Media Publikasi Promosi Kesehatan Indonesia (MPPKI)

Impact of a Food Sanitation Literacy Program on Food Handlers’ Behavior: A Quasi-Experimental Evaluation in the Upper Tapi Basin, Thailand

Pimpenjun Pan-in, Pimpiengjun Pan-in, Somsiri Decharat — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: The upper Tapi River area has been developed into a tourist attraction with more accommodations and restaurants. Food sanitation surveillance is therefore necessary to reduce the risk of foodborne diseases. This study addresses the need to evaluate the effectiveness of a Food Sanitation Literacy Development Program (FSLDP) on food handlers’ behavior.

Methods: This research is quasi-experimental with a one-group pretest-posttest design to study the effect of the food sanitation literacy development program (FSLDP) on the behavior of food handlers. A sample of entrepreneurs at 135 food and beverage restaurants will be obtained between May and October 2024. The Food Sanitation Literacy Development Program (FSLDP) was used in the experimental group for a total of 4 weeks, which consisted of organizing group activities with activities to enhance food sanitation knowledge, lectures, discussions, playing games, and practicing.

Results: Results showed a significant increase in food sanitation literacy, with mean scores rising from 99.89 (SD = 17.75) before the program to 125.38 (SD = 17.12) immediately after, and further to 126.82 (SD = 19.88) at the one-month follow-up. All six dimensions—access to information, knowledge and understanding, communication skills, self-management, media literacy, and decision-making—demonstrated consistent and sustained improvements. Food sanitation behavior scores similarly increased from 46.74 (SD = 9.20) at baseline to 62.50 (SD = 7.80) immediately post-program and 64.50 (SD = 5.85) at one month, indicating both immediate and maintained behavioral gains. Personal hygiene behaviors, particularly handwashing habits and correct handwashing steps, improved significantly, whereas appearance when handling food and behavior during work showed minimal change. Repeated-measures ANOVA confirmed that these improvements were statistically significant (p < 0.001) and largely maintained over time.

Conclusion: These findings suggest that structured educational interventions, supported by practical exercises and access to digital resources, can effectively enhance food safety literacy, foster proper hygiene practices, and contribute to the long-term implementation of safe food handling behaviors among food handlers in tourism-intensive areas.

Exploring Novel Dimensions of Burnout Among Malaysian Healthcare workers: A Qualitative Thematic Analysis

Suriya Kumareswaran Vallasamy — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Burnout among healthcare workers (HCWs) has gained increased attention in the post-pandemic landscape due to its profound implications on workforce sustainability and patient care quality. Existing burnout assessment tools, such as the Maslach Burnout Inventory, were developed for general occupational settings and often fail to capture the unique emotional and cognitive stressors specific to healthcare environments, particularly in low- and middle-income countries. This study aimed to explore previously underrecognized dimensions of burnout among Malaysian HCWs to inform the development of a healthcare-specific burnout assessment instrument.

Method: A qualitative study was conducted using a semi-structured focus group discussion with four expert participants specializing in mental and occupational health. Data were manually transcribed and analyzed using the framework method. Coding was performed collaboratively to ensure reflexivity, consistency, and reliability.

Result: Two overarching categories, emotional exhaustion and cognitive exhaustion were identified, encompassing 11 subthemes, including hopelessness, medical errors, and cognitive dissonance.

Conclusion: Findings highlight the inadequacy of existing generic burnout tools and underscore the need for a tailored assessment framework that encapsulates the psychological complexity of HCW burnout, especially in resource-constrained settings.

Oral Hygiene Maintenance Behavior and Community Periodontal Index in Systemic Lupus Erythematosus Patients: A Correlational Study

Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that commonly presents with oral manifestations, including xerostomia, mucosal ulcerations, dental caries, and periodontitis. Periodontitis, characterized by progressive destruction of tooth-supporting tissues, is frequently aggravated by inadequate oral hygiene practices. This study aimed to investigate the correlation between oral hygiene maintenance and periodontal health in patients diagnosed with SLE.

