Journal of Applied Nursing and Health

Nurse Competence, Work Environment, and Patient Safety: The Mediating Role of Bedside Handover in Indonesia: A Cross-Sectional Study

Sova Nova Kaparang, Kuswantoro Rusca Putra, Rinik Eko Kapti — Sat, 21 Mar 2026 00:00:00 +0700

Background: Patient safety remains a major global concern, especially in low- and middle-income countries (LMICs) where resource limitations and communication gaps contribute to preventable harm. Although bedside handover is recognized as a strategy to enhance transparency and safety culture, few studies have examined its mediating role between nurse competence, work environment, and patient safety.

Methods: This cross-sectional study, conducted in accordance with STROBE guidelines, involved 258 inpatient nurses selected through proportionate stratified random sampling from four hospitals in North Sulawesi, Indonesia. Eligible participants had at least one year of experience and were actively involved in bedside handover. Validated instruments the Nurse Competence Scale (NCS), Area of Worklife Survey (AWS), Nursing Handoff Competency Scale (NHCS), and Safety Care Activity Scale (SCAS), were used. Structural Equation Modeling with Partial Least Squares assessed measurement validity and structural relationships.

Results: All instruments met recommended validity and reliability standards, and the sample primarily comprised early-career female nurses. Structural modeling showed that both nurse competence and the work environment were positively associated with bedside handover, which in turn demonstrated a strong relationship with patient safety. Bedside handover partially mediated the influence of nurse competence and fully mediated the influence of the work environment on patient safety.

Conclusion: Bedside handover serves as a central mechanism linking individual capabilities and organizational conditions to safer patient outcomes. Strengthening competency development, promoting fairness and teamwork, and standardizing bedside handover practices may offer practical, low-cost pathways to improve patient safety in LMIC contexts

Factors Influencing Patient Perception of Clinical Laboratory Services: A Cross-Sectional Study

Afif Wahyudi Hidayat, Lyliana Endang Setianingsih, Emmelia Kristina Hutagaol — Sat, 21 Mar 2026 00:00:00 +0700

Background: Hospital clinical laboratories are essential for diagnosis, treatment monitoring, and clinical decision-making, and increasingly contribute to hospital revenue. However, in contrast to high-income settings where laboratory service quality has been more extensively studied, there is still limited empirical evidence from low- and middle-income countries (LMICs), including Indonesia, on how structural and process-related aspects of private hospital clinical laboratory services shape patient perceptions. This study aimed to analyze factors associated with patient perceptions of clinical laboratory services.

Methods: This quantitative cross-sectional study. A total of 114 consecutively recruited patients completed the Clinical Laboratory Service Perception Questionnaire (CLSPQ), a 22-item validated instrument covering education level, physical environment (laboratory room, cleanliness of rooms and toilets, waiting area comfort), service processes (waiting time, availability of tests, clarity of information), and overall perception of laboratory services. Data were analyzed using chi-square tests and multiple logistic regression to identify independent predictors of positive patient perceptions (p < 0.05).

Results: In multivariable analysis, higher education level, bright and hygienic laboratory rooms, comfortable and clean waiting areas, clear information about laboratory services, very clean laboratory rooms, clean and odorless toilets, shorter waiting times, and availability of all required laboratory tests were independently associated with positive patient perceptions of clinical laboratory services (all p < 0.001). Laboratory cleanliness showed the strongest association with positive perceptions, followed by toilet cleanliness and shorter waiting times.

Conclusion: Physical environmental conditions and key service delivery processes are major determinants of how patients perceive clinical laboratory services in this LMIC private hospital. Prioritizing low-cost improvements in cleanliness, waiting room comfort, queue management, and clarity of information within continuous quality improvement programmes may substantially enhance patient satisfaction and strengthen the professional image of hospital laboratories in similar resource-limited settings.

Nursing Supervision and Electronic Medical Record Documentation Quality among Practicing Nurses: A Cross-Sectional Study

Luh Gde Nita Sri Wahyuningsih, NLP Dina Susanti, Sarah Kartika Wulandari — Sat, 21 Mar 2026 00:00:00 +0700

Background: Digital transformation in healthcare has promoted the use of Electronic Medical Records (EMR) as the standard for nursing documentation. Supervision is a key managerial strategy influencing its successful implementation among practicing nurses. However, empirical evidence on how supervision components affect the quality of electronic nursing documentation in low- and middle-income countries remains limited. Therefore, this study aims to analyze the strategic role of nursing supervision in strengthening EMR documentation.

Methods: This analytical cross-sectional study examined the relationship between the role of supervision and the strengthening of electronic medical records. The sample included 352 practicing nurses selected through total sampling. Data were collected using a validated and reliable structured questionnaire (Cronbach’s alpha > 0.60). Analysis was conducted using Spearman’s rank correlation and binary logistic regression to assess the relationship and influence of supervision on documentation quality.

Results: The results showed that the supervision variable (planning, coordination, control, monitoring, and feedback) was significantly related to electronic medical record documentation (p < 0.001), with feedback being the most dominant factor (Exp(B)=233.049; 95% CI: 15,606–3480.287).

Conclusion: Nursing supervision plays a strategic role in strengthening the implementation of Electronic Medical Record documentation. From a managerial and policy perspective, these findings confirm that strengthening the supervision system, primarily through standardized and continuous feedback mechanisms, should be a priority for nursing leaders and hospital management.

Minahasa Culture, Family Support, Health Worker Support, Self-Efficacy, and Knowledge Associated with Self-Care Behavior among Hypertensive Patients: A Cross-Sectional Study

Dina Dewi Sartika Lestari Ismail, Christina Yunitha Pelealu, Lilik Supriati — Sat, 21 Mar 2026 00:00:00 +0700

Background: Hypertension is a leading cause of stroke and cardiovascular disease, and its high prevalence in Indonesia remains difficult to control. Evidence on how psychosocial and cultural factors, including Minahasa local culture, influence self-care is still limited. This study examined the effects of knowledge, self-efficacy, family support, health worker support, and Minahasa culture on self-care behavior among hypertensive patients in Southeast Minahasa Regency.

Methods: A quantitative correlational cross-sectional study was conducted among 165 hypertensive patients recruited by consecutive purposive sampling from the outpatient clinic of a general hospital in Southeast Minahasa. Data were collected using validated questionnaires, and associations between predictors and self-care behavior were analyzed using multiple linear regression (p < 0.05).

Results: Self-efficacy (β = 0.381; p < 0.001) and family support (β = 0.329; p < 0.001) had significant positive effects on self-care behavior. Knowledge (β = –0.009; p = 0.895), health worker support (β = –0.065; p = 0.643), and Minahasa culture (β = 0.127; p = 0.405) showed no significant direct effects. The model explained 34.7% of variance in self-care behavior (R² = 0.347).

Conclusion: Self-efficacy and family support are the main determinants of self-care behavior, whereas knowledge, health worker support, and Minahasa culture do not exert significant direct effects. These findings indicate that local cultural values alone do not automatically improve self-care and may act indirectly through family and psychosocial pathways. Hypertension programs should prioritize strengthening self-efficacy and mobilizing family support, and future longitudinal studies should test culturally grounded, family-centered interventions

Effectiveness of Citrus sinensis Aromatherapy and Nature Sound Therapy on Pain, Vital Signs, and Postoperative Nausea and Vomiting: A Quasi-Experimental Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Postoperative recovery in the early hours after surgery is often accompanied by pain, vital-sign fluctuations, and postoperative nausea and vomiting (PONV). Complementary therapies such as Citrus sinensis aromatherapy and nature sound therapy have been used as adjuncts to pharmacological management; however, evidence on their combined effects on multiple recovery indicators in the early postoperative period remains limited. This study evaluated the effectiveness of these interventions compared with standard postoperative care.

Methods: Three-group pretest–posttest quasi-experimental study was conducted in two hospitals using purposive sampling. Participants were conscious and hemodynamically stable adult patients 8–12 hours after surgery. Patients with chronic pain, hearing impairment, or olfactory dysfunction were excluded. Based on G*Power analysis (f = 0.25, α = 0.05, power = 0.80), 30 participants per group were required; therefore, 32 were recruited per group. Interventions were provided 8–12 hours post-surgery alongside standard care: Citrus sinensis aromatherapy (25 minutes) and nature sound therapy (30 minutes). Outcomes included pain intensity (Numeric Rating Scale), vital signs, and PONV severity (4-point scale). Data were analyzed using repeated-measures ANOVA in SPSS version 26.

Results: Both Citrus sinensis aromatherapy and nature sound therapy showed significant improvements in pain, vital-sign stability, and reduced PONV severity compared with the control condition (p < 0.05). No adverse effects were observed. Aromatherapy demonstrated a moderate effect on PONV reduction, while nature sound therapy showed a large effect on pain reduction and vital-sign stabilization.

Conclusion: Citrus sinensis aromatherapy and nature sound therapy are safe adjunctive interventions that may enhance early postoperative recovery by improving symptom burden and supporting physiological stability, with strong potential for integration into sensory-based postoperative comfort protocols.

Nurse Credentialing, Work Motivation, and Performance: A Cross-Sectional Mediation Study

Ahsan Ahsan, Deyfi Christine Wokas, Laily Yuliatun — Sat, 21 Mar 2026 00:00:00 +0700

Background: Nurse credentialing is intended to ensure professional competence, improve performance, and enhance work motivation. However, despite its widespread implementation, evidence regarding its actual impact on nurses’ motivation and performance remains inconsistent and inconclusive. This inconsistency reflects an unresolved gap in understanding whether credentialing directly influences nurse performance or operates indirectly through work motivation. This study aimed to examine the relationship between credentialing, work motivation, and nurse performance, with work motivation tested as a mediating variable.

Methods: This quantitative cross-sectional study followed the STROBE reporting guideline. The population comprised all inpatient nurses at Dr. Sam Ratulangi Tondano Regional General Hospital (N = 176). Using purposive sampling, 122 nurses were selected based on inclusion criteria of at least one year of work experience and direct involvement in nursing care; nurses on leave were excluded. Credentialing level (PK0–PK3) was the independent variable, nurse performance the dependent variable, and work motivation the mediating variable. Motivation and performance were measured using validated Likert-scale questionnaires, while credentialing data were obtained from institutional records. Structural Equation Modeling–Partial Least Squares (SEM-PLS) was used to test direct and mediating effects.

Results: Credentialing showed a negligible and non-significant effect on nurse performance (β = 0.002; p = 0.979) and work motivation (β = 0.027; p = 0.683). Conversely, nurse performance had a strong and significant effect on work motivation (β = 0.768; p < 0.001). Work motivation did not mediate the credentialing–performance relationship.

Conclusion: Credentialing alone does not significantly influence nurse performance or motivation. Integrating credentialing with performance management and continuous professional development systems is essential to enhance its effectiveness

Effects of Video-Guided Digital Menstrual Exercise on Premenstrual Syndrome and Dysmenorrhea Among Adolescent Girls: A Quasi-Experimental Study

Devi Permatasari, Sri Sat Titi Hamranani, Zahra Alfisyahrina, Supardi Supardi — Sat, 21 Mar 2026 00:00:00 +0700

Background: Adolescence is a transitional period of reproductive maturation in which many girls experience premenstrual syndrome and dysmenorrhea that can affect physical, psychological, and academic functioning. Video-guided digital menstrual exercise may help reduce these symptoms through relaxation and improved uterine circulation. However, evidence on nurse-led digital menstrual exercise remains limited; therefore, this study aimed to examine its effects on premenstrual syndrome symptoms and dysmenorrhea intensity among adolescent girls.

Methods: This quasi-experimental pretest–posttest control group study followed TREND guidelines. From 237 female students, 70 were selected through purposive sampling and assigned to intervention and control groups. The intervention was video-guided digital menstrual exercise, while outcomes were premenstrual syndrome and dysmenorrhea intensity measured using validated questionnaires and the Numeric Rating Scale (NRS). Data were analyzed using McNemar, Wilcoxon Signed Rank, and Mann–Whitney tests with p < 0.05.

Results: The intervention group showed a significant reduction in premenstrual syndrome symptoms, with 74.3% of participants reporting no premenstrual syndrome after the intervention video guided digital menstrual exercise program (p < 0.001). Dysmenorrhea intensity also significantly decreased, as 34.3% of participants reported no pain after the intervention, and a significant difference in pain intensity was observed between the intervention and control groups (p < 0.001). The results of the Mann–Whitney U test showed a statistically significant difference in pain intensity between the intervention and control groups (p < 0.001), with a very large effect size (r = 0.86).

Conclusion: Video-guided digital menstrual exercise is effective in reducing premenstrual syndrome symptoms and alleviating dysmenorrhea among adolescent girls with its effects plausibly explained through physiological and neuroendocrine mechanisms. This intervention can be recommended as a safe, practical, and non-pharmacological strategy to be implemented in school health programs to support adolescent reproductive health and improve daily functioning

Cultural Beliefs and Pregnancy Care among the Dayak Kenyah Community in East Kutai, Indonesia: An Ethnographic Study

Tuti Meihartati, Ringgit Ringgit, Sumiati Sumiati, Aries Abiyoga — Sat, 21 Mar 2026 00:00:00 +0700

Background: Maternal health during pregnancy, childbirth, and the postpartum period serves as one of the key indicators of community well-being. Various studies have emphasized that cultural practices exert a significant influence on maternal care across different communities. This study aims to explore and analyze cultural beliefs and pregnancy care among the Dayak Kenyah community in East Kutai, Indonesia.

Methods: This qualitative ethnographic study used purposive sampling with maximum variation. Data were gathered from 10 informants (6 pregnant women, 2 traditional leaders, 2 healthcare providers) through in-depth interviews and field notes. Analysis followed Braun and Clarke’s thematic approach. The study adheres to SRQR reporting guidelines to ensure rigor.

