Introduction: Despite Indonesia’s commitment to Universal Health Coverage (UHC), adolescents involved in customary marriages often remain beyond the reach of state protection. This study explores the "multilayered exclusion" experienced by these couples in accessing maternal health services in Munti Gunung, Bali. Methods: This exploratory qualitative case study involved 16 purposively selected participants, including early-married adolescent mothers (n=5), family gatekeepers (husbands/in-laws, n=5), health workers (n=5), and a community leader (n=1). Data were collected through in-depth interviews and analyzed using thematic analysis to identify barriers across the socio-ecological spectrum. Results: Inductively derived from localized empirical data, this study presents 'Administrative Invisibility' as an emergent conceptual construct describing how the lack of civil marriage certificates systematically excludes newborns from the National Health Insurance scheme. This qualitative exploration indicates that structural vulnerability is mediated by rigid household hierarchies and a mismatch in institutional capacity within resource-constrained primary care services. To secure immediate healthcare, families and local administrative actors navigate this socio-legal limbo by employing pragmatically effective yet legally high-risk informal workarounds. Conclusion: Within this single-site qualitative scope, the intersection of customary child marriage and legal identity exclusion appears to form a compounded structural node within the multi-layered matrix of healthcare exclusion for newborns. Achieving health equity requires proactive, affirmative structural reforms, specifically, piloting a 'Conditional Humanitarian Enrolment' model powered by an API-driven digital bridging framework to formally decouple an infant’s constitutional right to healthcare from parental marital status, safely integrating immediate neonatal survival with long-term socio-legal safeguards.
Introduction: Type 2 diabetes mellitus (DM) is a non-communicable disease with increasing prevalence and low adherence globally. Therefore, this study aims to evaluate changes in medication adherence and glycemic control after a WhatsApp-based education and interactive reminders among outpatients receiving insulin therapy. Methods: A pre-experimental study used a prospective one-group pre-test-post-test design among outpatients receiving insulin in a hospital. The intervention included DM education at the initial meeting, followed by educational videos and weekly interactive reminders provided through WhatsApp for 6 weeks. Patient knowledge was assessed with Diabetes Knowledge Questionnaire (DKQ) and adherence to medication was assessed using Adherence to Refills and Medications Scale (ARMS). Glycemic control indices (fasting blood glucose (FBG), two hours of postprandial blood glucose (2hPPBG), glycated hemoglobin (HbA1c)) were measured before and after the intervention. Additionally, a paired t-test was used to measure the effect of the intervention on knowledge, adherence, and glycemic control indices. Results: Among the 122 patients who fulfilled the inclusion criteria, there was a significant increase in knowledge (p < 0.001), with the proportion of highly knowledgeable patients rising from 19.7% to 38.5%. The increase in adherence to medication from 30.3% to 39.3% was not statistically significant (p = 0.228). Glycemic control indices showed a significant improvement (p < 0.001), with mean HbA1C, FBG, and 2hPPBG decreasing from 8.63% to 7.85%, 152.18 mg/dl to 138.72 mg/dl, and 268.84 mg/dl to 228.66 mg/dl, respectively. Conclusion: Following the 6 weeks WhatsApp-based education and interactive reminders, improvement were observed in patient knowledge and glycemic control indices, but medication adherence did not change significantly. This study lacked a control group, the findings represent observed changes after the study period and require confirmation in controlled studies with longer follow-up.
