Journal of Applied Nursing and Health

Determinants of Self-Medication Practices among Nursing and Midwifery Students: A Cross-Sectional Study from Ghana

Oscar Agyemang Opoku , Juliet Agyiriba, Henry Okudzeto — Fri, 07 Nov 2025 00:00:00 +0700

Background: Self-medication is a growing public health concern, particularly among healthcare students. Despite its risks, including adverse drug reactions and antibiotic resistance, little is known about the behavioral and socioeconomic factors influencing self-medication among nursing and midwifery students in sub-Saharan Africa. This study assessed the prevalence and determinants of self-medication among students at the Nursing and Midwifery Training College in Koforidua, Ghana.

Methods: A cross-sectional quantitative design was adopted, involving 275 students selected through stratified random sampling. Data were collected using a structured and pretested questionnaire covering demographic characteristics, knowledge, and self-medication practices. Descriptive statistics were performed using SPSS version 26 to summarize frequencies and percentages related to knowledge, behavior, and influencing factors.

Results: Self-medication was highly prevalent (94.3%) among respondents, with painkillers (52.2%), cold and flu medications (22.6%), and antibiotics (20.0%) being the most commonly used drugs. The main factors influencing self-medication were time constraints (91.7%), financial barriers (81.3%), family history (53.9%), and advice from friends or relatives (87.8%). Although 91.8% of respondents recognized the risks associated with self-medication, many continued the practice due to perceived convenience and cost-saving benefits.

Conclusion: Self-medication is widespread among nursing and midwifery students in Ghana, primarily driven by financial and time constraints as well as social influences. Educational interventions and institutional policies promoting rational drug use are urgently needed. Collaboration between nursing schools and the Ghana Health Service could enhance awareness and ensure responsible self-care behaviors among future healthcare professionals.

The Relationship between Body Fat Percentage and Physical Fitness: A Cross-Sectional Study among Medical Students in Indonesia

Frisca Ronauli Batubara, Wendy Hendrika, Shela A Prameswari — Fri, 07 Nov 2025 00:00:00 +0700

Background: Physical fitness is the ability to carry out daily and leisure activities efficiently without excessive fatigue, thereby reducing the risk of chronic diseases. However, few studies in Indonesia have explored the link between body fat percentage and physical fitness among medical students. This study aims to analyze that relationship in students of the Faculty of Medicine, Indonesian Christian University.

Methods: This observational cross-sectional study involved 57 university students selected using simple random sampling. Inclusion criteria were active medical students from the 2023 intake who were willing to participate. Exclusion criteria were students with musculoskeletal injuries or chronic diseases affecting physical performance. Body fat percentage was measured using skinfold calipers, and physical fitness was assessed using the Harvard Step Test. Data were analyzed using the Pearson correlation test. Ethical approval was obtained from the Health Research Ethics Committee of the Faculty of Medicine, Indonesian Christian University.

Results: The analysis showed that the majority of students had a low physical fitness index, with 71.9% of participants having low physical fitness. A significant correlation was found between body fat percentage and physical fitness (p = 0.015), with increasing body fat percentage associated with decreased physical fitness.

Conclusion: Increasing body fat percentage correlates with decreasing levels of physical fitness, suggesting that higher levels of body fat in college students are likely to negatively impact their ability to perform physical activity efficiently and reduce their risk of chronic disease.

The Effect of Digital Media-Based Nutrition Education on Animal-Based Food Feeding Behavior Among Parents of Toddlers: A Quasi-Experimental Study

Daniel Akbar Wibowo, Dini Nurbaeti Zen — Fri, 07 Nov 2025 00:00:00 +0700

Background: Low consumption of animal source foods (ASF) among children under five years children in Indonesia contributes to the high prevalence of stunting. Digital media–based nutrition education can potentially improve parental ASF feeding behavior. However, empirical evidence on its effectiveness in semi-urban and rural settings, particularly studies directly measuring parental behavioral change, remains limited. This study aimed to analyze the effect of digital media–based nutrition education on parental ASF feeding behavior among under-five children.

Methods: This quasi-experimental one-group pretest–posttest study involved 150 parents of under-five children in Sukadana Village, Ciamis Regency, West Java, Indonesia, selected through stratified purposive sampling by hamlet. Inclusion criteria: parents with children <5 years old, having smartphone access, willingness to participate in the intervention, and provision of written informed consent. Exclusion criteria: incomplete pretest or posttest questionnaire data. The intervention consisted of a ±10-minute educational video on the importance of ASF, its sources, safe preparation, and tips to increase consumption, validated by nutrition experts. Feeding behavior was measured using a structured questionnaire (20 items; 3-point Likert scale; Cronbach’s alpha = 0.82). Data were analyzed using paired sample t-tests and effect size calculation (Cohen’s d) with 95% confidence intervals (CI) in SPSS v26.

Results: Digital media–based nutrition education significantly improved parental ASF feeding behavior (p < 0.001), with a large effect size (Cohen’s d = 0.91; 95% CI: 0.69–1.12). The proportion of good behavior increased from 28.0% to 84.0%, while fair and poor behaviors decreased from 43.3% to 12.7% and from 28.7% to 3.3%, respectively.

Conclusion: Digital media–based nutrition education is efficacious in improving parental ASF feeding behavior in semi-urban settings. This strategy has the potential to be integrated into stunting prevention programs in primary healthcare, community health posts, and community-based interventions. Recommendation: Implementation should be accompanied by healthcare worker support and continuous monitoring to ensure sustainable behavior change

The Relationship Between Diet and the Incidence of Dyspepsia in School-Age Children (6-18 years) at the Sukabumi Health Center, A Cross-Sectional Study

Reni Anggraeni — Fri, 07 Nov 2025 00:00:00 +0700

Background: Dyspepsia, a disorder of the upper gastrointestinal tract, is a worldwide health problem. In Indonesia, it ranks among the most frequent conditions in primary healthcare. Research on the relationship between dietary habits and dyspepsia in school-aged children, particularly in primary health centers in Sukabumi, is limited. This study aims to explore the association between irregular eating patterns and dyspepsia in this age group.

Methods: This study used quantitative research with a cross-sectional design, involving 51 purposively selected children aged 6–18 years visiting the Sukabumi Public Health Center between January and March 2025. Inclusion criteria were children aged 6–18 years, with a history of dyspepsia, and willingness to participate by completing questionnaires. Exclusion criteria included diagnosis of Helicobacter pylori infection, use of gastrointestinal-impacting medications, or presence of malignant or chronic upper gastrointestinal diseases. Data were collected using a validated questionnaire adapted from prior research, demonstrating good validity and reliability.

Results: From the results obtained, 12 children had a good diet was 12 people (23.5%), and 39 children had poor diets (76.5%). Meanwhile, 35 children with dyspepsia (68.6%) and children who did not experience dyspepsia were 16 people (31.4%). There was a relationship between diet and the incidence of dyspepsia in school-age children (6-18 years) at the Sukabumi Health Center, with a p-value = 0.003, which could be interpreted as (p < 0.05) or (0.003 < 0.05)

Conclusion: Irregular dietary habits are linked to dyspepsia in school-aged children at the Sukabumi Health Center, emphasizing the need for healthy eating promotion in local, resource-limited settings of middle- and low-income countries.

Mothers’ Experiences in Implementing Responsive Feeding for Stunted Toddlers: A Qualitative Phenomenological Study

Erna Julianti, Elni Elni, Restu Amalia Azmy, Zamziri Zamziri — Fri, 07 Nov 2025 00:00:00 +0700

Background: Reducing stunting rates is a priority for health programs in Indonesia, including in Bangka Belitung. One of the factors of stunting is a responsive feeding problem. The problems experienced by mothers related to responsive feeding are that the way of feeding according to age is not optimal, does not provide examples of healthy eating habits, does not encourage children to eat, and does not interact with children when eating, because they are busy with household chores.

Methods: The research used a descriptive phenomenological approach, and the ethical considerations in the study were beneficence, justice, and Respect for human dignity. The research participants involved were five mothers having stunting children, because saturation (data saturation) was achieved during data collection, so that no new information was obtained. The sample was selected using a purposive sampling technique. Inclusion criteria included mothers with stunting toddlers who could express their experiences and spoke Indonesian. Researchers also conducted in-depth interviews to collect data. Researchers used COREQ as a guideline. The data were analyzed using the Colaizzi method.

Results: This research discovered five themes, including children's independence in eating versus being fed, refusal to eat, interaction between parents and children when eating, knowing signs of hunger and fullness in children, and eating texture according to the child's age.

Conclusion: Eventually, it is expected that mothers can apply responsive feeding and use it as a nursing intervention to improve children's eating habits and abilities more optimally.