Methods: This study employed a cross-sectional correlation design. It involved 100 participants, comprising 50 SLE patients and 50 healthy controls subjects, recruited through purposive sampling. Periodontal health was assessed using the Community Periodontal Index (CPI). Oral hygiene maintenance behavior was assessed using a self-administered structured questionnaire, adapted and modified from the Hiroshima University–Dental Behavioral Inventory (HU-DBI). Differences in community periodontal index between the SLE and control groups were analyzed using a Mann-Whitney test. The relationship between oral hygiene behaviors and CPI scores was examined using Spearman’s rank correlation test.

Results: The results revealed that SLE patients exhibited poorer oral hygiene knowledge, attitudes, and practices compared to healthy controls subjects, along with significantly worse periodontal health (p < 0.05). Furthermore, Spearman’s rank correlation test showed significant negative correlations between oral hygiene maintenance behaviors and CPI scores in the SLE group (r = - 0.156, p < 0.05; r = - 0.148, p < 0.05; r = - 0.148, p < 0.05, respectively) indicating that patients who practiced better oral hygiene tended to have lower CPI scores and, consequently, healthier periodontal status.

Conclusion: Improved oral hygiene practices are significantly correlated with enhanced periodontal health in patients with SLE. These findings underscore the importance of emphasizing effective oral hygiene measures as part of comprehensive periodontal management strategies for SLE patients.

Effectiveness of a Quartet-Based Educational Game in Improving Thalassemia Knowledge and Screening Awareness Among Senior High School Students

Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Thalassemia is one of the most common genetic disorders in Indonesia, however, the knowledge and awareness are still low, especially in rural area. This study aimed to evaluate the effectiveness of a game-based educational tool to increasing knowledge and awareness about thalassemia among senior high school students in rural area.

Methods: This quasi-experimental study explored the effectiveness of the Quartet card game in improving thalassemia knowledge and awareness among 93 high school students in rural East Java. An 11-item validated questionnaire was administered before and after the intervention. Their willingness to undergo the screening was measured in the end of the activity.

Results: Prior to the intervention, the respondents had poor knowledge (2.3?±?2.8), which increased to a moderate level (7.4?±?2.9, p< 0.001) after the intervention. Even though there is an increase in knowledge and decrease in misconceptions, but some persisted, particularly regarding contagiousness and differentiation from leukemia. No associations were observed between knowledge improvement and demographic characteristics.

Conclusion: The findings indicate that game-based education might enhance adolescent genetic literacy and may serve as a scalable strategy for health promotion. While effective in deliver fundamental concepts, additional strategies are needed to address persisted misconceptions and psychosocial aspects. Longer follow-up and more advanced or immersive serious games may help improve understanding and long-term knowledge retention.

Rasch Analysis of the General Life Skills Scale for Dating Violence Prevention in Indonesian Adolescents

Suci Musvita Ayu, Zahroh Shaluhiyah, Bagoes Widjanarko, Ani Purwanti — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Early life skills education has the potential to be an effective intervention in preventing adolescent dating violence (ADV). However, measurement tools for life skills in general in the context of ADV prevention are still limited.

Objective: This study aims to evaluate the psychometric properties of the General Life Skills Scale (GLSS) using the Rasch model.

Methods: This study is classified as research and development. A total of 366 junior high school students (111 students from private schools and 255 students from public schools) in Indonesia participated in the empirical validation of the General Life Skills Scale (GLSS). The GLSS consists of 48 items spread across the constructs of personal skills (22 items) and social skills (26 items). GLSS used a four-point Likert scale, from 1 (strongly disagree) to 4 (strongly agree). The psychometric properties of the GLSS were evaluated using Rasch modeling. The psychometric properties were reviewed based on reliability, item fit, unidimensionality, and item distribution at each level of difficulty.

Results: The results of the analysis showed that the GLSS had excellent reliability (? = 0.96; person reliability = 0.93; item reliability = 0.95). The separation index showed the scale's ability to distinguish respondents in five ability strata and items in six difficulty levels. Of the 48 items, 26 items met the Rasch model fit criteria, and unidimensionality analysis confirmed that the scale measured one main construct. However, the Wright map showed logit gaps between items, especially at the very easy difficulty level.