Introduction: Pharmaceutical procurement represents a significant proportion of hospital expenditure, with drug inventory accounting for approximately 10-20% of of total hospital costs. The ABC-VEN analysis has been widely used to improve pharmaceutical inventory management, but evidence regarding its application in outpatient cardiology services within Indonesia’s National Health Insurance (JKN) system remains limited. This study aims to evaluate drug use patterns, pharmaceutical expenditure, and inventory priorities using ABC–VEN analysis in outpatient cardiology services under Indonesia’s National Health Insurance (JKN) system. Methods: A retrospective observational study was conducted using all outpatient prescriptions under the national health insurance program in the cardiology clinic from January to March 2020. The ABC method carried out the analysis of drug use patterns and cost. ABC-VEN matrix was formulated by combining the results of ABC and VEN analysis. Results: A total of 4.443 prescriptions contained 482.457 items from 125 types of drugs. Based on usage value, Classes A, B, and C accounted for 68%, 21%, and 11%, respectively, while based on invesment value, they accounted for 68%, 27%, and 5%. Class A drug usage and cost represent only 6% and 2% of total drug types. VEN analysis identified no Vital drugs, whereas Essential medicines accounted for 94% of total drug utilization and 98% of total pharmaceutical expenditure The ABC-VEN matrix showed drug usage in Categories I, II, and III at 34%, 60%, and 6%, with the corresponding drug costs for 68%, 30%, and 2%. Category I drugs represented 34% of total drug use but consumed 68% of total pharmaceutical expenditure, indicating substantial budget concentration in a limited number of essential high-cost medicines. Conclusion: The ABC analysis based on usage value and invesment value and VEN analysis shows differing patterns. Pharmaceutical expenditure in outpatient cardiology services was highly concentrated among a limited number of essential medicines. ABC–VEN analysis provides a practical framework for procurement prioritization, budget optimization, and strategic inventory control, thereby supporting more efficient pharmaceutical management and sustainable medication availability.
Introduction: Artisanal and small-scale gold mining (ASGM) is a major source of mercury contamination in aquatic environments, threatening ecosystems and human health. Conventional remediation is often costly and difficult to apply in resource-limited mining areas. Phytoremediation using aquatic macrophytes offers a low-cost alternative. This study compared observed water-phase mercury removal by Ipomoea aquatica, Pistia stratiotes, Nymphaea spp., and Eichhornia crassipes under standardized bench-scale laboratory conditions. Methodology: ASGM liquid waste with an initial dissolved mercury concentration of 0.00448 mg/L was used. Each species was tested in triplicate over a 14-day exposure period, with water samples analyzed on Day 0, Day 9, and Day 14. Mercury concentrations were measured using Atomic Absorption Spectrophotometry, and removal effectiveness was calculated as percentage reduction from baseline. Because biomass-normalized uptake, plant tissue mercury accumulation, and abiotic controls were not included, findings are interpreted as plant-associated water-phase reductions rather than definitive evidence of uptake mechanisms. Results: All species substantially reduced dissolved mercury, with clear interspecies variation. By Day 14, water hyacinth reduced mercury to 0.00003–0.00004 mg/L, corresponding to 99.11–99.33% removal. Lotus showed comparable performance, achieving 98.21–98.44% removal. Water spinach produced intermediate reductions of 85.04–94.42%, with an approximate mean of 89.17%, while water lettuce showed the lowest removal range of 83.71–86.38%, with an approximate mean of 84.89%. Reductions were evident by Day 9 and greatest by Day 14. Mechanistic interpretations related to root morphology, biomass, rhizosphere processes, or internal translocation should remain cautious because these parameters were not directly measured. Conclusion: Aquatic macrophytes can substantially reduce dissolved mercury in ASGM-contaminated liquid waste under bench-scale conditions. Water hyacinth showed the highest observed removal, followed closely by lotus. Field application requires ecological containment, safe biomass disposal, abiotic control assessment, effluent characterization, and further tissue-based uptake studies.
ntroduction: According to the Global Burden of Disease study, approximately 775,000 lives were lost prematurely in 2017 due to poor sanitation. In 2020, only 54% of the global population had access to safely managed sanitation. Therefore, this study aimed to explore cross-sector collaboration for improving sanitation access at "last mile" communities in South Sulawesi, Indonesia. Barriers to achieving Open Defecation Free (ODF) status were emphasized, with a focus on the dynamics between health centers (puskesmas) and village governments. Methods: This qualitative case study was conducted with key stakeholders who were directly engaged in the STBM program, such as managers, district government officers, health officers, as well as sub-district, village, and puskesmas heads. Focus group discussions (FGDs) and in-depth interviews were used to collect data. Analysis was conducted thematically to determine patterns and obstacles to collaboration. Results: There was no synergy between puskesmas and village governments in enhancing access to sanitation. Puskesmas operated by modifying the behavior of communities to construct their own latrines, while the village governments operated by providing financial support through village funds. This isolation led to community reliance on outside assistance as well as lowered ODF program effectiveness. FGDs also showed misconceptions among the stakeholders, and external influences on the pathogen spread to water and food sources (e.g., vectors (e.g., flies) spreading pathogens). Conclusion: The synergy between puskesmas and village governments was a critical obstacle to attaining the ideal level of sanitation access and ODF status in the last-mile communities. Enhancing partnership by considering integrated planning, better communication, and participation of the community is necessary. The study showed that the existence of vectors, such as flies, worsened the sanitation issues. This underscores the significance of integrated and sustainable cross-sector partnerships to enhance access to sanitation and control vectors.
