Media Publikasi Promosi Kesehatan Indonesia (MPPKI)

Knowledge and Attitude of Patients Toward Hemorrhoids in Yogyakarta, Indonesia

Fadli Robby Amsriza, Rizka Fakhriani — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Hemorrhoids are enlarged and displaced vascular structures located in the anal canal that may cause symptoms such as bleeding, pain, discomfort, and itching, thereby affecting patients’ quality of life. Although hemorrhoidal disease is common, evidence regarding knowledge and attitudes toward hemorrhoids in Indonesia remains limited. This study aimed to assess knowledge and attitudes regarding hemorrhoids among adults diagnosed with hemorrhoids in Yogyakarta, Indonesia.

Methods: A cross-sectional study was conducted among adults aged ≥18 years diagnosed with hemorrhoids in Yogyakarta, Indonesia. Data were collected over six months using an online questionnaire adapted from previous studies. The questionnaire included demographic characteristics, 13 knowledge-related items regarding hemorrhoid definition, causes, complications, and preventive measures, as well as four questions assessing attitudes toward medical consultation and traditional medicine. SPSS version 24 was used to conduct descriptive statistics and chi-square analysis.

Results: The study included 70 participants with 52.9% being male. Majority of the participants had awareness of common hemorrhoid symptoms particularly bleeding during defecation (98.6%) and dilated anal or rectal veins (88.6%). However, misconceptions were still observed with regard to complications and preventive measures including fiber-rich diet and adequate fluid intake. Overall, 65.7% of the participants were categorized as having good knowledge. In terms of attitudes, most of the participants reported willingness to seek medical consultation if hemorrhoidal symptoms occurred (94.3%) while 30% indicated preference toward traditional medicine. Cultural perceptions were also considered a potential barrier to medical consultation by 61.4% of the participants.

Conclusion: Patients with hemorrhoids in Yogyakarta generally had good awareness of hemorrhoidal symptoms and positive attitudes towards seeking medical care. However, important misconceptions about prevention and complications were still found. These findings highlight the need for culturally sensitive educational interventions to improve public understanding of hemorrhoidal disease and to encourage timely medical consultation.

Knowledge and Practices Regarding Personal Listening Device Use and Associated Health Risks among Medical Students

Rizka Fakhriani, Asti Widuri, Danu Yudistira — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: The growing use of personal listening devices (PLDs) among young adults has raised concerns about unsafe listening practices, yet evidence on Indonesian medical students’ knowledge remains limited. This study aimed to assess undergraduate medical students’ knowledge of hearing-related risks and self-reported PLD listening practices.

Methods: An analytical cross-sectional study was conducted among undergraduate medical students at a university in Yogyakarta, Indonesia, from April to May 2022. A total of 182 students completed a structured self-administered questionnaire adapted from previous studies. The questionnaire covered demographic characteristics, knowledge of hearing-related risks, and safe listening practices. Chi-squared or Fisher’s exact tests were used to examine associations between categorical variables, with statistical significance set at p < 0.05.

Results: Most respondents (76.4%) had used PLDs for more than five years. Nearly half (49.5%) reported using PLDs for less than one hour per day, and 39.0% preferred a loud listening volume. Most participants recognised possible consequences of prolonged PLD use, including hearing loss (100%) and tinnitus (99.5%). Overall, 61.5% identified less than three hours as the safe limit at normal volume, and 72.0% identified less than one hour at loud volume.

Conclusion: Respondents generally recognised hearing-related risks; however, knowledge of safe-listening recommendations and exposure limits was incomplete, and potentially unsafe listening practices were reported. These findings support hearing-conservation education that emphasises practical safe-listening behaviours among university students.

Clinical Pathway Implementation and Hospital Outcomes Among Bronchopneumonia Patients Under the JKN System in Indonesia

Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Under Indonesia’s National Health Insurance (JKN) system, hospitals are expected to improve efficiency while maintaining quality of care. Clinical pathways (CPs) are widely implemented to standardize patient management, but evidence regarding their association with hospital outcomes among bronchopneumonia patients remains limited. This study examined the association between CP implementation and hospital outcomes under the JKN system.

