Policies and cultural beliefs: Community perceptions about COVID-19 vaccine hesitancy in Indonesia

OBJECTIVE

Vaccine hesitancy is a global concern and a significant threat to COVID-19 vaccination programs. This study aimed to explore vaccine hesitancy from the perspective of the Indonesian community related to policies and cultural beliefs.

DESIGN

A descriptive qualitative approach was utilized in this study.

SAMPLE

Twenty participants were recruited from various settings to ensure the representation of experiences in different contexts in Indonesia.

MEASUREMENT

Audio-recorded, semi-structured, individual, in-depth interviews were carried out. Content analysis was performed to identify the main key themes.

RESULTS

Twenty participants were recruited from various regions of Java Island, Indonesia. The participants revealed hesitancy about the COVID-19 vaccine, including the themes of mistrust, controversy, and the culture and beliefs of the community.

CONCLUSIONS

This study highlights COVID-19 vaccine hesitancy in Indonesia, which may have implications for the community's perceptions and beliefs regarding the uptake of the COVID-19 vaccine. The trust issue remains a major challenge to convincing the community to accept the vaccine at the grassroots level. Targeted education and communication strategies are essential in addressing trust issues surrounding COVID-19 vaccines among critical stakeholders and religious leaders in Indonesia. Public health nursing plays a crucial role in fostering community acceptance and ensuring the success of vaccination programs.

Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.

METHODS

We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.

FINDINGS

Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.

INTERPRETATION

As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed.

FUNDING

Bill & Melinda Gates Foundation.

Spirituality and Recovery From Severe Mental Disorders: A Systematic Review

PURPOSE

The current study investigated the impact of spirituality and mental disorder recovery practices among individuals with severe mental disorders.

METHOD

A comprehensive search across six databases-Scopus, ScienceDirect, ProQuest, SpringerLink, PubMed, and CINAHL-was performed to identify relevant articles. A total of 651 articles were screened, and 16 met inclusion criteria.

RESULTS

Findings revealed that spirituality significantly contributed to the improvement of individuals with severe mental disorders by fostering the development of self-confidence, self-control, strength, and hope, thereby enhancing overall quality of life. In addition, spirituality appeared to correlate with increased self-efficacy.

CONCLUSION

Within the mental health recovery framework, spirituality has emerged as a crucial element in facilitating significant life improvements through the exploration of essential motivational strategies. Psychiatric-mental health nurses could play a pivotal role in helping individuals with severe mental disorders by addressing their spiritual needs, thereby promoting holistic recovery and care. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Meta-analysis and moderator analysis of the prevalence of malnutrition and malnutrition risk among older adults with dementia

BACKGROUND

Aging and dementia are common and closely related health problems in older adults, affecting their ability to maintain a healthy diet and ultimately resulting in malnutrition.

OBJECTIVE

In this study, we estimated the global prevalence of malnutrition and malnutrition risk in older adults with dementia.

DESIGN

Meta-analysis.

DATA SOURCES

Embase, Ovid MEDLINE, PubMed, CINAHL, Scopus, and Web of Science were comprehensively searched for articles published from database inception to October 2022.

METHODS

Pooled prevalence analysis was conducted using a generalized linear mixed model and a random-effects model. I2 and Cochran's Q statistics were used for identifying heterogeneity. Publication bias was evaluated using Peters' regression test and a funnel plot. Moderator analyses were conducted to investigate variations in the prevalence estimates of the included studies. All statistical analyses were conducted using R software.

RESULTS

A total of 16 studies involving a total of 6513 older adults with dementia were included in the analysis. The results indicated that 32.52 % (95 % confidence interval: 19.55-45.49) of all included older adults with dementia had malnutrition, whereas 46.80 % (95 % confidence interval: 38.90-54.70) had a risk of malnutrition. The prevalence of malnutrition was found to be high among older patients living in institutionalized settings (46.59 %) and those with Alzheimer's disease (12.26 %). The factors moderating the prevalence of malnutrition included adequate vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms. The prevalence of malnutrition risk was high among women (29.84 %) and patients with Alzheimer's disease (26.29 %). The factors moderating the prevalence of malnutrition risk included total cholesterol level, vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms.

CONCLUSIONS

Approximately one-third of older adults with dementia are malnourished and nearly half of older adults are at a risk of malnutrition. Encouraging collaboration among health-care professionals and ensuring early assessment and effective management of malnutrition are crucial for maintaining a favorable nutritional status in older adults with dementia.

REGISTRATION

This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022369329).

TWEETABLE ABSTRACT

Globally, approximately 32.52 % of older adults with dementia are malnourished and approximately 46.80 % are at a risk of malnutrition.

How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review

Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013-2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely.

RETRACTED: Dewi et al. Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials. Medicina 2023, 59, 283

The journal retracts the article entitled "Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials" [...].

MIESRA mHealth: Marital satisfaction during pregnancy

The transition of a pregnant woman's role often causes emotional changes that have an impact on marital satisfaction. We develop MIESRA mHealth and evaluate its impact on satisfaction of husband-wife relationship during pregnancy. A quasi-experimental study was conducted on 82 couples of pregnant women and divided into control, single, and paired group. We implemented MIESRA mHealth for four weeks. In the couple group, the wife did mindfulness based on the information in the MIESRA mHealth together with her husband. In a single group, the wife sees the video as an initial guide to doing mindfulness. In the control group, respondents received programme interventions from hospitals which included education and consultation with obstetricians. Husband-wife relationship is evaluated using Compatibility of Husband-and-Wife Relationships / Kesesuaian Hubungan Suami Istri (KHSI) questionnaire and the generalised estimating equations (GEE) was used to analyse the data. The women's KHSI scores in the couple and single intervention groups (β = -7.46, p = 0.002; β = -9.11, p = 0.001) were better than the control group. The husbands' KHSI scores in the paired and individual intervention groups (β = -7.04, p<0.001; β = -3.74, p = 0.024) were better than the control group. Nursing interventions to build emotional bonds between parents and foetuses based on mHealth can be a promising intervention for marital harmony during the perinatal period. MIESRA m-Health is a promising intervention on marital satisfaction during pregnancy and can be implemented as a part of the antenatal care programme to increase marital satisfaction.

Islamic Mindfulness-Based Caring as an Intervention to Manage Fatigue

Purpose: This study aims to determine the effects of Islamic Mindfulness-based Caring (IMC) on fatigue among breast cancer patients. Design: A quasi-experimental study was undertaken in the chemotherapy unit of a hospital, in Bandung, Indonesia. Methods: A total of 112 females with stage III breast cancer undertaking chemotherapy treatment were recruited by purposive sampling technique. The experimental group (n = 53) was given both IMC and usual care, whereas the control group (n = 59) received only the usual care. Data were collected on days 1, 3, 23, and 44 using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and demographic information tools. Data analyses were carried out with the Mixed-Effects Linear Regression. Findings: We found a significant difference in fatigue between the control and experimental groups on days 23 (mean: 29.34-34.92; p = .001) and 44 (mean: 28.68-37.89; p < .001) after IMC intervention. The increase of time was significantly associated with a lower fatigue score (p < .05). Mixed-Effect Linear Regression showed a significant interaction between time and intervention of IMC effect on fatigue score on time-4 (adjusted β coefficient: 6.62; 95% CI: 2.17-11.06). Conclusions: Nurse-administered IMC is capable of reducing fatigue among breast cancer patients who underwent chemotherapy.