Introduction: Health literacy plays a pivotal role in chronic disease care, including hypertension, by influencing patients’ ability to understand health information and maintain long-term treatment adherence. However, evidence regarding its correlation with medication adherence among elderly populations remains limited, especially in developing countries with diverse socioeconomic and educational backgrounds. Accordingly, this investigation aimed to examine the association between health literacy and adherence to medication among older adults with hypertension residing in East Java, Indonesia. Methods: The study employed a cross-sectional design and was implemented from February to June 2024 at the 2 Primary Healthcare Centers in Lamongan, East Java province, Indonesia. Participants were eligible if they were diagnosed with hypertension, were at least 60 years of age, and had received antihypertensive treatment for no less than three months. The pill count method was used to evaluate medication adherence, with adherence defined as a score >80%. Participants’ health literacy levels were measured using the Indonesian version of the validated HLS-EU-SQ10 instrument., and the results were classified into four categories: inadequate, problematic, sufficient, and excellent. The relationship between variables was evaluated using Spearman’s rank correlation analysis. Results: A total of 212 patients were enrolled, the participants were predominantly female (75%), aged between 60–69 years (80%), and had low education. Most patients were prescribed amlodipine as monotherapy or in combination with other drugs. Health literacy levels were predominantly problematic (42.9%) and inadequate (40.1%). Meanwhile, 78.8% of the patients exhibited good adherence to medication. A weak positive correlation identified between health literacy and medication adherence (r=0.210, p=0.002). Conclusion: These findings suggest a significant weak correlation between health literacy and adherence to medication among elderly with hypertension. Health literacy may therefore be considered an important factor in hypertension management to support optimal therapeutic outcomes in elderly populations.
Introduction: Tuberculosis (TB) remains a critical global health challenge, with Indonesia ranking second in global TB burden. This study examines factors influencing TB incidence across Indonesian provinces and applies clustering to guide targeted interventions aligned with TB eradication goals by 2030. Specifically, these findings inform Indonesia’s End TB 2030 roadmap by identifying provincial heterogeneity that necessitates differentiated resource allocation and strengthened health governance frameworks. Methods: This ecological time-series study design analyzed data from 34 Indonesian provinces (2020–2022), including TB cases, healthcare services, HIV cases, smoking prevalence, food management places, and public facilities. Descriptive statistics summarized variable distribution, while panel data regression identified key factors using multicollinearity checks, model selection, and assumption testing. Fuzzy Possibilistic C-Means (FPCM) clustering grouped provinces based on similarity characteristics. Results: TB cases rose from 10,351 in 2020 to 21,303 in 2022. This study underscores the multifaceted factors influencing TB incidence in Indonesia. Significant factors included healthcare services (?1 = -8.37), HIV cases (?2 = 13.76), smoking prevalence (?3 = 905.32), food management places (?4 = 1.62), and public facilities (?5 = 1.11). This study proves that TB is not only influenced by health factors but also by non-health factors. Fuzzy clustering using the FPCM identified three clusters based on their possibilistic membership degrees: Cluster 3, with high HIV prevalence and public facilities, requiring urgent action; Cluster 2, needing improved healthcare and smoking reduction; and Cluster 1, with moderate challenges. Conclusions: Health and environmental factors significantly influence TB incidence. Addressing cluster-specific needs, such as enhancing healthcare, reducing HIV and smoking prevalence, and improving public health standards, is essential for TB control. Future studies should expand variables and periods to deepen insights.