Methods: A retrospective analytic study with a cross-sectional design was conducted using secondary data obtained from medical records of 113 JKN inpatients diagnosed with bronchopneumonia at Pertamina Brain and Heart Hospital Biringkanaya Makassar, Indonesia. CP implementation was classified as compliant or non-compliant based on documented adherence to the established clinical pathway. Hospital outcomes included length of stay (LOS), hospital cost efficiency, quality of care, and patient recovery. Data were analyzed using chi-square tests, Mann–Whitney U test, and multivariable binary logistic regression adjusted for age group and sex.

Results: After adjustment for age group and sex, clinical pathway compliance remained independently associated with shorter length of stay (AOR = 15.23; 95% CI: 5.74-40.41; p < 0.001) and greater hospital cost efficiency (AOR = 18.36; 95% CI: 6.77-49.83; p < 0.001). Clinical pathway compliance was also significantly associated with compliance with documented clinical service standards (OR = 140.800; 95% CI: 17.814–1112.876; p < 0.001). Median hospital treatment costs differed significantly between the compliant and non-compliant groups (Mann–Whitney U test, p < 0.001). No significant association was observed between clinical pathway compliance and patient recovery outcomes (p = 0.250).

Conclusion: Clinical pathway compliance was independently associated with shorter LOS, greater hospital cost efficiency, and better adherence to documented clinical service standards. These findings support the role of clinical pathways in promoting standardized and efficient hospital care under Indonesia’s JKN system.

Psychosocial Determinants of Antenatal Care Utilisation in Palopo City, Indonesia: An Integrated Health Belief Model and Intention-Based Approach

Dyah Tahir, Evawati Uly, Fadli Fadli, Andi Sastria Ahmad — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Antenatal care (ANC) is an essential maternal health service for preventing pregnancy complications. However, ANC utilisation remains suboptimal in many developing countries, including Indonesia. This study examined psychosocial determinants associated with ANC utilisation using an integrated Health Belief Model and an intention-based behavioural framework among pregnant women in Palopo City, Indonesia.

Methods: A cross-sectional study was conducted among 109 pregnant women in the second and third trimesters at Pontap Health Center, Palopo City, Indonesia. Data were collected using a structured questionnaire and analysed using partial least squares structural equation modelling (PLS-SEM) to examine direct and indirect associations among psychosocial constructs, intention, and ANC behaviour.

Results: Knowledge was inversely associated with intention (β = -0.410; p = 0.030), while risk perception (β = 0.333; p < 0.001), subjective norms (β = 0.187; p = 0.001), and self-efficacy (β = 0.893; p < 0.001) were positively associated with intention. Intention was positively associated with ANC behaviour (β = 0.598; p < 0.001). In contrast, knowledge and self-efficacy did not have significant direct associations with ANC behaviour. The reported indirect effects suggest a potential mediating role for intention. These findings highlight psychosocial and intention-based pathways associated with ANC behaviour among pregnant women in Indonesia.

Conclusion: This study highlights the association between psychosocial factors, particularly behavioural intention, and ANC behaviour among pregnant women. Health-promotion strategies that address risk perception, subjective norms, and self-efficacy may support ANC attendance. Longitudinal and intervention studies are needed to examine these relationships over time.

Mapping Communal Waste Shelters as Empirical Evidence to Support Health Policy Planning in Jambi Province

Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Waste management remains a major challenge in Indonesia, where 32.93% of waste is unmanaged. In Jambi Province, population growth of 1.30% has increased the volume of waste deposited at both standardised and non-standardised communal waste shelters. Under SNI 19-2454-2002, standardised shelters must be durable, watertight, cost-effective, publicly accessible, and easy to empty. This study aimed to map communal waste shelters as empirical evidence for health policy planning in Jambi Province.

