Background and purpose: Coronavirus Disease (COVID-19) is one of global health problems which affect all aspects of people’s life. Because hospitals are high-risk environments for COVID-19 transmission, healthcare workers' preventive behaviors are critical. These behaviors are shaped by the interaction of personal, interpersonal, and institutional factors. Therefore, this study aimed to explore the COVID-19 preventive behaviors of registration staff at three referral hospitals in Bali, utilizing the Socio-Ecological Model. Methods: This qualitative study applied a phenomenological approach based on the Socio-Ecological Model of Health Behavior. The study was conducted in March 2021 at three COVID-19 referral hospitals in Bali (Sanglah, Wangaya, and Tabanan Hospitals). We purposely sampled 50 health workers from the registration section. Data were collected via online semi-structured interviews, observations and documentation, then analyzed using phenomenological techniques. Data validity was ensured through source triangulation (comparing insights from staff in outpatient, emergency, and COVID-19 registration posts, as well as the unit heads) and methods triangulation. Results: The findings demonstrate that preventive behaviors at the personal level interacted dynamically with interpersonal and institutional dimensions. At personal level, workers adhered to standard protocols (masking, handwashing, and physical distancing), utilized hand sanitizer after patient registration, conducted routine disinfection, and wore appropriate personal protective equipment. Individual actions were reinforced through informational support from peers on how to safely interact with patients and their families. At the institutional level, the health facilities supported these personal and interpersonal efforts through official preventive policies and by physically modifying the environment in registration areas. Conclusion: Preventing the transmission of infectious diseases in healthcare facilities requires a comprehensive approach that encompasses individual behavior, interpersonal support, a safety-oriented work culture, and robust institutional policies. These findings may serve as a reference for developing training programs, establishing standard operating procedures (SOPs), and strengthening a culture of safety among healthcare workers, thereby enhancing their preparedness to respond to future infectious disease outbreaks.
Background and purpose: Depression is a mental disorder with a high prevalence among young adults in Indonesia. Environmental factors such as sunlight and PM2.5 potentially influencing risk of depression. This study aimed to determine the levels of sunlight and PM2.5 exposure and their association with depression among young adults in urban Jakarta. Methods: This study used a cross-sectional design conducted in Penjaringan, North Jakarta during December 2023 to November 2024. Sample was 90 young adults recruited using consecutive sampling methods. Data were collected using structured questionnaire to assess sun exposure and the Patient Health Questionnaire-9 (PHQ-9) to assess depression. The PM2.5 air-quality monitoring data was obtained from the World Air Quality Index (AQICN) platform. Data were analyzed descriptively and analytically using frequency distributions and the Chi-square test. Results: The mean age of respondent were 21.92 years old, 62.2% were male and 75.6% were working. Overall, 45.6% had high PM2.5 exposure, while 53.3% had low sun exposure and 45.6% had depression. PM2.5 exposure was significantly associated with depression (OR=2.66; 95%CI: 1.13–6.25), whereas sun exposure was not (OR=1.47; 95%CI: 0.64–3.39). Conclusion: The study identified substantial PM2.5 exposure and depressive symptoms among young adults, with higher PM2.5 exposure significantly associated with depression. Public health interventions should prioritize reducing air pollution and promoting healthier urban environments alongside mental health programs
Background and purpose: Stunting remains a major public health issue globally, including in Jember District. Despite the significant stunting reduction in the region—from 21.4% in 2020 to 6.6% in 2024—Rambipuji Public Health Center (PHC) reports a comparatively high prevalence of 19.94%, indicating a persistent public health concern. This study aimed to analyze the association between diarrheal history, exclusive breastfeeding, and feeding patterns with the incidence of stunting among children aged 24–59 months. Methods: An analytical observational study with a case–control design was conducted among 114 children aged 24–59 months (57 cases and 57 controls) selected by simple random sampling in the Rambipuji PHC area based on growth monitoring data from May 2025. Data which include stunting status, children characteristics and maternal characteristics were collected through structured interviews and observations, and analyzed using chi-square tests (α=0.05) with SPSS. Results: The results indicated significant associations between maternal education (OR=11.25; 95%CI: 1.354-93.504; p=0.026), exclusive breastfeeding (OR=3.352; 95%CI: 1.377-8.159; p=0.006), and feeding patterns (OR=10.5; 95%CI: 2.336-47.201; p=0.005) with stunting incidence. However, a history of diarrhea was not significantly associated with stunting. Conclusion: Maternal education, exclusive breastfeeding, and feeding patterns are associated with stunting among children. Strengthening maternal nutrition and feeding education, as well as optimizing services at integrated health posts (Posyandu) and public health centers (Puskesmas), are essential to reduce stunting prevalence.