Introduction: Stunting remains a major public health issue in Indonesia, particularly in coastal areas such as Barru District, South Sulawesi, which has shown a significant increase in prevalence. Parenting practices play a central role in stunting prevention; however, existing policies often fail to accommodate the local values embedded within communities. Among coastal Bugis communities, local wisdom-based parenting practices such as mattarana’ and yabelale are believed to contribute to the holistic development of children, yet they have rarely been studied in the context of health policy. This study aims to explore the concept of local wisdom-based parenting within Bugis coastal communities and to analyze its potential for integration into more contextual and participatory stunting prevention policies. Methods: A mixed-methods sequential exploratory design was employed with explicit qualitative–quantitative integration. The qualitative phase generated culturally grounded constructs of parenting through in-depth interviews, focus group discussions, and participatory observations with parents, community leaders, health workers, and posyandu cadres. These findings directly informed the development of quantitative survey instruments. The subsequent quantitative phase involved a descriptive survey of 326 caregivers selected via stratified random sampling. Integration occurred at the design level (instrument development), the methods level (sequential linkage), and the interpretation level, where qualitative themes were used to contextualize quantitative results. Data were analyzed using thematic analysis and descriptive statistics. Ethical approval was obtained from the Health Research Ethics Committee of Maluku Husada School of Health Sciences (RK.196/KEPK/STIK/VII/2025). Results: Qualitative findings revealed that mattarana’ is understood as a form of intensive maternal caregiving, while yabelale represents a spiritual-emotional practice that strengthens mother-child attachment. Quantitative data indicated that 93.3% of respondents had adequate knowledge about stunting and 99.4% demonstrated positive attitudes toward healthy parenting. However, parenting practices did not fully reflect this knowledge. Furthermore, 62.9% of respondents agreed that local wisdom should be integrated into stunting prevention policies. Integrated analysis indicates that local values shape how biomedical knowledge is interpreted and enacted in daily caregiving. Conclusion: Integrating the concept of mattarana’ into stunting prevention policies may enhance the effectiveness of interventions through a more culturally grounded, socially responsive, and locally contextualized approach. This strategy supports WHO’s whole-of-society principle and offers a more humanistic and sustainable framework for health development.
Introduction: Road traffic accidents remain a major global public health challenge, disproportionately affecting low- and middle-income countries (LMICs), where fatality rates among novice drivers are particularly high. Despite this burden, most empirical research on road safety education has focused on high-income settings, leaving significant gaps in evidence relevant to LMIC contexts. This study aims to systematically review the effectiveness of technology-based interventions for road safety education among novice drivers and to examine their behavioral outcomes, theoretical foundations, and contextual relevance in LMICs. Methods: A systematic literature review was conducted in accordance with PRISMA 2020 guidelines. Peer-reviewed journal articles published between 2015 and 2025 were retrieved from the Scopus database using predefined search terms related to road safety education, novice drivers, and digital or technology-enhanced interventions. After screening and eligibility assessment, 47 empirical studies were included for synthesis. Data were extracted on intervention type, theoretical framework, geographic setting, and behavioral outcomes, and analyzed using descriptive, thematic, and network-based approaches. Results: The findings indicate that technology-enhanced interventions, including gamification, virtual reality, mobile applications, telematics, and artificial intelligence, are generally associated with improved learner engagement, enhanced hazard perception, safer driving behavior, increased helmet use, and reduced traffic violations among novice drivers. However, most studies lack explicit theoretical grounding, rely on short-term outcome measures, and are concentrated in high-income settings, limiting generalizability to low- and middle-income contexts. Conclusion: This review highlights the need for theory-informed, culturally sensitive, and context-responsive road safety education strategies that integrate behavioral science with digital innovation. Strengthening longitudinal evaluation and expanding research in underrepresented regions are essential to inform effective policy and scalable intervention design.
Introduction: The treatment of vaginal discharge is pharmacological, such as cyclovir, podoflin 25%, and antiseptic solution for vaginal rinsing, and non-pharmacological, such as Annona muricata decoction. The aim of this study was to analyze the effectiveness of using pantyliners with Annona muricata extract nanoparticles against vaginal discharge in North Konawe Regency. Methods: This study used a two-group pre-posttest approach and a quasi-experimental design to compare the efficacy of regular pantyliners and pantyliner nanoparticles over a seven-day period. This study surveyed 124 childbearing women aged 15-49 in the North Konawe Regency who experienced vaginal discharge. Participants were those who could read and write, experienced moderate and severe discharge, and participated in ? 2 activities. This study used questionnaires to assess childbearing women's characteristics, knowledge of vaginal discharge, personal hygiene, observation sheets, and standard operating procedures. Wilcoxon, Mann-Whitney, and independent T tests were used. Results: The analysis revealed a significant difference in the level of vaginal discharge between the intervention and control groups (P = 0.000). However, changes in vaginal discharge differed between the intervention and control groups. The elimination of vaginal discharge was better in the group treated with Annona muricata extract panty than that in the control group. Conclusion: Annona muricata extract panty effectively reduced vaginal discharge in both the intervention and control groups. However, pantyliners containing Annona muricata extract may be more effective than regular panties.