Methods: This quantitative descriptive survey mapped communal waste shelters using a geographic information system (GIS). The base map was derived from the Bakosurtanal Digital Topographic Map. Thematic data were collected, processed, categorised, and integrated into the base map. Field observations in Batanghari, Tanjung Jabung Barat, and Tanjung Jabung Timur Regencies were used for updating and verification.

Results: Tanjung Jabung Barat Regency had the largest number of communal waste shelters (n = 186; 45% standardised and 55% non-standardised), followed by Tanjung Jabung Timur Regency (n = 144; 31% standardised and 69% non-standardised) and Batanghari Regency (n = 53; 13% standardised and 87% non-standardised). Across the three regencies, 383 shelters were identified. Overall, 35.25% were standardised, with a mean volume of 43.93 m³, whereas 64.75% were non-standardised, with a mean area of 30.23 m². Based on SNI 19-2454-2002, the minimum requirement was 2,562 standardised communal waste shelters.

Conclusion: The findings provide empirical evidence to support health policy planning and indicate a shortfall of 2,427 standardised communal waste shelters relative to the stated minimum requirement.

MEDIS (Mindfulness Meditation Combined with Tibetan Singing Bowls) for Dysmenorrhoea Among Adolescents: A Pre-experimental Study

I Gusti Agung Manik Karuniadi, Luh Putu Widiastini, Gusti Gede Mayun Surya Darma — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Dysmenorrhoea is one of the most prevalent menstrual disorders among adolescents. Non-pharmacological approaches, including mindfulness meditation and sound-healing therapies, are increasingly being explored as complementary pain-management strategies. Tibetan singing bowl therapy may promote relaxation through sound vibration and meditative effects, potentially reducing tension, anxiety, and pain. Combining these modalities may provide complementary psychophysiological benefits. This study examined changes in dysmenorrhoea pain scores before and after mindfulness meditation combined with Tibetan singing bowls among adolescents at SMPN 3 Abiansemal.

Methods: This pre-experimental study used a one-group pre-test-post-test design. Forty adolescent girls aged 10-14 years who experienced dysmenorrhoea were recruited by purposive sampling. The intervention was delivered three times per week for two weeks before menstruation, with each session lasting 15 minutes. Pain intensity was measured using the Numeric Rating Scale (NRS). Data were analysed using the Wilcoxon signed-rank test.

Results: Before the intervention, most participants experienced mild pain (67.5%), and the mean pain score was 2.57 ± 1.83. After the intervention, 57.5% of participants experienced mild pain and 37.5% reported no pain; the mean pain score was 1.17 ± 1.31. The Wilcoxon signed-rank test indicated a statistically significant reduction in dysmenorrhoea pain scores (Z = -4.916, p < 0.001).

Conclusion: MEDIS was associated with a statistically significant reduction in dysmenorrhoea pain scores. Pending confirmation in more rigorous studies, the intervention may offer an accessible complementary approach to dysmenorrhoea pain management in adolescents.

Needs Assessment of Sexual Harassment Protection Education Model for Children with Intellectual Disabilities

Cherly Marlina, Evi Martha, Rita Damayanti, Besral — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Children with intellectual disabilities face a high risk of sexual harassment, yet self-protection interventions for this population remain limited and tend to be reactive. National policies and reproductive health modules are available, implementation gaps at the operational level persist; therefore, teachers require structured pedagogical support to effectively deliver self-protection materials.

Methods: These qualitative needs assessment study was conducted in five special education schools for children with intellectual disabilities (SLB-C) in Bandung, Indonesia. Data were collected from 11 teachers and 5 principals through focus group discussion and in-depth interviews. This study explored experiences, current practices, systemic barriers, and the specific requirements for sexual harassment protection education. Data were transcribed verbatim and evaluated using thematic content analysis.