Background and purpose: General practitioners’ self-efficacy plays a crucial role in the successful diagnosis and management of mental disorders in primary care settings. In Bali, there is limited data on the factors influencing the self-efficacy of private practice general practitioners in handling mental health disorders. This study aimed to identify the factors associated with the self-efficacy of private practice general practitioners in the diagnosis and management of mental disorders in Bali. Methods: This was an analytical cross-sectional study involving 109 private practice general practitioners in Bali, conducted from September 2024 to March 2025. The sample included general practitioners who possessed a valid practice license, practicing either independently or at primary clinics in four cities/districts, selected using convenience sampling. Self-efficacy in this study was measured with the adapted General Self-Efficacy Scale (GSE). Data were collected through a structured self-administered questionnaire, which covered demographic characteristics, direct experience, vicarious experience, social persuasion, and emotional-physiological states. Data analysis was performed using Chi-square tests and multiple logistic regression. Results: The results showed that 67.0% of respondents had low self-efficacy in diagnosing and managing mental disorders. Factors significantly associated with self-efficacy among private practice general practitioners included direct experience (aOR=4.39; 95%CI: 1.59–12.10; p=0.004), social persuasion (aOR=3.58; 95%CI: 1.36–9.46; p=0.010), and emotional-physiological state (aOR=2.90; 95%CI: 1.14–7.42; p=0.025). Meanwhile, age, gender, years of practice, and vicarious experience were not significantly associated with self-efficacy. Conclusion: Direct experience, social persuasion, and emotional-physiological states were found to be factors associated with the self-efficacy of private practice general practitioners in diagnosing and managing mental disorders. It is recommended that the government develop
Mental health has become a critical global concern in 2025, influencing individuals, communities, and healthcare systems worldwide. Recognizing its significance is essential for fostering well-being and resilience across all aspects of life. The World Health Organization emphasizes that mental health is a basic human right and essential for both personal growth and societal progress. It empowers individuals to handle life’s difficulties, tap into their potential, learn effectively, perform well in their tasks, and make meaningful contributions to their communities1. Global threats to mental health today include economic and social inequalities; public health emergencies (including COVID-19); humanitarian emergencies (including conflict and forced displacement); and the climate crisis2. Mental health is closely linked to physical health. However, the relationship between mental health and physical disease tends to be neglected by communities as well as health care providers, specifically in Low Middle-Income Countries (LMICs)3. The vast majority of patients with mental disorder in LMICs have limited access to proper treatment 4. In contrast, European region countries (EUR) report the highest rate of mental health treatment compared to other regions5. Undetected mental disorders increased the risky behaviors related to chronic diseases, in turn, people with chronic diseases are also prone to experiencing mental health issues 6-10.