Conclusion: The GLSS is considered valid and reliable for measuring adolescents' life skills in the context of preventing dating violence; however, improvements in item distribution are recommended to enhance measurement accuracy.

Theoretically, this study contributes to the development of a general life skills scale in adolescent development theory. Practically, this study provides a validated scale for educators to design life skills curricula and can be integrated into school-based ADV prevention programs.

Sociodemographic and Health Insurance Ownership Related to Tuberculosis in Elderly: An Analysis of Indonesia Health Survey

Lili Amaliah, Oktia Woro Kasmini Handayani, Intan Zainafree — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Tuberculosis (TB) continues to be a significant public health issue globally, with Indonesia being one of the nation’s experiencing the highest TB burden in the world. The purpose of this study is to analyze the sociodemographic factors and health insurance ownership associated with the incidence of tuberculosis (TB) among the elderly in Indonesia.

Methods: This study used secondary data from the 2023 Indonesia Health Survey (SKI), focusing on elderly individuals (?60 years). A total of 97,339 participants were included after applying inclusion criteria. The dependent variable was the self-reported diagnosis of tuberculosis (TB), and independent variables included age, sex, marital status, education, occupation, health insurance, place of residence, and family status. Data were analyzed with univariate, bivariate (Chi-square), and multivariate (binary logistic regression) analyses.

Results: The study found that 0.57% of older adults self-reported the tuberculosis diagnosis. The significant associations between tuberculosis diagnosis and variables such as sex, marital status, education, occupation, health insurance, place of residence, and family status, with women, higher education levels, certain occupations, health insurance coverage, urban living, and being head of the household being less likely to report TB, while age showed no significant association. The binary logistic regression revealed that factors such as sex, education, occupation, health insurance, and family status significantly influence the likelihood of TB diagnosis, with females, higher education levels, certain occupations, no health insurance, and being a spouse showing reduced odds of being diagnosed with TB.

Conclusion: This study found that tuberculosis (TB) among older persons was significantly associated with several sociodemographic factors, including sex, education level, occupation, health insurance ownership, and family status. Female older adults and those with higher education levels were less likely to be diagnosed with TB. Similarly, those who were employed, especially as private employees, entrepreneurs, or farmers, and those without health insurance had lower odds of TB. It is suggested to improve TB prevention and treatment strategies for older adults, with a particular emphasis on gender, education, employment, and health insurance access.

Prevalence and Predictors of COPD in Indonesian Smokers Attending Posbindu Community Health Centers: A Cross-Sectional Analysis

Dian Mutia Sari, Besral Besral, Ratna Djuwita, Triya Damayanti, Farida Murtiani — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major global health burden, particularly in low- and middle-income countries. In Indonesia, the high prevalence of smoking, coupled with underdiagnosis and limited healthcare access, contributes substantially to COPD cases. Identifying key risk factors is critical to strengthen prevention and management strategies. This study aimed to determine the prevalence of COPD among smokers attending POSBINDU community health center in Indonesia and to identify significant predictors associated with the disease.

Methods: A population-based cross-sectional study was conducted in March 2023 across Integrated Care Posts (Posbindu) in Yogyakarta and East Java. A total of 548 smokers aged ?40 years were recruited using convenience sampling, which may limit generalizability. Only 17 COPD cases were identified (3.1% prevalence), constraining statistical power for multivariate analyses. Data collection involved structured questionnaires and spirometry testing following American Thoracic Society guidelines. Descriptive statistics, bivariate analysis, and multivariate logistic regression were used to identify independent predictors of COPD.

Results: The prevalence of COPD was 3.1% (17/548). Most participants were male (98.2%) and aged 40-49 years (44.2%). Bivariate analysis showed significant associations between COPD and sputum production (OR = 4.79; P = 0.001), shortness of breath (OR = 3.11; P = 0.017), asthma (OR = 23.03; P <0.001), cardiovascular disease (OR = 11.67; P = 0.005), and abnormal spirometry (OR = 12.59; P <0.001). In multivariate analysis, sputum production (AOR = 3.99; P = 0.019) and asthma (AOR = 8.64; P = 0.020) remained strong independent predictors. Conversely, a Brinkman Index ?20 pack-years showed a paradoxical protective effect (AOR = 0.16; P = 0.023).