Effectiveness of Progressive Muscle Relaxation on Pain and Sleep Quality in Lung Cancer Patients Undergoing Chemotherapy: A Quasi-Experimental Study

Mira Mira, Izma Daud, Laiya Ruwaida, Mahmud Mahmud, Mahrida Dwi Ariani — Fri, 07 Nov 2025 00:00:00 +0700

Background: Pain and sleep disturbances are common among lung cancer patients undergoing chemotherapy, negatively affecting comfort and quality of life. Progressive Muscle Relaxation (PMR) is a non-pharmacological intervention that potentially alleviates these issues. However, few studies have specifically examined the effects of PMR on chemotherapy-induced symptoms in lung cancer patients, particularly in Indonesia.

Methods: A quasi-experimental pretest–posttest study with a control group was conducted in Banjarmasin, Indonesia, involving 60 purposively selected lung cancer patients. Participants were assigned to an intervention group (n = 30) and a control group (n = 30). The intervention group performed daily PMR exercises for 14 consecutive days, while the control group received standard care. Pain was measured using the Numeric Rating Scale (NRS), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using the Wilcoxon signed-rank test, and ethical approval was obtained from the institutional review board.

Results: Demographic characteristics were comparable between groups. After the intervention, pain levels decreased significantly in the intervention group, with 40% reporting mild pain and 53.3% moderate pain, compared to the control group, where 66.7% reported moderate pain and 33.3% severe pain. All participants in the intervention group achieved good sleep quality, while no improvements were observed in the control group. Between-group differences were statistically significant (p < 0.05).

Conclusion: PMR effectively reduces pain and improves sleep quality in lung cancer patients undergoing chemotherapy. This study provides new evidence on the application of PMR in supportive care for lung cancer patients in Indonesia.

Effectiveness of the Early Warning Score in Enhancing Nurses’ Responsiveness to Critical Patients: A Quasi-Experimental Study in the Emergency Department

Ernawati Ernawati, Sri Purwanti Ariani, Pramunika Pramunika — Fri, 07 Nov 2025 00:00:00 +0700

Background: Emergency care services in Indonesia continue to face challenges in quickly identifying patients who are critically ill, which contributes to the high mortality rates in Emergency Departments (ED). While the Early Warning Score (EWS) has been proven effective for early detection of patient deterioration, there are limited studies on its implementation in Indonesian EDs, particularly in provincial hospitals. This highlights a gap in research that needs further attention.

Methods: This study used a quasi-experimental design with a pre-test and post-test control group at Dr. H. Moch Ansari Saleh Regional General Hospital, Banjarmasin. Twenty-three ED nurses participated. We measured nurse responsiveness by examining how quickly and accurately they took clinical actions after monitoring EWS. A prototype guideline for using EWS was also developed and integrated into the hospital’s ED reporting system. The research followed CONSORT guidelines for quasi-experimental studies.

Results: Most participants were female (60.9%), aged between 19 and 44 years (95.7%), with the majority holding a Diploma III in nursing (65.2%). Before introducing the EWS, 83.3% of nurses in the intervention group responded in one minute or longer, with only 25% accuracy. After the EWS implementation, 91.7% responded in under one minute, with 91.7% accuracy. In the control group, one-minute or longer response times remained high at 90.9%, and accuracy improved slightly from 18.2% to 27.3%. Statistical tests showed significant improvement in response time (p = 0.007) and accuracy (p = 0.005) in the intervention group.

Conclusion: Introducing the Early Warning Score improved nurses’ responsiveness in the ED, making their clinical actions faster and more accurate. Integrating EWS into daily practice with clear guidelines can help enable timely interventions and improve patient safety during emergency care.

Effectiveness of a Nursing-Based Fast Track Surgery Protocol on Postoperative Pain Reduction: A Quasi-Experimental Study

Sri Purwanti Ariani, Yuhansyah Yuhansyah, Ernawati Ernawati; Ainun Jariyah — Fri, 07 Nov 2025 00:00:00 +0700

Background: Ineffective management of postoperative pain can delay recovery, increase the risk of complications, and extend the length of hospital stay. Fast Track Surgery (FTS) is a multidisciplinary approach that speeds up recovery and reduces postoperative pain effectively. However, studies on the effectiveness of nursing-based FTS interventions in regional hospitals are still limited. This study examines the effectiveness of an innovative nursing-based FTS approach in reducing pain intensity among postoperative patients.

Methods: This quasi-experimental study used purposive sampling and involved 30 participants, divided into intervention and control groups. The study was conducted at TK III Dr. R. Soeharsono Hospital in Banjarmasin, South Kalimantan. Inclusion criteria were patients aged 18 to 65 years, postoperative, able to communicate well, and willing to participate. Pain intensity was measured using the Visual Analog Scale (VAS) before and two hours after the Fast Track Surgery intervention. The nursing-based FTS intervention included preoperative education, early mobilization, and multimodal analgesia management. The study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to ensure clarity and completeness.

Results: Most participants were between 19 and 44 years old, 60% were male, and the majority had completed high school. Before the intervention, patients mainly reported moderate to severe pain; after the FTS intervention, most reported mild pain. Pain intensity was significantly different between the intervention and control groups (p < 0.001).

Conclusion: The nursing-based Fast Track Surgery approach effectively reduces postoperative pain intensity. It is recommended that nurse-led FTS protocols be implemented in regional hospitals to improve pain management and accelerate patient recovery.

Resilience, Psychological Well-Being, and Academic Success in Blended Learning: A Cross-Sectional Study among Healthcare Students

Nuraeni Effendy, Rustiana Tasya Ariningpraja, Retno Lestari — Fri, 07 Nov 2025 00:00:00 +0700

Background: Students in healthcare are expected to face high clinical and academic stressors that may influence their psychological well-being and academic achievement. Resilience plays a significant role in helping students navigate these challenges while maintaining their well-being. The research examines the relationship between psychological well-being, resilience, and academic achievement among Universitas Brawijaya healthcare students in a blended learning environment.

Methods: A cross-sectional research design was employed, and 302 students participated through purposive sampling. Data were collected through the Academic Resilience Scale (ARS-30) and Ryff's Psychological Well-Being Scale, with GPA as an indicator of academic performance. This study was reported in accordance with the STROBE guidelines.

Results: A strong positive relationship between resilience and psychological well-being (r = 0.615, p < 0.01), highlighting the focus on resilience as an effective protective factor. There was, nonetheless, no significant correlation between resilience and GPA (r = -0.006, p = 0.913)..

Conclusion: Among the psychological well-being factors, environmental mastery, autonomy, and purpose in life contributed significantly to academic resilience. These findings suggest that cultivating psychological well-being, particularly ecological mastery and self-acceptance, can enable resilience in online learning environments.

Qualitative Policy Analysis of Hypertension Disease Control at Primary Health Centers in Surakarta, Indonesia

Fri, 07 Nov 2025 00:00:00 +0700

Background: Hypertension is a leading global health issue and a primary risk factor for cardiovascular disease. Despite national strategies in Indonesia, evidence on hypertension control implementation at the district and community levels remains scarce. Surakarta reports hypertension as the most common non-communicable disease (NCD), yet little is known about how policies are translated into practice at primary health centers.

Methods: This qualitative descriptive study applied a policy analysis approach, guided by the COREQ reporting standard. Five purposively selected participants (three health workers, one patient, and one district health officer) were interviewed between June and September 2023. Data were collected through in-depth interviews (30–60 minutes) and document reviews, and were analyzed thematically using Creswell’s framework.

Results: Three themes emerged: (1) hypertension control policies operationalized at the primary healthcare level and supported by innovations such as BU DESI (Buru Diabetes dan Hipertensi); (2) health promotion through Posbindu PTM and cadre empowerment; and (3) monitoring and evaluation via regular monthly reviews, though patient adherence and multisectoral collaboration remain limited.

Conclusion: While hypertension control in Surakarta aligns partially with national strategies, its novelty lies in integrating locally driven innovations such as BU DESI. The study highlights the need to strengthen community empowerment and multisectoral collaboration.

Effectiveness Of Health Education Through Video And Leaflets On Knowledge And Waste Sorting Behavior Among Elementary School Students: A Quasi-Experimental Study

Sadya Bustomi, Della Sulistiana — Fri, 07 Nov 2025 00:00:00 +0700

Background: Waste sorting has not been widely understood or implemented among elementary school students, resulting in poor waste management in the school environment. However, evidence comparing the effectiveness of video-based versus leaflet-based health education interventions in elementary school settings remains limited. This study aimed to determine the effectiveness of health education on waste sorting on students' knowledge and behavior in State Elementary Schools.

Methods: This quantitative study employed a quasi-experimental two-group pretest–posttest design with no control group, following the TREND reporting guidelines. The sample comprised 60 grade V students (30 from SDN Panggung Rawi and 30 from SDN Sukmajaya 1), selected through a total sampling method. Inclusion criteria were active enrollment as grade V students, ability to read and write, and provision of parental consent, while absent students were excluded at the time of data collection. SDN stands for Sekolah Dasar Negeri, which means State Elementary School (public primary school) in Indonesia. Data were collected using a 16-item, expert-validated questionnaire and tested for reliability (Cronbach’s alpha = 0.82 for knowledge and 0.79 for behavior). Univariate analysis used median values, while bivariate analysis applied paired t-tests/Wilcoxon signed-rank tests and independent t-tests/Mann–Whitney U tests, with effect sizes reported as Cohen’s d.