Results: The findings were classified into three main themes. First, factors shaping educational needs highlighted that the urgency of education is often hindered by a lack of institutional support and parental denial regarding children's vulnerability. Second, current practices and implementation gaps revealed that current education remains situational and is impeded by students' limited working memory and unsupervised gadget exposure. Third, design requirements for education formulated design specifications emphasizing that educational methods must be collaborative and gradually repeated (spaced repetition). The required learning media must be simple, concrete, visual, interactive, and multisensory.

Conclusion: Sexual harassment protection education for children with intellectual disabilities requires an integrated collaborative approach involving students, teachers, parents, and school institutions. The availability of multisensory media and structured modules is essential to accommodate children's cognitive limitations, simultaneously serving as a pedagogical instrument that enables teachers to deliver protection instruction in a directed and consistent manner that synergizes with the family environment.

Immediate Effect of Smart Paraffin Bath Therapy on Leg Pain among Third-Trimester Pregnant Women: A Quasi-Experimental Study

Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Leg pain is a frequent musculoskeletal complaint among third-trimester pregnant women due to physiological and biomechanics changes during pregnancy. Non-pharmacological pain management approaches are needed during pregnancy because pharmacological options may be limited due to maternal and fetal safety considerations. This study aimed to examine the immediate effect of Smart Paraffin Bath therapy on leg pain intensity among third-trimester pregnant women.

Methods: A quasi-experimental study with a non-equivalent control group design was conducted among 28 third-trimester pregnant women with leg pain. Participants were allocated into an intervention group (n = 14) receiving one supervised session of Smart Paraffin Bath therapy and a control group (n = 14) receiving conventional care. Pain intensity was measured using the Visual Analog Scale (VAS) before and immediately after the intervention. Data collection was conducted between May and November 2025. Data were analyzed using paired and independent t-tests.

Results: In the intervention group, the mean VAS score decreased from 5.71 ± 0.96 to 4.02 ± 0.88. In the control group, the mean score decreased from 5.91 ± 0.86 to 5.64 ± 0.88, with a mean reduction of 0.27 points (p < 0.001). Pain reduction was greater in the intervention group than in the control group (p < 0.001).

Conclusion: Smart Paraffin Bath therapy was associated with an immediate reduction in leg pain intensity among third-trimester pregnant women. However, these findings should be interpreted as preliminary evidence due to small sample size, non-random group allocation, and absence of follow-up assessment.

Effectiveness of Leaflet-Based Health Education on Health Behavior Change among Hypertensive Patients

Asyhariah B, Stang, Ridwan Amiruddin, A. Ummu Salmah, Shanti Riskiyani — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Hypertension is among the leading chronic non-communicable diseases and requires sustained lifestyle modification to achieve long-term blood pressure control. Within primary healthcare settings, printed leaflets are commonly incorporated into patient education because they are affordable, simple to distribute, and practical for routine health promotion. However, previous research has produced inconsistent evidence regarding the effectiveness of leaflets in improving various health-related behaviours. Therefore, this study investigated whether leaflet-assisted health education influenced multiple lifestyle behaviours among patients with hypertension receiving care at UPTD Puskesmas Tampapadang.

Methods: A quasi-experimental pretest–posttest approach was undertaken among 174 adults with hypertension who were assigned to either an intervention or a control group. Participants in the intervention group (n = 87) received leaflet-assisted health education, while those in the control group (n = 87) received routine counselling without printed leaflets. Outcomes assessed comprised physical activity, dietary behaviour, medication adherence, sleep quality, stress management, and smoking behaviour. Within-group changes were analysed using the Wilcoxon signed-rank test, whereas between-group differences were evaluated using the Mann–Whitney U test.

Results: Comparative analyses demonstrated significant between-group differences in medication adherence (p = 0.010), sleep quality (p = 0.001), and smoking behavior (p < 0.001). No statistically significant between-group differences were identified for physical activity, dietary behaviour, or stress management.