Results: Five interpretive themes emerged: (1) Cultural Practices and Beliefs, involving dietary and behavioral taboos to protect against supernatural risks; (2) Traditional and Social Support, where traditional birth attendants (TBAs) provide physical and diagnostic assurance; (3) Integration with Formal Healthcare, highlighting midwives as cultural mediators; (4) Healthcare Quality Improvement, focusing on cultural competency to reduce stigma; and (5) Service Expectations, emphasizing a need for home-based care.

Conclusion: Maternal care among the Dayak Kenyah is a hybrid process where ancestral rituals and clinical services coexist. Success in improving outcomes depends on integrating traditional practices with formal systems through culturally sensitive approaches.

Effect of Postoperative Methylprednisolone on Swelling and Pain After Mandibular Third Molar Surgery: A Randomized Controlled Trial

Sat, 21 Mar 2026 00:00:00 +0700

Background: Pain and swelling are common inflammatory complications following mandibular third molar surgery. Corticosteroids are widely used to control postoperative inflammation and improve patient comfort. However, evidence regarding the effectiveness of low-dose postoperative methylprednisolone, particularly at an 8 mg dose, remains limited, especially in low- and middle-income countries (LMICs). This study aimed to evaluate the effectiveness of an 8 mg dose of methylprednisolone on postoperative pain intensity and facial swelling following surgery.

Methods: This study employed a parallel-group, two-arm randomized controlled trial design conducted in accordance with the CONSORT guidelines. A total of 30 patients who met the inclusion criteria were randomly assigned to either the intervention group (8 mg methylprednisolone) or the control group (standard care), with 15 participants in each group. The independent variable was methylprednisolone administration, while the dependent variables included pain intensity measured using the Visual Analog Scale (VAS) and facial swelling. Outcome assessments were performed on postoperative days 1, 3, and 7. Statistical analyses were used for independent t-tests.

Results: Pain intensity was lower in the methylprednisolone group than in the control group at all postoperative time points, with large between-group effect sizes observed on day 1 (p = 0.003; Cohen’s d = 1.42), day 3 (p = 0.020; Cohen’s d = 1.36), and day 7 (p = 0.007; Cohen’s d = 1.18). Facial swelling also differed between groups, showing a lower degree of swelling in the methylprednisolone group during postoperative days 1–3 (p = 0.029; Cohen’s d = 0.98) and days 3–7 (p = 0.002; Cohen’s d = 0.87), indicating consistently large effects across outcomes.

Conclusion: Low-dose methylprednisolone is statistically and clinically effective in reducing postoperative pain and swelling following surgery and may be integrated as a safe and cost-effective adjuvant therapy in postoperative dental care.

Patient Satisfaction with Outpatient Pharmaceutical Services Under the National Health Insurance Scheme in Indonesia: A Cross-Sectional Study

Hermanus Ehe Hurit, Andini Adinda Putri, Nurjannah Bachri — Sat, 21 Mar 2026 00:00:00 +0700

Background: The utilization of Indonesia’s National Health Insurance Scheme has increased. However, evidence on patient satisfaction with pharmaceutical services under national health insurance schemes in low- and middle-income countries, particularly using the SERVQUAL framework, remains limited. This gap is important, as Indonesia’s National Health Insurance Scheme patient characteristics may shape perceptions of service quality and inform targeted service improvement strategies. This study aimed to analyze the relationship between Indonesia’s National Health Insurance Scheme patient characteristics and satisfaction with outpatient pharmaceutical services.

Methods: A quantitative cross-sectional study was conducted and reported in accordance with the STROBE guidelines. The study involved Indonesia’s National Health Insurance Scheme outpatients at the Pharmacy Installation of Dr. Suyoto Hospital, Jakarta, in 2023, who met the inclusion criteria (aged ≥18 years, received pharmaceutical services, and provided informed consent). Data were collected using a SERVQUAL questionnaire assessing five dimensions of service quality: tangible, reliability, responsiveness, assurance, and empathy. Patient characteristics (gender, age, education, and occupation) were analyzed as independent variables, while satisfaction served as the dependent variable. Associations were examined using Spearman’s rank correlation test.

Results: Significant and strong correlations were found between patient satisfaction and age (ρ = 0.71; p < 0.001) as well as education level (ρ = 0.70; p < 0.001). Gender and occupation demonstrated statistically significant but weak associations with satisfaction.

Conclusion: Satisfaction with outpatient pharmaceutical services among Indonesia’s National Health Insurance Scheme patients is significantly associated with specific demographic characteristics, particularly age and education. These findings underscore the importance of patient-centered service improvement strategies, with an emphasis on enhancing responsiveness and pharmaceutical communication to improve the quality of Indonesia’s National Health Insurance Scheme services sustainably.

Effect of a Local Food–Based Nutrition Intervention Using Moringa oleifera and Arachis hypogaea on Mid–Upper Arm Circumference among Pregnant Women with Chronic Energy Deficiency: A Quasi-Experimental Study

Erni Hernawati, Novita Yulianti, Sofa Nurul Hidayati — Sat, 21 Mar 2026 00:00:00 +0700

Background: Chronic energy deficiency (CED) among pregnant women remains a persistent public health problem in low- and middle-income countries, including Indonesia. Various nutrition programs have been implemented; however, evidence on practical, locally based food interventions—particularly those combining moringa leaves and peanuts in ready-to-consume cookie form—remains limited. This study addresses this gap by evaluating a combined local food–based intervention aimed at improving maternal nutritional status.

Methods: his study used a quasi-experimental design with a non-randomized control group and a pretest–posttest approach, reported according to the TREND guideline. The sample consisted of 100 pregnant women with chronic energy deficiency recruited through consecutive sampling at a primary healthcare center. Inclusion criteria were gestational age 12–28 weeks and MUAC < 23.5 cm, while women with pregnancy complications, chronic diseases, food allergies, or multiple pregnancies were excluded. MUAC was measured using a standard non-stretchable tape by trained midwives. The intervention group received moringa leaf and peanut cookies daily for two weeks in addition to standard antenatal care, while the control group received standard care only. Data were analyzed using paired and independent t-tests, and effect size was calculated using Cohen’s d.

Results: Both groups showed significant improvements in MUAC after the intervention period (p < 0.001). However, the intervention group demonstrated a greater mean increase in MUAC compared with the control group, with a moderate-to-large effect size (Cohen’s d), indicating not only statistical significance but also meaningful clinical improvement. The effect size was moderate-to-large (Cohen's d = 0.65).

Conclusion: The findings indicate that a combined local food–based cookie intervention using moringa leaves and peanuts is more effective than standard antenatal care alone in improving MUAC among pregnant women with CED. This approach supports the integration of culturally appropriate, locally available food interventions into primary healthcare nutrition programs, particularly in low-resource settings.

TERPATRI (Forgiveness Therapy and Gayatri Mantra–Based Spiritual Intervention) on Resilience among Sexual Harassment Survivors: A Quasi-Experimental Study

Ketut Eka Larasati Wardana, Putu Wahyu Sri Juniantari — Sat, 21 Mar 2026 00:00:00 +0700

Background: Victims of sexual abuse often experience long-term psychological impacts such as trauma, emotional distress, and reduced resilience. Although various interventions exist, most focus on cognitive and behavioral approaches and lack integration of culturally relevant spiritual aspects. Therefore, this study evaluates the effectiveness of TERPATRI—an integration of forgiveness therapy and Gayatri Mantra spirituality—in improving resilience among victims of sexual abuse.

Methods: This study used a pre-post quasi-experimental design with a control group. Participants were recruited using purposive sampling techniques, involving 64 victims of sexual abuse (32 in the intervention group and 32 in the control group). The inclusion criteria for this study were female victims of sexual abuse who were able to stand, open their mouths, hear, and communicate in Balinese and Indonesian. Meanwhile, the exclusion criteria for this study were victims of sexual abuse who had mental disorders, victims under the age of 5, and victims who were illiterate and did not have strong witnesses for this study. The main outcome variable was psychological resilience, which was measured using the Brief Resilience Scale (BRS). The analysis was performed using a paired t-test, with a significance level set at p < 0.05.

Results: The intervention group showed a significant increase in resilience after participating in TERPATRI, with average scores increasing from pre-intervention to post-intervention. The paired t-test showed a statistically significant difference (p < 0.001), accompanied by a large effect size (Cohen's d > 0.80), indicating a substantial increase in resilience compared to the initial condition and the control group.

Conclusion: TERPATRI has been proven effective in improving the resilience of sexual abuse victims. The integration of forgiveness therapy with Gayatri Mantra spirituality shows potential as a culturally and contextually sensitive mental health intervention, especially in communities with a strong spiritual background. This approach has the potential to be developed as a complementary intervention in psychological recovery services for victims of sexual violence.

Effectiveness of Honey Soy Milk on Hemoglobin Improvement among Adolescent Girls with Menstrual Anemia: A Quasi-Experimental Study

Yuniza Yuniza, Marwan Riki Ginanjar, Mar’atun Ulaa, Brett Williams — Sat, 21 Mar 2026 00:00:00 +0700

Background: Anemia is a common health problem among adolescent girls, primarily due to iron deficiency and blood loss during menstruation. Honey contains bioactive compounds beneficial to health, including the improvement of metabolism and hematological status. This study aims to determine the effect of honey soy milk on hemoglobin (Hb) levels among adolescent girls with menstrual anemia.

Methods: This quantitative study employed a quasi-experimental design with one group pretest–posttest, conducted at an educational institution in Indonesia. A total of 25 adolescent girls with menstrual anemia were selected using purposive sampling based on inclusion and exclusion criteria. The intervention consisted of administering 200 mL of honey soy milk twice daily for 5 consecutive days during menstruation. Hemoglobin levels were measured in g/dL using an EasyTouch GCHb digital analyzer before and after the intervention. Data analysis followed the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines.

Results: The mean hemoglobin level before the intervention was 11.15 ± 1.72 g/dL, and after the intervention, it increased to 12.92 ± 1.87 g/dL. Statistical testing showed a significant difference (p < 0.001), indicating that honey soy milk effectively improved Hb levels among participants.

Conclusion: Honey soy milk is effective in increasing hemoglobin levels in adolescent girls with menstrual anemia. These findings support the use of functional foods as an adjunctive strategy in anemia prevention and management programs for adolescents

Factors Associated with Knowledge of Pregnancy Danger Signs and Antenatal Care Compliance: A Cross-Sectional Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Adequate knowledge of pregnancy danger signs plays a critical role in promoting antenatal care (ANC) compliance. Poor adherence to ANC visits remains a significant contributor to preventable maternal complications. Research aimed to analyze the association between maternal knowledge of pregnancy danger signs and ANC compliance and to identify the most dominant predictors.

Methods: An analytical cross-sectional study was conducted among 249 pregnant women. Participants were selected using purposive sampling. Data were collected through structured questionnaire-based interviews and verification of ANC visits using medical records and Maternal and Child Health (MCH) books. Bivariate associations were tested using the Chi-square test. Variables with p < 0.25 were included in a multiple logistic regression analysis. Statistical significance was set at p < 0.05.

Results: Of the respondents, 55.0% were aged <27 years, 57.0% had education below junior high school, 56.6% were primigravida, and 55.4% lived within 5 km of a health facility. ANC compliance was observed in 55.8% of participants, while 55.8% demonstrated low knowledge of pregnancy danger signs. Bivariate analysis showed significant associations between ANC compliance and maternal age, educational methods, motivation, attitude, parity, distance to health facility, and knowledge (all p = 0.001). Multivariate analysis identified knowledge as the strongest predictor of ANC compliance (p = 0.019; OR = 3.380; 95% CI: 1.222–9.348), adjusted for maternal age (p = 0.048).

Conclusion: Maternal knowledge of pregnancy danger signs is the most influential factor associated with ANC compliance. Strengthening targeted health education strategies may improve maternal service utilization.

The Association Between Infant Massage Frequency, Body Mass Index, and Early Psychomotor Milestones Among Infants Aged 3–12 Months: An Analytical Observational Study in Aligned with SDG 3

Sat, 21 Mar 2026 00:00:00 +0700

Background: Infant massage is a non-invasive, low-cost intervention that supports early childhood growth and development and is increasingly promoted in community health programs. However, evidence on its relationship with Body Mass Index (BMI) and early psychomotor milestone achievement in low- and middle-income countries, particularly Indonesia, remains limited. Therefore, this study aimed to examine the effect of infant massage on BMI and early psychomotor milestones among infants aged 3–12 months in alignment with Sustainable Development Goal 3 (Good Health and Well-Being).

Methods: This study used a quantitative design with multiple linear regression analysis. The population consisted of infants aged 3–12 months in Semarang Regency, Indonesia, with a purposive sample of 250 infants. Inclusion criteria were good health status, age 3–12 months, and parental consent, while infants with congenital anomalies or developmental disorders were excluded. BMI was the dependent variable, and independent variables included infant massage frequency, psychomotor milestone achievement, feeding adequacy, and parental stimulation. Data were collected using WHO-standardized BMI measurements and psychomotor milestone checklists. Infant massage followed the standardized Love Baby Massage technique. Ethical approval was obtained, and data were analyzed using multiple linear regression with p-values, confidence intervals, and effect sizes reported.

Results: Descriptive analysis indicated that the majority of infants received regular massage and exhibited nutritional status within the WHO reference standards. Regression analysis demonstrated that infant massage frequency and psychomotor milestone achievement were significant predictors of BMI (p < 0.05). Feeding adequacy showed a positive association with BMI and a moderate effect size, while parental stimulation exhibited a smaller and statistically nonsignificant direct effect. Collectively, the independent variables contributed substantially to explaining variations in BMI among infants aged 3–12 months.