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050.

METHODS

Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively.

FINDINGS

In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%.

INTERPRETATION

Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.

FUNDING

Bill & Melinda Gates Foundation.

Determinants of Burden in Family Caregivers of Individuals With Schizophrenia: A Systematic Review

The current systematic review was performed to determine the specific burdens placed on families of individuals with schizophrenia. Scopus, PubMed, and CINAHL databases were searched, resulting in 21 articles that met inclusion criteria. Results showed that treatment of individuals with schizophrenia poses a burden on families. Most caregivers experienced emotional and financial problems that affected their quality of life. Influencing factors in caregivers were age, sex, educational level, family status, income, time spent with the individual per day, knowledge regarding schizophrenia, attitude, and psychological stress. Influencing factors in individuals with schizophrenia were age, sex, severity of illness, social function, and treatment adherence. Environmental factors were stigma, social support, and professional support from health care providers. Family caregivers of individuals with schizophrenia need to be empowered to improve resilience and acceptance in caring for these individuals. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 38-43.].

Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials

Ventilator-associated pneumonia (VAP) is hospital-acquired pneumonia that develops 48 h or longer following mechanical ventilation. However, cuff pressure fluctuates significantly due to patient or tube movement, which might result in microaspiration. Subglottic secretion drainage (SSD) has been suggested as a method for VAP prevention bundles. This systematic review and meta-analysis aims to investigate the efficacy and safety of subglottic SSD in preventing VAP. The secondary outcomes of this study are to investigate the intensive care unit (ICU) stay length and mortality rate regarding VAP. This study followed the Preferred Reporting Item for Systematic Review and Meta-Analysis guidelines. A thorough search of PubMed, Embase, and the Web of Science was conducted between June and August 2022. The study analysis used the Mantel-Haenszel method, and the quality of the included study was assessed using the Cochrane Risk of Bias 2. Eighteen randomized controlled trials with a total of 2537 intubated patients were included. It was found that SSD was associated with a lower risk of VAP (RR 1.44; 95% CI; 1.20-1.73; p < 0.0001). The subgroup analysis (utilizing intermittent and continuous methods) found no statistically significant difference between the two groups (p = 0.28). The secondary endpoints showed that there was no significant difference in mortality (RR 1.02; 95% CI; 0.87-1.20; p = 0.83), but there were substantial differences in ICU stays (mean difference, 3.42 days; 95% CI; 2.07-4.76; p < 0.00001) in favor of the SSD group. This was based on a very low certainty of evidence due to concerns linked to the risk of bias and inconsistency. The use of SSD was associated with a reduction in VAP incidence and ICU stay length, but there was no significant difference in the mortality rate.

Malnutrition: Undernutrition or overnutrition?

The definitions and terminology related to malnutrition need to be clarified. The Academy of Nutrition and Dietetics (Academy) and the American Society of Parenteral and Enteral Nutrition (ASPEN) have classified clinical nutrition into malnutrition (undernutrition), sarcopenia, frailty, and overnutrition (overweight and obese). In addition, determining indicators for determining diagnoses related to malnutrition also needs to be clarified. Thus, this information can be used by nurses and other health workers to be able to provide appropriate planning and interventions for patients with malnutrition.

Preventive Bacterial Translocation and Control of Ventilator-Associated Pneumonia: A Qualitative Study

Background: Bacterial translocation is one cause of ventilator-associated pneumonia among patients treated in the Intensive Care Unit. The study aimed to observe critical nurses information about bacterial translocation prevention and ventilator-associated control in clinical settings. Methods: A qualitative phenomenology design was undertaken from July to September 2021. We recruited 40 critical nurses in government and educational hospitals in Surabaya, Indonesia. The in-depth online interview was conducted during the interview process and analysed using Colaizzi’s technique. Results: We emerged five themes that consist of 1) limited of nurse’s competence, 2) unsupported work environment, 3) barrier of human resource management, 4) work motivation, and 5) development of bacterial translocation preventive tools. Conclusion: Prevention of bacterial translocation is needed by developing tools and accessible by nurses. Whereases, the capacity and ability need to be developed by training. Nurses and Hospital Managers consider putting the attention of evidence-based tools in clinical settings.

Nursing Care on HIV/AIDS-Positive Men Who Have Sex with Men: A Qualitative Descriptive Study of Nurse's Perspective in Indonesia

HIV/AIDS-positive men who have had sex with men (MSM) account for roughly one-third of new infections in the region, with numerous nations facing a high and rising prevalence. They often face stigmatization and discrimination from society, including nurses. This study aims to explore nurses' perspectives on caring for HIV/AIDS-infected MSM. A descriptive qualitative design was utilized. Fifteen nurses who cared for HIV/AIDS-positive MSM in the two hospitals in Jakarta, Indonesia, were recruited with purposive sampling techniques. A semi-structured and in-depth interview was conducted. Data were analyzed using thematic analysis. We emerged three superordinate and nine subordinate themes: (1) negative nurse perceptions in the early phase of treatment, (2) nurse attitudes contrasting with negative perceptions, and (3) nurses with knowledge of HIV/AIDS. The negative perceptions appeared only at the beginning of the treatment phase, and thereafter, they were followed by a positive attitude. Nurses appeared to develop a better understanding after interacting with their patients and receiving training on HIV/AIDS. Therefore, intensive training is expected to not only increase their knowledge but to encourage a positive attitude.

Five Cs as reflective learning attitude among Philippines nursing students

Introduction: Philosophical viewpoints from the first-hand source regarded as the best inception of COVID-19 knowledge are not widely explored. Humanity’s understanding grounded on experiences becomes substantial only when stringent documentation of any events is performed carefully. COVID-19 as a phenomenon and as an ongoing struggle has myriad global impacts; hence the study aims to explore the understanding of nursing students’ stances regarding the COVID-19 pandemic in their daily life. Methods: The study used a qualitative study design with online survey. A total of 41 nursing students were recruited through total sampling technique. The study was conducted to students in a university in the Philippines. Interview guidelines used open questions and were spread online. The data were subjected to thematic analysis. Results: The thematic analysis revealed five organizing themes, such as communication, commitment, care, collaboration, and change. Those themes were found among nursing students’ stance regarding the COVID-19 phenomenon. Conclusions: The communication, commitment, care, collaboration, and change as development of a crisis-induced framework from study findings satisfies the essential finding that the pandemic is likewise giving rise to a new normal. Moreover, the results assist nursing students and other health-inspired domains to effectively maintain positivity amidst catastrophic climates.

What I felt as a diabetes fatigue survivor: a phenomenology study

Purpose

Diabetes has resulted in an increase in diabetic fatigue syndrome, which has a negative influence on health, particularly the risk of worsening quality of life (QoL) due to physical and mental limitations. The purpose of this study was to evaluate the experiences of patients with unregulated type 2 diabetes mellitus (T2DM) and diabetes fatigue syndrome.

Methods

This study used a qualitative phenomenological design and focused on patients from four primary health centers (PHCs) in Surabaya, Indonesia with higher incidents of unregulated T2DM. Thirty participants were recruited using purposive sampling with the following inclusion criteria: adult T2DM patients, willing to participate in the study, and able to recount experiences associated with their illness. Data collection took place between April and June 2020 across 36 interview sessions. Semi-structured interviews were carried out face-to-face with each participant with the principles of social distancing applied due to the COVID-19 pandemic.