Introduction: Chronic diseases such as diabetes mellitus and hypertension are increasingly prevalent among older adults and require long-term medication use. Despite receiving routine health education in primary care, many patients continue to show gaps in medication knowledge and adherence, which can lead to poor treatment outcomes. Pharmacist-led education has the potential to address these gaps by combining professional guidance with behavioral reinforcement. This study aimed to evaluate the effectiveness of a community-based, interactive educational program in improving medication knowledge and adherence among older adults with chronic diseases. Methods: A quasi-experimental pretest–post-test design was conducted between June and August 2025 with 201 participants recruited from five primary health centers in Surakarta, Indonesia. Medication knowledge and adherence were assessed using a structured questionnaire administered before and after two pharmacist-led group education sessions. The educational sessions focused on proper medication use, lifestyle management, and strategies to reduce unintentional nonadherence. The questionnaire evaluated multiple domains of knowledge and self-reported adherence behaviors. Differences between pre- and post-intervention scores were analyzed using the Wilcoxon Signed-Rank test, with the level of statistical significance set at p < 0.05. Results: The Wilcoxon Signed-Rank test revealed statistically significant differences between pretest and post-test scores for both medication knowledge and adherence. Knowledge scores increased significantly following the intervention (Z= ?10.624, p < 0.05) indicating improved understanding of medication use and related health behaviors. Adherence scores also showed a significant increase (Z= ?9.767, p < 0.05). The greatest improvements were observed in lifestyle-related knowledge, such as diet and physiscal activity, as well as in behaviors associated with unintentional nonadherence, including forgetting doses or failing to bring medications while traveling. Minimal changes were observed in knowledge regarding diabetes-specific medications, showed minimal change, suggesting adequate baseline familiarity. Conclusion: The pharmacist-led community educational intervention was associated with statistically significant improvements in medication knowledge and adherence among older adults with chronic diseases. Further research is needed to assess the sustainability of these improvements over longer follow-up periods and across different primary healthcare settings.
Introduction: Medication adherence remains a major challenge in the management of diabetes mellitus, particularly in primary health care. Pharmacists play an important role in supporting adherence through pharmaceutical care. However, there is still limited evidence regarding pharmacists’ experiences and needs in implementing pharmaceutical care related to adherence in community health centers (Puskesmas) in Indonesia. Methods: This descriptive cross-sectional study was conducted among pharmacists working at Community Health Centers (Puskesmas) in South Kalimantan Province, Indonesia, between July and August 2025. A total of 244 pharmacists were invited, and 161 participated (response rate 66.0%). Data were collected using a validated structured questionnaire consisting of 35 items on a five-point Likert scale, covering pharmacists’ experiences, barriers, and needs in implementing pharmaceutical care to support medication adherence among patients with diabetes mellitus. Data were analyzed descriptively. Results: Pharmacists predominantly relied on indirect adherence assessment, most commonly through prescription refill monitoring (60.9%), while less consistently confirming patients’ understanding of therapeutic goals. Adherence-support interventions were largely limited to face-to-face education, with minimal use of remote/digital modalities (telephone or social media: 60.9% never). Monitoring and follow-up were also inconsistent, including limited assessment of adverse drug reactions. Key systemic and workflow barriers included limited time, lack of training, and restricted access to patients’ clinical information (75.8%). Pharmacists reported strong needs for standardized adherence assessment tools, accessible patient medication records, systematic guidelines, and training programs. Conclusion: Pharmaceutical care to support medication adherence among patients with diabetes mellitus in Puskesmas is not yet implemented consistently. Strengthening pharmacist competencies through practical tools, clear guidance, and continuous training, together with better access to patient information and appropriate use of digital resources, may improve the delivery of adherence services in primary care.