Conclusion: Regular infant massage plays a meaningful role in improving BMI and supporting early psychomotor development. Integrating massage practices with adequate nutrition and parental engagement is recommended as a comprehensive strategy to optimize infant growth and early development, consistent with SDG 3.

Effect of Slow Deep Breathing on Muscle Pain Reduction among Adults with Myalgia: A Quasi-Experimental Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Relaxation techniques and slow deep breathing are known to activate the parasympathetic nervous system, making them an integral non-pharmacological intervention for musculoskeletal pain management. However, evidence regarding the effectiveness of slow deep breathing interventions in reducing muscle pain in adults with myalgia, particularly in primary care settings, is limited. This study aimed to examine the effect of slow deep breathing on reducing muscle pain in adults with myalgia.

Methods: This study used a quasi-experimental pre-test-post-test control group design following TREND guidelines. Total sampling was used to recruit 36 myalgia patients at the Peneleh Community Health Center, Surabaya, who were divided into an intervention group (n = 18) and a control group (n = 18). Participants aged 17–65 years with pain intensity ≥3 on the Numeric Rating Scale (NRS) were included. The intervention group received slow deep breathing exercises for 15 minutes twice daily for five days, while the control group received standard care. Muscle pain intensity measured using the NRS was the outcome variable. Data were analyzed using the Wilcoxon Signed Rank Test due to non-normal distribution and the Mann–Whitney U test, with p < 0.05 considered statistically significant.

Results: Muscle pain intensity in the intervention group significantly decreased from 4.33 ± 0.84 to 2.50 ± 1.15, showing a mean reduction of 1.83 points (Wilcoxon Signed Rank Test, p < 0.001). The control group showed no significant change (from 4.22 ± 0.81 to 4.00 ± 0.80; mean reduction = 0.22; p = 0.102). Posttest comparison demonstrated significantly lower pain intensity in the intervention group than in the control group (mean rank 24.67 vs 12.33; Mann–Whitney U = 51.0, p < 0.001).

Conclusion: Slow deep breathing for five days significantly reduced muscle pain intensity in patients with myalgia compared to standard care, suggesting it is an effective non-pharmacological intervention for pain management in primary care settings.

Parental Support and School Environment as Determinants of Obesity Risk among School-Aged Children: A Cross-Sectional Study

Nurharlinah Nurharlinah, Ari Athiutama, Karyatin Karyatin, Rini Herdiani — Sat, 21 Mar 2026 00:00:00 +0700

Background: Childhood obesity is an increasing public health concern among school-aged children, particularly in low- and middle-income countries (LMICs). While parental support and the school environment are recognized as important determinants, evidence comparing their relative influence within a socio-ecological framework remains limited. This study aimed to examine the association between parental support, the school environment, and obesity risk among school-aged children in Indonesia.

Methods: A cross-sectional study was conducted on 120 children aged 7–12 years using a purposive sampling method. Data were collected using a validated parental support questionnaire, school environment assessment instrument, and anthropometric measurements to determine the body mass index (BMI) for age. Associations were analyzed using the chi-square tests and multivariable logistic regression. This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results: Both parental support and school environment were significantly associated with obesity risk. Children with low parental support had higher odds of obesity (OR = 2.50; 95% CI: 1.20–5.10), whereas those exposed to less healthy school environments had even higher odds of obesity (OR = 2.80; 95% CI: 1.35–5.80). Among the examined factors, the school environment demonstrated the strongest independent association with the risk of obesity.

Conclusion: Parental support and the school environment are important determinants of obesity risk among school-aged children; however, school-level factors appear to play a more dominant role in this regard. These findings highlight schools as a critical entry point for childhood obesity prevention within a socio-ecological framework, particularly in LMIC.

Happiness and Physical Discomfort as Determinants of Quality of Life Among Nursing Home Residents: A Cross-Sectional Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: QoL assessment is essential in delivering person-centered care for institutionalized older adults. However, evidence on the combined influence of happiness and physical discomfort on their QoL remains limited. This study aimed to examine the associations between happiness, physical discomfort, and QoL among nursing home residents.

Methods: This cross-sectional study followed the STROBE guideline and was conducted at Nursing Home A in Jepara Regency. Of the 81 elderly residents, 68 participants were selected using Slovin’s formula and recruited through purposive sampling. Inclusion criteria were age ≥60 years, permanent residence in the nursing home, willingness to participate, and ability to communicate effectively. The independent variables were happiness and physical discomfort, while QoL was the dependent variable. The questionnaires were administered through face-to-face interviews to ensure comprehension. QoL was assessed using the SF-36, happiness using the Oxford Happiness Questionnaire (OHQ), and physical discomfort using the Visual Analogue Scale (VAS). Associations between variables were analyzed using Spearman’s rank correlation test.

Results: The majority of elderly participants reported experiencing severe physical discomfort (33.8%) and demonstrated poor QoL (58.8%). A significant association was identified between physical discomfort and QoL (Spearman’s ρ = −0.37, 95% CI −0.56 to −0.14, p = 0.003). In addition, happiness was significantly correlated with QoL (Spearman’s ρ = 0.35, 95% CI 0.12 to 0.54, p = 0.004), with most participants who exhibited low happiness scores also reporting poor QoL.

Conclusion: The findings underscore the importance of integrated nursing strategies that address both physical discomfort management and emotional well-being to improve elderly QoL. Routine assessment of discomfort and happiness should be incorporated into daily nursing care and institutional policies within nursing homes.

Effectiveness Of Animation-Based Psychoeducation On Adolescent Mental Health And Risk Behavior: A Quasi-Experimental Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Adolescent mental health and risky behaviors, including the KRR TRIAD (Risky Sexual Behavior, Drug Abuse, and HIV/AIDS), remain significant public health challenges in Indonesia that contribute to school dropout rates. This study aimed to evaluate the effectiveness of PENA (Education and Animation)-based psychoeducation in improving knowledge and behavior related to mental health, TRIAD KRR, and dropout prevention.

Methods: This quasi-experimental study with a pretest-posttest control group followed the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) reporting guideline. A sample of 124 students was selected using a simple random sampling technique. The intervention group received PENA-based psychoeducation for a duration of 4 weeks (two sessions per week), while the control group received leaflets. Data were collected using a questionnaire that had been tested for validity and reliability. Data were analyzed using the Mann-Whitney test.

Results: The intervention group showed a significant increase in knowledge (Median 80, IQR: 75–85) compared to the control group (Median 45, IQR: 40–50) with $p = 0.015$. Furthermore, the intervention group demonstrated better behavior in preventing TRIAD KRR and school dropout with p < 0.001.

Conclusion: PENA-based psychoeducation is more effective than traditional leaflets in improving knowledge and fostering positive behavioral changes among adolescents.

Impact of Household Social Factors on Stunting among Under-Five Children in a Public Health Center: A Cross-Sectional Study

Rika Apripan, Rosmainun Rosmainun, Nayodi Permayasa — Sat, 21 Mar 2026 00:00:00 +0700

Background: Stunting is a chronic growth disorder in young children characterized by height below age standards and is closely linked to household social conditions. Factors such as parenting practices, maternal education, employment, and family socioeconomic status are believed to influence stunting. However, evidence remains limited regarding which household-level social determinants exert the strongest influence on stunting within primary healthcare settings in Indonesia. This study aimed to analyze the impact of household social factors on stunting among children under five.

Methods: This research employed an observational study with a cross-sectional design. A total of 215 mothers with children under five were selected from a population of 466 using purposive sampling. Data were collected through structured questionnaires. Statistical analysis was conducted using chi-square tests to examine associations and logistic regression to determine the most influential factors.

Results: The findings revealed significant associations between stunting and parenting practice (p = 0.001), maternal education level (p = 0.002), family income (p = 0.001), and complementary feeding practices (p = 0.001). Logistic regression analysis indicated that complementary feeding practices were the most dominant factor influencing stunting, with an Exp(B) value of 12.927.

Conclusion: Stunting among children under five is significantly influenced by household social factors, particularly complementary feeding practices, which play the most critical role. Strengthening nutrition education, promoting appropriate complementary feeding, and enhancing family support programs are strongly recommended to reduce stunting prevalence in the community.

A Complementary Health Approach to Tuberculosis Care: Antimycobacterial Activity of Red Betel Leaf and Shallot Ethanol Extracts

Sat, 21 Mar 2026 00:00:00 +0700

Background: Tuberculosis (TB) remains a major global health problem, particularly in low- and middle-income countries. The emergence of drug-resistant Mycobacterium tuberculosis has increased interest in alternative antimicrobial agents from medicinal plants. Red betel leaf (Piper crocatum) and shallot (Allium cepa L.) contain bioactive compounds with potential antibacterial activity. This study aimed to evaluate the inhibitory effect of ethanol extracts of red betel leaf and shallot at different concentrations on the growth of Mycobacterium tuberculosis in vitro.

Methods: A pre-experimental one-group study was conducted in the Microbiology Laboratory of Santa Elisabeth School of Health Sciences, Medan. Mycobacterium tuberculosis isolates from sputum samples were cultured and tested using the disk diffusion method. Ethanol extracts of red betel leaf and shallot were prepared and tested at concentrations of 40%, 60%, 80%, and 100%. Phytochemical screening was performed, and inhibition zones were measured for three days. Data were analyzed using one-way ANOVA followed by Tukey’s HSD post hoc test.

Results: Phytochemical analysis identified alkaloids, flavonoids, tannins, and saponins in the extracts. The mean inhibition zone diameters increased with extract concentration, ranging from 2.67 ± 0.58 mm at 40% to 11.67 ± 0.58 mm at 100%. One-way ANOVA showed a statistically significant difference among concentrations (F(3, 8) = 134.25, p < .001), and all pairwise comparisons were significant.

Conclusion: Ethanol extracts of red betel leaf and shallot demonstrated significant, concentration-dependent inhibitory activity against Mycobacterium tuberculosis in vitro, supporting their potential as complementary antimicrobial agents and warranting further research in nursing and health sciences.

Pre-Clinical Laboratory Evaluation of Chlorhexidine for Disinfection of Semi-Critical Respiratory Equipment in Nursing Practice

Sat, 21 Mar 2026 00:00:00 +0700

Background: Healthcare-associated infections (HAIs) remain a persistent challenge in nursing practice, particularly in the reprocessing of semi-critical respiratory equipment. Although chlorhexidine is widely used as an antiseptic, evidence regarding its pre-clinical disinfectant performance, physicochemical suitability, and waste safety within nurse-led device reprocessing workflows remains limited. This gap is especially relevant in settings where reusable respiratory devices are routinely handled by nurses.

Methods: This study employed a pre-clinical experimental laboratory design. The independent variable was chlorhexidine concentration, while dependent variables included antimicrobial efficacy (phenol coefficient), physicochemical parameters (pH, specific gravity, viscosity), and acute toxicity. Antimicrobial testing was conducted against Staphylococcus aureus and Pseudomonas aeruginosa. Physicochemical assessments followed standardized laboratory procedures, and acute toxicity was evaluated using Danio rerio (zebrafish) larvae to inform waste disposal safety. Expert validation was conducted using the Content Validity Index (CVI). Descriptive and endpoint-based analyses were applied without inferential statistics.

Results: Chlorhexidine demonstrated strong bactericidal activity against both test organisms, with phenol coefficient values indicating effective disinfectant performance. Physicochemical characteristics remained within acceptable ranges for semi-critical respiratory device reprocessing. Toxicity assessment showed dose-dependent larval mortality, indicating the need for dilution before waste discharge. Expert validation identified chlorhexidine 7.5% as the most clinically relevant concentration for nurse-led practice. No p-values were applied due to the endpoint-based experimental design.

Conclusion: Chlorhexidine shows effective pre-clinical disinfectant potential for semi-critical respiratory equipment within controlled laboratory conditions. Its application in nursing practice should be accompanied by standardized concentration control and mandatory dilution before disposal to mitigate environmental toxicity. Further clinical and field-based validation is recommended.

Socioeconomic and Health-Related Factors Associated with Chronic Energy Deficiency among Pregnant Women: A Cross-Sectional Study

Eva Ratna Dewi, Ingka Kristina Pangaribuan, Ribur Sinaga, Kiki Miftasari — Sat, 21 Mar 2026 00:00:00 +0700

Background: Pregnant women are a vulnerable group to nutritional problems, particularly Chronic Energy Deficiency (CED). Despite various efforts to improve the nutritional status of pregnant women, the prevalence of CED in the Lintang region remains high. Evidence regarding the determinants of CED in remote and resource-limited areas is limited, and few studies have specifically examined this issue in this area. This study aimed to analyze factors associated with CED among pregnant women.

Methods: This study used a cross-sectional design with a quantitative approach. The sample consisted of 60 pregnant women who met the inclusion and exclusion criteria. The variables studied included Education, income, parity, and history of infectious diseases as factors influencing CED. Data were analyzed using the chi-square test, with effect sizes in the form of odds ratios (ORs) and 95% confidence intervals.

Results: This study showed a significant association between Education (OR = 3.25; p = 0.008), income (OR = 3.45; p = 0.007), parity (OR = 2.95; p = 0.007), and history of infectious diseases (OR = 2.85; p = 0.016) with the incidence of CED among pregnant women. Although these results were statistically significant, conclusions should be viewed with caution, given the observational nature of the analysis.

Conclusion: Socioeconomic and health factors play a significant role in the incidence of CED among pregnant women in this area. To reduce the prevalence of CED, integrated interventions, including nutrition education, economic support, and infectious disease prevention, are needed, particularly in remote areas with limited access to health services. These findings provide important insights for health policy development and further research with more comprehensive designs.