Background and purpose: The COVID-19 pandemic has resulted in severe symptoms for many patients, continuing into the formation of post-COVID syndrome which affects the quality of life of patients. This study aims to assess relationship between history of physical activity and COVID-19 severity with post-COVID-19 syndrome. Methods: This was a cross-sectional study involving 87 randomly selected adult COVID-19 patients treated at Udayana University Hospital from January 2022 to December 2023. Data collected were characteristics of the participants, the history of physical activity measured with IPAQ questionnaire, the severity of COVID-19 based on several indicators on the medical records, and post-COVID syndrome assessed with questionnaire. Data analysis method used for the Bivariate test is Chi-Square, and Multivariate uses the Logistic Regression Test to find the relationship between all variables. Results: Of the 87 patients, 56.3% were men with age range from 19 to 56 years. The majority, 83.9% of patients had severe COVID symptoms and 43.7% experienced post-COVID syndrome, with the highest distribution being fatigue, at 81.6%. Low physical activity was associated with post-COVID syndrome (p=0.004), 60.5% patients with low physical activity experience post-COVID syndrome compared to 27.3% with moderate physical activity. A significant relationship was also found between the severity of COVID-19 symptoms and the incidence of post-COVID syndrome (p=0.002). As many as 35.6% of patients who experienced mild COVID-19 experienced post-COVID syndrome, while 85.7% of COVID-19 patients who experienced moderate-severe COVID-19 experienced post-COVID syndrome. The multivariate test also provided significant results between history of physical activity and post-COVID syndrome (p=0.014) and the relationship between COVID-19 severity and post-COVID syndrome (p=0.011). Conclusion: A relationship was found between the history of pre-COVID physical activity and the severity of COVID symptoms with the incidence of post-COVID syndrome. On the other hand, there is no relationship between gender, age and comorbidity with post-COVID syndrome.
People living with HIV (PLHIV) and key populations, including people who use drugs, sex workers, LGBTQ+ communities, and imprisoned individuals, represent groups with heightened vulnerabilities that are significantly magnified during public health emergencies such as the COVID-19 pandemic. These populations are disproportionately exposed to both the direct health impacts of the virus and systemic barriers that limit access to essential health services.1 One of the most critical aspects is access to antiretroviral therapy (ART), which is vital to suppress viral load and maintain immune system function in PLHIV.2 Equally important are other health services such as harm reduction programs, sexual and reproductive health care, and mental health support, which together ensure the physical, emotional, and psychological well-being of these groups.
Background and purpose: The National Health Insurance System has implemented a performance-based capitation (PBC) norm in primary health care facilities (PHCF). PBC has three indicators: contact rate, non-specialist referral ratio (NSRR), and controlled chronic diseases control program (Prolanis) participant ratio (CPPR). This study aims to explore the implementation of PBC payment at public health centers in Denpasar, Bali, Indonesia. Methods: This study utilizes an explanatory sequential mixed method design. Data collection was conducted from February to March 2023. In the first phase, quantitative data were gathered through documentation studies on PBC achievements. The second phase involved qualitative data collection through in-depth interviews with 11 informants, who were selected purposively. Thematic analysis was employed to identify internal and external factors hindering and driving PBC fulfillment. Results: Among the 11 public health centers in Denpasar, two met the PBC target in 2020, three in 2021, and seven in 2022. During 2020 to 2022, the NSRR and contact rate targets were achieved by all public health centers, except for the contact rate in 2021. The CPPR was the indicator with the lowest achievement, but shows an increasing trend. Strengths contributed to PBC's achievement including sufficient human resources and service facilities, an active Prolanis club, and a supportive Primary Care (P-Care). Weaknesses include the absence of planning documents, lack of capitation service reward, insufficient availability of medicines, and inadequate features of e-Puskesmas. Threats were suboptimal condition of Prolanis participants, the COVID-19 pandemic, non-specialist referral demands from patients, and increased number of target population. Conclusion: The achievement of PBC at public health centers in Denpasar from 2020 to 2022 was suboptimal. The emergence of various factors namely strengths, weaknesses, opportunities and threats, can be utilized in strategic formulation to optimize PBC in Denpasar public health centers.
Background and purpose: Balinese dance is a well-known traditional activity which has been proven to have physiological and psychological benefits. This study aims to compare the differences in lung function and self-efficacy between Balinese dancer and non-dancer students in Denpasar, Bali. Methods: This was an analytical observational study using a cross-sectional method, which was carried out directly at the Physiology Laboratory of the Faculty of Medicine, Udayana University and Denpasar “X” Institute, from January to September 2023. Participants were students of the Dance and Visual Communication Design Study Programs of Denpasar “X” Institute who met the study criteria accounted for 48 students in each group. The data collection was conducted using a Chestgraph HI-101 spirometry for lung function measurement and a self-efficacy scale by I Made Rustika for self-efficacy measurement. The data was analyzed with SPSS 26 using T-independent and Mann-Whitney tests for mean comparison. Results: The two groups have similar distribution of age, sex, weight, height and smoking status. The respiratory function indicators were higher in dancer group compare to non-dancer group, the mean difference of 0.34 (p=0.02) for FVC(L), 10.14 (p<0.001) for FVC%, 0.3 (p=0.04) for FEV1(L), and 0.77 (p=0.02) for FEV 25%. No significant difference in self-efficacy was observed. Conclusion: The dancer students have higher lung function compare to non-dancer student. This signify dancing can become one form of physical activities that can be introduced to improve lung function since early age.