Results

Analysis identified five themes and thirteen subthemes. The first theme was participants’ experiences during blood glucose imbalance. Other themes included experiences of boredom with diet, physical and psychological distress, financial problems during treatment, and sexual problems.

Conclusion

Participants with T2DM who experienced diabetes fatigue reported negative effects on their life, especially on health, functional daily activity, and finances. The results of this study can provide information for nurses and other healthcare providers to promote interventions for patients with T2DM, such as modifying lifestyle, self-acceptance, and self-efficacy.

Factors Associated with National Health Insurance Coverage in Indonesia

Background: The National Health Insurance (NHI) program is the Indonesian government's national health program. However, health insurance coverage has not been maximized. This study aims to analyze the factors associated with health insurance coverage in Indonesia.   Methods: Retrospective cross-sectional data were obtained from the Indonesian Demographic and Health Survey 2017. A total of 39,580 respondents were selected using two-stage stratified cluster sampling. The data come from the DHS Questionnaire Phase 7. In this study, we explored age, education level, wealth quintiles, residence, the number of children who are alive, marital status, current employment status, earnings, and health insurance status in relation to health insurance coverage. Then, we analyzed the data using chi-squared and binary logistic analyses.   Results: The prevalence of health insurance coverage in the Indonesian population is 62.3%. Respondent aged 15-24 years [AOR=0.88; 95% CI=0.77-1.00], secondary education level [AOR=0.44; 95% CI=0.41-0.47], poorer wealth index [AOR=0.76; 95% CI=0.71-0.82], live in rural area [AOR=0.78; 95% CI=0.75-0.82], divorced [AOR=0.72; 95% CI=0.63-0.83] were less likelihood to have health insurance. Conversely, the respondent who received earnings [AOR=1.25; 95% CI=1.18-1.32] was more likely to have health insurance.  Conclusion: This finding pointed to education level, economic status, and demographic area such as respondents who lived in rural areas should more pay attention to NHI. Intervention through the provision of appropriate information about NHI should be promoted.

The Impact of Online Learning among Adolescents during the COVID-19 Pandemic: A Qualitative Study of Mothers' Perspectives

BACKGROUND

The COVID-19 pandemic changed the educational system from conventional learning in schools to online learning. The use of the internet as a learning medium can have positive and negative impacts on adolescents and cause concern for mothers. In this study, mothers' perspectives were explored with the phenomenological approach to assess their experience of the effect on line learning during the COVID-19 pandemic among adolescents.

MATERIALS AND METHODS

The qualitative study design: phenomenology was conducted on mothers with children at senior high school education levels. The data were collected using in-depth interviews from June to November 2020 in West Java, Indonesia. A total of 13 mothers were recruited using the purposive sampling technique. Data analysis was performed using the Colaizzi method and NVIVO software for managing the coding process.

RESULTS

We obtained four themes, namely (1) formation of adolescent behavior with the internet, (2) prevention of internet addiction, (3) disturbance of cognitive development, and (4) negative effect of online learning.

CONCLUSIONS

The usage of the internet cannot be avoided. By guiding adolescents, the negative effects of the internet could be prevented. Developing learning programs, media, and online learning strategies according to students' needs should be promoted.

Prevalence and determinants of diarrhea among under-five children in five Southeast Asian countries: Evidence from the demographic health survey

PURPOSE

To describe the prevalence and the correlation between individual, environmental and household, health behavior, and source of information factors with diarrhea among under-five children in five Southeast Asian countries based on the National Health Survey.

DESIGN AND METHODS

Cross-sectional design conducted in five countries in Southeast Asia. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in five countries were analyzed.

RESULTS

A total of 12,447 children under 5 years of age from five countries in Southeast Asia (Indonesia 1807, Cambodia 2650, Myanmar 1717, the Philippines 3669, and Timor-Leste 2614) were included in this study. Binary logistic regression was performed to analyze the data. A total of 12,447 under-five children were included in the study. Overall, in five Southeast Asian countries, the prevalence of diarrhea is known from 8.39% in the Philippines to 18.21% in Indonesia. Several factors related to diarrhea are individual; environmental and household; health behavior such as stool disposal, breastfeeding mothers, and children's food history; and source of information factors.

CONCLUSION

The findings of this study indicate that diarrhea is a serious public health problem in the Southeast Asian region that must be addressed using preventive and curative approaches.

PRACTICE IMPLICATION

The results indicate the need for cross-collaboration among nurses, medical doctor, and sanitarian is needed to tackle the childhood diarrhea and minimize the severity based on those determinants.

Resilience-based Islamic program as a promising intervention on diabetes fatigue and health-related quality of life

Psychological problems commonly experienced by patients with type 2 diabetes mellitus (T2DM) cause diabetes fatigue conditions that can further worsen the treatment prognosis. We conducted this investigation to determine the effectiveness of a resilience-based Islamic program on diabetes fatigue and health-related quality of life (HRQoL) by measuring the biochemical indicators of T2DM. This was a quasi-experimental study performed from May to August 2021, in which 80 respondents aged 18–64 years diagnosed with T2DM were included through purposive sampling at a male:female sex ratio of 1:1 in the control group and 17:23 in the treatment group. A resilience-based Islamic program (a combination of stress management, mindfulness, prayer, and dhikr (the ritual formula of Sufi brotherhood recited devotionally in praise of Allah and as a means of attaining ecstatic experience)) was implemented in the treatment group for six sessions by blended online and offline interventions. Multidimensional Fatigue Inventory-20 and World Health Organization Quality of Life, Brief Form were used to evaluate diabetes fatigue and HRQoL. Blood tests were performed to measure HbA1c, total antioxidant serum, insulin, cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) levels from baseline to 3 months. Statistical analyses were conducted using paired t test, Wilcoxon signed-rank test, independent t test, and Mann–Whitney U test. The resilience-based Islamic program had a beneficial impact on the levels of HbA1c (p < 0.001), lipid profile (triglyceride) (p = 0.011), HDL-c (p = 0.01), LDL-c (p < 0.001), total antioxidant serum (p = 0.001), insulin (p < 0.001), diabetes fatigue (p < 0.05), and HRQoL (p < 0.05) in patients of the treatment group. The results of biochemical tests related to T2DM also indicated a reduction in diabetes fatigue and an increase in HRQoL due to the resilience-based Islamic program. Considering that a patient’s resilience to diabetes is an important factor in the management of diabetes fatigue, the resilience-based Islamic program can be applied at public health centers and community levels to increase T2DM resilience.

Investigation of discriminatory attitude toward people living with HIV in the family context using socio-economic factors and information sources: A nationwide study in Indonesia

Background

The well-being of people living with HIV (PLHIV) remains a concern. In addition to facing discrimination in their communities, many PLHIV have family members who have a discriminatory attitude. This study analyzes the discriminatory attitude toward PLHIV in the family context using socio-economic factors and information sources in Indonesia.

Methods

A cross-sectional study design was adopted using secondary data from the 2017 Indonesian Demographic Health Survey (IDHS). A total sample of 28,879 respondents was selected using two-stage stratified cluster sampling. The study variables are information sources, sex, age, education, residence, earnings, and familial discriminatory attitude. We used the STATA 16.1 software to analyze Chi-square and binary logistics with a 95% confident interval (CI) with a significance of 5% (p-value < 0.05).