Self-Efficacy and Emotion Regulation as Correlates of Psychological Distress among Family Caregivers of Working-Age Hemodialysis Patients in Indonesia: A Cross-Sectional Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: The increasing prevalence of chronic kidney disease among working-age populations has heightened psychological distress among family caregivers, especially in low- and middle-income countries. However, the roles of self-efficacy and emotion regulation in influencing this distress remain unclear. This study aimed to examine the relationships between self-efficacy, emotion regulation, and psychological distress among family caregivers of patients undergoing hemodialysis.

Methods: This cross-sectional study, reported in accordance with STROBE guidelines, involved 201 family caregivers recruited through convenience sampling to ensure accessibility in hemodialysis settings. Self-efficacy and emotion regulation were independent variables, while psychological distress was the dependent variable. Data were collected using validated and reliable instruments General Self Efficacy Scale (GSE), Emotion Regulation Questionnaire (ERQ), The Kessler Psychological Distress and analyzed using Spearman’s rank correlation tests.

Results: The results show significant negative correlations between psychological distress and both self-efficacy (r = −0.346, p < 0.001) and emotion regulation (r = −0.217, p < 0.001). These findings indicate that higher levels of self-efficacy are associated with lower psychological distress. Similarly, better emotion regulation is associated with reduced psychological distress, with self-efficacy demonstrating a stronger association.

Conclusion: These findings highlight the importance of psychosocial resources in supporting caregiver well-being in family-centered care contexts. It is recommended to integrate psychological counseling programs for families of patients with chronic kidney disease undergoing hemodialysis, along with structured educational interventions emphasizing the importance of emotion management.

Association of Total Ischemic Time With Hospital Length of Stay and Early Graft Function After Living-Donor Kidney Transplantation: A Retrospective Cohort Study

Ardika Satria Kusuma, Indrawarman Indrawarman, Tanaya Ghinorawa — Sat, 21 Mar 2026 00:00:00 +0700

Background: Total Ischemic Time (TIT) is a critical determinant of graft survival in deceased-donor transplantation. However, its specific impact on hospital Length of Stay (LOS) and immediate postoperative renal function remains unclear in the context of living-donor transplantation, where ischemic intervals are typically shorter, and graft quality is higher.

Methods: This retrospective cohort study, reported according to STROBE guidelines, employed a total sampling technique to analyze 40 living-donor kidney transplant recipients at Dr. Sardjito Hospital. Adult patients with complete operative and laboratory records were included, while pediatric cases and incomplete datasets were excluded. We evaluated the relationship between the independent variable (TIT) and dependent variables (LOS and serum creatinine at Day 1 and Day 7) using Pearson correlation analysis to determine effect sizes and statistical significance.

Results: The mean TIT was 90.7 ± 24.0 minutes. Analysis revealed a statistically significant, moderate positive correlation between TIT and LOS (r=0.58, p<0.001). Conversely, the associations between TIT and serum creatinine at Day 1 (r=0.22, p=0.17) and Day 7 (r=0.27, p=0.11) indicated weak positive trends that did not reach statistical significance.

Conclusion: While prolonged ischemic time did not immediately compromise graft function in this living-donor cohort, it served as a significant predictor of extended hospitalization. These findings underscore that minimizing ischemic time is crucial not only for biological safety but also for optimizing Kidney Transplantation; Ischemia; Length of Stay; Creatinine; Graft Function.

The Relationship Between Perceptions and Experiences of Diploma Nursing Students in Chronic Disease Patient Education in Community Settings: A Cross-Sectional Study

Agus Sustiyono, Fifi Musfirowati, Asra Asra — Sat, 21 Mar 2026 00:00:00 +0700

Background: The increasing burden of chronic diseases requires nurses to play an active educational role in empowering patients and supporting self-management. Therefore, nursing students must develop appropriate perceptions and gain practical experience in patient education. This study aimed to analyze the relationship between perceptions and experiences of Diploma Nursing students in providing chronic disease education in community settings.

Methods: A quantitative cross-sectional study was conducted in accordance with the STROBE guidelines. The study involved 73 final-year Diploma Nursing students who had completed family and community nursing practice. Participants were selected using proportionate stratified random sampling. Students’ perceptions of patient education were treated as the independent variable, while their educational practice experiences were considered the dependent variable. Data were collected using a structured questionnaire with confirmed validity and reliability, and were analyzed using Pearson’s correlation test with a significance level of 0.05.

Results: The majority of students demonstrated high perceptions regarding the importance of chronic disease patient education in community settings (76.8%) and reported favorable educational practice experiences (65.7%). Statistical analysis revealed a significant positive correlation between perceptions and experiences (r = 0.612; p < 0.001), indicating a moderate to strong association.

Conclusion: Positive perceptions of the nurse’s educational role are associated with better educational practice experiences among Diploma Nursing students in community settings. These findings highlight the importance of strengthening community-based nursing education and integrating theoretical learning with practical patient education experiences to enhance students’ preparedness to function as effective health educators.

Effects of Maternal Storytelling-Based Stimulation on Language Development among Preschool Children: A Quasi-Experimental Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: The age of 3–4 years is a critical period for children’s language development, strongly influenced by environmental stimulation, particularly from mothers as primary caregivers. Storytelling is a simple and practical method for language stimulation, yet quantitative evidence of its effectiveness in community or family settings remains limited. Therefore, this study aimed to analyze the effect of maternal storytelling stimulation on the language development of children aged 3–4 years.

Methods: This study employed a quasi-experimental design using a one-group pretest–posttest approach. A total of 44 mother–child pairs with children aged 3–4 years were selected through purposive sampling. Participants received education and structured guidance to implement storytelling-based language stimulation over four weeks. Children’s language development was assessed using a language screening instrument adapted from the KPSP. As the data were not normally distributed, the Wilcoxon signed-rank test was used for analysis with a significance level of 0.05.

Results: The findings demonstrated a statistically significant increase in children’s language development scores following the intervention.

Conclusion: Maternal stimulation using the storytelling method significantly improves language development in children aged 3–4 years. This approach is recommended as an evidence-based language stimulation strategy at the family and community levels

Social Media Use and Anxiety Levels Among Nursing Students in Indonesia: A Cross-Sectional Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: The widespread use of social media among students is associated with increased anxiety levels. In Indonesia, high social media use combined with limited institutional support may heighten students’ vulnerability. Although some studies report benefits such as social support and stress relief, evidence suggests negative impacts are more common. Therefore, this study examines the relationship between social media use and anxiety among nursing students.

Methods: This study used a cross-sectional correlational design. A purposive sampling method was applied to select active students who use social media for at least three hours per day and were willing to participate, resulting in 57 respondents. Data were collected through an online questionnaire covering social media usage duration, platform types, and content types. Anxiety levels were measured using the validated Generalized Anxiety Disorder-7 (GAD-7) instrument and categorized into low (≤9) and high (≥10) anxiety. Data were analyzed using the Chi-Square test with Odds Ratios (OR) and 95% Confidence Intervals (CI) at a significance level of p < 0.05.

Results: A significant relationship was found between social media usage duration and anxiety levels (p = 0.022). Students who utilized social media for less than three hours per day had a lower likelihood of experiencing high anxiety (OR = 0.254; 95% CI: 0.08–0.79). The type of platform was also significantly associated with anxiety (p = 0.038), where Instagram and WhatsApp users exhibited a greater proportion of high anxiety compared to TikTok users. Content type further demonstrated a meaningful relationship (p = 0.032); educational content was associated with a higher proportion of low anxiety compared to entertainment and informational content

Conclusion: The use of social media among nursing students is related to anxiety dynamics influenced by usage duration, platform characteristics, and content types. These findings underscore the importance of a promotive approach based on digital capabilities and anxiety level screening within higher education settings to support students' psychological well-being.

Effect of Citrus Sinensis Aromatherapy on Pain and Anxiety Among Hemodialysis Patients: A Quasi-Experimental Study

Rustiana Tasya Ariningpraja, Endah Panca Lydia Fatma, Retno Lestari — Sat, 21 Mar 2026 00:00:00 +0700

Background: Pain is a common problem in hemodialysis patients and is often accompanied by anxiety. Aromatherapy is a simple, low-cost complementary intervention, but evidence in hemodialysis patients is still limited and inconclusive. Citrus sinensis essential oil is of particular interest because its major bioactive components are analgesic and anxiolytic agents. The purpose of this study was to determine the effect of citrus sinensis aromatherapy on pain and anxiety in hemodialysis patients.

Methods: A quasi-experimental design with a control group included 50 hemodialysis patients (25 control and 25 intervention) selected by purposive sampling at the Bangil Health Centre in Pasuruan City. Eligible patients were ≥ 18 years old, have good sense of smell, on routine hemodialysis. Pain was measured using the Numeric Rating Scale (NRS) and anxiety using the Generalized Anxiety Disorder-7 (GAD-7)—data analyzed with a paired t-test. The intervention was given twice a week for 30 minutes. Ethical clearance was obtained.

Results: In the intervention group, mean pain score decreased from 6.2 ± 1.1 to 3.4 ± 1.0, and anxiety scores decreased significantly (both p < 0.001), while changes in the control group were not significant. Between-group comparisons showed a greater reduction in pain and anxiety in the intervention group (p < 0.05).

Conclusion: The Citrus sinensis aromatherapy was effective to reduce on pain scale and anxiety level in chronic kidney disease patients undergoing hemodialysis. These findings suggest that citrus sinensis aromatherapy can be considered as a simple complementary nursing intervention to improve comfort and psychological well-being during hemodyalisis period.

Effectiveness of Video and Leaflet Educational Media on Postpartum Mothers’ Knowledge and Attitudes Toward Exclusive Breastfeeding: A Quasi-Experimental Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Exclusive breastfeeding (EBF) is essential to reduce infant morbidity and mortality, yet EBF coverage in Indonesia remains suboptimal, partly due to limited maternal knowledge and less supportive attitudes. Comparing educational media such as video and leaflets is important to identify effective and scalable approaches for postpartum breastfeeding counseling. To determine the effectiveness of video media and leaflet media in improving postpartum mothers’ knowledge and attitudes toward exclusive breastfeeding.

Methods: This quasi-experimental two-group pretest–posttest study was reported in line with the TREND guideline for nonrandomized evaluations. Participants were recruited using purposive sampling from postpartum mothers and allocated into two nonrandomized intervention groups (video vs leaflet; 30 per group). Inclusion criteria were postpartum mothers ≤6 weeks, willing to participate, able to communicate in Bahasa Indonesia, and (for video group) having smartphone access to view the material; exclusion criteria included cognitive/psychological disorders or inability to complete the session. Knowledge and attitude were assessed using validated questionnaires before and immediately after a standardized 30-minute education session. Data were analyzed using SPSS version 25; within-group changes were tested with paired-samples t-tests, and effect sizes were calculated using Cohen’s d.

Results: Both interventions significantly improved knowledge and attitude scores (p<0.001). In the video group, knowledge increased from 50.67±9.59 to 89.77±7.27 (Cohen’s d=3.93), and attitude increased from 48.53±10.23 to 85.37±5.56 (Cohen’s d=3.56). In the leaflet group, knowledge increased from 49.60±10.13 to 88.00±6.75 (Cohen’s d=3.89), and attitude increased from 48.17±10.29 to 85.53±6.25 (Cohen’s d=3.31).

Conclusion: Video and leaflet education were both highly effective in improving postpartum mothers’ knowledge and attitudes toward EBF, with very large effect sizes in both groups; video showed a slightly larger effect on attitudes. Integrating video and leaflets into routine postpartum counseling may strengthen EBF promotion in primary care settings.

Effectiveness of a Nature-Based Virtual Reality Intervention on Preoperative Anxiety among First-Time Major Surgery Patients: A Quasi-Experimental Study

Dodi Aflika Farama, A. Gani, Wahyu Dwi Ari Wibowo — Sat, 21 Mar 2026 00:00:00 +0700

Background: Major surgery is frequently associated with high levels of preoperative anxiety, which can negatively affect physiological stability and postoperative recovery. Despite evidence supporting the effectiveness of nature-based virtual reality (VR) therapy in reducing anxiety in high-income settings, its applicability in low- and middle-income countries (LMICs), particularly district hospitals, remains unclear. This study aimed to evaluate the effectiveness of nature-based VR therapy in reducing preoperative anxiety among first-time major surgery patients.

Methods: This study employed a quasi-experimental pre-test–post-test control group design, reported in accordance with the TREND guideline. A total of 104 adult patients scheduled for first-time elective major surgery were recruited using consecutive sampling and equally allocated to an intervention group (n=52) and a control group (n=52). The independent variable was nature-based VR therapy, and the dependent variable was preoperative anxiety. Anxiety was measured using the State Anxiety subscale of the State–Trait Anxiety Inventory (STAI), a validated instrument with good reliability (Cronbach’s α = 0.83). The intervention group received a single 5-minute nature-based VR session 20–30 minutes before surgery, while the control group received standard preoperative care. Data were analyzed using paired and independent t-tests, and effect size was calculated using Cohen’s d.

Results: Participants were predominantly aged 46–60 years (39.4%), equally male and female, mostly classified as ASA II (69.2%), and commonly scheduled for abdominal surgery (40.4%). The intervention group showed a significant anxiety reduction (mean difference = −16.10; p < 0.001; Cohen’s d = 1.98), whereas the control group showed no significant change (−2.38; p = 0.062). Post-intervention anxiety scores were significantly lower in the VR group than in the control group (t = 9.074; p < 0.001; Cohen’s d = 1.78).

Conclusion: Nature-based VR therapy is an effective, nurse-led, non-pharmacological intervention for reducing preoperative anxiety in first-time major surgery patients. Integration of VR into routine preoperative nursing care may enhance patient-centered care and support anxiety management in resource-limited hospital settings.