Results: At α = 0.05, there was a significant difference in knowledge between the video and leaflet groups (p = 0.012; Cohen’s d = 0.54, medium effect). Similarly, there was a significant difference in behavior change between the video and leaflet groups (p = 0.001; Cohen’s d = 0.71, large effect). No participants dropped out, and complete data were obtained from all respondents..

Conclusion: Health education through videos was more effective than leaflets in improving elementary school students' knowledge and behavior regarding waste sorting. Waste sorting interventions can be effectively integrated into school-based waste management programs.

Exploring Parent-Based Health Promotion Models For The Prevention Of Sexual Violence Against Children In Bekasi City: An Exploratory Sequential Mixed Study

Handayani Handayani, Nurul Husnul Lail — Fri, 07 Nov 2025 00:00:00 +0700

Background: Child sexual abuse (CSA) is a serious problem that continues to increase and is often perpetrated by people close to the child, making it difficult to detect. It has a long-term impact on child development. However, systematically tested parent-based interventions are still limited, especially in Indonesia. This study aims to develop and evaluate a parent-based health promotion model to prevent CSA in Bekasi City..

Methods: This study used a sequential exploratory mixed methods design in accordance with GRAMMS guidelines. The qualitative stage involved in-depth interviews with 12 informants (perpetrators, parents of victims, and child victims of KSPA) which were analyzed thematically. The quantitative stage used a cross-sectional design with 209 respondents selected through proportional sampling in each sub-district and simple random sampling. The inclusion criteria were parents with children aged 6–13 years, cooperative, residing in Bekasi, and willing to be respondents. The data were analyzed using multivariate logistic regression (p-value) and paired samples test.

Results: Qualitative analysis identified three main themes: children's vulnerability due to lack of early sex education, permissive parenting, and parental adaptive strategies. The Handayani model identified perpetrator, child, and parental factors that influence KSPA prevention. Quantitative analysis showed that parenting (p<0.001), attitudes, perceptions, and knowledge (p<0.01) were significant. The paired samples test confirmed an increase in all variables after the intervention (p<0.001). The Handayani model proved effective as a guide for parents in improving KSPA prevention through parenting, attitudes, perceptions, and knowledge..

Conclusion: The Handayani model has been proven effective in improving parenting, attitudes, perceptions, and knowledge of parents, so that children are more aware of predators. These findings emphasize the importance of early sex education and protective parenting in family-based prevention programs

Maternal Knowledge of Stunting in Toddlers: A Cross-Sectional Study in Indonesia

Rosmiati Rosmiati, Eka Wulansari, Marhumi Marhumi — Fri, 07 Nov 2025 00:00:00 +0700

Background: Stunting remains a major public health issue in Indonesia, where maternal knowledge is a critical factor for prevention. However, limited evidence exists regarding the specific knowledge gaps of mothers in semi-urban communities in Indonesia, which hampers targeted interventions. This study aimed to analyze maternal knowledge levels regarding stunting and its associated factors.

Methods: This research utilized a descriptive cross-sectional design (reported according to STROBE guidelines) with 265 mothers of toddlers selected via stratified random sampling. Sample size justification and detailed inclusion/exclusion criteria were included. A validated and reliable questionnaire (Cronbach's α=0.87) was used. Data were analyzed using the Chi-Square test.

Results: Most respondents (71.7%) had a good knowledge level. However, a statistically significant knowledge deficit was found concerning the specific causes of stunting (χ2=49.900;p<0.001). Factors such as education and employment status were significantly associated with knowledge levels.

Conclusion: While general awareness of stunting is high, a critical gap exists in mothers' understanding of its complex causes. Educational interventions must become more focused. Future studies should employ longitudinal or interventional designs to assess the causal pathways between maternal knowledge and stunting prevention behaviors (Harmonized with Practical Implications).

Caregiver Knowledge and Functional Status in Preventing Pressure Ulcers among Stroke Patients: A Cross-Sectional Study

chrisyen Damanik, Salwa Setya Anggun Pratama — Fri, 07 Nov 2025 00:00:00 +0700

Background: Stroke is a leading cause of death and disability, often reducing patients' quality of life and increasing caregiver burden. Immobility after stroke raises the risk of pressure ulcers, worsening outcomes, and prolonging hospital stays. Caregivers are crucial in prevention, as their knowledge and functional ability affect care effectiveness. However, few studies have explored the direct link between caregiver knowledge and functional status in pressure ulcer prevention, particularly in home or community settings. This study aims to examine that relationship.

Methods: This cross-sectional study (June–July 2025) in Indonesia involved 38 primary caregivers of stroke patients, selected via consecutive sampling. Eligible caregivers were ≥18 years old, had ≥1 month of caregiving experience, and consented; professional caregivers and those caring for acute-phase patients were excluded. Data were collected using bilingual questionnaires on caregiver knowledge (15 items, α = 0.739) and functional status (18 items, α = 0.878). Descriptive statistics summarized participant characteristics, and Pearson’s correlation analyzed the relationship between knowledge and functional status.

Results: Most caregivers were aged 46–55 (42.1%), female (76.3%), educated to junior/high school level (71.1%), and predominantly housewives (47.4%). A majority (76.3%) had no prior caregiving experience. The mean knowledge and functional status scores were 10.58 ± 1.605 and 61.95 ± 4.550, respectively. Pearson’s correlation revealed a strong, significant positive relationship between caregiver knowledge and functional status (r = 0.634; p < 0.001), suggesting that greater understanding of pressure ulcer prevention is associated with improved caregiving performance in stroke care.

Conclusion: Caregivers’ knowledge and functional status directly affect their effectiveness in stroke care. Better-informed caregivers more successfully prevent pressure ulcers, emphasizing the need for structured training programs that build skills and confidence, improve patient outcomes, and reduce complications.

Effect of Blanched Pineapple and Massage Therapy on Uterine Involution and Breast Milk Production: A Quasi-Experimental Study in Postpartum Mothers

Yeni Aryani, Annisa Tri Yustita — Fri, 07 Nov 2025 00:00:00 +0700

Background: Optimal postpartum recovery and lactation are vital for maternal and neonatal health. Pineapple, rich in bromelain and bioactive compounds, may aid uterine involution and lactogenesis, while massage therapy promotes oxytocin release and milk production. Evidence on their combined effect remains limited. This study examined the impact of blanched pineapple consumption with massage therapy on uterine fundal height reduction and breast milk production in postpartum mothers.

Methods: A quasi-experimental study with a two-group pretest–posttest design followed the TREND reporting guideline. 50 postpartum mothers were recruited using purposive sampling (25 intervention, 25 control). Inclusion criteria included mothers within 24–48 hours postpartum, aged 20–35 years, with a singleton birth and no obstetric complications; exclusion criteria were allergy to pineapple, postpartum hemorrhage, or medical contraindications for massage. The intervention group received blanched pineapple consumption (200 g/day for 7 days) combined with standardized massage therapy, while the control group received routine postpartum care. UFH was measured using a non-elastic tape, and breast milk production was assessed through maternal report and expressed volume (validated measurement protocol). Ethical approval was obtained from the institutional review board. Data were analyzed using paired and independent t-tests, and effect sizes (Cohen’s d, 95% CI) were calculated.

Results: Mothers in the intervention group experienced a significantly greater reduction in UFH (mean difference = 2.1 cm, p < 0.01, Cohen’s d = 0.78) compared to the control group. Breast milk production was also higher in the intervention group, both in average volume (+45 mL/day, p < 0.01, Cohen’s d = 0.72) and frequency of breastfeeding episodes (OR = 2.3, 95% CI: 1.4–3.8). These findings indicate a synergistic effect of pineapple’s enzymatic properties and massage-induced oxytocin release on uterine involution and lactogenesis.

Conclusion: Blanched pineapple consumption combined with massage therapy effectively accelerates uterine involution and enhances breast milk production in postpartum mothers. This integrated, non-pharmacological approach can be considered a safe and culturally adaptable adjunct to routine postpartum care. Healthcare providers are encouraged to incorporate such interventions into maternal recovery programs to support exclusive breastfeeding and improve maternal health outcomes.

Effect of Family-Centered Nursing-Based Health Education on Activities of Daily Living among Elderly Hypertensive Patients in Indonesia: A Quasi-Experimental Study

Fri, 07 Nov 2025 00:00:00 +0700

Background: Hypertension is a common chronic condition in the elderly, leading to decreased independence in performing Activities of Daily Living (ADL). Family support is a key determinant in maintaining the independence of the elderly. However, the family's role is still not optimal. Health education based on family-centered nursing (FCN) is expected to empower patients and families to manage hypertension and improve functional abilities.