Conclusion: This study highlights the importance of early screening and intervention among high-risk smoker populations. Community-based platforms such as Posbindu can play a critical role in facilitating prevention, early diagnosis, and improved management of COPD.

Effect of a Simulation-Based Educational Video on Menarche Readiness Among Fourth-Grade Girls in Yogyakarta

Wahyuni Idvia Nova, Andari Wuri Astuti, Djauhar Ismail — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Menarche is a key biopsychosocial milestone in early adolescence, yet many young girls experience it with limited knowledge and emotional readiness due to inadequate, age-appropriate reproductive health education. This lack of readiness stems from insufficient understanding, limited information provided by parents and teachers, and suboptimal reproductive health education in schools. Providing education that is both comprehensive and age-appropriate about the physical and emotional changes of puberty is essential to help reduce fear, correct misconceptions, and lessen the stigma associated with menstruation.

Methods: The study aimed to analyze the effect of simulation-based video media on adolescent readiness to face menarche. This study employed a pre-experimental design with a one-group pretest-posttest approach. The sample comprised 54 fourth-grade female students within elementary school, selected via total sampling. The research instrument was a questionnaire assessing readiness to face menarche. The intervention video presented realistic scenarios depicting the physical and emotional experiences associated with menarche, including hygiene management and coping strategies for discomfort, to support both cognitive and affective learning.

Results: The analysis revealed an increase in readiness scores following the intervention, with a pretest mean of 15.44 and a posttest mean of 18.40. The Wilcoxon Signed Rank Test yielded a p-value of 0.000 (p < 0.05), indicating a significant effect of simulation-based video media on adolescent readiness to face menarche. Simulation-based video media effectively enhances adolescent readiness to face menarche and serves as a viable alternative for reproductive health education in elementary schools.

Conclusion: This media can be implemented as an effective and practical method for delivering reproductive health education in primary school settings. It also serves as a feasible tool to support adolescents’ preparation for menarche by improving their readiness and understanding of this developmental milestone.

Development of an Android-Based Mobile Application and Digital Book through the ADDIE Model for Early Detection and Stunting Prevention Education

Lia Artika Sari, Enny Susilawati, Diniyati Diniyati — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Stunting remains a major nutritional problem in Indonesia that affects the quality of human resources in the future. Adolescent girls play an important role in preventing stunting, but their nutritional literacy levels are still low. This study aims to develop an Android-based mobile application and digital book as educational media for early detection and prevention of stunting in adolescent girls.

Methods: The research was conducted in the city of Jambi in 2025 using the Research and Development (R&D) method through the ADDIE model (Analysis, Design, Development, Implementation, and Evaluation). The research subjects were 20 adolescent girls selected through purposive sampling. Data were collected through questionnaires, interviews, observations, and tests.

Results: The needs analysis revealed substantial gaps in adolescents’ understanding of nutrition and hematologic health, particularly concerning the interrelationship between anemia, hemoglobin status, and stunting risk. These findings underscored the necessity for accessible, technology-based learning tools tailored to adolescent users. Consequently, a mobile application and companion digital book were developed to integrate early detection features such as hemoglobin and body mass index assessments with interactive nutrition education. Expert evaluations confirmed the high feasibility and content validity of these media, while preliminary trials demonstrated their user-friendliness, contextual relevance, and potential to enhance adolescents’ engagement and comprehension in stunting prevention.

Conclusion:The mobile application and digital book developed are proven to be suitable for the needs, feasible to use, and have the potential to increase the knowledge and awareness of adolescent girls in preventing stunting. This technology-based intervention can be a strategic innovation in supporting the program to accelerate the reduction of stunting in Indonesia.

Social Perception Among Husbands of Women Diagnosed with Primary Infertility: A Qualitative Study in Semarang City, Central Java

Dewi Puspitaningrum, Mohammad Zen Rahfiludin, Mohammad Irsam — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Primary infertility is a significant reproductive health issue that not only affects women but also their husbands. However, most health education programs still focus predominantly on women, leaving men’s perceptions underexplored. Understanding husbands’ social perceptions is crucial for developing inclusive interventions that address both partners’ needs. This study aimed to explore the social perceptions of husbands whose wives have primary infertility, focusing on their views regarding health education, psychological well-being, and support systems.