The Effect of Barefoot Morning Walking on Blood Pressure in Adults with Hypertension

Eka Novitayanti, Christiana Arin Proborini — Sat, 21 Mar 2026 00:00:00 +0700

Background: Hypertension is a health problem that affects many people and carries the risk of serious complications if not properly treated. Walking barefoot in the morning is a non-pharmacological method believed to help lower blood pressure by stimulating nerve endings and increasing body relaxation. In low- and middle-income countries, walking barefoot is common. The public felt more productive rather than having to use. This study was conducted to analyze the effect of barefoot morning walking on blood pressure in hypertensive patients.

Methods: This study used a one-group pre-experimental design with a one-group pretest-posttest approach. Technique collection sample, namely purposive, n 31, which meets the inclusion criteria, namely history of hypertension, willing given barefoot morning walk intervention according to established procedures, and criteria for respondents who cannot walk. Blood pressure was measured before and after the intervention using a validated digital blood pressure monitor. Data were analyzed using the Wilcoxon test.

Results: The results of the study showed that before the intervention, most respondents were in the stage I hypertension category (64.5%), while after the intervention, the majority were in the prehypertension category (67.7%). Statistical tests showed a significant decrease in blood pressure in both systolic (p < 0.00 1 ) and diastolic (p < 0.00 1 ) blood pressure, thus indicating a significant effect of barefoot morning walking on reducing blood pressure.

Conclusion: Barefoot morning walking intervention can reduce blood pressure in hypertensive patients, which can be applied to help control blood pressure.

Effect of Henderson’s Need Theory–Based Nursing Care on Medication Adherence among Patients with Tuberculosis: A Quasi-Experimental Study

Tri Wahyuni, Cau Kim Jiu, Sri Ariyanti — Sat, 21 Mar 2026 00:00:00 +0700

Background: Medication adherence remains a major challenge in tuberculosis (TB) management, particularly in low- and middle-income countries where socioeconomic and health system barriers affect treatment continuity. Although educational and psychosocial interventions have shown benefits, the application of structured nursing theories in TB care is still limited. This study aimed to examine the effect of Henderson-based nursing care on medication adherence among TB patients

Methods: This quasi-experimental study with a pretest–posttest control group design followed the TREND reporting guideline. A purposive sampling procedure was conducted by screening outpatient TB registries and applying predefined inclusion and exclusion criteria, resulting in 60 eligible participants (intervention n = 30; control n = 30). The independent variable was nursing care based on Henderson’s fourteen fundamental needs, while the dependent variable was medication adherence. Adherence was measured using a validated Medication Adherence Scale (Cronbach’s α = 0.87). Before parametric testing, assumptions of normality and homogeneity of variance were examined. Paired and independent t-tests were performed, and ANCOVA was used to control for age, education level, and treatment duration. Effect size (Cohen’s d) and 95% confidence intervals (CI) were calculated.

Results: Baseline characteristics were comparable between groups (p > 0.05). In the intervention group, mean adherence scores increased from 68.7 ± 8.9 to 88.3 ± 6.4 (mean difference = 19.6; 95% CI: 16.1–23.1; p < 0.001), representing a large effect size (Cohen’s d = 2.52). The control group showed no significant improvement (mean difference = 2.4; p = 0.27). The adjusted mean difference between groups at posttest was 16.8 points (p < 0.001). Additionally, the proportion of patients classified as having high adherence increased substantially in the intervention group compared to the control group. ANCOVA confirmed a significant intervention effect (F = 64.82; p < 0.001), independent of demographic covariates.

Conclusion: Henderson’s Need Theory–based nursing care significantly improves medication adherence among TB patients and demonstrates a large clinical effect. Integrating structured, theory-driven nursing interventions into routine TB services may strengthen adherence-focused care, enhance patient independence, and contribute to improved treatment completion rates in resource-limited settings.

Effectiveness of a Warm Cinnamon Compress on Pain Intensity in Community-Dwelling Older Adults with Gout Arthritis: A Quasi-Experimental Study

Abdul Gani, Dodi Aprika Farama, Gunardi Pome, Sonlimar Mangunsong — Sat, 21 Mar 2026 00:00:00 +0700

Background: Gout arthritis is a chronic inflammatory joint disorder in older adults that causes persistent pain and limits daily functioning. Despite growing interest in non-pharmacological pain management, most available evidence comes from clinical or hospital-based settings, while evidence from community contexts in LMICs, including Indonesia, remains limited. This study aimed to evaluate the effectiveness of a warm cinnamon powder compress in reducing pain intensity among community-dwelling older adults with gout arthritis.

Methods: This quasi-experimental study with a non-equivalent control group pretest–posttest design was conducted in accordance with the TREND reporting guideline at Pagar Agung Health Center, Lahat Regency. A total of 70 older adults with gout arthritis who met the inclusion criteria were recruited and allocated to an intervention group (n = 35) and a control group (n = 35). The independent variable was warm cinnamon powder compress therapy administered once daily for 15 minutes over seven consecutive days, while the dependent variable was pain intensity measured using the Numeric Rating Scale (NRS). The control group received routine care. Data were analyzed using the Wilcoxon signed-rank test for within-group comparisons and the Mann–Whitney U test for between-group differences.

Results: The intervention group demonstrated a marked reduction in mean pain scores from 5.11 ± 0.82 at pretest to 2.14 ± 0.93 at posttest, representing a very large within-group effect (Cohen’s d = 3.38), while the control group showed only a minimal change from 5.03 ± 0.79 to 4.89 ± 0.88 (Cohen’s d = 0.17). Between-group comparison indicated a significantly greater reduction in pain in the intervention group than in the control group, with a large effect size (Cohen’s d = 1.54). Clinically, the intervention group predominantly shifted from moderate–severe pain to mild pain categories, indicating a meaningful improvement in pain experience.

Conclusion: Warm cinnamon powder compress therapy is effective in reducing pain intensity among older adults with gout arthritis and can serve as a safe and practical complementary intervention in community healthcare settings.

Improving Social Interaction Competence in Incarcerated Adolescents Through Group Therapy: A Quasi-Experimental Study

Idawati Manurung, Yuliati Amperaningsih — Sat, 21 Mar 2026 00:00:00 +0700

Background: Social interaction competence is essential for the successful rehabilitation of juvenile offenders. However, empirical evidence on structured group therapy targeting social interaction competence among incarcerated adolescents in low-resource correctional settings remains limited. This study aimed to evaluate the efficacy of a module-based group therapy intervention in improving social competence and to identify the environmental factors influencing these outcomes.

Methods: A quasi-experimental pretest-posttest with control group study was conducted with 80 adolescents (primarily aged 16–17). The intervention group (n=44) received a structured group therapy program, while the control group (n=36) received standard institutional care. Data were analyzed using paired t-tests, independent samples t-tests, and multivariate regression to identify predictors of social competence. Data were collected using a questionnaire and a validated social interaction scale (Cronbach’s alpha = 0.905).

Results: The intervention group demonstrated a statistically significant improvement in social interaction scores, increasing from 54.64±15.43 to 63.45±12.65 (p < 0.05), with a medium-to-large effect size (Cohen’s d = 0.62). Conversely, the control group showed no significant change (p > 0,05, d = 0.42). Multivariate analysis revealed that while age was a positive predictor of competence (beta = -0.20, p < 0.05), the length of detention emerged as a notable negative factor (beta = -0.36, p < 0.05), suggesting a "prisonization" effect where social skills erode over time.

Conclusion: Structured group therapy significantly enhances social interaction competence and serves as a vital buffer against the social decay associated with prolonged incarceration. These findings underscore the necessity of early, module-based interventions within correctional rehabilitation programs to counteract the restrictive nature of the prison environment.

The Effect of Tempeh Dietary Intake on Blood Glucose Levels in Prediabetics

Manuntun Rotua, Sriwiyanti Sriwiyanti — Sat, 21 Mar 2026 00:00:00 +0700

Background: Rediabetes is a high-risk metabolic condition that precedes type 2 diabetes mellitus and is associated with increased morbidity. Dietary intervention plays a critical role in glycemic control. Tempeh, a traditional fermented soybean product, contains bioactive compounds such as isoflavones and high-quality protein that may improve glucose metabolism. However, evidence on its effectiveness in prediabetic populations remains limited. This study aimed to evaluate the effect of daily tempeh consumption on blood glucose levels among individuals with prediabetes.

Methods: A comparative pre-experimental study with a pretest–posttest control group design was conducted at Mohammad Hoesin Hospital, Palembang. A total of 60 participants with prediabetes were randomly assigned to intervention (n=30) and control (n=30) groups. The intervention group received 250 g/day of tempeh for 14 days, while the control group followed a regular diet. Blood glucose levels were measured before and after the intervention. Data were analyzed using paired and independent t-tests with a significance level of p<0.05.

Results: Baseline characteristics between groups were comparable (p>0.05). The intervention group showed a significant reduction in mean blood glucose levels from 139.83±16.52 mg/dL to 104.30±13.11 mg/dL (p<0.001), while the control group also showed a smaller decrease from 137.83±14.87 mg/dL to 121.93±13.09 mg/dL (p<0.001). The mean reduction was significantly greater in the intervention group (35.53 mg/dL) compared to the control group (15.90 mg/dL), with a statistically significant between-group difference (p<0.001).

Conclusion: Daily consumption of 250 g tempeh for 14 days significantly reduces blood glucose levels in individuals with prediabetes. Tempeh may serve as an effective dietary strategy for glycemic control and prevention of diabetes progression.

Exploring the Lived Spiritual Needs of Individuals with Schizophrenia: A Phenomenological Study Informing Holistic Mental Health Care

Bambang Kuncoro, Nur Rachmat, Betty Hidayati — Sat, 21 Mar 2026 00:00:00 +0700

Background: Spirituality has increasingly been recognized as an important dimension of recovery in severe mental illness. However, qualitative understanding of the lived spiritual needs of individuals with schizophrenia remains limited, particularly in Low- and Middle-Income Countries (LMICs). This study aimed to explore the lived spiritual needs of individuals with schizophrenia and examine their significance within recovery-oriented mental health care.

Methods: This qualitative study employed van Manen’s interpretive phenomenology grounded in Heideggerian philosophy. Seven participants diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases, Tenth Revision (ICD-10; F20.x) were recruited using purposive sampling. Inclusion criteria included clinical stability, living with family, and the ability to communicate verbally. Exclusion criteria included acute psychotic exacerbation and severe cognitive impairment interfering with communication. Data were collected through face-to-face semi-structured interviews (40–60 minutes; mean 52 minutes), supported by field notes. Data saturation was achieved when no new codes emerged in the final interviews. Data were analyzed using an interpretive phenomenological approach guided by van Manen, supported procedurally by Miles and Huberman’s interactive model for data organization. This study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results: Three major themes emerged: (1) Transcendence (inner peace, actualization of trust, hope, forgiveness, religious doctrine); (2) Sense of Existence (social support and usefulness); and (3) Personal Values (gratitude and search for meaning). Spirituality functioned as an existential integration mechanism facilitating emotional regulation, identity reconstruction, and recovery-oriented meaning-making.

Conclusion: Spiritual needs play a central role in recovery processes among individuals with schizophrenia. Integrating culturally sensitive spiritual assessment into psychiatric services may strengthen holistic and recovery-oriented mental health care in LMIC contexts.

Caregiver Resilience and Burden in Long-Term Care Family of Children with Developmental Disabilities: A Cross-Sectional Study

Sarah Kartika Wulandari, LG Nita Sriwahyuningsih, Israfil Israfil — Sat, 21 Mar 2026 00:00:00 +0700

Background: A family with a child with special needs experiences a struggle to provide care and quality of life. However, empirical evidence on the relationship between resilience and caregiver burden in the long-term care of children with developmental disabilities (DDC) in low- and middle-income countries remains limited, with a family nursing perspective in Indonesia, especially in Bali. This study aimed to determine the relationship between caregiver burden and resilience in long-term care of children with developmental disabilities.

Methods: This study was reported in accordance with the STROBE guidelines. A cross-sectional study was conducted online using network sampling DDC in Denpasar City. The questionnaires were the Burden Scale for Family Caregivers (BSFC) to measure the family burden as the independent variable and the Resilience Scale for Adults (RSA) used to measure the resilience of the caregiver as the dependent variable. Spearman’s rank correlation was used for data analysis.

Results: As many as 102 parents or siblings of DDC joined the research online. Data showed most caregivers were mothers (67,6%), with more than one child (65,7%), and with various types of DDC. A moderate negative correlation was observed between caregiver burden and resilience (r = −0.294, p < 0.005). The higher burden experienced by siblings (mean= 13.5), when fathers have the highest resilience (mean= 99.83), as they felt less burden (mean= 8.93).

Conclusion: The greater burden experienced by the family implied a lower capacity to express resilience. Coping skill training could be developed as a response to the burden to build better family coping and boost resilience.

Effectiveness of the Manori Sapuka Community-Based Adherence Program on Blood Pressure Control Among Hypertensive Patients

Faisal Faisal, Ambo Anto, Muhammad Indra Ibrahim — Sat, 21 Mar 2026 00:00:00 +0700

Background: Hypertension is a chronic disease often referred to as a "silent killer" because it frequently presents without symptoms until serious complications occur. Adherence to blood pressure control is essential for successful management and prevention of complications. However, adherence among hypertensive patients remains low in many primary healthcare settings. To address this issue, the "Ikan Manori Sapuka" program was implemented as a community-based intervention to improve patient adherence to blood pressure control. This study aims to determine the effectiveness of the Ikan Manori Sapuka program in improving adherence among hypertensive patients.

Methods: This study used a pre-experimental one-group design that followed the TREND reporting guideline. The sample consisted of 84 respondents obtained through a total sampling technique. Inclusion criteria included patients aged 40–85 years who consented to participate, while exclusion criteria were a history of stroke or refusal to participate. Data analysis was performed using the McNemar test to see significant differences before and after the intervention.