Methods: A quasi-experimental design with a non-equivalent control group was applied to evaluate the effect of Family-Centered Nursing (FCN)-based education on Activities of Daily Living (ADL) among elderly hypertensive patients. 64 participants meeting the inclusion criteria were selected using simple random sampling from the Rubaru Community Health Center, Indonesia. Data were collected using the validated Barthel Index questionnaire and analyzed with the Wilcoxon and Mann–Whitney tests using SPSS version 25.

Results: Based on the paired t-test, the daily living activities score, p-value <.001, and the Independent test, p-value < .001 was obtained for both the control and treatment groups. This demonstrates the influence of family-centered nursing education on the independence of daily living activities of hypertension sufferers in the work area of the Rubaru Community Health Center.

Conclusion: Family-centered nursing education has an impact and is effective on the daily living activities of older people with hypertension in the Rubaru Community Health Center (Puskesmas) area. It is recommended that the Community Health Center integrate family-based education programs into routine health services for the elderly.

Behavior Disorders in Early Childhood and Maternal Anemia History: A Cross-Sectional Study in Indonesia

Noviana Dewi, Almas Awanis, Sevy Astriyana, Anniez Rachmawati Musslifah — Fri, 07 Nov 2025 00:00:00 +0700

Background: Anemia is a health condition caused by genetic factors, infectious disorders, and the environment. Lead exposure increased the risk of anemia, with several sources including cigarette smoke, motor vehicle exhaust, pesticide residues, and contamination from synthetic textile dyes. Mothers with anemia frequently give birth to children who also experience the same condition, thereby disrupting growth and development and causing behavioral disorders. Therefore, this study aimed to examine the relationship between maternal anemia and behavioral disorders in early childhood in areas with high lead exposure.

Methods: A cross-sectional analysis was conducted, and samples were selected using purposive non-random sampling. This study included 16 early childhood education (PAUD) students, 16 parents, and 4 PAUD teachers. Data analysis included descriptive and correlational analyses using SPSS 23.

Results: The results showed a correlation between maternal hemoglobin levels and emotional and behavioral disorder scores (-0.508, p < 0.05), as well as autism risk detection (-0.610, p < 0.05). There was also a correlation between the pre-screening child development questionnaire and autism risk detection scores (-0.525, p <0.05)..

Conclusion: Mothers with anemia tend to give birth to children who also develop the same condition. The condition disrupts growth and development in children, contributing to behavior disorders.

Body Mass Index, Glucose, and Triglycerides as Predictors of HbA1c Control in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Farida Anwari, Amellya Octifani — Fri, 07 Nov 2025 00:00:00 +0700

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease with rising global and national prevalence. Glycemic control, measured by glycated hemoglobin (HbA1c), is essential to prevent complications. Previous studies showed inconsistent findings on the effects of age, gender, body mass index (BMI), and triglycerides on HbA1c levels, with limited use of logistic regression. This study examined the influence of age, gender, BMI, glucose, and triglyceride levels on HbA1c control in Indonesian patients with T2DM.

Methods: A cross-sectional study was conducted using secondary medical records of 55 T2DM patients treated at RA Basoeni Clinic, Mojokerto, Indonesia, in 2024. Inclusion criteria included patients aged ≥18 without anemia or hemoglobinopathy; patients with incomplete data were excluded. HbA1c values were estimated from average fasting and postprandial glucose over the past three months using the American Diabetes Association (ADA) 2019 conversion table. HbA1c status was categorized as controlled (≤6.5%) and uncontrolled (>6.5%). Logistic regression analysis was performed using SPSS version 25.0. The study adhered to STROBE reporting guidelines.

Results: Of the 55 patients, 24 (43.6%) had controlled HbA1c and 31 (56.4%) had uncontrolled HbA1c. Logistic regression showed that BMI (OR=1.192, p=0.047), glucose (OR=1.026, p=0.044), and triglycerides (OR=1.017, p=0.049) significantly predicted HbA1c status. Age (p=0.837) and gender (p=0.884) were not significant predictors. The model explained 68.9% of the variance (Nagelkerke R²=0.689) with an overall classification accuracy of 83.6%..

Conclusion: BMI, glucose, and triglycerides are significant predictors of HbA1c control in T2DM patients, while age and gender are not. To improve glycemic outcomes, clinical management should prioritize weight regulation, glucose monitoring, and triglyceride control.

Implementing the KiVA Program to Prevent Bullying: A Qualitative Phenomenological Study in Indonesian Elementary Schools

Rachmawaty M.Noer, Mira Agusthia, Kiki Rizki Dasaryandi, Yulianti Wulandari — Fri, 07 Nov 2025 00:00:00 +0700

Background: Bullying in Indonesian schools remains a major issue affecting children’s psychological, social, and academic well-being. Reports from KPAI and UNICEF indicate that prevention at the elementary level remains inadequate. While most studies focus on punishment and counseling, research on community-based programs such as the KiVA Method—promoting awareness, empathy, and conflict management—is limited, underscoring the need to explore their application in Indonesia’s socio-cultural context.

Methods: This study employed a qualitative case study approach to explore the experiences of teachers, counselors, students, and parents in implementing the KiVA Method. Participants were selected purposively, including those actively involved in or experienced with the program for at least one semester. Individuals who were not actively participating or had communication barriers were excluded. Of 30 invited participants, 25 met the criteria and agreed to join, while 5 declined due to time, unwillingness, or health issues. Data were gathered through 45–60-minute interviews and field observations, with official approval from the Education Office and the school. Thematic analysis using NVivo 12 followed COREQ guidelines to ensure research transparency and credibility.

Results: Of the 25 participants, consisting of 8 teachers, 4 counselors, 10 students, and 3 parents, it was found that implementing the KiVA Method increased school community awareness of bullying behavior, strengthened social empathy, and encouraged positive student interactions. Teachers and counselors reported a significant decrease in bullying incidents, while students felt safer and more supported in an inclusive learning environment. Thematic analysis revealed four main themes: increased social-emotional literacy, changes in classroom communication patterns, strengthening teachers' roles as empathetic facilitators, and parental support for implementing anti-bullying values.

Conclusion: The research results indicate that the KiVA Method positively contributes to building collective awareness of bullying, strengthening empathy among school members, and creating a supportive and inclusive learning climate. However, the program's long-term effectiveness requires further research with a longitudinal design and a cross-school comparative approach to assess its sustainability in Indonesia's primary education context.

Effect of the Antenatal Care Group Model on Childbirth Preparedness among Pregnant Women: A Quasi-Experimental Study

Kurniawan Dewi Budiarti, Eti Sulliyawati, Sulastin Sulastin, Suci Badriyah — Fri, 07 Nov 2025 00:00:00 +0700

Background: Childbirth preparedness is essential to prevent complications and improve the safety of both mothers and infants. Knowledge, attitudes, and social support strongly influence maternal readiness. Group antenatal care (ANC) has been shown to enhance maternal engagement, but most studies have focused on face-to-face services. However, limited studies have examined digital ANC groups in Indonesian primary care settings. Therefore, this study aimed to analyze the effect of WhatsApp-based group ANC on maternal readiness for childbirth..

Methods: This study employed a quasi-experimental pre–post design with a control group, following the TREND reporting guideline. A total of 40 pregnant women in their second or third trimester were purposively selected. Inclusion criteria were residence in Samarang, no medical complications, and willingness to participate; exclusion criteria included refusal or diagnosed complications. The instrument was a validated childbirth preparedness questionnaire (15 items, Cronbach’s alpha = 0.87). The intervention was delivered via a WhatsApp group over two weeks (six sessions), facilitated by trained midwives using validated materials. Data were analyzed using independent t-tests after testing normality and homogeneity, with a significance level of 0.05, 95% confidence interval (CI), and effect size calculated using Cohen’s d.

Results: The mean preparedness score was higher in the experimental group (58.80 ± 5.01) compared to the control group (54.35 ± 6.43). The mean difference of 4.45 points was statistically significant (p < 0.001; 95% CI [2.1–6.7]) with a moderate-to-large effect size (Cohen’s d = 0.78). These findings indicate that WhatsApp-based ANC groups significantly improved maternal knowledge and childbirth preparedness..

Conclusion: WhatsApp-based group ANC effectively enhances maternal childbirth preparedness and is feasible for implementation as a maternal health education strategy in primary care settings.

Determinants of Psychological Disorders Among Pregnant Women in Indonesia: A Cross-sectional Study on The Roles of Social Support, Parity, and Anxiety

Astrida Budiarti, Puji Hastuti, Iis Fatimawati, Rahmah Sulistyawati — Fri, 07 Nov 2025 00:00:00 +0700

Background: Pregnancy involves physical and emotional changes that can impact a woman's psychological well-being. However, few studies have explored the combined influence of social support, parity, and anxiety on psychological disorders among pregnant women in Indonesia. This study aimed to examine the relationship between social support, parity, and anxiety with psychological disorders among pregnant women in Indonesia.