Methods: This qualitative study used a phenomenological approach and was conducted in Semarang City, Central Java. Participants were recruited purposively, consisting of husbands whose wives were clinically diagnosed with primary infertility. Data were collected through in-depth interviews using a semi-structured guide and analyzed thematically.

Results: Findings showed that husbands of women diagnosed with primary infertility were aged > 45 years old 13 persons (65%) and had education levels ranging bachelor school 9 persons (45%). They worked most as private sector employees 13 persons (65%). Most lived with their wives 11 persons (55%). Health education programs mostly targeted the wives, with minimal psychological support for husbands. Education on healthy behaviors was delivered generally, and mental health topics were addressed only upon request. No program specifically designed for husbands existed. Several husbands had low knowledge and attitudes about infertility and felt excluded from reproductive health discussions.

Conclusion: Current reproductive health education programs inadequately address the needs of husbands of women with primary infertility. Developing husband-inclusive interventions that integrate physical and psychological health components is essential.

Community Empowerment for Stunting Prevention: A Quasi-Experimental Study in Indonesia

Agung Suharto, Budi Joko Santosa, Suparji Suparji — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Stunting remains a major public health challenge in Indonesia, with long-term consequences for human resource quality. Empowering Posyandu (integrated health post) cadres through theory-based approaches is considered a strategic intervention to strengthen prevention efforts.Objective:This study aimed to evaluate the effectiveness of a community empowerment model grounded in the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) in improving preventive behaviors among Posyandu cadres.

Methods: A quasi-experimental design with a non-equivalent control group and pretest–posttest approach was employed. The study was conducted in Magetan Regency, East Java Province, from January to September 2023. The intervention group was drawn from Panekan Sub-district and the control group from Plaosan Sub-district, with geographic separation used to minimize contamination. The study population comprised 400 cadres, from which 200 respondents were recruited proportionally and selected using random sampling within each sub-district (intervention = 100; control = 100). The intervention consisted of structured training modules integrating HBM and TPB constructs, including risk perception, benefits of prevention, self-efficacy, barrier reduction, and behavioral planning. Data were collected using a validated Likert-scale questionnaire measuring perceived susceptibility, perceived benefits, attitudes, intentions, subjective norms, and preventive behaviors. Analyses employed paired-samples t-tests for within-group comparisons and independent-samples t-tests for between-group differences, with significance set at p < 0.05.

Results: The intervention group demonstrated statistically significant improvements across all measured variables (p < 0.001). Preventive behavior scores increased from 12.11 (SD = 1.06) at baseline to 21.10 (SD = 1.87) post-intervention. Between-group analyses confirmed higher posttest scores in the intervention group compared to controls (p < 0.001).

Conclusion: Empowerment training based on HBM and TPB was effective in enhancing cadres’ cognitive and behavioral components related to stunting prevention. These findings provide preliminary evidence supporting the integration of theory-driven empowerment models into community health programs, while highlighting the need for sustained training and longer-term evaluation to ensure durability of behavioral change.

Ethnomedicine and Knowledge Transmission among Dayak Communities in Central Kalimantan: An Ethnographic Inquiry

Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Traditional medicinal knowledge is central to cultural identity and community well-being among the Dayak communities of Central Kalimantan yet its continuity is increasingly threatened by modernization and declining youth engagement. This study aims to examine how ethnomedicinal knowledge is transmitted practiced and sustained through therapeutic traditions eco spiritual values and intergenerational learning.

Methods: A qualitative ethnographic approach was conducted in four regions of Central Kalimantan involving twelve purposively and snowball-selected participants including traditional leaders elders and women healers. This design was chosen to capture culturally embedded meanings that cannot be accessed through quantitative techniques. Data were collected through participant observation in depth interviews and documentation then transcribed verbatim and analyzed using thematic coding procedures.