Results: Adherence to blood pressure control increased from 33.3% before the intervention to 82.1% after the intervention. This improvement was statistically significant (p < 0.001), with a risk difference of 48.8%, indicating a substantial magnitude of improvement following the intervention.

Conclusion: The findings demonstrate that a structured, community-based intervention significantly improves adherence to blood pressure control among hypertensive patients in remote island settings. This evidence supports the use of low-cost, locally adaptable community engagement strategies to strengthen hypertension management in primary healthcare services.

Effectiveness of a Local Wisdom–Based Spiritual Intervention on Work Happiness and Caring Behavior among Nurses: A Randomized Mixed-Methods

Sat, 21 Mar 2026 00:00:00 +0700

Background: Nurses often face high job demands and emotional stress that may reduce work happiness and caring behavior. Previous studies have examined workplace well-being interventions; however, culturally grounded spiritual programs integrating local wisdom remain insufficiently tested using rigorous experimental designs, particularly in low- and middle-income countries (LMICs). This study aimed to evaluate the effectiveness of a local wisdom–based spiritual program in improving work happiness and caring behavior among inpatient nurses in Indonesia.

Methods: A mixed-methods randomized controlled trial following CONSORT guidelines was conducted with 120 inpatient nurses at two hospitals in Jember, Indonesia. Eligible nurses (>1-year inpatient experience) were randomly assigned to either an intervention group (n = 60) or a control group (n = 60). The intervention group participated in a 12-week spiritual program (Pengajian and Tari Molong Kopi) that included routine activities. The independent variable was program participation, and the dependent variables were work happiness and caring behavior measured using the Oxford Happiness Questionnaire (OHQ) and Caring Behavior Inventory (CBI) at baseline, week 6, and week 12. Data were analyzed using repeated-measures ANOVA, effect sizes (Cohen’s d), correlation, and 95% confidence intervals. Qualitative responses were analyzed thematically.

Results: Participants were mostly female (87%) with a mean age of 32 years. The intervention group showed significantly greater improvements in OHQ and CBI scores at weeks 6 and 12 compared with controls (p < 0.001), with moderate-to-large effects (d = 0.65–0.82). Work happiness correlated with caring behavior (r = 0.52). Themes included enhanced mindfulness, emotional release, renewed professional meaning, and stronger collegial relationships.

Conclusion: Local wisdom–based spiritual programs significantly enhance nurses’ work happiness and caring behavior. Integrating culturally grounded spiritual practices into workplace well-being initiatives may strengthen the quality of nursing care in LMIC hospital settings.

Effect of Brassica Oleracea Biscuit Supplementation on Immunity and Hemoglobin Levels in Pregnant Women: A Quasi-Experimental Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Maternal mortality remains a major concern, with anemia as a key contributing factor during pregnancy. Limited adherence to iron supplementation highlights the need for alternative approaches. Brassica oleracea, rich in essential nutrients, may support immune function and hemoglobin synthesis. This study aimed to evaluate the effect of this product in biscuit form on immunity and hemoglobin levels in pregnant women.

Methods: A quasi-experimental study with a pre-test–post-test control group design was conducted. Baseline measurements were obtained from both intervention and control groups. The intervention group received Brassica oleracea biscuits in addition to standard care, while the control group received standard care alone. Post-intervention assessments were conducted in both groups.

Results: There was a statistically significant difference in immune status between the intervention and control groups (p = 0.044). However, no significant difference in hemoglobin levels was observed between groups (p = 0.560).

Conclusion: Brassica oleracea biscuit supplementation significantly improved immune status in pregnant women but did not result in a statistically significant difference in hemoglobin levels compared to standard care. These findings suggest that Brassica oleracea–based functional foods may serve as a complementary strategy to enhance maternal immunity during pregnancy.

Effectiveness Of Movement-Based Relaxation And Positive Affirmation Therapy in Reducing Anxiety And Pain Among Cancer Patients: A Quasi-Experimental Study

Muhamad Candra Romadon Candra, Erna Rochmawati — Sat, 21 Mar 2026 00:00:00 +0700

Background: Cancer patients frequently experience anxiety and pain that may negatively affect treatment adherence and quality of life. Complementary non-pharmacological interventions integrating relaxation, physical movement, and positive affirmation have shown potential benefits in symptom management. However, most previous studies evaluated relaxation, movement, or affirmation separately, and evidence regarding integrated mind–body interventions remains limited. This study aimed to examine the effectiveness of movement-based relaxation and positive affirmation therapy in reducing anxiety and pain among cancer patients.

Methods: A quasi-experimental pretest–posttest control group design was conducted in an oncology inpatient unit of a tertiary hospital in Indonesia. This study adhered to the TREND guideline. The independent variable was movement-based relaxation combined with positive affirmation therapy, while the dependent variables were anxiety and pain levels. Forty-eight adult cancer patients were recruited using consecutive sampling and allocated into intervention (n = 24) and control groups (n = 24). The intervention group received six sessions (three times per week for two weeks; 25–30 minutes per session), while the control group received standard hospital care. Data were analyzed using the Wilcoxon Signed Rank Test and Mann–Whitney U Test.

Results: Anxiety scores significantly decreased in the intervention group. Anxiety decreased from 61.3 ± 6.2 to 47.4 ± 7.1, and pain decreased from 6.9 ± 1.2 to 4.1 ± 0.9 in the intervention group. The mean difference in anxiety was 14.25 ± 5.18 (p < 0.001; 95% CI 11.82–16.68), while pain showed a mean difference of 2.67 ± 0.98 (p < 0.001; 95% CI 2.18–3.16), compared to the control group. Large effect sizes were observed for anxiety (d = 2.68) and pain (d = 2.54).

Conclusion: Movement-based relaxation and positive affirmation therapy effectively reduced anxiety and pain among cancer patients. This integrated mind–body intervention represents a feasible complementary nursing strategy to enhance holistic oncology care.

What Factors Drive Childhood Stunting? Examining Child Health Risks, Maternal and Early-Life Determinants, Nutrition, and Socioeconomic Influences

Sat, 21 Mar 2026 00:00:00 +0700

Background: Childhood stunting remains a major global public health challenge driven by complex interactions among child health risks, nutritional status, maternal and early-life determinants, and socioeconomic conditions. Although the literature on stunting has expanded substantially, a comprehensive bibliometric mapping focusing on immunization, nutrition, and maternal determinants remains limited. This study aimed to map global research trends, thematic structures, and collaboration networks related to childhood stunting determinants.

Methods: This study employed a bibliometric analysis of Scopus-indexed publications. Data were retrieved from the Scopus database in January 2026 using search terms related to childhood stunting, immunization, nutrition, and maternal factors. Eligible documents included journal articles and review articles published between 2010 and 2026 in English. After screening and data cleaning, 323 documents were included for analysis. Bibliometric indicators were analyzed using VOSviewer version 1.6.20, including publication trends, keyword co-occurrence, co-authorship networks, and thematic clustering.

Results: The findings showed a growing volume of publications on childhood stunting determinants over time, indicating increasing global scholarly attention. Keyword co-occurrence analysis identified four major thematic clusters: child health risk factors, maternal and early-life determinants, socioeconomic influences, and nutritional status and malnutrition. The term “stunting” emerged as the central keyword with strong links to child health, maternal nutrition, breastfeeding, poverty, and sanitation. The results indicate that stunting research has evolved into an interdisciplinary field integrating biological, maternal, environmental, and structural perspectives.

Conclusion: Research on childhood stunting has developed within an increasingly multidimensional and collaborative scientific landscape. Bibliometric mapping highlights the need for integrated research and policy strategies that connect maternal care, nutrition interventions, immunization services, and socioeconomic support. Future studies should strengthen cross-country collaboration, expand interdisciplinary approaches, and address research gaps in low- and middle-income settings.

How Is Mental Health Nursing Research Evolving? Advancing Collaboration, Community-Based Care, and Digital Mental Health Interventions

Sat, 21 Mar 2026 00:00:00 +0700

Background: Mental health disorders represent a major global public health challenge and significantly affect quality of life and healthcare systems. Mental health nursing research has expanded rapidly in response to increasing global mental health needs. However, comprehensive bibliometric mapping of global research trends and collaboration networks in mental health nursing research remains limited. This study aimed to analyze global publication trends, research productivity, and collaboration networks in mental health nursing research indexed in Scopus.

Methods: This study employed a bibliometric analysis approach informed by systematic review procedures. Data were retrieved from the Scopus database. The search included publications from 2000 to 2024. A total of 275 publications that met the eligibility criteria were included in the analysis. Bibliometric indicators analyzed included annual publication growth, citation patterns, co-authorship networks, and keyword co-occurrence. Metadata such as authors, institutions, countries, publication year, and keywords were extracted and organized for analysis. Network visualization and bibliometric mapping were performed using VOSviewer version 1.6.18.

Results: The analysis identified 275 publications on mental health nursing research, demonstrating a notable increase in research output after 2022. Bibliometric mapping revealed several thematic clusters related to mental health disorders, psychological stress, social support, digital mental health interventions, and community-based mental health care. Collaboration network analysis showed increasing international research partnerships among authors, institutions, and countries, highlighting the growing importance of global collaboration in advancing mental health nursing knowledge.

Conclusion: Mental health nursing research has experienced substantial growth globally, particularly in recent years. Bibliometric findings highlight the importance of international collaboration and interdisciplinary research in addressing global mental health challenges. Future studies should strengthen collaborative networks and focus on emerging research themes such as digital mental health interventions, community-based care, and culturally responsive mental health services to support evidence-based nursing practice and policy development.

Comparative Effects of Fenugreek and Moringa Extract Supplementation on Lactation Performance among Postpartum Breastfeeding Mothers: A Quasi-Experimental Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Inadequate breast milk production remains a frequent reason for early supplementation and discontinuation of exclusive breastfeeding. Fenugreek (Trigonella foenum-graecum) and moringa (Moringa oleifera) are widely used as natural galactagogues; however, comparative evidence examining their relative effectiveness within the same postpartum population remains limited, particularly in community maternal health settings.

Methods: A quantitative quasi-experimental study with a posttest-only control group design was conducted in 2025 in Karawang Regency, Indonesia, and reported in accordance with the TREND statement. A total of 45 postpartum breastfeeding mothers were allocated consecutively by facility to three groups: control (n = 15), fenugreek (n = 15), and moringa (n = 15). No pretest was conducted; therefore, baseline equivalence was not confirmed. The fenugreek group received 500 mg fenugreek seed extract twice daily for 7 days; the moringa group received 250 mg moringa leaf extract twice daily for 7 days — both doses based on published therapeutic evidence. Lactation performance was assessed on day 8 using a validated structured questionnaire and observation sheet (Cronbach’s α = 0.81; CVI = 0.89). Data were analysed using the Kruskal-Wallis test, followed by Mann-Whitney U post hoc comparisons with Bonferroni correction

Results: Post-intervention lactation performance scores (mean ± SD) were 5.93 ± 1.03 (control), 8.93 ± 1.03 (fenugreek), and 9.73 ± 0.46 (moringa). The Kruskal-Wallis test showed a significant overall difference (H = 34.21, df = 2, p < 0.001, η² = 0.76). Pairwise comparisons showed significant differences for control vs. fenugreek (U = 4.50, Z = −4.68, p < 0.001, r = 0.85), control vs. moringa (U = 0.00, Z = −5.20, p < 0.001, r = 0.95), and fenugreek vs. moringa (U = 54.00, Z = −2.87, p = 0.004, r = 0.52).

Conclusion: Both fenugreek and moringa supplementation significantly improved lactation performance compared with routine care. Moringa demonstrated statistically significantly higher performance than fenugreek. Randomised controlled trials with objective lactation indicators and confirmed baseline equivalence are needed to confirm these findings.

Village Midwives’ Experiences with Maternal Emergency Management and Digital Health Systems: A Phenomenological Study in Rural Indonesia

Mon, 30 Mar 2026 00:00:00 +0700

Background: Maternal and neonatal mortality remain significant challenges in low- and middle-income countries, particularly in rural Indonesia, where village midwives serve as the first responders to obstetric emergencies. Despite numerous digital health initiatives, fragmented systems and poor usability often hinder timely emergency management. This study aimed to explore the lived experiences, challenges, and expectations of community midwives in designing an effective maternal–neonatal emergency digital application in Tanah Laut District, South Kalimantan, Indonesia.

Methods: This qualitative study employed a Husserlian descriptive phenomenological approach. Ten active village midwives were recruited through purposive sampling; inclusion required at least one year of experience, while those unable to attend or refusing participation were excluded. Data were collected in August 2024 through a focus group discussion (FGD) lasting 120 minutes. Data were analyzed using Colai

zzi’s phenomenological analysis method, and reporting followed the COREQ guideline.

Results: Five interrelated themes emerged: (1) Maternal emergencies as multidimensional crises, (2) Informal communication as the real emergency network, (3) Fragmented and burdensome reporting systems, (4) Digital and infrastructural barriers in rural practice, and (5) Expectations for an integrated, user-friendly digital solution. These themes progress conceptually from the initial crisis experience, through the mobilization of informal networks due to systemic barriers, culminating in user-driven expectations for digital design.

Conclusion: The study highlights midwives’ resilience amid digital fragmentation. Policymakers and developers should adopt participatory co-design approaches involving midwives to ensure the usability and sustainability of maternal emergency digital systems

Association Between Daily Gadget Use and Anxiety Levels Among Indonesian Elementary School Children: A Cross-Sectional Study

Santi Rinjani, Yani Annisa Fauziah, Winasari Dewi — Mon, 30 Mar 2026 00:00:00 +0700

Background: Background: The use of digital gadgets among school-aged children has increased substantially and may contribute to psychological problems, particularly anxiety. However, empirical evidence examining the association between daily gadget use duration and anxiety levels among elementary school children in Indonesia remains limited. Therefore, this study aimed to examine the association between daily gadget use duration and anxiety levels among elementary school children in Garut, Indonesia using a cross-sectional design.