Methods: A cross-sectional study was conducted among 114 pregnant women attending antenatal care at East Java, Indonesia, community health centers. Participants were selected using a simple random sampling technique. Inclusion criteria were pregnant women living with their husbands or family members, while those who declined participation were excluded. Data were collected using the Multidimensional Scale of Perceived Social Support (MSPSS), Depression Anxiety Stress Scale-21 (DASS-21, anxiety subscale), and the Antenatal Risk Questionnaire (ANRQ). Data were analyzed using descriptive statistics and Spearman’s rho correlation. This study complied with the STROBE reporting guidelines.

Results: Most respondents were aged 24–29 years (43.9%), had senior high school education (75%), were housewives (54.4%), and had moderate family income (46.5%). The results showed that low social support (p = 0.002), being multiparous (p = 0.003), and higher anxiety levels (p = 0.001) were significantly associated with increased psychological disorder risk. Women with low social support or severe anxiety had the highest risk. Multiparous women were more likely to report psychological distress compared to primiparous women. Social support, parity, and anxiety were significant factors associated with psychological disorders during pregnancy.

Conclusion: Mental health should be an integral part of antenatal care. These findings underscore the need to integrate mental health screening and family-based support into routine antenatal care to improve maternal psychological well-being.

The Comparative Effects of Hatha Yoga and Prenatal Exercise on Physiological and Psychological Outcomes in Primigravid Women: A Randomized Controlled Trial

Sat, 15 Nov 2025 00:00:00 +0700

Background: Primigravid women are prone to stress due to physical and psychological changes during pregnancy, which can lead to hypertension, preeclampsia, preterm birth, fetal growth restriction, and postpartum depression. While non-pharmacological interventions like hatha yoga and prenatal exercise are used to reduce stress, comparative evidence—especially on oxygen saturation (SpO₂)—is limited. This study analyzes the effects of hatha yoga and prenatal exercise on stress, blood pressure, and SpO₂ among primigravid women, and compares both interventions across these outcomes.

Methods: This randomized controlled trial (RCT) followed the CONSORT 2010 guidelines. Forty-eight eligible primigravid women were selected using a probability sampling technique, specifically the simple random sampling method. Random numbers were generated using Microsoft Excel to determine participant selection from the maternal cohort register. Inclusion criteria were a normal singleton pregnancy at 24–28 weeks of gestation, maternal age 20–35 years, and normal Body Mass Index (BMI) (18.5–24.9 kg/m²). Exclusion criteria included regular exercise more than twice a week, abnormal fetal heart rate, and scheduled elective cesarean delivery. Participants were randomly assigned to either a hatha yoga group or a prenatal exercise group (24 each). Both interventions were conducted twice weekly for four weeks. Data were analyzed using the Wilcoxon and Mann–Whitney tests.

Results: Data were analyzed using the Wilcoxon and Mann-Whitney tests. Median stress scores decreased from 22 to 12 in the hatha yoga group and from 22 to 17 in the prenatal exercise group (p < 0.001). Median SpO₂ increased from 96.88% to 98.38% and from 96.81% to 97.00%, respectively (p = 0.002). Median systolic pressure changed from 120.06 to 121.31 mmHg and 118.75 to 117.44 mmHg (p = 0.009), while diastolic pressure showed no significant difference (p = 0.076). Overall, hatha yoga showed greater improvements in stress, SpO₂, and blood pressure stability than prenatal exercise.

Conclusion: Hatha yoga proved more effective than prenatal exercise in reducing stress, increasing SpO2, and stabilizing systolic blood pressure among primigravid women, although no significant difference was found in diastolic pressure. These findings strengthen the evidence supporting yoga as a safe, non-pharmacological approach to enhance maternal physiological and psychological well-being during pregnancy.

The Experience of Nurses Transitioning to Primary Nursing in Indonesia: A Hermeneutic Phenomenological Study

Septyarani Sitanggang, Gilny Aileen Joan Rantung — Sat, 15 Nov 2025 00:00:00 +0700

Background: Primary nursing is promoted globally for better continuity, accountability, and engagement,, butthere is limitede is limited evidence from Indonesia on nurses' transition from team to primary care. This study explored the lived experiences of nurses transitioning from team nursing to primary nursing in Indonesia, aiming to understand how they adapt, the barriers they encounter, and the impact of this shift on nurse–patient relationships.

Methods: A qualitative approach was used, employing Van Manen’s hermeneutic phenomenology. Ten registered nurses working in medical–surgical wards of a tertiary hospital in Bandung, Indonesia, were purposively sampled. Inclusion criteria included registered nurses with experience in both team and primary nursing models. Nurses in managerial roles without bedside duties were excluded. Data were collected through in-depth semi-structured interviews lasting 45–60 minutes, conducted face-to-face or via secure online platforms. These interviews were audio-recorded, transcribed verbatim, and member-checked. Analysis followed Van Manen’s reflective approach, with thematic analysis supported by NVivo (QSR International, version 12) for data organization. Trustworthiness was maintained through audit trails, reflexivity, peer debriefing, and thick description. Ethical approval was obtained (No. 513/KEPK-FIK.UNAI/EC/VI/25). Reporting followed COREQ.

Results: Three themes emerged: (1) Readiness and adaptation to change, where nurses emphasized mindset and gradual learning as essential to adaptation; (2) Challenges in practice and system limitations, including high nurse-to-patient ratios, administrative burden, delayed support services, and training misaligned with practice; and (3) Strengthened nurse–patient relationships, reflecting improved trust, openness, and professional accountability, which sustained motivation despite systemic barriers.

Conclusion: This study reveals how Indonesian nurses manage transitioning to primary nursing. Despite systemic challenges that affect continuity and workload, nurses' commitment and strong patient ties sustain their efforts. The findings highlight the importance of aligning training with practice, improving staffing ratios, and ensuring consistent patient assignments to support primary nursing

Profile of Post-Ischemic Stroke Patients: A Retrospective-Crossectiona

Agus Yudawijaya, Patria Adri Wibhawa, Febriani S. — Sat, 15 Nov 2025 00:00:00 +0700

Background: Stroke remains a major health issue in Indonesia, with ischemic stroke being the most common type. Evidence on the demographic characteristics and risk factors of post-ischemic stroke patients in outpatient settings is still limited, indicating a gap in secondary prevention efforts. This study aimed to describe the profiles of post-ischemic stroke patients treated at the neurology outpatient unit of Dr. Suyoto Hospital between December 2023 and December 2024.

Methods: This study employed a retrospective descriptive-analytical design using patient medical records. The study population was all patients with post-ischemic stroke treated in the neurology outpatient clinic during the study period. Inclusion criteria were patients aged ≥18 years with a confirmed diagnosis of ischemic stroke documented in their medical records, while exclusion criteria included incomplete or missing records and concomitant neurodegenerative disorders. A total of 115 patients met the requirements. Data analysis included descriptive univariate statistics and bivariate analysis (Chi-square and Fisher’s exact test) to assess associations between demographic characteristics and risk factors. The study followed the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guideline for observational research reporting..

Results: The study found that age over 65 years (35.7%), male sex (66.1%), and hypertension (78.3%) were predominant. Other risk factors included obesity (45.2%), total cholesterol above normal (53.9%), LDL cholesterol above normal (66.1%), normal HDL cholesterol (58.3%), normal triglyceride cholesterol (62.6%), hyperglycemia (59.1%), and hyperuricemia (55.7%). Most patients had no prior history of heart disease (65.2%).

Conclusion: This study concludes that uncontrolled risk factors in post-ischemic stroke patients, namely hypertension, obesity, elevated total cholesterol, high LDL cholesterol, hyperglycemia, and hyperuricemia, contribute to the risk of recurrent stroke and require more effective outpatient management strategies.

Effectiveness of Lemongrass (Cymbopogon citratus) Decoction as a Non-Hormonal Therapy for Preventing Early Menopause Among Women Aged 40–45 Years in Indonesia: A Randomized Controlled Trial

Sat, 15 Nov 2025 00:00:00 +0700

Background: Early menopause (before age 45) increases risks of osteoporosis, cardiovascular disease, and reduced quality of life. Although hormonal therapy is effective, its adverse effects have driven interest in safer alternatives. However, evidence on community-based herbal interventions for preventing early menopause is scarce in Indonesia. This study examined the effectiveness of Cymbopogon citratus (lemongrass) decoction as a low-cost, non-hormonal preventive therapy for early menopause.

Methods: This parallel two-arm randomized controlled trial, conducted in Perbulan Village, Karo Regency, involved 30 women aged 40–45 years, randomly assigned to an intervention group receiving lemongrass decoction and a control group. Participants consumed 250 ml of decoction daily for 30 days. Menopausal symptoms were measured using the Menopause Rating Scale (MRS) and menstrual cycle regularity was recorded. Data were analyzed with the Mann–Whitney U test following the CONSORT 2010 guidelines, with statistical significance set at p < 0.05 and 95% confidence intervals (CI) reported. Ethical approval was obtained from the institutional review board.

Results: Mean MRS scores in the intervention group decreased significantly from 20.5 ± 2.0 to 13.4 ± 1.6 (p < 0.001, 95% CI [5.7, 8.4], d = 1.45, large effect), while the control group showed no significant change. Menstrual cycle regularity improved in 73.3% of intervention participants compared with 13.3% in controls (p < 0.001). Compliance was high (86.7%) and no adverse events were reported.