Conclusion: The impact of leaflet-assisted health education differed according to the behavioural outcome evaluated. Improvements were more evident for medication adherence, sleep quality, and smoking behaviour whereas no significant effects were found for physical activity, dietary behavior, or stress management compared with routine health counseling. Overall, printed leaflets may serve as a valuable educational resource in primary healthcare, particularly when integrated with complementary educational strategies.

Health Belief Model-Framed Leaflet for Open Waste Burning Knowledge and Attitudes: A One-Group Pretest-Posttest Study

Mustafa, Amsal, Ros Arianty, Idyani Sangadjisowohy, Siti Jubaida Lutiah — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Open waste burning threatens peri-urban communities in Indonesia. This study assessed changes in knowledge and attitude and descriptively examined reports of burning and burn marks following an HBM-framed leaflet intervention.

Methods: A quantitative one-group pretest–posttest study was conducted with 100 household heads or adult household representatives in North Palu District, Indonesia, selected purposively from households that had burned waste in the past 6 months. The leaflet was developed using Health Belief Model (HBM) constructs as a content framework; however, these constructs were not measured as separate variables. Knowledge and attitude scores were collected before and one week after a 15–20-minute face-to-face leaflet education session. Knowledge was scored from 0–8, while attitudes ranged from 8–40, with higher scores indicating a stronger rejection of open waste burning and greater support for safer waste management. Paired t-tests were used to estimate changes in mean scores, and behavioural and burn-mark data were analysed descriptively.

Results: Mean knowledge scores increased from 3.11 (SD = 1.30) to 6.94 (SD = 0.97), with a mean difference of 3.83 points (95% CI: 3.52–4.14; p < 0.001). The Wilcoxon sensitivity analysis supported the same conclusion for knowledge (p < 0.001). Mean attitude scores increased from 22.98 (SD = 2.49) to 32.87 (SD = 2.81), with a mean difference of 9.89 points (95% CI: 9.18–10.60; p < 0.001). Descriptively, frequent self-reported burning decreased from 39.0% to 3.0%, and fresh burn marks decreased from 54.0% to 8.0% at one-week follow-up.

Conclusion: The HBM-framed leaflet was linked to short-term gains in knowledge and attitudes about open waste burning. The behavioural and burn-mark results should be seen as preliminary descriptions rather than proof of lasting behaviour change or emission reduction. Controlled long-term studies with objective environmental measurements are needed to establish causal relationships.

Caring-Based Psychosocial Intervention Associated with Reduced Diabetes Burnout Among Older Adults with Type 2 Diabetes

Ummu Muntamah; Maksum, Wulansari — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Diabetes burnout is a significant psychosocial challenge among older adults with type 2 diabetes, contributing to emotional exhaustion, maladaptive coping, and reduced quality of life. Conventional diabetes management programmes often emphasise biomedical outcomes while insufficiently addressing psychosocial needs. This study examined whether a caring-based psychosocial approach integrated into a community diabetes programme was associated with reduced diabetes burnout and improved coping mechanisms and quality of life among older adults with type 2 diabetes.

Methods: A quasi-experimental pretest-post-test control-group study was conducted among 176 older adults with type 2 diabetes enrolled in PROLANIS at primary healthcare centres in Semarang Regency, Indonesia. The intervention group received a four-week caring-based psychosocial programme delivered weekly by trained healthcare providers, focusing on empathetic communication, emotional support, autonomy support, coping-skills training, and family involvement. The control group received standard PROLANIS education. Diabetes burnout, coping mechanisms, and quality of life were assessed using validated instruments. Between-group differences were analysed using comparative tests and analysis of covariance (ANCOVA), with adjustment for baseline scores.

Results: Participants receiving the caring-based psychosocial intervention demonstrated significantly greater reductions in diabetes burnout and greater improvements in coping mechanisms and quality of life than participants in the control group (all p < 0.001). Mean burnout scores decreased more in the intervention group (Δ = -16.88 vs -11.73), while coping scores (Δ = 38.28 vs 22.41) and quality-of-life scores (Δ = 40.20 vs 11.77) increased more substantially. ANCOVA confirmed significant between-group differences after adjustment for baseline values.

