Abstract
Background:
Acupressure is one of the selfcare methods that is quite simple and noninvasive, which is easy to teach to patients. Due to its ease and minimal side effects, acupressure is often recommended as an appropriate choice for patients to manage various health conditions. However, the integration of acupressure into medical education is still limited, including in Indonesia. The lack of education about acupressure can lead to a lack of understanding among health care providers in teaching acupressure to patients. The objective of this study was to present scientific evidence supporting the efficacy of acupressure in managing various medical conditions and to propose its integration into the medical curriculum.
Method:
A literature search using the Google Scholar, PubMed, and Embase databases was conducted through Boolean Operators with selected keywords such as acupressure, acupressure training, and health education.
Result:
A total of six studies obtained met the predetermined inclusion criteria. Through self-administered acupressure counseling and training, there was a significant increase in knowledge scores regarding acupressure and the effects of acupressure on reducing complaints of various ailments. Findings from clinical evidence discussing the use of acupressure have affirmed its effective role in enhancing patient well-being. The integration of education about acupressure as a complementary therapy into the medical education curriculum is becoming increasingly important.
Conclusion:
Acupressure is effective in addressing various clinical disorders, and through adequate education and training, as well as incorporating acupressure into the medical curriculum, it is expected to provide holistic and effective care to patients.
INTRODUCTION
Acupuncture is a traditional Chinese medicine that has been widely used to treat various clinical disorders and is now increasingly recognized and widely accepted worldwide as an effective complementary treatment method.1,2 For centuries, acupuncture has been an integral part of Asian medical traditions, used to treat various health conditions and enhance general well-being. 3 Self-care interventions are one approach that can improve well-being and health. 3 Self-care is beneficial for everyone because it is easily accessible, accepted, and relatively affordable. This encourages the active participation of individuals in taking care of their health, leading to better health conditions. 3
Acupressure is a relatively simple and noninvasive self-care method that can be easily taught to patients. Due to its ease of use and minimal side effects, acupressure is often recommended as a suitable option for managing various health conditions. Acupressure involves stimulating acupuncture points on the body using massage or pressure. 4 It can be performed with fingers, other body parts or blunt-ended tools. To perform acupressure effectively, start by cleaning the skin where acupressure will be applied, identify the appropriate points based on the complaint, then apply firm pressure or massage each point 20–30 times and the pressure should be strong enough to turn one-third of the fingernail white or adjust the pressure accordingly if using a blunt-ended tool. Acupressure is useful for reducing pain, tension, fatigue, and other disorders. It can be an excellent method to apply at home because it is easy to perform and is completely cost-free. 5 However, the integration of acupressure into medical education remains limited, even in many medical schools, including those in Indonesia. This lack of education about acupressure can lead to a lack of understanding among health care providers, which ultimately affects their confidence in recommending and teaching acupressure to patients.
Studies have shown that one of the main barriers to adopting non-pharmacological methods, such as acupressure, is a lack of training and awareness among both service providers and patients. 6 Therefore, it is important to incorporate these methods into medical curriculum and continuing professional development programs. By increasing education on the advantages and application of acupressure, it is hoped that there will be increased acceptance and use of this method among health professionals. 7 The objective of this study is to present scientific evidence supporting the efficacy of acupressure in managing various medical conditions and to propose integration of acupuncture learning into the medical curriculum. We introduce the teaching of acupressure using currently available evidence to guide the design of medical student curriculum.
METHODS
The literature search was conducted using Google Scholar, PubMed, and Embase databases with Boolean operators and the following selected keywords: acupressure, acupressure training, health education. Articles were selected based on the inclusion criteria, which included acupressure interventions, publications in Indonesian and English, and articles published within the last 5 years. A total of six studies met the predetermined inclusion criteria.
RESULTS
There were 6 recent studies met the inclusion criteria. The following are the basic characteristics of these studies The basic characteristics of these studies are summarized below (Table 1). The first study was conducted by Djaali (2023) regarding community service and training on hypertension prevention conducted in Kepulauan Seribu, Indonesia, in 2022. This community service reduces the incidence of hypertension and improves the quality of life of elderly people. The evaluation was performed using questionnaires before and after the activity, along with repeated acupuncture procedures for some participants. The results showed an average increase in participants’ knowledge following the activity. 8 In 2022, acupressure training in Indonesia focused on headache relief, consisting of educational and practical training sessions, evaluated using “pre and posttest questionnaires”. The results indicated an increase in acupressure knowledge scores for headache management. 5 Health education and community training on acupressure techniques empower individuals to take an active role in maintaining their health. Participants can apply the knowledge they gained from these activities to themselves or to their families. 5
Acupressure Research Findings Based on Literature Review
This table summarizes the findings of six studies evaluating the effects of acupressure on various clinical conditions.
Diploma III: equivalent to an Associate Degree.
Diploma IV: equivalent to a Bachelor’s Degree.