Conclusion: Lemongrass decoction effectively reduced menopausal symptoms and regulated menstrual cycles, supporting its use as a safe, acceptable, and affordable non-hormonal option for community-based women’s health promotion. The findings suggest potential integration of herbal therapy education into midwifery and public health programs to strengthen preventive reproductive care.

Cultural and Academic Adaptation Experiences of Timor-Leste Nursing Students in Indonesian Universities: A Qualitative Phenomenological Study

Sat, 15 Nov 2025 00:00:00 +0700

Background: International education is rapidly expanding, with more students seeking study opportunities abroad. Timor-Leste students in Indonesia often face challenges involving language, academic expectations, and cultural adjustment. However, limited studies have explored their lived experiences. This study aims to explore the cultural and academic adaptation of Timor-Leste students in Indonesian universities.

Methods: This study employed a qualitative phenomenological design using Colaizzi’s approach. The population comprised Timor-Leste students currently studying at Indonesian universities. Participants were selected using purposive sampling, with inclusion criteria focusing on students who had studied for at least one academic year, while those with less than six months of experience were excluded. A total of ten participants were included. Data were collected through semi-structured interviews and direct observations. Instruments included an interview guide validated through expert review. Ethical approval number 3470/UN25.8/KEPK/DL/2025. Given that the study was interview-based, its design, conduct, and reporting adhered strictly to the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure transparency, reflexivity, and rigor in qualitative interview research. Data were analyzed following Colaizzi’s seven-step method.

Results: Thematic analysis revealed three core themes: (1) Cultural and academic shock — students experienced challenges adapting to local customs, social norms, and complex academic language; (2) Differences in learning systems — participants struggled with the shift from teacher-centered to independent learning approaches; and (3) Coping and adaptation strategies — students demonstrated resilience through peer networks, social engagement, and self-adjustment. These themes collectively highlight the dynamic process of cross-cultural adaptation among Timor-Leste students in Indonesian universities.

Conclusion: Timor-Leste students in Indonesia encounter significant cultural and academic adaptation challenges. Universities should strengthen inclusive support through structured orientation, language assistance, intercultural mentorship, and psychosocial programs to enhance their academic success and well-being.

Effectiveness of Game Health Education Anemia (GHEA) Guided by the Health Belief Model on Improving Knowledge and Attitudes Toward Iron-Deficiency Anemia Prevention Among Adolescent Girls: A Quasi-Experimental Study

Imam Nur Fauzi, Kumboyono Kumboyono, Fransiska Imavike Fevriasanty — Sat, 15 Nov 2025 00:00:00 +0700

Background: Iron-deficiency anemia (IDA) remains a significant health problem among adolescent girls, affecting growth, academic achievement, and reproductive health. Traditional education methods like lectures and booklets are often less engaging and ineffective in changing behavior. Few studies have tested gamified, theory-based health education for anemia prevention in Indonesian adolescents. This study evaluated the effectiveness of the Game Health Education Anemia (GHEA) compared with a Digital Pocket Book in improving knowledge and attitudes toward IDA prevention among adolescent girls.

Methods: A quasi-experimental study, guided by the Health Belief Model (HBM) and reported according to the TREND checklist, was conducted at SMP Islam Ma’arif 02 Malang, Indonesia, in June 2025. Sixty female adolescents were selected through purposive sampling based on power analysis (effect size = 1.12, α = 0.05, power = 0.95). Inclusion criteria were female students aged 12–18 years, healthy, and owning a digital device; exclusion criteria were prior exposure to digital anemia education or incomplete participation. Participants were equally assigned to an intervention group (GHEA) and a control group (the Digital Pocket Book). Data were collected using a validated questionnaire and analyzed with Wilcoxon signed-rank, paired t-, and Mann–Whitney U tests at a 0.05 significance level.

Results: The mean age of participants was 14 years (range 13–15). The GHEA group showed significant improvements in knowledge (Z = -4.847, p < 0.001) and attitudes (Z = -4.275, p < 0.001), while the control group showed smaller yet significant gains. Between-group analysis revealed higher post-test scores in the intervention group for both knowledge (Z = -5.284, p < 0.001) and attitudes (Z = -3.081, p = 0.002).

Conclusion: The GHEA intervention was more effective than the Digital Pocket Book in improving adolescents’ knowledge and attitudes toward IDA prevention, indicating that gamification-based education can serve as an engaging and effective tool for school-based health promotion

Interactive Counseling Skills Method to Improve Parental Compliance and Self-Efficacy in Child Tuberculosis Prevention Therapy: A Mixed Methods Study

Ethyca Sari, Martha Lowarni Siagian, Devi Aprilia — Fri, 21 Nov 2025 00:00:00 +0700

Background: Tuberculosis (TB) is transmitted through saliva droplets containing Mycobacterium tuberculosis. TB Preventive Therapy (TPT) is provided to individuals infected with M. tuberculosis who do not show symptoms of active disease, particularly as part of a child contact investigation. The success of TPT largely depends on parental self-efficacy and adherence in supporting their children throughout therapy. The Interactive Counseling Skills (ICS) strategy is proposed to strengthen these factors. The aim is to examine the effect of ICS on parents’ self-efficacy and adherence in accompanying their children during TPT..

Methods: This study used a mixed-methods approach with quantitative and qualitative data, applying a sequential explanatory design. Sampling was conducted using a quasi-experimental method with a total of 60 participants divided into intervention and control groups. Instruments used included questionnaires and interview guides, with validity tested through Cronbach’s Alpha and triangulation. Data analysis was conducted using the Paired T-Test/Wilcoxon test and thematic analysis.

Results: The findings showed a significant increase in parental self-efficacy (p = 0.001) and treatment adherence (p = 0.002) in the intervention group compared to the control group. Qualitative findings supported the quantitative results, with parents in the intervention group stating that the interactive counseling sessions provided them with a better understanding of TB, increased their confidence in supporting the therapy process, and helped them understand the importance of regular TPT administration after attending the ICS sessions.

Conclusion: This study demonstrates strong convergence, where the parents’ experiential narratives reinforce significant statistical data. The intervention not only increased self-efficacy and adherence rates but also fostered changes in attitude, understanding, and confidence. It is necessary to develop ICS training modules for healthcare workers so that this intervention can be implemented sustainably and consistently within family-based health services

Comparative Effectiveness of Haruan and Salmon Fish Extracts in Preventing Stunting Among Toddlers: A Quasi-Experimental Study

Widya Warastuti, Tri Ratna Ariestini, Fetty Rahmawati, Elisa Elisa — Fri, 21 Nov 2025 00:00:00 +0700

Background: Stunting, a condition characterized by impaired growth and short stature in toddlers resulting from chronic malnutrition, remains a primary health concern in Indonesia, including Central Kalimantan. A significant contributing factor is the inadequate consumption of animal protein. Fish, such as haruan (Channa striata) and salmon, are excellent sources of protein and essential nutrients crucial for growth. However, comparative studies examining the efficacy of the local haruan fish extract and imported salmon fish extract in preventing stunting are scarce. This study aims to compare the effectiveness of these two fish extracts among toddlers in the operational area of the Pahandut Community Health Center, Palangka Raya City.

Methods: This quasi-experimental study followed TREND reporting guidelines. The study involved 100 toddlers, selected by purposive sampling based on specific inclusion/exclusion criteria. Participants were divided into two groups: one group receiving haruan fish extract and the other group receiving salmon extract. The intervention was conducted for three months (June to August 2023). Anthropometric measurements of mid-upper arm circumference (MUAC), body length, and body weight were taken monthly. Data were analyzed using the Wilcoxon Signed-Rank Test and the Mann-Whitney U Test.

Results: The Wilcoxon Signed-Rank Test showed that both haruan and salmon fish extracts significantly increased MUAC, Body Length, and Body Weight in each group (p < 0.001). The average increase in MUAC was 0.8 cm for the haruan group and 0.9 cm for the salmon group. However, the Mann-Whitney U Test did not show a statistically significant difference between the two treatment groups in terms of increases in MUAC (p = 0.452) and Body Weight (p = 0.387). These findings indicate that both extracts are equally effective in improving the nutritional status of stunted children.

Conclusion: Haruan and salmon fish extracts are equally effective in improving the anthropometric status of stunted toddlers, suggesting that locally sourced haruan can serve as a cost-effective, sustainable alternative to imported salmon in stunting prevention programs.

Effects of Audiovisual Education on Community Knowledge of Snakebite Management

Fri, 21 Nov 2025 00:00:00 +0700

Background: Snakebites are an emergency that can cause death if not treated immediately. Lack of community knowledge on first aid for snakebites can increase the incidence of infection or death. Education is needed to improve community knowledge. However, community education using audiovisual methods for snakebite prevention remains limited. The purpose of this study was to analyze the effects of audiovisual education on knowledge of handling snakebites in the community at UPT Puskesmas Kepanjenkidul, Blitar City.