Introduction: Anemia among adolescent girls remains a global public health concern. Adolescence is a critical window of rapid growth and increased iron requirements. The World Health Organization recognizes adolescent anemia as a priority. Although weekly iron supplementation programs have been widely implemented, adherence remains suboptimal. Previous studies have primarily identified associated factors using bivariate or conventional regression approaches, with limited application of multivariate pathway modelling to simultaneously examine determinants of adherence and hemoglobin outcomes. This study aimed to examine predictors of iron tablet adherence and their association with hemoglobin levels among adolescent girls using Partial Least Squares Structural Equation Modeling (PLS-SEM) approach. Methods: A quantitative study with a pretest–posttest one-group design without a control group was conducted. Data were collected using validated questionnaires from adolescent girls (n = 772), of whom 483 participated in final analysis attending schools in Bali, Indonesia, between August and November 2024. Statistical analyses and PLS-SEM were performed to identify key predictors of adherence and hemoglobin levels. Results: A total of 483 adolescent girls participated in the study (response rate: 62.6%). The structural model explained 4.6% of the variance in iron tablet adherence (R² = 0.046) and 38.4% of the variance in hemoglobin levels (R² = 0.384). Family support (? = 0.051; p = 0.041), school support (? = 0.131; p = 0.011), and attitude (? = ?0.071; p = 0.003) significantly predicted adherence. In turn, adherence showed a positive association with hemoglobin levels (? = 0.570; p < 0.000). Conclusion: Family support, school support, and attitude were significantly associated with iron supplement adherence among adolescent girls. Although the explanatory power of the model for adherence was modest, adherence was positively associated with hemoglobin levels at post-test measurement. These findings should be interpreted as exploratory and hypothesis-generating. Multifactorial strategies that strengthen social support and sustained monitoring may enhance the effectiveness of anemia prevention programs among adolescent girls.
Introduction: The operating room consists of various health professionals so that they must build good teamwork to realize optimal anesthesia and surgical services. Therefore, it is necessary to have work motivation to be able to improve the quality of anesthesia and surgical services. The purpose of this study was to determine the components of work motivation in the operating room and anesthesia that can provide implications for anesthesia and surgical services. Methods: This type of research is quantitative with cross sectional. The sample used was nurse anesthetist who worked at the hospital, using accidental sampling so that a sample of 188 nurse anesthetists was obtained. The research instrument was a Motivating Potential Score (MPS) questionnaire and a surgical anesthesia service questionnaire from the Ministry of Health Accreditation Standards Year 2022 which was provided via google form. Data analysis using Spearman rank correlation coefficient. This research has obtained permission from the IPAI professional organization and is ethically feasible No. 209/09.KEPK/UBK/VIII/2024. Results: The results indicate that the average work motivation score was 9.86 (min 3.6; max 12), while the quality of anesthesia and surgical services averaged 14.31 (min 8.14; max 16). All components of work motivation: skill variety, task identity, job significance, autonomy, and feedback showed significant associations with service quality. Notably, autonomy demonstrated a moderate positive correlation with anesthesia and surgical service quality (r = 0.511, p < 0.001, 95% CI: 0,42-0,59), highlighting the magnitude of its effect and strengthening the analytical robustness of the findings. Conclusion: There is an influence of motivation on anesthesia and surgical services with a p value of 0.013 and a CC value of 0.181. Increasing conducive work motivation successfully provides satisfaction for nurse anesthetists and has an important role in quality anesthesia and surgical services.
Introduction: The rapid growth of household waste in urban areas poses a serious challenge to environmental health. The integration of the IoT into waste management is considered an innovative solution, offering real-time monitoring, collection efficiency, and greater system transparency. This study aims to examine the influence of perception, attitude, awareness, and practices on environmental health impacts in the context of IoT adoption. Methods: A cross-sectional survey was conducted with 120 households in the Greater Jakarta area, and the data were analyzed using SEM-PLS. Results: The results reveal that perception significantly influences attitude (p < 0.001), and attitude significantly influences awareness (p < 0.001). The structural model demonstrates strong predictive power with R² values of 0.566 for attitude, 0.552 for awareness, and 0.839 for environmental health impacts. Standardized path coefficients show significant effects for perception ? attitude (? = 0.752; p < 0.001), attitude ? awareness (? = 0.743; p < 0.001), and practices ? environmental health impact (? = 0.864; p < 0.001). Model diagnostics confirm reliability and validity, including AVE > 0.50, CR > 0.70, HTMT < 0.85, and VIF < 3. However, awareness does not directly affect environmental health (p > 0.05), indicating the presence of an intention–behavior gap. In contrast, actual waste management practices emerged as the most dominant predictor, with the largest effect on environmental health outcomes (p < 0.001). Conclusion: These findings highlight the necessity of policy strategies that go beyond raising awareness and digital literacy, ensuring the transformation of awareness into consistent practices through adequate infrastructure, incentive systems, and regulatory enforcement. This study contributes to strengthening the concept of smart cities and supports sustainable development strategies in urban settings.