Conclusion: Integration of a caring-based psychosocial intervention into community diabetes management was associated with reduced diabetes burnout and improved psychosocial outcomes among older adults with type 2 diabetes. Empathetic communication, emotional support, coping facilitation, autonomy support, and family involvement may enhance psychosocial adaptation and well-being in ageing populations. Further randomised longitudinal studies are needed to confirm long-term effectiveness and underlying mechanisms.

Exploring Adolescent Reproductive Health Education Needs for Digital Application Development: A Qualitative Needs Assessment

Eti Salafas, Haryono, Irwan Budiono, Evi Widowati — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Adolescent reproductive health (ARH) education is an effort to improve health literacy and support healthy behaviours. However, many adolescents still experience limited access to credible information on reproductive health due to inadequate school-based education, sociocultural stigma, and barriers to open communication. Although digital education approaches are increasingly promoted, evidence regarding adolescents’ educational needs and stakeholder perspectives to inform contextually relevant digital interventions remains limited. This study aims to explore adolescent reproductive health education needs and identify considerations for the future development of a digital educational application.

Methods: A qualitative needs assessment design was employed. Data were collected between September and November 2025 through semi-structured interviews and focus group discussions involving junior high school students (n = 6), teachers (n = 3), and health and government stakeholders (n = 8), who were purposively selected. All interviews and discussions were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke’s six-phase thematic analysis framework, with NVivo 15 used to support data management and coding.

Results: Six major themes were identified: reproductive health literacy gaps, adolescent behavioural risks, barriers in school-based reproductive health education, limitations in teacher capacity and learning resources, challenges in policy and programme implementation, and the need for innovative digital reproductive health education applications. These findings revealed a mismatch between adolescents’ preference for private, practical, and digitally accessible reproductive health information and the limited readiness of schools, teachers, families, and existing support systems to provide structured, credible, and non-stigmatising education. Participants emphasised the need for age-appropriate content, confidential access to information, interactive learning features, stronger teacher support, and better integration with existing school and health programmes.

Conclusion: This study provides formative empirical evidence regarding adolescent reproductive health education needs and preliminary requirements for digital application design. The findings may inform the development of adolescent-centred educational technologies and support future strategies to strengthen school-based reproductive health education, teacher capacity, and cross-sector collaboration.

Cross-Cultural Adaptation and Preliminary Psychometric Evaluation of the Indonesian Antenatal Risk Questionnaire

Siti Rafika Putri, Bambang Budi Rahardjo, Ari Yuniastuti — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Perinatal depression affects the health of mothers, children, and families. One approach to preventing postpartum depression is to screen for psychosocial risk factors as early in pregnancy as feasible. The multidimensional Antenatal Risk Questionnaire (ANRQ) was developed to identify psychosocial risk factors during pregnancy. This study undertook the cross-cultural adaptation and initial psychometric testing of the ANRQ among pregnant women in Indonesia.

Methods: A methodological study was conducted. A three-round Delphi review involving nine experts was undertaken, together with forward translation, back-translation, and pilot testing. Content validity was assessed using the item-level Content Validity Index (I-CVI) and scale-level Content Validity Index (S-CVI). To assess construct validity, ANRQ scores were compared among women whose risk of depressive symptoms was classified as high risk and low risk using an EPDS-based categorisation method. Cronbach’s alpha was used to assess internal consistency, and the intraclass correlation coefficient (ICC) was used to assess test–retest reliability over a two-week interval. Ninety-three pregnant women were recruited from antenatal care facilities in Bogor Regency, Indonesia, for the initial psychometric evaluation.