Results

In Indonesia, familial discriminatory attitude has a prevalence of 72.10%. In the survey, the respondents with access to some information about HIV (AOR: 0.794; 95% CI [0.722-0.873]), women (AOR: 0.768; 95% CI [0.718-0.820]), and those living in rural areas (AOR: 0.880; 95% CI [0.834-0.929]) were the least likely to have a familial discriminatory attitude. Meanwhile, the respondents aged 15-24 years (AOR: 1.329; 95% CI [1.118-1.581]) and those with a secondary level of education (AOR: 1.070; 95% CI [1.004-1.142]) were the most likely to have a familial discriminatory attitude.

Conclusion

In the study, we found that, the younger the age and the lower the educational level of the respondent, the more likely they were to have a familial discriminatory attitude. The government may consider these factors when designing policies to tackle familial discrimination faced by PLHIV; in particular, education on HIV and AIDS should be promoted.

Determinants of under-five mortality in Indonesia: A nationwide study

BACKGROUND

The mortality rate for infants and children under five in Indonesia is an ongoing challenge for the government, with figures exceeding the targets set for the country by the Sustainable Development Goals (SDGs).

OBJECTIVES

This study aims to discover the factors causing under-five mortality in Indonesia.

METHODS

This study will employ a cross-sectional study design with data sourced from the 2017 Indonesian Demographic and Health Survey (IDHS) between July and September 2017. The sample included 10,014 women who had given birth in the five years prior to the survey. The data was analyzed using Binary logistic regression with a significance level of p < 0.05.

RESULTS

The significant factors relating to under-five mortality in Indonesia are: mother's age at birth (AOR = 2.04; 95% CI 95% = 1.11-3.77); birth weight (AOR = 7.60; 95% CI 95% = 5.17-11.19); the sex of the child (AOR = 1.80; 95% CI 95% = 1.28-2.52); frequency of using the internet (AOR = 1.13; 95% CI 95% = 0.02-0.95); residence (AOR = 0.64; 95% CI 95% = 0.33-0.94); and birth interval (AOR = 0.52; 95% CI 95% = 0.29-0.92). Birth weight is the more likely cause for under-five mortality in Indonesia.

CONCLUSIONS

This study revealed that the characteristics of mothers, children, the area of residence, and the behavior of the mother affect the under-five mortality.

PRACTICE IMPLICATIONS

Pediatric nurses can have a role to play in developing knowledge about health for both mothers and families. Additionally, accessible health education on issues from planning a pregnancy to childcare should be promoted in both rural and urban areas as well as a campaign on proper hygiene practices.

Indonesian nursing students' intention to accept COVID-19 vaccines: an online, multicentre survey

BACKGROUND

The determinants of intention to accept the COVID-19 vaccine and associated factors among nursing students during this pandemic need to be identified.

AIMS

The study assessed nursing students' attitudes to vaccination, health engagement and trust in government, as well as their intention to have a COVID-19 vaccination.

METHODS

A cross-sectional study was carried out among nursing students in three provinces of Java, Indonesia, from December 2020 to February 2021. Convenience sampling was used to gather primary data from 640 participants through a structured online survey. Multiple linear regression was used to analyse the results.

FINDINGS

All items of vaccine attitude and health engagement as well as trust in government were positive predictors of vaccine acceptance after adjusting for confounding factors.

CONCLUSION

Nursing students were more likely to accept vaccination if they had a positive attitude to vaccination, high levels of health engagement and trust in the government regarding tackling the COVID-19 pandemic.

HIV-related knowledge, information, and their contribution to stigmatization attitudes among females aged 15-24 years: regional disparities in Indonesia

BACKGROUND

Stigmatization attitudes among youths toward people living with HIV (PLWH) is still an issue and concern in Indonesia. The purpose of this study was to determine the regional disparities, levels of HIV-related knowledge, information, and contributions related to stigmatization attitudes among females aged 15-24 years in Indonesia.

METHODS

A cross-sectional study with The 2017 Indonesian Demographic Health Survey (IDHS) was used. A total of 12,691individual records of females aged 15-24 years were recruited through two-stage stratified cluster sampling. The endpoint was stigmatization attitude. Then, bivariate and multivariate binary logistics were performed.

RESULTS

The findings showed that female youths who have no HIV-related knowledge (62.15%) and some source of information (52.39%). The highest prevalence of stigmatizing attitude was 59.82%, on Java Island. Multivariate analysis showed that females living in Sulawesi and Kalimantan; those living in a rural area; and those with more HIV-related knowledge were less likely to have a stigmatizing attitude. Conversely, females with the middle- to richest-wealth index and had some HIV-related information were more likely to have a stigmatizing attitude.

CONCLUSION

An understanding of stigmatizing attitudes should be considered through demographic factors, knowledge, and source of HIV-related information. The Indonesian government should pay more attention to indicators of HIV-related knowledge and information. Moreover, we suggest that the government collaborates with youths to disseminate information and restructure and reanalyze policies about HIV.

Association of stigma with mental health and quality of life among Indonesian COVID-19 survivors

BACKGROUND AND OBJECTIVE

Coronavirus disease 2019 (COVID-19) survivors face societal stigma. The study aims to analyze the association of this stigma with the mental health and quality of life of COVID-19 survivors.

METHODS

In this cross-sectional study, we observed 547 adults who were previously documented as severe acute respiratory syndrome coronavirus (SARS-CoV-2) positive by a polymerase chain reaction (PCR) test, treated in a hospital or an emergency hospital and proven to be SARS-CoV-2 negative by their latest PCR test. We adopted the Berger HIV Stigma Scale to measure stigma; the World Health Organization Quality of Life Brief Form to measure quality of life; and the Mental Health Inventory-38 to measure mental health. The chi-square and binary logistic regression tests were used to find the correlation between the variables.

RESULTS

The multivariate analysis revealed that medium stigma was more likely related to quality of life and mental health than low stigma. Females were less likely to experience stigma related to mental health than men, and respondents who worked as laborers and entrepreneurs were less likely to experience stigma related to mental health than those who worked as civil workers/army personnel/teachers/lecturers. COVID-19 survivors experienced medium stigma in society and lower quality of life and mental health status. We found that quality of life and mental health were affected by stigma, sex, and occupation.

CONCLUSION

COVID-19 survivors are a vulnerable group that is most at risk when they return to their communities. Creating a safe environment and providing respectful care, including addressing complex stigma factors, is vital for developing appropriate interventions.

Assessment of Characteristics, Sources, and Anxiety Levels in Women with Single Parent Status during the COVID-19 Pandemic

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had an impact on people globally, including mothers living in coastal regions. Therefore, this study aims at identifying the psychological status of single mothers living in the coastal regions of Indonesia. METHODS: A descriptive quantitative cross-sectional design was used with non-probability sampling in coastal regions of West Java, Indonesia. Furthermore, the Zung Self Rating Anxiety Scale was used to assess the anxiety level of single mothers. RESULTS: The anxiety of single mothers during the COVID-19 pandemic was generally moderate (n = 45.77.59%), with 44.83% attributing it to health and the economy. Furthermore, previous results showed that this condition was observed in the elderly (n = 38.65.52%), though it lasted <5 years in the majority of cases (n = 33.56.90%). Symptoms associated with the anxiety of single mothers during the pandemic include an increase in restlessness, nervousness, and anxiety. CONCLUSION: The economy and health of single mothers were the primary sources of anxiety during the COVID-19 pandemic. A high percentage of these women suffer from mild anxiety and require immediate care to prevent the development of other health problems. Therefore, health cadres and community nurses are expected to take action to achieve optimal psychological welfare among single mothers during the pandemic. Further study can be conducted by focusing on the theme of defense mechanisms or resilience.