Another study also examined the effects of acupressure therapy training and assistance on midwives in Aceh, Indonesia, which was evaluated using questionnaires before and after the activity. During this activity, midwives also performed acupressure therapy on patients monitored by education providers. There was an increase in the knowledge of midwives after receiving education and training, where the knowledge score increased by 44% from the results before the activity to 95%. 9 In another study, acupressure was also applied to 59 nurses who had working hours patterns that could cause stress, fatigue, and anxiety. Acupressure was performed by a trained researcher on participating nurses. The results also showed that acupressure could reduce stress, fatigue, and anxiety levels more than the control group. Based on the findings of this study, acupressure is recommended as a nursing intervention to reduce stress, fatigue, and anxiety in nurses who work shifts in clinical practice. This acupressure can be performed independently by the nurse for personal health care, without time or place restrictions. 10
Another study conducted in Hong Kong in 2019, related to the effect of acupressure on knee osteoarthritis, also showed that acupressure can reduce pain intensity, as assessed by a numerical rating scale, and improve the patient’s quality of life. 12
DISCUSSION
Preliminary data suggest that acupressure may have a role in improving patient well-being. Therefore, the integration of acupressure education into the medical education curriculum is becoming increasingly important. Through hands-on clinical placement experiences, medical students can deepen their understanding of the benefits of complementary therapies for patient health. Additionally, students trained in acupressure can be catalysts in promoting self-care practices for patients, which is an important aspect of holistic health management. Thus, the integration of complementary therapies into medical education can help equip future medical practitioners with the knowledge and skills necessary to provide holistic and effective care to patients. 7
Currently, acupressure is not included in the Indonesian medical education curriculum. However, several health care institutions have conducted acupressure training programs for health care workers and medical personnel. This is due to several factors, including the inadequate knowledge and skills of medical students regarding acupressure and the limited information on the benefits and importance of learning acupressure as a valuable alternative therapy for the community. Therefore, as a foundation for the acupressure learning process in medical education, an acupressure curriculum must be developed.
The parameters that need to be considered in acupressure education include: (1) Graduate Profile; (2) Learning Outcomes; (3) Curriculum Material Design; (4) Module Design in Acupressure Learning; and (5) Core Material Design of Acupressure Techniques. As outlined in the acupressure technique module, the curriculum material design for acupressure learning includes several indicators, such as competency elements, study materials, and duration of learning sessions, as shown below (Table 2). The module design for acupressure learning consists of two modules: counseling and education regarding acupressure for patients with health difficulties and internship practice (Table 3). The core material design of acupressure learning techniques includes material descriptions, learning objectives, subjects, learning activities, and learning materials (Table 4). Graduate profiles are expected to be able to perform acupressure as independent care for patients. Learning Outcomes are as follows: (1) Attitude and values: Possess knowledge of applicable rules, laws, and social norms related to acupressure services; (2) Work ability: ability to perform acupressure and provide education on performing acupressure according to patient conditions; (3) Knowledge mastery: ability to perform acupressure and provide education on performing acupressure according to patient conditions; and (4) Rights and responsibilities: ability to take responsibility for performing acupressure therapy in accordance with professional ethics.
Curriculum Material Design for Acupressure Learning
This table presents the structure of subject matter and competencies in acupressure education along with LH.
1 LH, 50 min; LH, learning hours (the unit of time used in the learning process).
Module Design in Acupressure Learning
This table presents the proposed module design for teaching acupressure, including the allocated LH, topics, and teaching methods.
1 LH = 50 min; EBM, evidence-based medicine; LH, learning hours (the unit of time used in the learning process).
Core Material Design of Acupressure Techniques for Acupressure Learning
This table outlines the proposed core material design for teaching acupressure techniques, including learning objectives, topics, activities, and materials.
A structured policy advocacy strategy must be established to support the integration of acupressure education into the Indonesian medical curriculum. One suggestion would be to have a review committee conduct a direct dialogue with government medical education policy makers for consideration and to move forward. The committee can initiate formal dialogues with key stakeholders in Indonesia’s governmental medical education sector, including the Ministry of Education and the Ministry of Health. This study recommended and validated acupressure curriculum parameters for their formal adoption into national medical training standards. This step is essential to ensure policy alignment, curriculum standardization, and the sustainable implementation of acupressure training at the institutional level.
LIMITATIONS
Some cited studies focused more on changes in participants’ knowledge levels rather than measuring the degree and duration of pain symptom changes or other clinical outcomes. Additionally, some of the cited studies lacked blinding and did not have control groups, as some participants were aware that they were receiving acupressure for a specific condition. Another limitation is the lack of information about the technique, duration, and frequency of acupressure stimulation in some studies. Because further studies are needed, these results cannot yet be fully generalized, but the preliminary data suggest acupressure may be a useful addition to self-care for certain conditions.
CONCLUSION
Preliminary data suggest that acupressure is an effective adjunct therapy for certain clinical disorders. Acupressure has great potential as an easily accessible and relatively affordable self-care method, but there are still challenges in its integration into medical education and public awareness. By enhancing adequate education and training, as well as incorporating complementary therapies like acupressure into medical curriculum, the role of future medical practitioners in providing holistic and effective care to patients can be strengthened. This will not only increase understanding of the benefits of acupressure but also encourage active participation in taking care of their own health, leading to a healthier and more prosperous society.
AUTHORS’ CONTRIBUTIONS
M.M. led the research conceptualization and manuscript writing. D.L.A. and T.W.H. supported the research conceptualization and manuscript writing. H.M., Y.V., and W.D. contributed to the data interpretation. M.M., D.L.A., T.W.H., and W.D. contributed to the manuscript revision. All authors contributed to read and approve the final version of the manuscript.
Footnotes
AUTHOR DISCLOSURE STATEMENT
The authors declare no conflict of interest.
FUNDING INFORMATION
This research was funded by a grant from Universitas Indonesia, with grant number: NKB-657/UN2.RST/HKP.05.00/2024, “Hibah Publikasi Terindeks Internasional (PUTI) Q2 Tahun Anggaran 2024-2025”.