Methods: This cross-sectional study was conducted among elementary school children aged 6–12 years in Garut, Indonesia. Participants were recruited using stratified random sampling. Inclusion criteria were students aged 6–12 years who consented to participate, while students with diagnosed neurological or psychiatric disorders were excluded. The independent variable was daily gadget use duration, and the dependent variable was anxiety level measured using the Spence Children’s Anxiety Scale (SCAS), which showed good reliability (Cronbach’s alpha = 0.938). Spearman correlation analysis was performed. This study adhered to the STROBE guidelines.

Results: The median daily gadget use duration was 3.0 hours (IQR 2.0–4.0), and the median anxiety score was 51.0 (IQR 40.0–60.0), with a mean of 49.65 (SD 17.17). Spearman correlation analysis revealed a significant positive association between daily gadget use duration and anxiety level among elementary school children (r = 0.215, 95% CI 0.01–0.40, p = 0.040), indicating a weak but statistically significant correlation. This finding suggests that longer gadget use duration was associated with slightly higher anxiety levels among children.

Conclusion: Higher daily gadget use duration was associated with increased anxiety levels among elementary school children. These findings underscore the importance of monitoring gadget use and implementing early mental health screening to identify anxiety symptoms. School-based and community-based interventions may help promote healthy digital habits and support child mental health, particularly in resource-limited settings.

Community-Based Mobile Self-Assessment for Tuberculosis Screening Among Parents and Children: A Cross-Sectional Study

Widya Warastuti, Reny Sulistyowati, Tri Ratna Ariestini — Mon, 30 Mar 2026 00:00:00 +0700

Background: Conventional tuberculosis screening is often limited by reporting delays and low accessibility. This study evaluates a digital solution to address this gap by integrating behavioral assessment and screening of two populations into a single community-based platform. The study aimed to evaluate the NOR TBC mobile app in identifying suspected tuberculosis cases and analyze the relationship between cognitive factors and preventive behaviors.

Methods: This cross-sectional observational study followed STROBE guidelines. Using convenience sampling, 70 parents, were recruited. Data were collected via the app’s integrated modules for Knowledge, Attitude, and Practice and self-screening. App quality was validated using ISO 25010 and expert review. Data were analyzed using descriptive statistics and Chi-Square tests (p < 0.05).

Results: The NOR TBC mobile identified 5.7% adult and 14.3% child presumptive TB cases. Technical evaluation rated the app as "Good" (76.67%), with expert validation confirming it as "Very Feasible" (60%) and "Feasible" (40%). Most respondents exhibited good knowledge (58.6%), positive attitudes (94.3%), and favorable behaviors (82.9%). Chi-square analysis showed significant associations: respondents with good knowledge were 4.2 times more likely to engage in tuberculosis prevention (p=0.012; OR=4.2), and those with positive attitudes had 3.8 times higher odds of favorable behavior (p=0.034; OR=3.8).

Conclusion: The NOR TBC mobile application demonstrates strategic potential in strengthening community-level tuberculosis detection and improving health literacy. This digital innovation reaches vulnerable populations that may be missed by conventional surveillance. Further development and controlled trials are recommended to evaluate long-term effectiveness

Emergency Psychiatric–Mental Health Nursing Interventions for Older Adults: A Systematic Review and Meta-Analysis

Mon, 30 Mar 2026 00:00:00 +0700

Background: Older adults represent a highly vulnerable population in psychiatric emergency settings due to cognitive decline, multimorbidity, and psychosocial instability. Although psychiatric emergency nursing interventions are increasingly implemented, existing evidence remains fragmented and lacks comprehensive synthesis focusing specifically on nursing-led, non-pharmacological approaches in emergency contexts. The research aimed to evaluate the effectiveness of psychiatric emergency nursing interventions in reducing agitation, physical restraint use, and emergency pharmacotherapy among older adults, and to identify the most effective intervention components.

Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The protocol has been submitted to PROSPERO and is currently under review. A comprehensive search was performed in PubMed, CINAHL, PsycINFO, and Scopus for studies published between January 2013 and December 2023, with the final search conducted in December 2023. A total of 1,246 records were identified; 27 studies met the inclusion criteria and were included in the meta-analysis. Risk of bias was assessed using design-appropriate appraisal tools. Data were synthesized using a random-effects model. Statistical heterogeneity was evaluated using the I² statistic, and sensitivity analyses were performed to assess robustness.

Results: Psychiatric emergency nursing interventions including intensive therapeutic communication, structured de-escalation strategies, and family involvement significantly reduced agitation among older adults (pooled effect size = -0.68; 95% CI: -0.84 to -0.52; I² = 75%). These interventions were also associated with decreased use of physical restraints and emergency pharmacological management. Most randomized studies demonstrated low risk or some concerns, while non-randomized studies exhibited moderate risk of bias.

Conclusion: Nursing-led psychiatric emergency interventions are effective in reducing agitation and minimizing restrictive practices among older adults in emergency settings. However, substantial heterogeneity across studies limits the certainty of evidence. These findings support the development of standardized evidence-based clinical protocols and targeted geriatric psychiatric nurse training, particularly in resource-constrained emergency systems. Further high-quality randomized trials are required to strengthen the evidence base and inform policy implementation

Lived Experiences and Motivating Factors of Online Commercial Sex Work Among Adolescents: A Phenomenological Qualitative Study

Qori Ila Saidah, Hastuti Puji, Irnanda Elma — Mon, 30 Mar 2026 00:00:00 +0700

Background: Online commercial sexual activity among adolescents is an emerging public health concern in low- and middle-income countries (LMICs), increasing risks of sexually transmitted infections, unintended pregnancy, and psychosocial harm. This issue is highly relevant to nursing and community health practice, particularly in prevention and early identification efforts. However, the psychosocial and environmental factors driving adolescents to engage in online commercial sex remain insufficiently explored, especially within LMIC contexts. Therefore, this study aims to analyze the factors influencing adolescents’ involvement in online commercial sexual activities.

Methods: This is a phenomenology research. The population in this study were adolescents and young age who made online worker of commercial sex in Surabaya region. The sample was five teenager with inclussion criteria aged 18-23 years old, using platform to offering sexual commercial and agree to share their experience selected with purposive sampling. Data were collected through in-depth interviews and recording and use data analize with Colaizi’s approach. Research team, study design, analysis and finding are stricly align with Consolidated Criteria for Reporting Qualitative Research (COREQ) standards.

Results: There are five themes have been founded in this study. Most paticipantss engaged in online commercial sex due to economic and lifestyle factors. The income earned through online commercial sex was considered sufficient to support their lifestyle. This led to addiction, both economically and for pleasure, leading to continued online commercial sex activity.

Conclusion: This study highlights three key factors influencing online commercial sex activity among adolescents. Economic incentives emerged as the primary driver, particularly in fulfilling lifestyle-related needs, while perceived enjoyment also motivated engagement. These findings underscore the need for targeted prevention strategies that address adolescents’ economic vulnerability, strengthen family communication, and develop digital-based health promotion and policy interventions to mitigate online sexual risk behaviors.

Effects of Flexible Transfemoral Prostheses on Dynamic Balance in Unilateral Amputees: A Quasi-Experimental Within-Subject Study

Nur Rachmat, Bambang Kuncoro — Mon, 30 Mar 2026 00:00:00 +0700

Background: Dynamic balance impairment is a major functional challenge in individuals with transfemoral amputation and is closely associated with mobility limitations and increased fall risk. Flexible transfemoral prostheses are widely prescribed to improve ambulation. However, limited biomechanical evidence exists examining how flexible transfemoral prostheses influence dynamic balance performance using standardized functional clinical assessments. This study aimed to examine the effect of flexible transfemoral prosthesis use on dynamic balance in unilateral transfemoral amputees.

Methods: This quasi-experimental within-subject study followed the TREND reporting guideline. Thirty unilateral transfemoral amputees were recruited using purposive sampling from the Department of Prosthetics and Orthotics at Poltekkes Kemenkes Surakarta, Indonesia. Inclusion criteria were medical stability and ability to perform multidirectional stepping; exclusion criteria included bilateral amputation and neurological disorders. The independent variable was ambulation condition (axillary crutch ambulation versus flexible transfemoral prosthesis use), and the dependent variable was FSST completion time. Dynamic balance was assessed using the Four Square Step Test (FSST). Analyses were conducted using paired t-tests with 95% confidence intervals.

Results: Participants were predominantly male (76.7%) with a mean age of 33.6 ± 9.4 years and a mean post-amputation duration of 4.2 ± 2.1 years. FSST completion time significantly decreased during flexible transfemoral prosthesis use compared with axillary crutch ambulation (mean difference = 8.97 seconds; 95% CI, 7.72–10.22; p < 0.001), demonstrating a very large effect size (Cohen’s d = 2.68).

Conclusion: Flexible transfemoral prosthesis use significantly enhances dynamic balance in unilateral transfemoral amputees. Flexible transfemoral prostheses should be considered an essential component of function-oriented rehabilitation strategies to optimize postural control and safe mobility. Future longitudinal and instrumented biomechanical studies are warranted to further elucidate underlying adaptation mechanisms.

Effectiveness of Allium cepa L. Compress in Reducing Body Temperature Among Under-Five Children with Acute Respiratory Infections: A Quasi-Experimental Study

Dini Nurbaeti Zen, Daniel Akbar Wibowo — Mon, 30 Mar 2026 00:00:00 +0700

Background: Acute Respiratory Infections (ARI) are among the most common illnesses affecting children under five and are often accompanied by fever. Inadequately managed fever may lead to discomfort and potential complications. One complementary therapy widely used in communities is the application of shallot (Allium cepa L.) compresses. This study aimed to analyze the effectiveness of Allium cepa L. compresses in reducing body temperature among toddlers with ARI.

Methods: A quasi-experimental design with a pretest–posttest control group approach was employed. The study involved 48 toddlers, divided into 24 intervention and 24 control groups, selected using purposive sampling. Body temperature was measured using a digital thermometer. Data were analyzed using Wilcoxon and Mann–Whitney tests.

Results: The mean body temperature in the intervention group decreased from 38.2°C before intervention to 36.6°C after intervention, with an average reduction of 1.63°C. Statistical analysis showed a significant effect (p < 0.05). The control group experienced a smaller decrease (0.28°C). There was a significant difference between the intervention and control groups, with a large effect size (r = 0.87).

Conclusion: Allium cepa L. compresses are effective in reducing body temperature among toddlers with ARI and can be considered a non-pharmacological intervention in pediatric nursing practice, particularly in primary healthcare settings.

What Are the Emerging Trends, Research Gaps, and Future Directions of Personalized Care in Nursing?

Satriya Pranata, Shu-Fang Vivienne Wu, Shu-Yuan Liang, Yeu Hui Chuang — Mon, 30 Mar 2026 00:00:00 +0700

Background: Trends show that research on personalized care continues to increase annually. In future studies, researchers need information on trends and innovations to inform personalized care research. The purpose of the study was to explore the trend of the number of publications, the trend of the number of citations, the journal with the highest number of publications, which field has the most consent to publish, network visualization, overlay visualization, and density visualization on the topic of personalized care through bibliometric analysis.

Methods: This study qualifies as a bibliometric analysis. Papers in this study are restricted to those published from 2021 to 2026, with a focus on the fields of health sciences and nursing, and on publication types. The data sources used in this study are based on online searches via https://app.dimensions.ai/. Data was collected in January 2026. Researchers analyse the data using VOS viewer.

Results: Research on personalized care began to increase in 2021, peaking in 2025. Through this study, we identified that the use of artificial intelligence can achieve the goal of personalizing patient needs. Numerous studies have been conducted on the development of artificial intelligence in nursing, but they are still limited to systematic reviews, scoping reviews, literature reviews, and meta-analyses. Moreover, the system surrounding the patient to achieve personalization comprises family, caregivers, health workers, and the patient. The tendency of which diseases are most often developed and discussed in the personalized care approaches is cancer (lung cancer and breast cancer), chronic diseases (diabetes, heart disease, and kidney disease), with cancer being the most frequently discussed topic. The focus of personalized care interventions across various diseases is on exercise, diet, medication adherence, and chemotherapy. Overall, personalization is expected to reduce levels of anxiety, fatigue, complications, and depression, as well as improve the quality of life of each patient. On the other hand, the least frequently discussed topics in personalized care are patients with mental disorders, dementia, cancer, self-care, and spiritual care.

Conclusion: Personalized care emphasizes not only the use of artificial intelligence and genetic technology to identify each patient's individual needs but also considers patient preferences and health profiles. Personalized care is a challenge that must be addressed to improve patient satisfaction with healthcare services in the future.

Cesarean Delivery and Early Breastfeeding Outcomes: A Cross-Sectional Study of EIBF and Early Postpartum Difficulties

Sat, 21 Mar 2026 00:00:00 +0700

Background: Cesarean section (CS) rates continue to increase globally, particularly in low- and middle-income countries (LMICs) such as Indonesia. While CS is often medically indicated, it may interfere with early initiation of breastfeeding (EIBF) and early postpartum lactation. However, evidence examining both EIBF and early breastfeeding difficulties within Indonesian LMIC settings remains limited.

Methods: This cross-sectional study followed STROBE guidelines and was conducted among 150 postpartum mothers within the first 10 days after delivery. Participants were recruited using consecutive sampling. Eligibility criteria included mothers aged ≥18 years, live singleton birth, and clinical stability. Data were collected using a structured Breastfeeding Initiation and Early Lactation Difficulty Questionnaire adapted from validated instruments (Cronbach’s α = 0.82). Chi-square tests were used to assess associations, with assumptions verified (expected cell count ≥5). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to estimate effect size.