Self-Fetal Wellbeing Monitoring and Ante-Natal Care during the COVID-19 Pandemic: A Qualitative Descriptive Study among Pregnant Women in Indonesia

Pregnant women are expected to have a high level of awareness when it comes to checking their fetal health and ensuring their welfare. This study explored the experiences of pregnant women in Indonesia who were monitoring their fetal wellbeing during the COVID-19 pandemic. A qualitativedescriptive study design with a constructivist paradigm was used. Twenty-two pregnant women were recruited and participated in a semi-structured interview. Analysis of the transcribed interviews used a content, thematic and comparative process. Three themes emerged from the analysis: feelingsand responses, changes to the ante natal care service during the COVID-19 pandemic, and the fetal wellbeing monitoring, tools, and methods used. Advice on how pregnant women should conduct fetal wellbeing monitoring during COVID-19 is urgently needed. The results of this study indicate there is a need for interventions to help pregnant women carry out self-fetal wellbeing monitoring in times where they have fewer contacts with health professionals such as during the COVID-19 pandemic.

Regional disparities and their contribution to the coverage of the tetanus toxoid vaccine among women aged 15-49 years in Indonesia

Background: The prevention of Clostridium tetani bacterial infection through the administration of the tetanus toxoid (TT) vaccine in women is important. The purpose of this study was to determine the regional disparities and factors associated with TT vaccine coverage in women aged 15–49 years in Indonesia.

Methods: The Indonesian Demographic Health Survey (IDHS) 2017 data was used in this study. A total of 36,028 women, aged 15–49 years were recruited using the two-stage stratified cluster sampling technique. The questionnaire used was based on the DHS Questionnaire Phase 7. Chi-squared and binary logistic regression were used in this study as part of the analysis.

Results: We found that the TT vaccine coverage was 75.32% and that the majority were spread across several provinces. The provinces of Bali and Nusa Tenggara, the richer respondents, living in a rural area, visiting the health facility, having health insurance, and those currently working were factors making it more likely that the women would receive the TT vaccine. The respondents aged 15–24 years with a primary education level and the respondents who were divorced were less likely to receive the TT vaccine.

Conclusion: The coverage of the TT vaccine among women can be increased by considering the regional disparities in Indonesia and the socio-economic demographic details of the respondents. Strengthening the policies from the central government in the local governments can improve the screening process and vaccine delivery outcomes. In addition, the importance of giving the TT vaccine to women needs to be relayed through health education in collaboration between health workers and the public.

Factors Associated with the Behavior of Men who Have Sex with Men in the Prevention of Human Immunodeficiency Virus Transmission

Background: The prevalence of HIV/AIDS transmission caused by the behavior of men who have sex with men (MSM) is still a concern. The purpose of this study was to determine the factors associated with MSM behavior in relation to the prevention of HIV transmission. Methods: This study used a cross-sectional design. The total sample was 176 respondents determined using consecutive sampling technique. The variables consist of demographic data, knowledge, attitude, beliefs, the accessibility of the health facilities, health-related skills, peer support, health care provider support and the prevention behavior concerning HIV transmission. The data was obtained using a questionnaire and it was analyzed using Chi-square and ordinal logistic regression. Results: From the sample of 176 MSM, the behavior of the prevention of HIV transmission was 43.75%, which is a moderate level. Through ordinal logistic regression, we found that knowledge [OR:1.171, CI: 0.414-1.929] and peer support [OR: 1.902, CI: 0.721, 3.082] are more likely to prevent HIV transmission. Conclusion: Knowledge and peer support are known to be very important factors concerning the behavior engaged in the prevention of HIV transmission. Increasing the level of knowledge and increasing the youth networks in the form of groups as a form of support can be promoted by nurses, health workers, and the community in order to prevent HIV transmission.

Determinants of Nurse Preparedness in Disaster Management: A Cross-Sectional Study Among the Community Health Nurses in Coastal Areas

Purpose

Because Indonesia has a high risk of natural disasters, nurse preparedness is necessary to reduce and prevent deaths in the aftermath of such disasters. The aim of this study was to determine the factors associated with nurse preparedness in disaster management among a sample of community health nurses in coastal areas.

Patients and Methods

A cross-sectional study was undertaken from May to August 2020. The sample consisted of 142 nurses who worked at six Public Health Centers in Pangandaran, West Java, Indonesia. Participants were recruited using the total sampling technique. The data were collected using the Emergency Preparedness Information Questionnaire and analyzed using Chi-Square and binary logistic regression.

Results

Of the 142 respondents, 54.24% had a high level of preparedness. Multivariate analysis showed that nurses with higher levels of preparedness had worked between 6 and 10 years (adjusted odds ratio (AOR): 12.755, 95% confidence interval (CI): 2.653-61.314). Respondents who lacked disaster training were less likely to have a high level of disaster preparedness (AOR: 4.631, 95% CI: 1.604-13.367). Respondents who had never served as disaster volunteers were also less likely to have disaster preparedness (AOR: 0.18, 95% CI: 0.053-0.616).

Conclusion

With nearly half of the respondents (45.77%) having a low level of disaster preparedness, this topic needs more attention from the government and healthcare workers. Several actions are needed to improve community nurses' disaster preparedness: providing them with routine disaster-related training, encouraging them to serve as volunteers in various disaster conditions, and offering them useful disaster-related information.

Internet Addiction Among Male Adolescents in Indonesia: A Qualitative Study

Internet has become an important part of the daily life of adolescents. Easy access to internet and its social appeal among adolescent males render them at an increased risk of internet addiction and the associated adverse physical and psychosocial effects. We conducted a qualitative study using a phenomenological approach. A purposive sample of nine male adolescents was recruited in West Java, Indonesia. Semistructured interviews were conducted until data saturation was achieved. Data were subjected to thematic analysis. We identified four main themes from the experiences of adolescents with internet addition: reasons for internet addiction, unmet social need without the internet, effects of internet addiction, and self-control over internet usage. Internet addiction among male adolescents is a major public health problem that should be addressed. The findings of this study may be useful for health professionals and families to help male adolescents manage their internet addiction.

Description the Importance of Developing a Self-Reliance Instrument for Schizophrenic Patients in the Hospital Setting

Abstract Background: The level of independence among schizophrenia patients is still a problem that must be resolved. The development of appropriate relevant instruments is needed. This study aims to develop a nursing rehabilitation therapy instrument to increase the independence of schizophrenia patients in the hospital setting. Methods: This study used a research and development study design. The study was conducted in a Psychiatric Hospital in Surabaya, Indonesia from August to December 2020. The total sample in this study consisted of 100 nurses determined by a simple random sampling technique. In addition, 50 medical records were observed. The inclusion criteria were nurses who cared for patients with schizophrenia with a minimum work experience of 1 year. Respondents were excluded from the study if they did not follow the study through to completion. The data collection process was done online by filling in a Google form. The data was analysed using descriptive statistics and a FGD followed with 10 nurses to discuss the new instrument. Results: The data found that a rehabilitation therapy instrument is not currently available (53%). The FGD results show that it is necessary to develop the nurse’s knowledge and to provide adequate facilities and rooms, as well as to develop instruments to use as measuring tools in order to evaluate the rehabilitation therapy given. Conclusion: Rehabilitation therapy instruments are important to develop for schizophrenia patients. It is hoped that the development of the instrument in this study will optimise the rehabilitation of schizophrenia patients.