Methods: A quasi-experimental one-group pre–posttest design was used. Participants were ≥18 years old community members recruited from the outpatient registry using simple random sampling. A validated 15-item knowledge questionnaire was administered before and after a 5-minute audiovisual educational intervention. Inclusion criteria: consent to participate; exclusion: prior training on snakebite management. Data was collected using a knowledge questionnaire used to assess community knowledge regarding snakebite management. The study reporting followed the TREND Statement for non-randomized evaluations of behavioral interventions. Data were analyzed using the Wilcoxon rank test with α < 0.05..

Results: The level of knowledge of handling snakebites before education was in the fair category for most of the respondents (45 respondents or 51.1%). After education, almost all respondents (80 respondents or 90.9%) had a good level of knowledge. Results of the Wilcoxon test showed a p < 0.001.

Conclusion: Health education using audiovisual media influences knowledge of handling snakebites. Audiovisual media can display elements of images and sound simultaneously in conveying information. Video media in the learning process is more effective in increasing knowledge. Thus, health workers are expected to provide education using audiovisual media since it is easy to receive and understand by the community.

Effectiveness of Foot Soaking Therapy Using Lemongrass (Cymbopogon citratus) Decoction to Reduce Blood Pressure among Pregnant Women with Mild Hypertension

Fri, 21 Nov 2025 00:00:00 +0700

Background: Hypertension in pregnancy is a major contributor to maternal morbidity and mortality. Pharmacological therapy is common; however, evidence on safe and affordable non-pharmacological alternatives—such as lemongrass (Cymbopogon citratus) foot soaking—remains limited among pregnant women. Lemongrass contains citral and flavonoids that promote vasodilation and relaxation, potentially reducing blood pressure..

Methods: A quasi-experimental one-group pretest–posttest design following the TREND guideline was conducted at Sarfina Primary Outpatient Clinic, Medan, Indonesia (February–April 2025). Thirty pregnant women with mild hypertension (140–159/90–99 mmHg) participated voluntarily after providing informed consent. Exclusion criteria were preeclampsia, chronic illness, or lemongrass allergy. Participants soaked their feet daily for 15 minutes in 1 L of warm lemongrass decoction (38–40 °C) for four weeks. Blood pressure was measured twice using a validated Omron HEM-7130 device, and the mean was analyzed with the Wilcoxon signed-rank test.

Results: Mean systolic pressure decreased from 147.6 ± 5.8 mmHg to 132.4 ± 6.3 mmHg, and diastolic pressure from 93.8 ± 3.9 mmHg to 83.7 ± 4.2 mmHg (Z = –3.21, p < 0.001). The effect size (r = 0.59; 95% CI [–18.5, –11.3]) indicated a moderate clinical effect

Conclusion: Lemongrass foot soak therapy effectively lowers mild hypertension in pregnancy through vasodilatory and relaxation mechanisms. It represents a safe, simple, and culturally appropriate complementary method that midwives can integrate into antenatal care. Larger controlled trials are recommended to confirm its long-term efficacy.

Effectiveness of Foxy Oil Combined with Oxytocin Massage on Breast Milk Production among Postpartum Mothers in Indonesia: A Quasi-Experimental Study

Fri, 21 Nov 2025 00:00:00 +0700

Background: Optimal breast milk production meets infants’ nutritional needs, crucial in stunting prevention. Many postpartum mothers face insufficient milk production, which can affect infant weight gain and increase the risk of stunting. The innovation of combining oxytocin massage with Foxy Oil is expected to enhance breast milk volume, frequency of wet diapers, and infant weight gain—key indicators in stunting prevention.

Methods: This study used a quasi-experimental design with purposive sampling, involving 60 postpartum mothers: 30 in the intervention group and 30 in the control group. Statistical analyses were conducted using SPSS 26 for univariate and bivariate data. Data normality was tested using the Kolmogorov-Smirnov test and bivariate analysis with the Mann-Whitney test. Breastfeeding optimisation was assessed based on breast milk volume, number of wet diapers, and infant weight over one month in the working area of Tanjung Morawa Community Health Centre. The husband or a close family member performed an Oxytocin massage twice daily for 10–15 minutes.

Results: Bivariate analysis after oxytocin massage showed significant effects on breast milk volume (p = 0.000), number of wet diapers (p = 0.000), and infant weight (p = 0.039). The analysis indicates that the combination of Foxy Oil and oxytocin massage positively affects breast milk production, frequency of wet diapers, and infant weight gain.

Conclusion: Foxy Oil's innovation, combined with oxytocin massage, can be widely applied in midwifery practice to support successful exclusive breastfeeding and contribute to stunting prevention.

Effectiveness of Health Belief Model–Based Psychoeducation in Enhancing Adolescent Mental Health Accessibility

Fri, 21 Nov 2025 00:00:00 +0700

Background: Adolescent mental health is a growing public health concern, yet behavioral interventions addressing help-seeking barriers remain limited in low-resource settings. While the Health Belief Model (HBM) has been extensively applied to physical health behaviors, its relevance for improving mental health accessibility among adolescents is underexplored. This study aimed to evaluate the effectiveness of HBM-based psychoeducation in enhancing adolescents’ self-awareness, self-efficacy, and emotional regulation.

Methods: A quantitative pre-experimental two-group pretest–posttest design was conducted in Bangun Rejo Village, North Sumatra, Indonesia, following the TREND reporting guideline for non-randomized evaluations. Participants included 50 adolescents aged 12–16 years, selected through cluster sampling. Inclusion criteria were residence for at least six months and parental consent, while adolescents with prior psychiatric treatment were excluded. Data were collected using an HBM-based Mental Health Accessibility Questionnaire (Cronbach’s α = 0.87), with self-awareness and self-efficacy as independent variables and mental health accessibility as the dependent variable.

Results: The experimental group showed a higher posttest score (87.60 ± 7.45; 95% CI [84.51, 90.69]) compared to the control group (76.48 ± 11.98; 95% CI [71.58, 81.38]). Between-group differences were significant (t(48) = 3.75, p < 0.001, Cohen’s d = 1.06), indicating a large effect size..

Conclusion: HBM-based psychoeducation effectively enhances adolescents’ accessibility to mental health services by improving self-awareness, self-efficacy, and emotional regulation. The findings support incorporating HBM-based approaches into school and community health programs as low-cost, culturally adaptable strategies to promote adolescent mental health in resource-limited settings.

The Relationship Between Work Environment, Occupational Safety and Health Implementation, and Employee Performance: A Cross-Sectional Study

Vidi Posdo A. Simarmata, Randolph Serep Marantuan, Patar Hutagalung — Fri, 21 Nov 2025 00:00:00 +0700

Background: A safe and comfortable work environment, along with effective OHS implementation, is essential for maintaining healthcare personnel productivity and performance; however, studies on the combined effect of both on employee performance in community health centers remain limited. At the same time, inadequate facilities, inconsistent procedural compliance, and minimal OHS socialization continue to hinder optimal service delivery. This study aims to analyze the relationship between the work environment and OHS implementation on employee performance at the East Bogor Community Health Center.

Methods: A quantitative, correlational analytical design was employed, involving all 51 employees of the East Bogor Community Health Center as the total population sample. Data were collected through a structured and validated questionnaire, which was tested for reliability using Cronbach’s alpha (α > 0.80). The questionnaire measured three primary variables: work environment, OHS implementation, and employee performance. Data were analyzed using Pearson correlation and multiple linear regression at a 95% confidence level, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines..

Results: The findings revealed a positive and statistically significant relationship between the work environment and employee performance (p = 0.012; r = 0.412, indicating a moderate correlation), as well as between OHS implementation and employee performance (p = 0.008; r = 0.436, also moderate). Together, both variables explained 38% of the variance in employee performance (R² = 0.38), suggesting that improvements in environmental and safety management factors can meaningfully enhance staff outcomes.

Conclusion: A conducive work environment and sound OHS implementation jointly contribute to improved employee performance at the East Bogor Community Health Center. Management is recommended to strengthen OHS policies, improve work facilities, and enhance safety training to support optimal performance among healthcare workers.

Effectiveness of Mind–Body–Based Psychoeducation in Strengthening Midwives’ Role and Enhancing Breastfeeding Self-Efficacy Among Postpartum Mothers: A Quasi-Experimental Study

Sun, 30 Nov 2025 00:00:00 +0700

Background: Breast milk is the best nutrition for babies and has long-term benefits for both mother and child health. A critical factor in successful breastfeeding is breastfeeding self-efficacy (BSE), a mother's confidence in her ability to breastfeed.

Methods: This quasi-experimental study employed a pre-test and post-test design with a control group and purposive sampling. The sample comprised 60 postpartum mothers: 30 in the intervention group and 30 in the control group. The intervention involved using the PIANA application for four weeks. Statistical tests were performed using SPSS 26 for univariate and bivariate data analysis. Outcomes were measured using the Wilcoxon and Mann-Whitney U tests to assess whether psychoeducation could increase postpartum mothers' confidence in breastfeeding.