Introduction: The peak of Indonesia's demographic bonus period is estimated to be in 2035, requiring government efforts in an integrated stunting prevention program to minimize risks. Cross-sector and cross-profession collaboration in the health field is needed to support optimal stunting services through the role and practice of pharmacists in community pharmacy facilities. This study aims to explore two topics: the role of community pharmacists and the practice of pharmaceutical service in stunting prevention programs in Indonesia. Methods: A pragmatic qualitative-descriptive study, using structured interview techniques with a Standardized Open-Ended Interview (SOEI). Nine community pharmacists were recruited using purposive sampling through interview consent. The data obtained from the interviews consisted of video and audio recordings that were transcribed, and then thematically analyzed. Results: The findings of this study are mapped into two main domains. The roles are identified as 1) The role of pharmacists in stunting prevention education through educational services, 2) in cross-sector collaboration among healthcare workers to prevent stunting in the community, and 3) in pharmaceutical services specifically for stunting prevention, which reflects practices in community pharmacy facilities in providing 4) basic education and counseling services related to stunting, 5) pharmaceutical product services for stunting needs, 6) promotive and preventive services in the stunting program, and 7) curative and referral services in the stunting program. Conclusion: These findings indicate a high level of awareness and professional competence among community pharmacists, and practices in the field show involvement and collaboration that can be integrated into Indonesia's health policy system in the future.
Introduction: Objectives This study was conducted to assess the impact of adding mobile health (mHealth) application on pharmacist-mediated patient counseling to improve accuracy of insulin pen self-administration skills among diabetic patients. Introduction Every day, diabetes mellitus (DM) remain one of the worlds biggest health problems where insulins therapy acts among the mainstay in treating type 1 and ineffective treatment for type 2 diabetes mellitus (T2DM). Insulin pens have increased convenience and adherence to insulin therapy compared with traditional vials and syringes; however, administration errors are still prevalent. These errors typically due to incorrect priming, wrong injection angle or failure to discharge air bubbles can lead to hypoglycemia, hyperglycaemia, and loss of glycemic control, with consequent negative impact on therapeutic outcomes. Although the results provide evidence of substantial improvement in dosing accuracy of insulin, causal inference and generalizability are limited by the single-group pretest–posttest design. Controlled studies moving forward are required to validate these results. The goal of this study was to determine if the addition of these mHealth technologies in pharmacist-led education could help us fill this important procedural gap. Methods: Between December 2023 and May 2024, this study took place in the outpatient clinic of PKU Muhammadiyah Gamping Hospital, Yogyakarta, Indonesia as a pre-experimental, one-group pretest–posttest study. Hundred adult diabetic patients were selected. Structured questionnaires and direct observations based on a standardized insulin pen checklist were used to collect the data. Ethics approval was obtained from Health Research Ethics Committee of PKU Muhammadiyah Gamping Hospital, and all individuals provided written informed consent. Results: At baseline, 29% of participants achieved high proficiency but post-intervention all (100%) achieved this level. Mean accuracy score significantly improved, from 10.28 (SD = 1.36) to 14.12 (SD = 1.03) (p <0.001). Procedural enhancements were to mix insulin and remove air bubbles. Conclusion: Pharmacist-led education with mHealth integration, the application of mobile technology in health monitoring, represents a novel and potentially generalisable approach in efforts to improve practices of insulin self-administration.