A Qualitative Study Inquiry among Patients with Diabetic Foot Ulcers: What have They Felt?

BACKGROUND: Diabetic foot ulcers (DFU) caused physical and psychosocial problems and the risk of amputations and death. AIM: The aim of the study was to overview the feelings of diabetes mellitus patients with DFU. METHODS: A phenomenological qualitative study design was undertaken from January to April 2020. A total of 25 patients with DFU were determined through the purposive sampling technique. The study was conducted among the patients undertaking home-based wound care in Bojonegoro, Indonesia. The proposed discussion guidelines were used to collect the data through in-depth interviews. Colaizzi’s technique was used to analyze the data and it was managed by NVIVO. RESULTS: We emerged two themes: Psychological and physiological response of patients with DFU and coping mechanisms in caring DFU. Among the patients with DFU, we determined their psychological responses and coping mechanisms as reported in this study. CONCLUSIONS: Patients with DFU are expected to be able to control themselves psychologically. Health workers such as doctors and nurses can provide interventions by considering the psychological condition of patients with DFU. A good psychological condition can ensure that their blood sugar is regulated properly.

The Effect of Learning Module Program on Mothers’ Ability to Adapt to New Foods, Feeding Styles, and Self-efficacy to Their Children with Avoidant Restrictive Food Intake Disorder

BACKGROUND: The education to improve a mother’s knowledge is deemed to be important because it may improve children’s nutritional status. AIM: The aim of this study was to examine the effects of learning module program on the mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with avoidant restrictive food intake disorder (ARFID). METHODS: Quasi-experimental design was used to evaluate the effectiveness of learning module program. Fifteen mothers of experimental group were given four meetings within 4 weeks. Each meeting ran about 50 min. Fifteen mothers of control group were conducted home visit and received twice education about the health principals of feeding children. Both experimental group and control group had pre-test and post-test. The data were analyzed using Chi-square test, Fisher’s exact test, and Mann–Whitney U-test. RESULTS: The participants of the experimental group have shown bigger surge of new foods adaptation (t = –2.973, p < 0.003), feeding style (t = –4.646, p < 0.001), self-efficacy (t = –3.652, p = 0.001) than the control group has. CONCLUSION: The findings indicated that the learning module program was deemed to be effective to improve mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with ARFID.

Determinants of Stunting Prevention among Mothers with Children Aged 6–24 Months

AIM: The purpose of this study was to analyze the determinants of stunting prevention in relation to mothers with children aged 6–24 months in Madura Indonesia. METHODS: The design of this study was cross-sectional. The number of samples totaled 109 respondents using a purposive sampling technique. The independent variables were knowledge, attitudes, income, cultural values, and parenting. The dependent variable was stunting prevention. The data were collected using a questionnaire and then analyzed using the Chi-square test with a significance level of α _< 0.05. RESULTS: The factors associated with stunting prevention were knowledge (p = 0.007), attitude (p = 0.034), income (p = 0.006), cultural values (p = 0.016), and parenting patterns (p = 0.000). CONCLUSIONS: Knowledge, attitude, income, cultural values, and parenting influenced the parent’s strategy when it came to prevent stunting in their children. Stunting prevention programs should focus on improving parental behavior by modifying these factors.

Pro-and Anti-vaccination among Mothers in Deciding Children’s Immunization: A Qualitative Study

BACKGROUND: Society participation in the mandatory basic immunization program has declined in the last 2 years in Indonesia. One of the causes is the widespread of anti-vaccine issue, which has recently been debated on social media. This study aimed to explore the perspectives, backgrounds, experiences, and aspects that underlie the mother’s confidence in anti-vaccine and pro-vaccine groups who join the Facebook social media forum. METHODS: A phenomenology qualitative design was undertaken. The data were collected from June to August 2020. We conducted in-depth structured interviews with 5 anti-vaccine participants and 5 pro-vaccine participants. We obtained saturation data with ten participants. The data managed by NVIVO 12 software and analyzed using the thematic analysis method. RESULTS: We obtained 4 themes, including social media values, perceptions of immunization, immunization barriers, and knowledge about immunization. Anti-vaccine parents were firm not to immunize their children even though they knew the purpose of immunization and were perceived that there were no barriers to taking immunization. Pro-vaccine parents were determined to take basic immunization despite experiencing various barriers. CONCLUSION: This study showed that social media, perceptions, knowledge, and barrier about immunization affect mothers in considering the decision to give immunization to their children. Nurses and other healthcare workers should be provided positive communication and mutual trust between parents and health services are required to develop parental vaccine confidence so that basic immunization coverage can increase.

The determinants of willingness to care for people living with HIV-AIDS: A cross-sectional study in Indonesia

Acceptance and willingness to care for people living with HIV-AIDS (PLHA) in society is still a concern. The purpose of this study is to analyse the determinants of willingness to care for PLHA in Indonesia. A cross-sectional study was conducted to process the secondary data from the Indonesian Demographic Health Survey (IDHS) conducted in 2017. A total sample of 13,731 individuals was obtained by a two-stage stratified cluster sampling technique. The variables used were socioeconomic characteristics (age, sex, education, wealth quintile, residence, employment status and earnings), knowledge about HIV-AIDS, information about HIV-AIDS and willingness to care for PLHA. Binary logistic regressions were used to analyse the data. According to the data from IDHS 2017, 71.84% of total respondents in Indonesia are willing to care for PLHA. Female respondents, individuals in all wealth quintiles and those who have more information are more likely to care for PLHA. Respondents aged 35-49 years old and currently working are less likely to care for PLHA. However, level of education, level of knowledge, residence and earnings are not related willingness to care for PLHA. The dissemination of correct and accurate information about HIV-AIDS can help the community and society understand this condition. Thus, community members can accept PLHA and become more willing to provide care. The government can determine further policies for the appropriate dissemination of information, maximally and in accordance with recommendations. Collaborations among the government, health workers and the community are needed.

Contributing Factors of Cyberbullying Behavior among Youths During Covid-19

Introduction: The use of information technology during the Covid-19 period is inevitable and can lead to cyberbullying. Mental and life health conditions can be threatened due to being the victim of cyberbullying. This study aims to determine the factors that contribute to the formation of cyberbullying behavior among youths in South Sumatra, Indonesia.Methods: A cross-sectional study was undertaken. The population was youths in South Sumatra, Indonesia with a total sample of 213 respondents who were determined based on purposive sampling. The data collection was done by distributing questionnaires via Google Forms. The questionnaire was developed based on the concept of cyberbullying behavior inclusive of repetition, power imbalance, deliberation and aggression.  The data was analyzed using ANOVA and MANOVA.Results: In the study, we found that gender contributes the most to shaping cyberbullying behavior (p=0.000), followed by the parent’s occupation (p=0.018).Conclusion: It is necessary to establish an interconnected system between parents, youth groups and the education sector to avoid cyberbullying behavior. The ability of youths to adapt constructively to the increasing advancement of information technology and to use it wisely is something urgent that needs to be observed so then the cyberbullying cycle can be eradicated.