Background and purpose: The COVID-19 pandemic has significantly interrupted the care of asthma patients. In order to determine whether online search data and the number of COVID-19 cases were related, many Google Trends-based investigations were carried out throughout the pandemic. This study investigates whether asthma patients use the internet for self-management and treatment advice. Methods: A netnographic approach with data sources from Google Trends was used in our research. The data were taken from www.https://trends.google.co.id and were collected within two timeframes: (1) the beginning of COVID-19 (March 2, 2018-March 1, 2020) and (2) during the pandemic COVID-19 (March 2, 2020-March 1, 2022). The data is displayed graphically on a scale of 0 to 100, referred to as the Relative Search Volume (RSV). The Spearman correlation test on each keyword and the confirmed cases of COVID-19 in Indonesia were done in SPSS version 25 (IBM Corp., Armonk, NY) to determine if a correlation existed. Results: This study found an increased search volume for asthma therapy. According to the correlation test results, the keywords "inhaler" and "nebulizer" significantly correlated with the number of confirmed COVID-19 cases. However, no link between asthma symptoms and the number of COVID-19 was found. Conclusion:Indonesians sought more information on asthma self-medication during the rise of COVID-19, however not directly associated with the prevalence of the disease. Google Trends can become a potential source to explore people behaviour in relation to certain health information, however it cannot be used as the sole data collection tool for health research, especially in Indonesia.
Background and purpose: The drastic elevation in the number of patients during the COVID-19 pandemic demands the preparedness of nurses to provide quality services to COVID-19 patients. The purpose of this study was to determine the relationship between knowledge, attitudes, self-esteem, and nurses' intentions towards preparedness in facing the COVID-19 pandemic and an overview of the factors that influence it. Methods: This study used a quantitative method with a cross-sectional analytic design, conducted at Sanglah General Hospital in Bali Province, Indonesia and involved 333 nurses with a total sampling technique. The research data was collected with a google form related to demographic characteristics (age, gender, education level, and length of work), knowledge, attitudes, self-esteem, intentions, and nurse preparedness. Furthermore, data were analyzed using descriptive statistics and Chi-Square tests (α<0.05). Results: Most of the respondents were female (85.6%), had an associate degree Diploma III education history (75.7%), had the longest working time of 34 years, and the oldest age was 57 years. This study found that most nurses had poor preparedness (53.8%), good knowledge (65.5%), good attitude (51.7%), high self-esteem (68.2%), and good intentions (86.5%). The correlation test showed a significant relationship between gender (p=0.033), attitude (p<0.001), self-esteem (p<0.001), and intention (p<0.001) on preparedness for the COVID-19 outbreak. Meanwhile, knowledge (p=0.784), ages (p=0.120), education levels (p=0.094), and length of work (p=0.100) were not related significantly to nurses' preparedness for the COVID-19 pandemic. Conclusion: Nurses’ readiness is related to attitude, self-esteem, intention, and gender. In improving nurses' preparedness in carrying out disease management during a pandemic, efforts are needed to improve attitudes, self-esteem, and intentions. These efforts can be part of the hospital disaster plan program by providing psychosocial support to improve attitudes, self-esteem, and intentions.