Results: Three major findings emerged. First the transmission of medicinal plant knowledge is weakening as younger generations increasingly rely on biomedical services. Second ritual practices such as offerings prayers and ecological ethics remain central in legitimizing healing and guiding responsible plant harvesting. Third the perceived effectiveness of key plants including kalakai pasak bumi and bajakah is reinforced through lived experiences of vitality and longevity although sustainability is challenged by shifting health preferences and environmental change.

Conclusion: Dayak ethnomedicine reflects an integrated system combining therapeutic efficacy cultural identity and ecological stewardship. The findings highlight the importance of eco spiritual practices and intergenerational dynamics in sustaining traditional healing. Strengthening documentation pharmacological validation and youth-focused digital revitalization initiatives is essential for ensuring the resilience of Dayak ethnomedicinal knowledge.

The Role of Self-Directed E-Learning-Based Mental Health Models in Strengthening Mental Health Literacy among Nurses in West Lombok Regency, Indonesia: A Cross-Sectional Study

Sirajunnasihin Sirajunnasihin, Wulandari Dewi Susilawati, Musparlin Halid — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Nurses at Public Health Centers (PHCs) are at the forefront of providing health services, including mental health services. Adequate Mental Health Literacy (MHL) is crucial to enhance their ability to recognize, manage, and support patients with mental health disorders. Improving MHL through an Self-Directed E-Learning (SDE) based learning approach is expected to be an innovative solution to strengthen nurses' competencies. The study aimed to analyze the association between the self-directed e-learning-based mental health model and the strengthening of MHL among nurses at PHC.

Methods: The study used a cross-sectional design to analyze the association between exposure to SDE with the strengthening of MHL among nurses at PHC in West Lombok, West Nusa Tenggara, Indonesia, with a sample size of 263. Descriptive analysis was performed to describe the characteristics of the respondents. Chi-square and binary logistic regression tests were performed to determine the association between variables with a significance level of p<0.05 with 95% Confidence Interval (CI) and Adjusted Odds Ratio (AOR) to determine the depth of the association.

Results: The results of the study show that most nurses with high SDE exposure have better MHL-work levels than nurses with low SDE exposure. Males have a higher chance of achieving competency improvement than females (AOR=3.046; p=0.004). Participants with a Diploma in Nursing also showed a significant improvement compared to Bachelor of Nursing graduates (AOR=2.208; p=0.042). Work experience of ?5 years had a significant effect (AOR=2.851; p=0.006). A history of work-related MHL training significantly increased the likelihood of competency (AOR=3.575; p=0.001). Higher exposure to SDE, including the number of reflective discussion and practice sessions (AOR=2.333; p=0.029), longer e-learning duration (AOR=3.524; p=0.001), and the number of modules completed (AOR=2.617; p=0.018), and the number of mental disorder patients treated (AOR=3.703; p=0.001) were found to be significantly associated with increased competency. Meanwhile, workload did not show a significant association (p=0.231).

Conclusions: The study findings confirm that experience, education, training, and intensity of involvement in the SDE program are important determinants in improving MHL competencies.

Lean–Visual Management Integration in Hospital Information Systems to Sustain Pharmacy Performance Under High Workload

Chintya Puspa Ayu Tirta, Merita Arini — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Hospital pharmacy services face increasing operational complexity, requiring efficient, adaptive, and data-driven systems. Integrating Lean Thinking (LT) and Visual Management (VM) into Hospital Information Systems (HIS) offers strategic potential to enhance workflow transparency, reduce waste, and improve service quality. This study aimed to evaluate the impact of LT–VM within HIS on service effectiveness, measured through prescription response times, and process efficiency, measured using the Value Added Ratio (VAR) derived from Value Stream Mapping (VSM).

Methods: A quantitative case study was conducted in the outpatient pharmacy unit of PKU Muhammadiyah Wonosobo Hospital, Central Java, Indonesia. Secondary data of 55,767 outpatient prescriptions were analyzed (17,373 pre-implementation and 38,394 post-implementation), while primary data were collected through direct workflow observation using VSM. Statistical analysis used the Mann–Whitney U test to assess pre-post differences, while process efficiency was examined through VAR calculations for compounded and non-compounded prescriptions.