Determinants of the Discriminatory Behavior Experienced by People Living with HIV in Indonesia: A Cross-sectional Study of the Demographic Health Survey

Introduction:

The discriminatory behavior experienced by People Living With HIV (PLWH) remains an unresolved problem in Indonesia. The aims of this research were to determine the factors associated with the discriminatory behavior experienced by PLWH in Indonesia.

Methods:

This study used cross-sectional design data by processing secondary data from the Indonesian Demographic Health Survey (IDHS) conducted in 2017. The total sample in this study was 15,413 records obtained via the two-stage stratified cluster sampling technique. The variables in this study were knowledge, information, socioeconomic and demographic details and the discriminatory behavior experienced by PLWH. The instrument refers to IDHS 2017. The data were analyzed using a chi-squared test and multinomial logistic regression.

Results:

The results obtained show that approximately 78.87% of respondents exhibited discriminatory behavior against PLWH in Indonesia. Respondents who had more knowledge about HIV [RRR: 25.35; CI: 2.85, 225.18] and who had earnings [RRR: 2.15; CI: 1.18, 3.92] were more at risk of discriminatory behavior than others. Respondents who lived in a rural area were less likely to engage in discriminatory behavior against PLWH than those who lived in urban areas [RRR: 0.51; CI: 0.29, 0.91].

Conclusion:

An increased understanding of HIV-AIDS and Indonesian people's acceptance of PLWH can occur through the provision of accurate information that is designed to prevent discriminatory behavior against PLWH. The government can consider this problem and further related policies so that PLWH can coexist in society and enjoy the same rights as those living without discrimination.

Quality of Life of Diabetic Foot Ulcer Patients with Hyperbaric Oxygen Therapy

DM with ulcer can result in a decrease in the quality of life of patients and need to reduce the intensity of pain and odor on the ulcer, preventing amputation and Hyperbaric Oxygen as an adjuvant therapy in accelerating wound healing. This study aims to explain the effect of HBO on the quality of life of patients with diabetic foot ulcers at RSAL Dr. Ramelan Surabaya. Methods: The research used quasi-experimental design with a non-equivalent control group design approach. The samples were 70 patients from population of all diabetes patients who suffered from diabetic foot ulcers at RSAL Dr. Ramelan. Data were collected by WHOQOL-BREF questionnaire. Analyzed byWilcoxon signed rank test and Mann Whitney U test. Result: Mann Whitney in the post test, the physical p-value domain (0.000), psychological domain (0.012), social domain (0.003), and environmental domain (0,001), where the intervention group has a better value than the control group. Wilcoxon signed rank test results on the physical domain (0,000), psychological (0,012), social (0,003), and environmental (0,001), meaning there were significant differences between pre post test in intervention group. Discussion: Diabetes mellitus patients with foot ulcers given hyperbaric oxygen showed improvement on wound condition, thus reducing pain and medical needs. This makes patients motivated, reduce anxiety, and improve interpersonal support and confidence. Therefore, it is necessary to socialize the effect of HBO on DM patients with foot ulcer, as a treatment option in improving the quality of life of DM patients with foot ulcers.

A qualitative study exploring diabetes resilience among adults with regulated type 2 diabetes mellitus

BACKGROUND AND AIMS

Type 2 diabetes mellitus (T2DM) patients often experience unregulated blood glucose due to the lack of resilience. The aim of this study was to explore diabetes resilience among adults with regulated T2DM.

METHODS

This study used a qualitative case study design. A total of 15 participants with T2DM were recruited through snowball sampling. The study was conducted in four Health Primary Centers in Surabaya, Indonesia. The indicators of diabetes resilience were proper management of diet, activity, stress, and drugs. Interview guidelines were used to collect the data through in-depth interviews. The data were subjected to thematic analysis.

RESULTS

In this study, the results identified four themes, namely, resilient, support, benefits, and self-care agency. These themes were found among the participants with a resilient condition and regulated blood glucose.

CONCLUSIONS

Resilient, support, benefits, and self-care agency are the themes for achieving diabetes resilience by adults with T2DM. Policymakers and health workers need to consider health interventions for increasing the resilience of T2DM patients so that they can achieve a better glycemic control condition, and manage their diet, medication, activity and stress properly.

Summary Guidance for Daily Practices on Glycemic Control and Foot Care Behavior

Introduction: The Prevalence of Diabetes Foot Ulcers (DFU) in Indonesia is increasing every year. Summary Guidance for Daily Practice (SGFDP) is a media used to discuss and share knowledge to prevent foot ulcer in patients with Type 2 Diabetes Mellitus (T2DM). The aim was to know the influence of applying SGFDP on glycemic control (fasting blood glucose levels) and foot care behavior.Methods: The study was quasi-experimental utilizing a pretest-post-test with a control group design. The sample obtained was 232 respondents through consecutive sampling. The variables were SGFDP, glycemic control, and foot care behavior. The intervention was conducted for three weeks meeting. The data collected using observation sheets and the Nottingham Assessment of Functional Footcare (NAFF) questionnaire. The results were analyzed using the Wilcoxon and Mann-Whitney tests.Results: Most of respondents were elderly aged 41-50 years old. Respondents showed significant progressed of foot care behavior on before and after treatment. The results showed a significant influence from SGFDP on foot care behavior (p=0.001).Conclusion: The application of SGFDP as an approach to prevent foot ulcers among adults T2DM was significantly affected. It was conducted by discussing and sharing knowledge and utilizing a foot ulcer prevention simulation with foot exercises. Sharing information and the attention given by the nurses in the form of regular meetings can increase patient knowledge and induce behavior changes among adult T2DM.  

Safety behaviour and healthy diving: a qualitative study in the traditional diverse fishermen

BACKGROUND

Traditional divers from the Maluku Province of Indonesia have not received formal education and training related to standard diving tools. They only become accomplished at diving generation by generation. The use of non-standard diving tools increases the risk of injury and illness. This study aimed to get an overview of the health and safety behaviours of traditional divers.

MATERIALS AND METHODS

The study was qualitative, involving 15 traditional divers who used compressors for at least 1 year and who'd had decompression sickness and barotrauma as a result of diving. The data was obtained through in-depth interviews, analysed through the Colaizzi method.

RESULTS

The participants' diving health and safety behaviour is triggered by the perception of the risk of diving. This is supported by the reinforcing social and environmental factors leading to the form of health and safety behaviour when diving. These behaviours include diving without planning, using a compressor, and making "sesajen" (kind of food, leaves, and water that are believed to be a form of surrender to the creator) which is an offering or present to the gods or ancestors. This behaviour causes complaints such as trauma and an increased economic burden. Some participants consider complaints as a threat and plan to stop diving. The participants made a plan before dive and declared that they would change their behaviour to ensure safety.

CONCLUSIONS

Health and safety behaviour related to diving must be socialised and facilitated. The establishment of a divers' community that cares about health and safety behaviour needs to become important as a support system.