Results: The Indonesian version of the ANRQ showed preliminary evidence of high content validity in the study population (I-CVI = 0.89–1.00; S-CVI/Ave = 0.983; S-CVI/UA = 0.85). Known-groups validity testing showed significantly higher ANRQ scores among pregnant women classified as being at high risk of depressive symptoms according to EPDS scores than among low-risk participants (p < 0.001). Internal consistency was good (Cronbach’s alpha = 0.85), and test–retest reliability showed good temporal stability (ICC = 0.834, 95% CI: 0.631–0.931; p < 0.001).

Conclusion: The Indonesian version of the ANRQ demonstrated preliminary psychometric evidence; however, further validation is required before broader implementation.

Towards Health-Promoting Occupational Health and Safety in Aluminium Smelter Feasibility Planning: A Macroergonomic Case Study

Ahmadan Ulul Azmi, Hendra Djamalus — Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Aluminium smelter feasibility studies must address not only technical and economic viability but also the early design of a safe socio-technical work system. This study evaluated how occupational safety, process safety, human factors, contractor interfaces, and operational readiness were integrated into one aluminium smelter feasibility study

Methods: An evaluative qualitative case study combined a structured document review, literature- and standards-based benchmarks, and semi-structured interviews with four purposively selected experts. Each analytical indicator was classified as present, partially operationalized, or absent. The judgment was derived from explicit evidence requirements, document content, interview convergence or contradiction, and relevance to feasibility-stage decisions. NVivo supported data organization and auditability but coding frequency was not used as evidence of thematic importance.

Results: The document contained conventional feasibility components and generic safety provisions. However, most macroergonomic dimensions were only partially operationalized. Competence planning, occupational hygiene, organizational arrangements, and process safety were mentioned but lacked defined requirements, deliverables, responsibilities, or verification criteria. Human-machine interface evaluation, contractor interface governance, major-accident analysis, and operational-readiness gates were absent or insufficiently specified. Expert evidence converged on six priority gaps: competency assurance, HMI and control-room risk, HAZOP/PHA and major-accident scenarios, contractor interfaces, occupational hygiene baselines, and operational readiness.

Conclusion: This single-case study does not establish a general model for all aluminium smelter projects. Its contribution is a case-based evaluative framework that makes macroergonomic judgments traceable through explicit indicators and evidence thresholds. The framework can support identification of feasibility-stage gaps that may otherwise be transferred to engineering, commissioning, and operations, but its predictive value requires testing in additional projects and longitudinal settings.

Association of Protein Intake with Anemia among Adolescent Girls in Indonesia: A Systematic Review

Wed, 19 Aug 2026 00:00:00 +0700

Introduction: Anemia remains highly prevalent among adolescent girls. Protein intake influence haemoglobin synthesis, iron transport, and overall diet quality. However, evidence regarding the association between protein intake and anemia remains inconsistent. The aim of this study was to examine the association between protein intake and anemia among adolescent girls in Indonesia.

Methods: A systematic review was undertaken with the PRISMA. The literature searched in PubMed, Embase, Scopus, Web of Science and Google Scholar from inception to August 2025. The search used the keywords related to anemia, protein intake, and adolescents. Eligible studies included Indonesian adolescent girls aged 10–19 years that assessed dietary protein intake and reported anemia-related outcomes, including haemoglobin concentration, or iron status indicators such as ferritin or haematocrit. Data were extracted on study characteristics, exposure and outcome assessment, and key findings. Risk of bias was appraised using established checklists corresponding to each included study.

Results: Eighteen studies (2016–2025) met the inclusion criteria. The included studies showed inconsistent findings regarding the association between protein intake and anemia among adolescent girls. Overall, inadequate protein intake tended to be associated with lower haemoglobin levels and higher anemia risk. However, the association became weaker or non-significant after adjustment for iron intake, menstrual characteristics, and other potential confounding factors.

Conclusion: Protein intake appears to be associated with anemia among adolescent girls in Indonesia, particularly when accompanied by adequate iron and micronutrient intake. However, further research using longitudinal and intervention designs are needed to disentangle the specific role of protein intake from other major determinants of anemia.