Results: Non-compounded prescriptions showed a significant improvement in response time (p = 0.005), despite a 2.5-fold increase in prescription volume, indicating sustained system performance. Notably, unlike most Lean studies that emphasize waiting-time reduction, the present findings demonstrate that LT–VM–HIS integration primarily contributed to maintaining workflow stability under increased workload. Compounded prescriptions exhibited no significant change (p = 0.424), although reduced variability suggested improved consistency. VSM results showed VAR of 40.08% for non-compounded and 51% for compounded prescriptions, highlighting persistent bottlenecks during workflow transitions and the limited influence of digital interventions on labor-intensive manual tasks.

Conclusion: The integration of LT–VM within HIS enhanced process consistency, reduced variability, and maintained operational performance under increased workload. However, manual compounding tasks limited efficiency gains, underscoring the need for hospital-wide Lean digitalization and synchronized scheduling to balance demand and capacity. These findings support the broader application of Lean-based digital transformation to achieve resilient and patient-centered healthcare systems.

Health Literacy Based Health Promotion Strategy for the Prevention of Periodontal Disease Caused by Porphyromonas gingivalis in Communities Exposed to Environmental Heavy Metals: A Scoping Review

Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Periodontal disease in communities exposed to environmental heavy metals represents not only a biological problem but also a public health challenge closely linked to limitations in health literacy. While the pathogenic role of Porphyromonas gingivalis and the toxic effects of heavy metals such as Pb, Cd, and Hg contribute to inflammation and periodontal tissue damage, insufficient health literacy constrains individuals’ capacity to recognize risks, adopt preventive behaviors, and engage in effective disease prevention strategies.

Methods: A scoping review was conducted using the PEOS framework, with article searches in PubMed, ScienceDirect, EBSCO, and Google Scholar. Of the 512 articles identified, 20 met the inclusion criteria (2015–2023) and were analyzed through data charting and quality assessment.

Results: Heavy metals have been shown to increase the risk of periodontitis through immune suppression, oxidative stress, and changes in the oral microbiota. P. gingivalis enhances pathogenesis by disrupting epithelial defenses and triggering chronic inflammation. Increasing health literacy has been shown to be influential in encouraging preventative behaviors and managing environmental exposure risks.

Conclusion: Strengthening health literacy is a central and unifying strategy in reducing periodontal disease risk in populations exposed to environmental heavy metals. Integrating biologically informed risk communication with community-based, literacy-sensitive health promotion interventions enhances prevention efforts against periodontal disease associated with P. gingivalis in high-risk communities

Global Research Trends on Occupational Health and Safety in Informal Sector Workers (2010-2025): A Bibliometric Study

Iksaruddin Iksaruddin, Onny Setiani, Sutopo Patria Jati, Yuliani Setyaningsih — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Occupational health and safety (OHS) among informal sector workers is a growing global concern, as this workforce, representing approximately 60% of the world’s total employment, often operates outside formal regulatory and social protection systems. Informal workers face elevated risks of occupational injuries, hazardous exposures, and poor access to healthcare. This study analyzes global research trends on OHS in informal sector workers from 2010 to 2025 through a bibliometric approach.

Methods: A bibliometric study was conducted using the PubMed database to identify relevant articles published between 2010 and 2025. The search yielded 235 eligible articles, which were analyzed using VOSviewer for keyword co-occurrence, thematic clustering, and collaboration network mapping. The PICO framework guided the analysis, focusing on research trends, hotspots, and collaborative patterns related to OHS in the informal sector.

Results: The number of publications increased markedly after 2018, reaching a peak of 32 papers in 2021. Most studies originated from Asia (43%), followed by Africa (28%) and Latin America (17%). Keyword analysis revealed four dominant clusters: “occupational exposure” (47 occurrences), “workplace safety” (39), “precarious employment” (29), and “vulnerable workers” (22). International collaboration accounted for approximately 35% of total publications, showing a gradual upward trend in recent years.