Background and purpose: The quality of hospital services during the COVID-19 pandemic tends to decline. This can affect patients’ satisfaction in carrying out treatment and care. Risk communication and caring behavior are important aspects that can affect patient satisfaction. The purpose of our study was to determine the relationship between risk communication and caring behavior of nurses with patient satisfaction on internal medicine polyclinic in the Mangusada Regional Hospital, Badung District, Bali Province, Indonesia. Methods: Our research design is analytic observational with cross sectional approach. We conducted research at the internal medicine polyclinic of the Mangusada Regional Hospital, Badung District from March 1 to April 21, 2022. Samples of our study were 120 patients who visited the internal medicine polyclinic. Variables of our study which include patient characteristics, risk communication and caring behavior were collected using a questionnaire and analyzed with univariate, bivariate and multivariate approach using multiple logistic regression test with 95% confidence interval. Results: The study revealed that 52.5% of patients had low satisfaction, 54.2% of patients perceived low risk communication and 54.2% of patients perceived low caring behavior. There is a relationship between nurse risk communication with patient satisfaction (aOR=5.2; 95%CI: 1.9-14,3, p=0.001) and nurse caring behavior with patient satisfaction (aOR=9.8; 95%CI: 3.7 – 26,0, p=0.000). Conclusion: Risk communication and nurse caring behavior are related to patient satisfaction at internal medicine polyclinic in the Mangusada Regional Hospital, Badung District. This underscores the importance of focusing on improving care practices and communication strategies to enhance patient satisfaction. It also emphasizes the need to ensure the good ratio of health care workers to the number of patients in order to provide quality health services.
Background and purpose: The COVID-19 pandemic has brought about new-normal conditions across all sectors. At the onset of the return to offline learning, new health protocol regulations were introduced. This study aimed to predict student behaviour in the post-COVID-19 learning process using the Health Belief Model (HBM) within a restricted face-to-face learning context. Methods: This cross-sectional survey involved 331 students from both public and private universities in South Sumatra Province, selected through convenience sampling from those participating in post-pandemic face-to-face learning. Data were collected between April and July 2022 using an online questionnaire that covered sociodemographic characteristics and perceptions based on the HBM framework. Descriptive analysis was conducted, and behavioural predictions were tested using Structural Equation Modelling (SEM). Results: The majority of participants were female (54.4%), aged 18–21 years (64.4%), predominantly undergraduate students (84%), and residing in Palembang (63.3%). Regarding vaccination status, 54.4% had received the second dose, 39% the third dose, 5.7% only the first dose, and 0.9% were unvaccinated. Perceived benefits (β=0.129, p=0.034), cues to action (β=0.319, p<0.001), and self-efficacy (β=0.442, p<0.001) were found to be significant predictors of students’ compliance with health protocols. Conclusion: Students’ compliance with health protocols is influenced by health-related information and their level of self-efficacy. The Health Belief Model proves effective in predicting this behaviour in a post-COVID-19 context. Policymakers are encouraged to promote compliance to health protocols through positive messaging, such as public service announcements.
Stunting is one of the triple malnutrition burdens in Indonesia, beside obesity and micronutrient deficiency. Stunting is a reflection of long-term undernourishment which resulted in stunted growth. National Health Survey Data showed the reduction of stunting rate among under-five children in Indonesia from 37.2% in 2013 to 30.4% in 2018 and 21.5% in 2023. Despite this decreasing trend, the national stunting rate was still above the World Health Organization threshold of 20%. There is also a wide discrepancy between provinces in Indonesia with stunting rate ranges from 7.2% in Bali to 39.2% in Papua. Back in 2011, there was a movement by 28 countries including Indonesia regarding the 1000 first day of life (1000-days) program. This was an approach targeting children during their 1000 first day of life through specific and sensitive nutritional interventions. The 1000-days is started during pregnancy until the child is two years old. This movement involved related stakeholders from national and sub-national level including ministries, community organization, private sectors, professional organization, academics and others.
