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DAMA (Discharge against Medical Advice) is an indicator of the lack of quality of hospital health services. DAMA among patients in general is caused by reduced faith or hope for recovery. One kind of approach that can raise hope for healing is through a cultural approach. A culture that is known in Bolaang Mongondow (Bolmong) is Mododuluan. Mododuluan is a form of mutual cooperation to help traditionally bequeathed ancestors. The purpose of this study is to obtain a model of improving quality of life in the context of controlling incidences of forced discharges using a cultural approach of the Bolmong community. This research is a quantitative research. The number of respondents was 156 patients. The study was conducted at Datoe Binangkang Bolmong Hospital in August 2019. The research variables were quality of life, DAMA, health insurance, and Mododuluan. Data was collected using copies of a questionnaire. Data was analyzed with SEM analysis using SmartPLS. The results showed that age, education, type of occupation, LOS, and quality of hospital services are indicators of DAMA. The most influential indicator was age. BPJS participation and general patients are indicators of health insurance. The most influential indicator was BPJS participation. Ethos of unity (Motobatu), ethos of cooperation (Mobobatungan), mutual improvement (Pogogutat), and mutual support are indicators of Mododuluan. The most influential indicator was ethos of unity. Physical functions, emotional functions, social functions, psychological welfare dimensions, and environmental dimensions are indicators of quality of life. The most influential indicator was social function. Mododuluan culture positively and significantly influenced quality of life, and quality of life and Mododuluan culture positively and significantly influenced DAMA. This study also showed that improvement of quality of life through DAMA was increased through Mododuluan culture, and DAMA through quality of life was decreased where Mododuluan was the strongest moderating variable. Mododuluan was the strongest moderating variable to improve quality of life in order to control the DAMA of patients from the hospital. Based on the results of this study, Mododuluan must be preserved

Quality of Life Improvement Model Related to Discharges Against Medical Advice (DAMA) Modulated by Mododuluan’s of the Bolaang Mongondow Ethnic Group in North Sulawesi, Indonesia