Results: Bivariate analyses of the variables were conducted using statistical tests after the application, namely the Midwife's Role variable (p = 0.023), the Psychoeducation variable (p = 0.032), and the BSE variable (p = 0.012). The results of the bivariate analysis of the three variables showed that the Midwife's Role with BSE psychoeducation positively affected postpartum mothers' confidence in breastfeeding.

Conclusion: Psychoeducational applications using a mind-body approach have been shown to improve breastfeeding self-efficacy in postpartum mothers. Optimizing the role of midwives through this medium can serve as an effective, flexible educational tool to support postpartum mothers in achieving breastfeeding success.

Development of a Community-Based Early Warning System (EWS) Model For Stunting Prevention in Nutritional Status Among Children Under Five Years

Apriyani Puji Hastuti, Shinta Wahyusari, Aldila Eka Servitia — Sun, 30 Nov 2025 00:00:00 +0700

Background: Stunting is one of the problems in the context of the triple burden of disease. Growth conditions below standard indicate growth obstacles in the child. This research aims to analyse the factors that influence EWS and to evaluate the application of the EWS model in improving nutritional status in toddlers. The purpose of the study is to develop an EWS for nutritional status in children.

Methods: This research used an explanatory design to determine EWS; quasi-experimental sampling was randomised (multistage random design) with 180 respondents in stage 1 and 38 respondents in stage 2—inclusion criteria: mothers who have children and are raising their own child. The research was conducted in the public health sector of Malang Regency. Data collection will be done using a questionnaire for each variable. Data analyzed with Partial Least Square, Wilcoxon Signed Rank Test, and Mann Whitney The results of this study showed that determining factors of EWS were body weight (X1.3), height (X1.4), birth length (X1.6), history of infection (X1.7), minimal weight gain (X1. 11), participation in integrated health service (X2.2), history of maternal infection (X3.2), birth interval (X3.3), land use (X4.2), food hygiene (X5.2), complementary feeding (X6. 1), responsive feeding (X6.2)..

Results: The EWS model's effectiveness is associated with minimal weight gain in children (ρ<0.001), but not with nutritional status (ρ=1.000) or upper arm circumference (ρ=0.207).

Conclusion: It is hoped that the development of this model can be an intervention with an integrated approach to improve the minimal weight gain which in the long term may enhance nutritional status.of children under five.

Flexible Work Shift Policy, Burnout, and Performance among Hospital Administrative Staff: A Cross-Sectional Correlational Study

Miftahul Jannah, Arianus Zebua — Sun, 30 Nov 2025 00:00:00 +0700

Background: Flexible work shift policies are increasingly adopted to promote employee well-being and productivity. However, empirical evidence regarding their impact on burnout and job performance among non-medical hospital staff in Indonesia remains limited, creating a gap in understanding how such policies function in this context. This study aimed to analyse the effects of flexible work-shift policies on burnout and performance among administrative staff at Medan Adventist Hospital.

Methods: A cross-sectional correlational design was used, following the STROBE reporting guideline, involving 50 administrative employees selected through saturated sampling. Instruments included the Flexible Work Shift Questionnaire, Maslach Burnout Inventory, and a performance questionnaire based on Robbins’ theory. All tools demonstrated acceptable validity and reliability. Data analysis employed Pearson correlation with a significance level of p < 0.05, accompanied by effect size (r²) calculations.

Results: Flexible work shifts were negatively associated with burnout (r = –0.512, p = 0.001, r² = 0.26) and positively associated with performance (r = 0.628, p < 0.001, r² = 0.39). Burnout also showed a negative correlation with performance (r = –0.473, p = 0.002, r² = 0.22)..

Conclusion: Flexible work shift policies significantly reduce burnout and enhance job performance. These findings highlight the value of structured, well-supervised flexibility as an evidence-based HR strategy that supports employee well-being and strengthens hospital operational quality.

Determinants of Emergency Department Length of Stay Using the Time Frame Emergency Care Model: A Retrospective Study

Lydia Maryendi Sompie, Retno Lestari, Suryanto Suryanto — Sun, 30 Nov 2025 00:00:00 +0700

Background: Timely management in the emergency department (ED) is critical for patient safety and quality of care. Prolonged Length of Stay (LOS) in the ED, often linked to delays in patient processing, can lead to poor outcomes, particularly in high-risk populations. This study aims to explore the time-related factors influencing LOS using the Time Range Guidance Model.

Methods: A retrospective cross-sectional study was conducted, analysing 377 patient records from June to August 2025. Data were extracted from electronic medical records (EMR), focusing on time intervals for initial assessment, review/consultation, and transfer phases. Multivariate regression was used to identify the factors influencing LOS.

Results: The review/consultation time (β = 0.3, p < 0.001) and transfer waiting time (β = 0.356, p < 0.001) were significant predictors of LOS. The model explained 22.6% of the variability in LOS (Adjusted R² = 0.226). Initial assessment time did not significantly correlate with LOS (r = 0.045, p = 0.321).

Conclusion: Delays in the review/consultation and transfer phases have a greater impact on ED LOS than the initial assessment. These findings suggest that optimizing these phases can improve ED efficiency and patient outcomes, particularly in resource-constrained settings such as Indonesia.

Effectiveness Of Pisbro Cookies In Improving Hemoglobin Levels Among Pregnant Women: A Quasi-Experimental Study

Sun, 30 Nov 2025 00:00:00 +0700

Background: Anemia in pregnancy remains a major cause of maternal complications, low birth weight, and stunting. Although iron–folic acid supplementation is widely implemented, there is a lack of culturally appropriate, food-based interventions using locally available ingredients that can sustainably improve hemoglobin levels in low-resource settings. This gap highlights the need for innovative, community-adaptable nutritional interventions that complement existing programs. The objective was to evaluate the effectiveness of Pisbro cookies (banana–broccoli cookies) in improving hemoglobin levels among pregnant women with anemia.

Methods: This study used a quasi-experimental two-group pretest–posttest design and followed the TREND reporting guideline. A purposive sampling method was used to recruit 40 pregnant women with mild–moderate anemia from the Sentosa Baru Health Centre, Medan. Inclusion criteria included: (1) confirmed anemia based on Hb examination, (2) gestational age 12–36 weeks, (3) willingness to participate for 30 days, (4) adherence to Fe tablet consumption. Exclusion criteria included pregnancy complications, chronic illness, allergies to ingredients, and incomplete follow-up. The intervention group received 5 Pisbro cookies/day for 30 days, while the control group received routine antenatal care without additional intervention. Hemoglobin levels were measured at baseline and after 30 days using a calibrated hemoglobin meter. Data were analyzed using an independent t-test at α = 0.05.

Results: The intervention group showed an increase in mean hemoglobin levels from 9.56 ± 0.48 g/dL to 9.79 ± 0.51 g/dL, while the control group decreased from 9.62 ± 0.47 g/dL to 9.40 ± 0.50 g/dL. The difference between groups was statistically significant (p = 0.019), indicating a positive effect of Pisbro cookies on maternal hemoglobin levels.

Conclusion: Pisbro cookies were effective in improving hemoglobin levels among pregnant women with anemia. As a low-cost, culturally acceptable food-based intervention using locally available ingredients, Pisbro has potential to complement maternal nutrition programs and support anemia and stunting prevention efforts.

Individual and Environmental Factors Associated with Pulmonary Tuberculosis: A Cross-Sectional Study in an Urban Community

Sun, 30 Nov 2025 00:00:00 +0700

Background: Tuberculosis is a contagious disease caused by the bacterium Mycobacterium tuberculosis. TB cases have increased at the Balongsari Health Center in recent years. The research aims to analyze individual and environmental factors related to pulmonary tuberculosis incidence at the center.

Methods: This study applied the STROBE guidelines. It was an analytical observational study using a cross-sectional design. The study population comprised 152 tuberculosis (TB) patients and TB suspects registered at the Balongsari Health Center between January and December 2022. The sample consisted of pulmonary TB patients (TCM+) and TB suspects (TCM−) in a 1:1 ratio, selected through simple random sampling. The variables assessed included age, sex, HIV/AIDS status, diabetes mellitus, nutritional status, smoking history, lighting conditions, and housing occupancy density. Data were analyzed using the Chi-Square test.

Results: The analysis showed that the factors significantly associated with the incidence of pulmonary tuberculosis at the Balongsari Health Center were age (p = 0.01), diabetes mellitus (p < 0.001), nutritional status (p < 0.001), smoking history (p < 0.001), and lighting conditions (p < 0.001). In contrast, gender (p = 0.15), HIV/AIDS status (p = 0.08), and occupancy density (p = 0.10) were not significantly associated with the incidence of pulmonary tuberculosis.

Conclusion: Factors associated with the incidence of pulmonary tuberculosis included age, diabetes mellitus, smoking history, nutritional status, and lighting conditions. Conversely, gender, HIV infection, and occupancy density were not associated with pulmonary tuberculosis incidence.