Background and purpose: Since 2016, Badung District, Bali has implemented a free HPV vaccination program for school children, with vaccination coverage reported to be over 90% in 2016-2018. This study aims to objectively assess the coverage of HPV vaccination among school children in Badung District. Methods: This survey used a cross-sectional design that conducted between March and June 2019. Sample selection was done by systematic random sampling, following the WHO guidelines. A total of 216 families met the sample criteria, with a total of 249 children from all families. Respondents in this study were eligible girls' mothers or families who knew the child's vaccination history. Variables of this study were sociodemographic characteristics of respondents and children, HPV vaccination recall and HPV child vaccination validation. The data collected were analyzed descriptively to calculate the coverage of recall and validation of HPV vaccination. Results: The majority of respondents were mothers (70.83%) with a high school education (51.85%). The median age was 43 years (IQR=8 years). Each family had a mean of 1.15 eligible children (SD=0.39). Of the 249 children, most were aged 16-19 years (43.37%), with age at vaccination mostly ≤12 years (46.52%). HPV vaccination coverage by recall was 82.32% (95%CI: 77.56-87.09), with HPV vaccination coverage by validation was 76.59% (95%CI: 70.74-82.43). Conclusion: After validation, vaccination coverage was lower than vaccination coverage by recall. The health office needs to improve the vaccination registration system, in particular the uniformity of registration and record keeping to ensure proper traceability of vaccination history.
Background and purpose: Studies have investigated that Vitamin D serum level is associated with sleep quality and circadian rhythms in pregnant women in Asia, but the results remained controversial. This systematic review is conducted to explore the association between Vitamin D serum level and sleep quality among pregnant women population in Asia. Methods: We conducted systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies that discussed the association between Vitamin D serum level and sleep quality was retrieved from Pubmed, EBSCO, and Proquest. The outcome variable was sleep-quality which measured with Pittsburg Sleep Quality Index (PSQI) questionnaires and the independent variable was the serum 25(OH)D levels. A total 2,285 articles were excluded, leaving 3 final articles to be analyzed. The risk of bias was assessed with the New-Castle Ottawa Quality Assessment Scale (NOS). Results: Three studies included in this review with a total of 1,359 pregnant women in Asia, ranging from 18 to 68 years old. All three studies were controlled for covariates. Out of three studies, two studies showed a significant result of the association between Vitamin D serum level with sleep quality with a p-value <0,05. Causal reasons remained unexplained considering the studies were completed in cross-sectional and cohort design. Conclusion: This study gives an overview of the role of Vitamin D in the sleep quality of pregnant women in Asia. Future research should focus on conducting more comprehensive studies with stringent criteria to further explore this association in diverse Asian populations
Background and purpose: There is a great deal of mythical erroneous information regarding children's nutrition that can affect styles of parental feeding. If it is left uncontrolled, it may influence the nutritional status that led to malnutrition. The purpose of this study is to determine association between styles of parental feeding and nutritional status of children ages of 2 to 5 years old. Methods: This was a cross-sectional study, conducted in November-December 2023 in Jember, East Java, Indonesia. Samples were 244 mothers who were selected purposively and satisfied the inclusion and exclusion criteria. Data was collected with interview which include parents’ and children’s characteristics, the feeding practices using a validated structured questionnaire (FPSQ-28), and children nutritional status. Descriptive analysis followed by correlation analysis were performed. Results: Most parents earn more than IDR 2,000,000 and work as self-employed, whereas more than half of the respondents, both fathers and mothers, had at least a high school education, and the majority of height in both were 150-170 cm with normal body mass index. There is a weak positive association between the styles of parental feeding with the body weight for age (r=0.183; p=0.040) while no significant association with body weight for height (r=0.08; p=0.216). Conclusion: Styles of parental feeding affected children's feeding and nutritional status, particularly when it comes to chronic conditions and in order to maintain children's nutrition or balanced nutrition, it is necessary to conduct education and evaluation of parental feeding styles.