Results: CS was significantly associated with failure to perform EIBF (OR = 214.79; 95% CI: 27.90–1653.65; p < 0.001). Mothers undergoing CS were also more likely to experience breastfeeding difficulties during the first 10 days postpartum (OR = 17.26; 95% CI: 6.24–47.74; p < 0.001).

Conclusion: CS delivery is strongly associated with delayed EIBF and increased early breastfeeding difficulties. Structured post-cesarean lactation support integrated into surgical recovery protocols is recommended, particularly in LMIC settings.

Sociodemographic and Cultural Determinants of Hypertension-Controlling Beliefs Among Older Adults: A Cross-Sectional Study Based on the Health Belief Model

Sat, 21 Mar 2026 00:00:00 +0700

Background: Hypertension control among older adults in Indonesia is hindered by low adherence and strong cultural beliefs. However, there is insufficient evidence on how sociodemographic and cultural determinants interact with health belief constructs to influence hypertension-control beliefs in older populations. This study examines sociodemographic and cultural determinants of hypertension-controlling beliefs using the Health Belief Model (HBM).

Methods: A cross-sectional study was conducted among 232 older adults (≥60 years) in coastal Madura, Indonesia. Data were collected via structured interviews using the HBM Questionnaire (HBMQ) and cultural belief items. Descriptive, bivariate, and multivariate analyses were performed.

Results: Higher education, retirement, and perceiving hypertension as a lifestyle consequence were significantly associated with stronger beliefs (p < 0.05). Although 76.3% trusted doctors, 40.9% still visited traditional healers. Belief in lifestyle etiology was the strongest predictor (β = 0.20, p = 0.002).

Conclusion: Cultural and educational factors significantly shape hypertension beliefs. Interventions should integrate biomedical education with cultural sensitivity to improve self-management in older populations.

Effectiveness of Participatory Education on Knowledge, Attitudes, and Malaria Prevention Practices in Endemic Communities in Indonesia: A Quasi-Experimental Study

Kismiyati Kismiyati, Theresia Febriana Christi Tyas Utami, Nasrah Nasrah — Sat, 21 Mar 2026 00:00:00 +0700

Background: Malaria remains a major public health problem in endemic areas of Papua, Indonesia, contributing substantially to morbidity and hindering community productivity. Effective, sustainable, and community-based prevention strategies are urgently needed to reduce transmission and improve preventive behaviors. This study aimed to assess the effectiveness of participatory education compared with conventional leaflet-based education in improving knowledge, attitudes, and malaria prevention practices among community members in an endemic area.

Methods: A quasi-experimental study with a control group design was conducted involving 220 community members. Participants were assigned to an intervention group that received participatory malaria prevention education and a control group that received educational leaflets with minimal explanation. A structured Knowledge, Attitude, and Practice (KAP) questionnaire was administered before and after the intervention to measure changes in malaria-related knowledge, attitudes, and preventive practices. Data were analyzed using comparative statistical tests and paired t-tests to determine differences within and between groups.

Results: The findings demonstrated a statistically significant increase in knowledge and malaria prevention practices in the intervention group (p < 0.001). In contrast, the control group showed a modest but significant improvement in knowledge (p = 0.006) and no significant change in prevention practices (p = 0.377). Neither group experienced a statistically significant change in attitudes toward malaria prevention (p > 0.05).

Conclusion: Participatory education is more effective than conventional leaflet-based education in improving malaria-related knowledge and preventive practices. However, changing attitudes may require more intensive and sustained interventions. Integrating participatory approaches into routine public health programs is recommended to strengthen malaria prevention efforts in endemic community.

Effectiveness of a Positive Deviance–Based Educational Intervention on Children’s Self-Esteem for Bullying Prevention: A Quasi-Experimental Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Bullying is a critical school issue rooted in low self-esteem, which serves as a major vulnerability factor for children. This study aims to analyze the role of Positive Deviance (PD) education in improving children’s self-esteem as a bullying prevention strategy.

Methods: A quantitative quasi-experimental pretest–posttest control group design was employed. The population consisted of grade VI students at SD Negeri 101893 Bangun Rejo, with a total sample of 58 students, divided into an experimental (n=29) and a control (n=29) group. Sampling involved identifying "positive deviants"—children who successfully overcame bullying risks—to develop the PD education module. Variables measured included knowledge, self-esteem (SE), and Positive Deviance Bullying behavior (PB) as dependent variables, collected via validated instruments. Ethical clearance was ensured throughout the procedure, and data were analyzed using Paired and Independent t-tests.

Results: Most respondents were aged 11–12 years, and the experimental group had a higher proportion of females (65.5%). The experimental group showed significant improvements in knowledge (p=0.0001), self-esteem (p=0.043), and behavior (p=0.034). Independent t-test results confirmed significant differences between the experimental and control groups for knowledge (p=0.013), self-esteem (p=0.037), and behavior (p=0.024), indicating the intervention's effectiveness.

Conclusion: Positive Deviance education effectively enhances children’s self-esteem, providing a vital psychological foundation for bullying prevention. It is recommended that future programs adopt a whole-school approach involving teachers and parents to support long-term behavioral change and sustainability.

Association Between Hemoglobin Levels, Duration of Hemodialysis, and Mental Health Outcomes in CKD Patients: A Cross-Sectional Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Chronic kidney disease (CKD) is a global health problem that can progress to end-stage renal failure requiring hemodialysis. Patients on long-term hemodialysis often experience anemia and mental health problems, yet evidence from Indonesia and other LMICs on the relationship between clinical factors and mental health remains limited. This study aims to analyze the association between hemodialysis duration and hemoglobin levels with mental health and emotional role functioning in hemodialysis patients.

Methods: This quantitative study used a cross-sectional design. A consecutive sampling method was used, involving 75 patients undergoing hemodialysis from hospitals across Bangka Island between June and August 2024. Inclusion criteria are undergoing hemodialysis twice a week, and exclusion criteria are experiencing sudden shortness of breath and being in unstable or emergency conditions during data collection. Independent variables are years on hemodialysis and hemoglobin; dependent variables are the Mental Health and Role Emotional domains of the SF-36. The SF-36 questionnaire is a valid instrument used in patients undergoing hemodialysis to study physical activity and rehabilitation. Data analysis included univariate analysis to determine the mean and standard deviation, as well as bivariate analysis using the Pearson correlation test using SPSS Version 26.

Results: The mean score for the Mental Health (MH) domain was 59.22, and for the Role Emotional (RE) domain, it was 30.67, indicating that patients undergoing hemodialysis had relatively low scores in both domains. A significant correlation was found between years on hemodialysis and hemoglobin levels with mental health and role emotional scores (P =0,0001) (P value < 0,05).

Conclusion: Mental health and role emotional issues in patients with CKD undergoing hemodialysis are still understudied, which negatively affects their quality of life. Healthcare professionals need to conduct comprehensive assessments that consider not only the physical but also the mental health and emotional role aspects of these patients. Many patients undergoing hemodialysis have poor mental health and emotional functioning. Factors such as years on hemodialysis and hemoglobin levels are associated with improvements in these domains.

Exploring Reproductive Health Education Needs and Barriers Among Adolescent Girls with Disabilities: A Qualitative Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: Adolescents with disabilities remain among the most marginalized populations in accessing reproductive health services. Structural inaccessibility, social stigma, and limited awareness among health providers perpetuate inequities that compromise their reproductive rights and well-being. This study aims to explore the reproductive health service needs, experiences, and barriers faced by adolescents with disabilities to inform the development of inclusive and responsive reproductive health programs.

Methods: A qualitative exploratory design was employed. Data were collected through in-depth interviews and focus group discussions with adolescents with various disabilities, their parents or caregivers, and key health workers. A total of 12 participants were purposively selected to represent diverse disability types and socio-demographic backgrounds. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was applied in this research. Thematic analysis was conducted using an inductive coding approach to identify emerging patterns related to accessibility, service experience, and social attitudes.

Results: Four interrelated themes emerged from the analysis: (1) Limited access and barriers to reproductive health information; (2) Sociocultural stigma and silences surrounding sexuality; (3) Unmet educational and emotional needs; (4) Strategies and aspirations for inclusive reproductive health education. This theme indicated that adolescent girl with disabilities face significant structural and information barriers that limit their ability to access accurate and accessible reproductive health information, thereby increasing their vulnerability to misinformation and unmet health needs.

Conclusion: Adolescents with disabilities face multiple and intersecting barriers to accessing reproductive health services. Addressing these challenges requires systemic transformation through disability-sensitive training for health providers and a rights-based, inclusive education that reduces stigma and improves access.

Association Between Nurses’ Compliance With Adult Early Warning Score Implementation and Inpatient Survival: A Cross-Sectional Study

Sat, 21 Mar 2026 00:00:00 +0700

Background: The adult Early Warning Score (EWS) is an essential instrument for early detection of a patient's deteriorating clinical condition. However, the effectiveness of EWS depends on nurses' compliance with its implementation. Non-compliance with EWS implementation can hinder early detection of patients' conditions and affect patient survival. This study aims to analyze the relationship between adult EWS implementation compliance and inpatient survival status. However, the evidence on the effect of compliance with EWS implementation on patient survival in real inpatient settings remains limited. This study aimed to examine the association between nurses’ compliance with adult EWS implementation and inpatient survival status.

Methods: This study used an observational, cross-sectional design and was reported according to the STROBE guidelines. The research sample comprised 188 patients selected using a phased sampling technique (cluster sampling followed by simple random sampling). Data were obtained from the medical records of inpatients who met the inclusion and exclusion criteria. The independent variable in this study was compliance with the Early Warning System (EWS), while the dependent variable was the patient's survival status. Statistical analysis was carried out using Fisher's Exact test.

Results: A total of 188 patients were analyzed, with 173 patients (92%) surviving and 15 patients (8%) dying. In the group that did not comply with the Early Warning System (EWS), there were 6 deaths (16.7%) and 30 patients survived (83.3%), while in the group that did comply with the Early Warning System (EWS), there were 9 deaths (5.9%) and 143 patients survived (94.1%). There was a significant association between EWS compliance and inpatient survival status (p = 0.044). Patients with EWS adherence had a higher chance of survival than non-compliant patients (OR = 3.18; 95% CI: 1.06–9.54).

Conclusion: The implementation of EWS that is compliant plays an essential role in detecting early deterioration of patient conditions and improving patient survival and safety.

How Do Older Adults Experience Depression and Social Isolation in Nursing Homes? A Descriptive Phenomenological Study

Lilik Ma’rifatul Azizah, Amar Akbar, Imam Zainuri, Siti Khotijah — Sat, 21 Mar 2026 00:00:00 +0700

Background: Depression and social isolation are common psychosocial problems among older adults living in nursing homes. Institutional living may intensify feelings of loneliness, loss of meaningful roles, and emotional withdrawal, which can negatively affect psychological well-being and quality of life. Understanding the lived experiences of older adults is essential to inform holistic nursing care. This study aimed to explore the lived experiences of depression and social isolation among older adults residing in nursing homes.

Methods: A qualitative study using a descriptive-phenomenological approach and following COREQ guidelines was conducted. Using purposive sampling, 15 potential participants were approached; 12 participants met the inclusion criteria (aged ≥60, residing ≥3 months, and GDS score ≥5) and completed the study, while 3 declined due to health fatigue. Data were collected through in-depth, face-to-face interviews and analyzed using the Colaizzi method to identify essential themes. Ethical approval was obtained before data collection, and data collection continued until data saturation was achieved at the 12th participant.

Results: Six major themes emerged: Feeling forgotten and abandoned; Living among others yet feeling alone; Loss of role and identity; Emotional withdrawal and silence; Longing for meaningful connection; and Searching for acceptance and inner peace.

Conclusion: Depression and social isolation are deeply rooted in perceived loss and unmet emotional needs. Practical implications include the need for psychosocial nursing interventions that prioritize meaningful interpersonal communication and family engagement strategies.

Maternal Sadness in the Context of Developmental Disabilities: A Cross-Sectional Study of Autism, Down Syndrome, and Intellectual Disability

Cau Kim Jiu, Sri Ariyanti, Tri Wahyuni, Usman Usman, Solikhah Solikhah — Sat, 21 Mar 2026 00:00:00 +0700

Background: Mothers of children with special needs are vulnerable to emotional challenges; however, specific emotional responses such as sadness remain underexplored in the literature. This study aimed to describe the levels of sadness among mothers of children with Autism Spectrum Disorder (ASD), Down syndrome, and intellectual disabilities.

Methods: A cross-sectional descriptive study was conducted between July and December 2025 involving 62 mothers recruited through purposive sampling. Data were collected using a self-reported questionnaire consisting of 15 Likert-scale items measuring sadness levels. Scores ranged from 0 to 60 and were categorized into four levels. Data were analyzed using descriptive statistics, ANOVA, and chi-square tests with a significance level of p < 0.05.

Results: The majority of respondents reported moderate to high levels of sadness. The highest mean sadness score was observed among mothers of children with ASD (M = 49.30), followed by Down syndrome (M = 48.67), both indicating high levels. In contrast, mothers of children with intellectual disabilities reported moderate levels (M = 44.25). There was a significant difference in sadness levels across disability types (p = 0.001). Bivariate analysis showed that maternal education, occupation, family income, and type of disability were significantly associated with sadness levels (p < 0.05), whereas maternal age, child’s age, and gender were not (p > 0.05).

Conclusion: Sadness is a prevalent emotional response among mothers of children with special needs, with variations across disability types and socioeconomic factors. These findings highlight the importance of targeted psychosocial support to improve maternal well-being.