Needs As The Dominant Factor of Generation Z in Telemental Health (TMH) Services Utilization

Nowadays, mental health is still an unfinished problem in Indonesia. Telemental health (TMH) exists as a form of adaptation toward technological developments that are expected to help address challenges in mental health services. There is a continuous increase in the number of Generation Z who suffer mental health problems. Meanwhile, the coverage of mental health services is still low even though the convenience of TMH has supported it. This study aims to analyse the factors that influence the utilisation of TMH among Generation Z based on Andersen's theory. This quantitative research collected 180 respondents and then analysed them using univariate, bivariate, and multivariate. Results showed a relationship between the needs factor, access to TMH, health worker support, and residence on the use of TMH. While the variables that aren't related are gender, education, occupation, marital status, and knowledge. The needs factor dominates the effect of using TMH among Generation Z in Indonesia, where a change in it can affect 15 times the utilisation of TMH. To develop TMH into sustainable services, providers can create the right strategy. It’s recommended to Generation Z to avoid self-diagnosis accompanied by enriching knowledge about maintaining mental health.


INTRODUCTION
Nowadays, mental health continues to be an unresolved concern in Indonesia. Concerning

Access to TMH Services
Respondents with easy access to TMH services (83.2%) are likelier to utilise TMH services than respondents with difficult access (70.6%).Some respondents underutilised TMH services because the services were not available 24/7 (19.4%), and each service session needed to be longer (13.9%).Based on the chi-square test, it was found that access to TMH services is associated with the utilisation of TMH services.Still, the ease or difficulty of access is not the sole determinant for an individual to utilise healthcare services.
Other factors influencing an individual's decision to use TMH services include their perception of mental healthcare, their ability to accept assistance, and the alignment between available services and their needs (Maulany et al., 2021).

Healthcare Personnel Support
Respondents who received support from healthcare personnel in the supportive category (82.4%) are more likely to utilise TMH services at a higher intensity than respondents receiving less supportive healthcare personnel support (65.5%).The primary data collection revealed that respondents received healthcare personnel support in expressing their perceived mental health disorders, appropriate advice or solutions for their concerns, and motivation.
Based on the chi-square test, healthcare personnel support is associated with utilising TMH services.However, the quality of support healthcare personnel provides alone does not compel an individual to use TMH services.Factors such as self-stigma and family support also play a role in an individual's decision to utilise healthcare services, in this case, TMH.(Kamaradova et al., 2016;Ramadia et al., 2022).

Place of Residence
Respondents utilising TMH services in urban areas (80%) outnumber those residing in rural areas (63.3%).Based on the chi-square test, place of residence is associated with utilising

Gender
Based on the chi-square test, gender is not associated with utilising TMH services.
Multiple logistic regression modelling for multivariate analysis includes gender as a covariate.An interesting finding emerged in this study: male respondents using TMH services (87.5%) outnumbered female respondents (75%).Nevertheless, an intriguing situation was identified in this research, as female respondents dominated those who reported experiencing mental health disorders in the past year, accounting for 73%.
The above situation may arise due to the pubertal phase and differences in the anatomy of the anterior ventral insula, contributing to differences in responses between females and males when experiencing mental health disorders (Cereda et al., 2002;Darmayanti, 2008).Nevertheless, this condition does not mean that females will seek healthcare services whenever they experience mental health disturbances.Females have a higher estrogen hormone level than males, allowing them to regulate such troubles (Wirasto, 2020).Therefore, not everyone will rely on healthcare services to address perceived mental health disorders.

Education
There is a finding where respondents utilising TMH services with higher education levels (78.2%) outnumber those with lower education levels (50%).The chi-square test results indicate no association between education and the utilisation of TMH services.
Multiple logistic regression modelling for multivariate analysis includes teaching as a covariate.People with a higher level of education are often assumed to be better at making judgments about something.
However, when considering the occurrence of mental health disorders, it is found that individuals with higher formal education levels tend to experience stress during the learning process.This condition increases the vulnerability of individuals with higher education to mental health disorders (Agung, 2015).Allo, where 75% of the population had positive coping mechanisms for their daily stressors (Setianingsih, 2012).Therefore, individuals with good and poor knowledge have their ways of maintaining mental health, which is not always achieved through healthcare services.