Background and purpose: HIV pre-exposure prophylaxis (PrEP) is aimed to prevent the transmission of HIV infection. The use of PrEP by female sex workers (FSWs) in Badung District, Bali Province was relatively low. This study explores critical strategies to increase the acceptance of HIV PrEP program by FSWs in Badung District, Bali, Indonesia. Methods: A qualitative descriptive study was conducted in Badung District. This study involved 16 purposively selected informants consisting of 5 FSWs who had used PrEP, 5 FSWs who had not and 6 stakeholders whom involved in the PrEP implementation. Data was collected using in-depth interviews which include: strategies for strengthening self-confidence, social support, effectiveness of PrEP implementation, and accessibility of health services. Data was analyzed using a thematic approach. Results: The research highlights several key strategies to enhance the acceptance of PrEP including strengthening self-efficacy, empowering individuals with the confidence and skills to utilize PrEP effectively, bolstering of social support networks by reducing stigma and fostering a supportive environment. The effectiveness of PrEP program implementation is crucial by ensuring well-structured, responsive, and capability to meet the population needs. Finally, improving service accessibility is crucial, as it removes barriers to obtaining PrEP. Together, these strategies form a comprehensive framework for improving PrEP acceptance. Conclusion: To increase PrEP acceptance among FSWs, the primary strategy that needs to be implemented is strengthening the service sector. For this reason, it is suggested that the health office carry out outreach and increase access to health services and assistance.
Background and purpose: The risk of hypertension increases in the elderly, while treatment adherence plays a crucial role in controlling blood pressure in the elderly. This study aims to explore the elderly's perception of hypertension and its treatment. Methods: This study used an exploratory qualitative design. Data were obtained through in-depth interviews about the elderly's perception of hypertension and its medication, health-seeking behavior, and cues to action in undergoing treatment for 6 elderlies with hypertension and 4 health workers in Gianyar District in July-September 2020. The data obtained were analyzed using thematic methods. Results: This study identified 2 big themes, namely the elderly's perception of hypertension and seeking behavior. The elderly's perception of hypertension is described from the perceived vulnerability from the aspect of age, lifestyle, and heredity. Hypertension is seen as a serious disease by the elderly, particularly from the complications aspect, while complaints felt are not considered serious unless they interfere with activities or have to undergo treatment. Reduced complaints and controlled blood pressure are the perceived benefits of treatment and lifestyle adjustments: long-term medication, side effects of drugs, and traditional medicine as obstacles for the elderly in undergoing treatment. The elderly seek treatment based on their trust and comfort in health workers, infrastructure, access to health services, and support from health workers and the government. Conclusion: The perception of barriers to treatment and health-seeking behavior of the elderly in seeking treatment play a significant role in determining the medicational therapy that the elderly undergoes, which can prevent complications. Family support for the elderly is essential in overcoming obstacles and increasing elderly adherence to medication.
Background and purpose: COVID-19 pandemic has a major impact on the health care system, including nurses. The rapid increase in the number of patients, lack of knowledge of the disease, and the high risk of being exposed to the virus, are some challenges faced by nurses in hospitals. During this situation, nurses need to build resilience to provide good services for patients as well as to protect themselves from COVID-19 infection. This study aims to explore resilience of the emergency room (ER) nurses at Sanglah Hospital Denpasar during the early stage of COVID-19 pandemic. Methods: A qualitative study with a phenomenological approach was conducted in the ER of Sanglah Hospital Denpasar, from October to November 2020. Data were collected through in-depth interviews that involved six nurses. The information collected include nurses' experiences in dealing with pandemics, nurses' knowledge about COVID-19, challenges and obstacles to nursing services during the COVID-19 outbreak, efforts to protect themselves, family and closest relatives, as well as management responses regarding the protection of health workers, especially among nurses. Data were analyzed by Interpretive Phenomenological Analysis (IPA) and presented narratively. Results: Nurses have the internal strength to deal with increased workloads and working conditions that were considered difficult during the pandemic situation. Nurses’ resilience is also formed by external supports such as from co-working partners, family, and organizations. The challenges and obstacles faced in maintaining resilience are the implementation of services, amidst the uncertainty of the status of COVID-19 patients and the stigma among health workers, as they were suspected as virus carriers. Efforts to strengthen resilience are conducted by increasing capacity, taking care of oneself, and setting work schedules. Conclusion: The resilience of nurses consists of the resilience to face increased workloads and difficult working conditions during a pandemic. This resilience comes from internal and external strengths such as friends and organizations. In difficult situations, nurses are still able to think of concrete steps to protect themselves and their families. However, challenges and obstacles need to be overcome to improve the quality of patient care during a pandemic.