Introduction: Banyumas Regency, with its diverse rural and urban characteristics, is a strategic location to study this condition because of the socio-economic differences, access to education, and family parenting patterns that can influence the level of adolescent depression. This study aims to analyze the relationship between internal and external factors and depression levels in adolescents Therefore, the study draws on data from both rural and urban settings, offering a comprehensive understanding without conducting rural–urban comparisons. Methods: This study was a quantitative study with a cross-sectional design between social support, emotional autonomy, self-efficacy, parenting patterns, and parental attachment with adolescent depression level in Banyumas Regency. The study population was all junior high school students in Banyumas Regency, with a sample determined using the Slovin formula of 307 respondents and proportional random sampling techniques. Data were analyzed using the Chi-Square test and ordinal logistic regression to examine the relationship between the independent and dependent variables. Results: Emotional autonomy, self-efficacy, and social support were significantly associated with depression levels (p value < 0.05). Adolescents with lower self-efficacy (AOR = 1.90; 95% CI: 1.23–2.91) and inadequate social support (AOR = 1.71; 95% CI: 1.08–2.7) had higher odds of elevated depressive symptoms, indicating that high self-efficacy and adequate social support act as protective factors. Emotional autonomy showed an association in bivariate analysis but was not independently significant after adjusting for age and gender. Depression levels did not have any significant relationship with parenting patterns and parental attachment. Men adolescents were less likely to have high depressive symptoms than females. Conclusion: Self-efficacy and sufficient social support level are protective factors against depression in the adolescents. Depression among adolescents may be prevented, using intervention programs in schools and families that improve self-efficacy, problem-focused coping, and social support.
Introduction: Global health systems face challenges from fragmented services, high costs, and workforce shortages, impacting care quality. Interprofessional education (IPE) is a key strategy for preparing a collaborative workforce. According to ADDIE instructional design model, this study aimed to develop and implement a policy-relevant team-building training program to enhance collaboration, communication, and problem-solving skills among health professional students, supporting health system transformation goals. Methods: The program was developed through the five phases of the ADDIE model—Analysis, Design, Development, Implementation, and Evaluation. A needs assessment guided the design of interactive, experiential activities to improve teamwork competencies in interprofessional education. The training program was piloted for 16 hours (two separate days) with health professional students from diverse disciplines (N=11). A mixed-methods approach was implemented, while the quantitative data were collected via the reaction level of the adjusted Kirkpatrick-Phillips’ questionnaire to assess satisfaction scores, and qualitative data were collected through focus group discussions (FGDs). Results: The implementation of the team-building program significantly improved participants' teamwork skills, communication effectiveness, and overall group cohesion. Participants reported highly positive participant reactions and perceived teamwork enhancement. Conclusion: Applying the ADDIE model to structure team-building activities provides an effective educational strategy to foster interprofessional collaboration early in training. More importantly, such structured interventions represent a strategic investment in human resources for health, contributing to policy objectives for integrated and team-based care delivery.
Introduction: Dysmenorrhea is a common menstrual disorder among adolescents and constitutes a significant public health concern due to its adverse effects on school attendance, academic performance, and quality of life. In low- and middle-income countries, including Indonesia, school-based evidence examining associations between biological, psychological, and lifestyle factors and dysmenorrhea remains limited. This study aimed to investigate associations between selected biopsychosocial variables and dysmenorrhea among senior high-school girls in Makassar, Indonesia. Method: A school-based cross-sectional study was conducted among 45 female students at SMA Bajiminasa Makassar using a total sampling approach. Data were collected through a structured, self-administered questionnaire assessing dysmenorrhea status, physical activity level, psychological stress, family history of dysmenorrhea, age at menarche, and menstrual cycle regularity. Descriptive statistics were used to estimate prevalence. Associations between variables were examined using bivariate analyses, including chi-square or Fisher’s exact tests when appropriate, and effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Results: The prevalence of dysmenorrhea was 82.2%. Bivariate analyses indicated statistically significant associations between dysmenorrhea and inadequate physical activity, psychological stress, positive family history of dysmenorrhea, earlier age at menarche, and irregular menstrual cycles. Adolescents reporting psychological stress or a family history of dysmenorrhea demonstrated particularly high proportions of menstrual pain within this sample. Conclusion: Dysmenorrhea is highly prevalent among senior high-school girls in Makassar and was associated with several biological, psychological, and lifestyle variables examined in this exploratory analysis. These findings are consistent with biopsychosocial perspectives on adolescent dysmenorrhea, although the cross-sectional and bivariate analytical design limits causal interpretation. The results highlight the potential relevance of integrated school-based screening and health education initiatives addressing physical activity, psychological well-being, and menstrual health. Given the small sample size and single-school setting, findings should be interpreted cautiously and warrant confirmation in larger multi-site studies.