CONCLUSION
The need for healthcare services motivates condition has motivated them to seek an understanding and control over the perceived causes of their mental health disorders.Based on the collected primary data, stress was the most commonly perceived cause of mental health disorders among the respondents (92.8%).As for the diagnoses made by healthcare professionals during TMH utilisation, anxiety disorders were the dominant diagnosis (74.4%).Additionally, respondents sought TMH services due to the service's flexibility in terms of time (96.7%),location (93.9%), and communication medium that facilitates interaction with healthcare professionals (86.7%).The chi-square test yielded a p-value of 0.000, indicating a significant relationship between need factors and the utilisation of TMH services.The findings from the bivariate analysis align with a study conducted in 2019 by Lee et al., where need factors were significantly associated with the utilization of telemedicine in a rural population with a pvalue <0.05 (Lee et al., 2019).The multivariate analysis conducted in this study revealed that need factors influence the utilization of TMH services, with changes in need factors having a 15-fold impact on the decision of Generation Z individuals to utilize TMH services.The findings of this study align with Andersen's Health Services Utilization Theory, where need factors are the most influential in an individual's decision to utilise healthcare services.The sense of need for curative healthcare services serves as a driving force that compels individuals to seek treatment to address their perceived mental health disorders, even in the presence of predisposing or enabling factors that may act as barriers.When viewed through the lens of predisposing and enabling factors, an individual may still utilise healthcare services even when facing difficulties accessing them to ensure their health needs are met.Conversely, someone may refrain from using healthcare services even when access is convenient due to a lack of alignment with their health needs(Maulany et al., 2021).Similar situations arise with individuals who continue to use healthcare services because of alignment with their health needs despite having low knowledge, and individuals with good knowledge may not necessarily utilise healthcare services because they are aware of alternative methods to address their health concerns(Oktarianita et al., 2021;Widiyastuty et al., 2023).The elaboration above aligns with the findings of this research, where it was observed that 70.6% of respondents continued to utilise TMH services even when facing challenges in access, and 79% of respondents had limited knowledge of mental health but still utilised TMH services.These findings may be attributed to the respondents' need for mental health services provided through TMH to fulfil their needs.Based on the results of the bivariate and multivariate analyses conducted, it can be concluded that the need factor for TMH services has a significant relationship and influence on the utilisation of TMH services among Generation Z individuals in Indonesia.
of residence and TMH service utilisation, it does not alone determine whether an individual will use TMH services.Other inevitable factors come into play, such as personal attitudes and societal stigma within the local community regarding mental health disorders and their treatment.Both of these factors also influence the willingness of individuals experiencing mental health disorders to seek treatment(Deng et al., 2022;Oruh and Agustang, 2020).
individuals to utilise healthcare services to address perceived health issues, even with barriers from both predisposing and enabling factors.The results of this study indicate a relationship between the need factor, TMH service accessibility, healthcare professional support, and place of residence with the utilisation of TMH services among Generation Z individuals in Indonesia.Among these four related variables, the need factor is the most significant influence on utilising TMH services.Meanwhile, gender, education, occupation, marital status, and mental health knowledge do not show should include data collection and credibility screening of TMH services and supervision to maintain service quality.2) TMH service providers should develop TMH platforms that are easily accessible through various devices (Android, iOS, desktop).They should consider providing 24-hour services, adjusting session durations, ensuring the competence of healthcare professionals, and developing their skills.3) Generation Z individuals should utilise TMH services and follow up on consultation results.They should avoid self-diagnosis, enhance their understanding and ability to manage stressors and select TMH platforms and healthcare professionals suitable for their mental health issues.

Table 1 .
Cross Tabulation and Chi-square Test Results of Independent and Dependent Variables RepublikIndonesia, 2018).This situation falls far short of the targets set in the Action Plan for 2020 -2024 of the Directorate of A.W. Alifa, C. Suryawati, P.A.Wigati.Needs As The Dominant Factor of Generation Z in Telemental Health (TMH) Services Utilization 30 DOI: 10.32668/jitek.v11i1.1200univariate, bivariate, and multivariate approaches.Bivariate analysis of the preliminary data will involve using the chisquare test.Independent variables can be associated with dependent variables if the pvalue is <0.05.Meanwhile, multivariate analysis will be conducted using the backward method of multiple logistic regression, where only independent variables with a p-value <0.25 will undergo multivariate analysis.RESULT AND DISCUSSION This study was predominantly composed of Muslim female students aged 22 -28 years residing in Central Java, with their highest educational background at the high school level (SMA) and unmarried marital status.The most frequently utilised TMH services by respondents were Halodoc and Alodokter.Based on the table below, it can be observed that 4 out of 9 independent variables are associated with the dependent variable.These four independent variables are need factors, TMH service accessibility, healthcare personnel support, and place of residence.

Table 2 .
Multiple Logistic Regression Modeling value, is interpreted as the magnitude of the influence of the independent variable on the dependent variable.The need factor variable has an Exp (B) value of 15.308 ~ 15, which means that Generation Z individuals with a greater need will utilise TMH services approximately 15 times more than those with lower requirements.

The Influence of Needs Factor on the Utilization of Telemental Health Services among Generation Z
Respondents with a condition (94.8%) will A.W. Alifa, C. Suryawati, P.A.Wigati.Needs As The Dominant Factor of Generation Z in Telemental Health (TMH) Services Utilization 34 DOI: 10.32668/jitek.v11i1.1200