techniques. Relaxation is a technique or therapy in reducing tension and anxiety. One of these relaxation techniques can be done with five finger hypnosis. Five finger hypnosis is an intervention to reduce anxiety by helping clients to hypnotize themselves by imagining pleasant events in their lives. The use of 5 finger hypnosis is an art of verbal communication that aims to bring the client's mind waves into trance (alpha/theta waves). Also known as selfhypnosis which aims to self-programming, eliminate anxiety by involving the parasympathetic nerves and will reduce the increase in heart work, respiration, blood pressure, sweat glands etc. (Evangelista, Widodo, & Widiani, 2016) These efforts can be modified in accordance with the 4.0 industrial revolution by using digital technology. Five-finger hypnosis will be developed in the H5J ( Hypnosis 5 Jari) Mobile Aplication) model. The content of the application is in the form of non-pharmacological relaxation therapy materials, relaxation reactions in the form of five-finger hypnosis (hypnosis guide and five-finger hypnosis sound). With the Hypnotis 5 Jari mobile application, patients are able to access and use the health service model to reduce anxiety before undergoing chemotherapy via a smartphone. The purpose of this study was to develop H5J (Mobile Application Hypnotic 5 Fingers) to reduce anxiety problems in chemotherapy patients.

Methods:
This study used a quantitative approach to determine the perceptions of three experts and respondents about using the application by 5 finger Hypnosis, and was conducted in Jember Regency, East Java, Indonesia. The samples used were experts in mental, medical surgical nursing and as well as those in the information technology fields. Furthermore, the respondents were 100 chemotherapy patient This application was developed in two stages, the first was creating it by determining the contents to be included, then inputting them into the system to develop H5J Mobile Application. The following were the system contents: This application was created by experts in the information technology field in the form of a smartphone gadgets. The supporting applications, such as Microsoft Word, Power Point (Microsoft Office), and animation editing gadgets were also included. Therefore the contents in these applications were introduced to chemotherapy patient. The

Results:
The H5J Mobile application contains menu content that provides information about non-pharmacological relaxation therapy material relaxation distraction in the form of five-finger hypnosis (hypnosis guide and five-finger hypnosis wave) in industrial era 4.0, anxiety prevention and management. The following were figures of the application content Jurnal Kesehatan dr. Soebandi Vol. 9, No. 2 http://journal.uds.ac.id/index.php/jkds Publisher : LP3M STIKES dr. Soebandi Jember

Figure 1. H5J Content
Furthermore, the perception test results using ICC analysis were shown in table 1 below: Based on the content reliability test results, the evaluator value was 0.875, while the average value of the 3 assessors was 0.964> 0.5, therefore it was concluded that the application developed had an adequate reliability coefficient. This correlated with the Polger and Thomas (2000) study "The Introduction to The Research in Health Sciences" stating that the measuring instrument had adequate stability when the ICC value between the gauges was> 0.5, while for high stability, it was> 0.80. Furthermore, from the feasibility test conducted on 100 patient chemoteraphy in Jember Regency, East Java, Indonesia, 86.78% stated that the application was very suitable for use, while 13.22% commented that it was feasible.

Discussion:
This application is a combination of various concepts, the first containing the concept of anxiety where this situation is often experienced by patients with chemotherapy which greatly impacts the mental health of cancer patients undergoing chemotherapy. (Juniarti, Rizona, & Hikayati, 2019). Various efforts were made in order to reduce the anxiety that is often experienced by patients with chemotherapy, including the development in the industrial revolution 4.0 era by incorporating internet technology. Technology development by utilizing smartphone applications also has the potential to expand the capacity to interact directly as feedback from smartphone-touser. This capability presents further potential for anxiety self-management. Smartphone-based applications are of great concern especially in anxiety management. This condition shows that there is continuous rapid progress in the availability of digital as a new innovation in line with the development of industry 4.0 (Firth, Torous, Carney, Newby, & Cosco, 2018;Khalil, Faheem, Fahim, Innocent, & Mansoor, 2016) The second concept in this application is the availability of the development of five-finger hypnosis waves developed in the form of an application. The five-finger hypnosis wave is able to reach the subconscious mind where emotions are processed so that the level of anxiety and other emotional problems decreases (Nugroho & Anggorowati, 2016) In the last concept, there is a measurement of the level of anxiety that can be used in chemotherapy patients. Overall, these concepts are incorporated into the H5J (5 Finger Hypnosis) Mobile Application which can be used as one of the technological development innovations in the health sector to be applied to patients with chemotherapy.