Behaviour model for diabetic ulcer prevention

Purpose

Diabetic ulcers are one of the complications that often occur in patients with DM. The aim is to develop a behaviour model for diabetic ulcer prevention by integrating Lawrance Green Theory and the Theory of Planned Behaviour.

Methods

An explanative observational design was used with a cross-sectional approach. The population consisted of DM patients who had underwent treatment at the internal medicine clinic of Sidoarjo District Hospital. The sample size of 133 respondents was obtained through purposive sampling. The data analysis used Partial Least Square.

Results

Predisposing factors (knowledge), supporting factors (availability of health facilities and accessibility of health resources) and driving factors (the role of health workers and family support) significantly influence the main factors (attitudes toward behaviour, subjective norms and perceptions of self-control) with a statistical T value>1.96. The main factor influences intention (T = 48.650) and intention influences behaviour (T = 4.891).

Conclusion

Intention is influenced by the attitudes toward behaviour, subjective norms and self-control perceptions. Good intentions can increase the preventive behaviour related to diabetic ulcers. Increasing the diabetic ulcer prevention behaviour can be done by providing regular education to both the patients and their families about diabetic ulcers and their prevention through the appropriate management of DM, lifestyle modification and regular foot care that requires active involvement from the family and health care workers.

Attitude of Nurses Related to The Implementation of Patient Safety in The Intensive Care Unit

Introduction: The error events in the Intensive Care Unit (ICU) were caused by nurses focusing more towards collaborative intervention with other medical staff and workload documentation which was not optimal. The purpose of this study was to determine the predisposing factors related to the implementation of patient safety in the ICU.Methods: This study was a descriptive analytic correlational study. Sample size was determined by purposive sampling and obtained 26 nurses. The independent variables were the predisposing factors and the dependent variable was the implementation of patient safety.  Instruments used were a questionnaire and observation sheet. Analysis was performed using Spearman's Rho and Logistic Regression.Results: Spearman’s Rho showed there was a significant correlation between knowledge (p=0.019) and attitude (p=0.040) towards implementation of patient safety. There was no significant of motivation (p=0.073) towards the implementation of patient safety. Logistic Regression showed the dominant factor in implementation of patient safety was attitude.Conclusion: Predisposing factors, that include knowledge and attitude, had a significant effect on the implementation of patient safety, but still required high motivation in the implementation of patient safety. In addition to knowledge and good attitude, nurses are expected to improve motivation in the implementation of patient safety.

The Benefits of Fasting to Improve Health Conditions and to Prevent Cardiovascular Disease

Introduction: Fasting is defined as the voluntary abstinence from eating for variable time intervals and it has been associated with potential beneficial impacts on human health. The study was to review the benefits of fasting on cardiovascular health in humans with or without cardiovascular disease.Methods: The databases search was done using the keywords ‘fasting’ and ‘cardiovascular system’ using Scopus, Science Direct and ProQuest, limited to between 2013 and 2019 for publication year. A total of 3.619 articles were obtained and 15 articles involving experimental and non-experimental studies were used as the reference material.Results: The findings showed that in people who are healthy, fasting can reduce the inflammatory markers (IL-1 & IL-6, TNF-α), the oxidative stress marker (Malondialdehyde), body weight, abdominal circumference, fasting blood glucose, LDL, triglyceride and blood pressure. In people at risk or with cardiovascular disease, fasting can reduce body weight, body mass index, abdominal circumference, fat percentage, blood pressure, triglyceride, the biomarker of inflammation (serum amyloid A), the biomarker of oxidative stress (protein carbonyl), the biomarker of endothelial dysfunction (asymmetric dimethylarginine) and increase the vascular endothelial growth factor.Conclusion: Based on these findings, fasting can improve the health condition of people at risk or with cardiovascular disease by improving the risk factors such as blood pressure, overweight and endothelial dysfunction. In people who are healthy, fasting can be used for the prevention of cardiovascular disease by helping to maintain their weight, blood pressure, LDL and triglyceride within the normal limits.

Deep Breathing Relaxation for Decreasing Blood Pressure in People with Hypertension

Various non-pharmacological therapies can be used to reduce blood pressure. One of them is deep breathing relaxation. This study aimed to know the influence of deep breath relaxation to decrease the blood pressure of people with hypertension. The design of this study was an Pre-Experimental One Group Pretest-Post-test design which covered 30 respondents as the sample. They fulfilled the inclusion criteria and were chosen through purposive sampling. The independent variable in this study was deep breath relaxation and the dependent variable was blood pressure. The data collection technique was using the observation sheet of blood pressure measurement. Data were analyzed using the paired t test. The findings of this study majority there were decrease blood pressure after deep breath. Before doing the breath relaxation exercise, most of the respondents were hypertension level 1. Nonetheless, after the deep breath relaxation had been executed, most found that their blood pressure decreased although several respondents were at hypertension level 2 with stable blood pressure. The results showed that there were differences in the blood pressure patients with hypertension before and after the deep breath relaxation. There were several points which influenced the decrease in blood pressure after implementing the deep breath relaxation such as stress, cigarettes etc.

A Review of Personality Type D on Cardiovascular Disease Patients

Introduction: The type of personality that a patient has as a psychosocial factor has been associated with the incidence and progression of cardiovascular disease. The aim of the study was to review the evidence and correlation between personality type and the development of cardiovascular disease.Methods: Articles were searched for using the PRISMA approach in the CINAHL, Science Direct and Scopus databases, limited to the last 5 years. The articles were from 2013 to 2018 and the language used was English. The studies focused on personality type D and cardiovascular disease, and the participants were above 18 years old.Results: Most of the findings of the studies showed that individuals with a type D personality have a relationship with more severe heart disease, which relates to several physiological factors, namely emotion increase, anxiety, stress, biological factors, cognitive decline and the decrease in quality of life.Conclusion: Individuals with type D personality have a higher level of stress, significant blood pressure, higher pulse and they experience an increase in cortisol compared to non-type D personalities. Individuals who suffer from cardiovascular disease with personality type D tend to experience a more severe progression of the condition of cardiovascular disease.

A Qualitative Inquiry into The Adherence of Adults Type 2 Diabetes Mellitus with Dietary Programs

Introduction: Diabetes mellitus (DM) is a chronic disease with the characteristic of treatment complexity. The toughest challenge for DM patients is dietary adherence. On the other hand, the socio-culture is one of the factors that influences dietary adherence. The aim of this study was to examine the dietary adherence of adults with type 2 Diabetes mellitus (T2DM), particularly to dietary programs.Methods: This study used a qualitative case study design with a positivist approach. The total participants consisted of 14 T2DM patients obtained through snowball sampling. The research phenomenon was the adherence of adults with type 2 Diabetes mellitus to dietary programs. The data collection was conducted through in-depth interviews with question guidelines analyzed using qualitative thematic analysis.Results: This study obtained five themes regarding the dietary adherence of T2DM patients such as activity, motivation, intention, behavior, and the benefits of dietary adherence. The focus points were activity, motivation, and the intention to comply with the dietary recommendations, including reducing the fatty and fried foods consumed. The patients who felt the benefits of complying with the dietary program found following the dietary adherence to be easier.Conclusions: Activity, motivation, intention, behavior and the benefits of the dietary adherence program all make it easier for the patient to comply with their diet. This result suggests that health workers should provide education to the patients on the importance, benefits and the way to comply with the T2DM dietary program.