Conclusion: Global research on OHS in informal workers has grown substantially but remains quantitatively limited relative to the size of the informal workforce. Most studies emphasize hazard identification rather than preventive interventions. Greater cross-country collaboration and policy-oriented research are essential to strengthen OHS protection for informal sector workers worldwide.

Programmatic Assessment in Medical Education: A Bibliometric and Narrative Review of Its Potential Contributions to Health Literacy and Health Promotion Competencies

N Juni Triastuti, Tri Nur Kristina, Titi Savitri Prihatiningsih — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Programmatic assessment (PA) has emerged as a transformative framework in medical education, emphasizing longitudinal evaluation, meaningful feedback, and data-informed decision-making to enhance learner development. Its role extends beyond competency measurement, contributing to broader educational goals such as strengthening health literacy and health promotion competencies—core attributes for future healthcare professionals. This bibliometric and narrative review aimed to map global research trends, influential contributors, and thematic patterns in programmatic assessment while synthesizing evidence on its potential to advance health literacy and health promotion competencies in medical education.

Methods: A comprehensive search was conducted in Scopus database for articles published between 1977 and 2025. Inclusion criteria of eligible studies were those addressing programmatic assessment in medical or health professions education—including portfolios, decision processes, or programmatic feedback—and explicitly linking these approaches to health literacy or health promotion competencies. The dataset comprised 822 records and a final sample of 166 publications eligible for bibliometric analysis. Bibliometric indicators were analysed using VOSviewer, including publication trends, author networks, organizational and country contributions, and keyword co-occurrence. Narrative synthesis integrated empirical findings on PA implementation and its educational outcomes.

Results: A total of 1092 authors, 502 organizations, and 44 countries contributed to 1737 indexed keywords, of which 167 met inclusion thresholds. Thematic clustering identified four dominant domains: feedback and learning analytics, competency-based assessment, digital and AI-supported assessment, and professional identity formation. Recent literature emphasizes PA’s capacity to cultivate reflective practice, communication skills, and health advocacy—key components of health literacy and promotion.

Conclusion: Programmatic assessment represents an integrative and evidence-driven approach that not only enhances learning and assessment quality but also fosters essential competencies in health literacy and promotion, aligning medical education with 21st-century public health priorities.

The Effectiveness of Health Promotion Media on Increasing Knowledge and Participation of Women of Reproductive Age in VIA Screening: A Systematic Literature Review

Astin Nur Hanifah, Nana Usnawati, Nuryani Nuryani — Mon, 02 Feb 2026 00:00:00 +0700

Introduction: Cervical cancer remains a major cause of morbidity and mortality among women in Indonesia, largely due to low awareness and limited participation in Visual Inspection with Acetic Acid (VIA) screening. Health promotion media are essential to improving knowledge, shaping positive attitudes, and increasing willingness to participate in early detection efforts. This systematic literature review evaluates the effectiveness of various health promotion media in increasing knowledge and VIA screening participation among women of reproductive age (WRA).

Methods: This review followed the PRISMA 2020 protocol. Literature searches were conducted exclusively through Google Scholar for studies published between 2021 and 2025. Thirteen eligible studies were analyzed using the PICO framework, focusing on population characteristics, intervention types, comparison strategies, and measured outcomes. Most studies used quasi-experimental pre-post designs. This review has limitations, including reliance on a single database, restriction to Indonesian studies, and predominance of quasi-experimental designs without control groups. These limitations may introduce selection bias and reduce generalizability.

Results: Overall findings show significant improvements (p<0.05) in knowledge, attitudes, and VIA participation following health promotion interventions. Audiovisual media, mobile-based applications and live demonstrations produced the strongest effects by enhancing multisensory learning and reducing psychological barriers such as fear or embarrassment. Printed media, including booklets, modules and leaflets remained effective as complementary tools, especially in areas with limited digital access. Intervention success was also supported by family involvement, cultural appropriateness, and active engagement of health workers.

Conclusion: In conclusion, multimodal and community-centered health promotion strategies are effective in increasing WRA knowledge and participation in VIA screening. Future research should employ stronger methodological design, expand database coverage, and incorporate cross-national comparisons to enhance the evidence base for cervical cancer screening programs.