Media Publikasi Promosi Kesehatan Indonesia (MPPKI)

Dissemination of the Free Nutritious Meal Program for Students: Case Study in Rote-Ndao Regency – Indonesia

Thu, 02 Apr 2026 00:00:00 +0700

ntroduction: Health has been a priority in Indonesia’s development agenda over the past two decades. One initiative is the Free Nutritious Meal Program, launched in early 2025. The program targets students, pregnant women, breastfeeding mothers, toddlers, and other groups vulnerable to nutritional deficiencies. This study examines the educational activities of the Free Nutritious Meal Program for students in Rote Ndao Regency, focusing on educational steps, media use, message formats, media exposure, and the determinants of educational agendas.

Method: This qualitative research employs a case study method, with data collected through in-depth interviews, observation, and documentation. Informants were chosen through purposive sampling, and data was analyzed using methods like Pattern Matching and Explanation Building. These techniques were used to interpret the information from the viewpoints of innovation diffusion and development communication.

Results: The Rote Ndao government has not yet implemented educational activities for the Free Nutritious Meal Program in a planned, direct, and systematic manner. Teachers, students, and parents primarily obtain information about the program independently through media sources. Television remains the most frequently used conventional mass medium, mainly through news broadcasts. In addition, local communities also access program information via new media. Students receive program information primarily in the form of video content, textual news narratives, and oral accounts in daily conversations. Program exposure among students in Rote Ndao Regency is relatively low, at only 14.28%. The implementation of the program’s educational activities in the regency remains suboptimal, influenced by several factors, including government educational agendas, media and information accessibility, technological competence, and communication infrastructure.

Conclusion: This study concludes that the educational activities of the Free Nutritious Meal Program in Rote Ndao Regency have not been implemented optimally. It confirms that the program’s execution in the regency has prioritized operational stages while neglecting the role of communication variables as a key factor in its success. The findings may serve as a reference for stakeholders to enhance the program’s effectiveness in the future, particularly regarding the urgency of an educational agenda.

A Qualitative Phenomenological Study of Perinatal Loss Experiences in Indonesia: A Trauma-Informed Care Perspective

Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Perinatal loss is a profound health event that extends beyond medical complications and encompasses emotional, social, and spiritual consequences for the women and their families. This study aimed to explore the experiences of women, their partners, and healthcare providers. In many setting, care following perinatal loss remains primarily biomedical, with limited attention to psychosocial and bereavement needs. This study aimed to explore how women, their partners and healthcare professionals’ experience and engage with perinatal loss in Indonesia and to provide recommendations for more holistic and responsive maternal healthcare services.

Methods: A qualitative phenomenological design was conducted between June and September 2025 in Yogyakarta and Central Java, Indonesia. A total of 27 participants were recruited, including 11 women who experienced perinatal loss, 7 husbands, and 9 healthcare providers (midwives and general practitioners). Data were collected through in-depth interviews and focus group discussions and analysed thematically using Braun and Clarke’s six-step approach, guided by Trauma-Informed Care principles. Ethical approval was secured from the Health Research Ethics Committee of Universitas ‘Aisyiyah Yogyakarta.

Results: The analysis identified four overarching themes: pregnancy journey and risks, healthcare services experiences, spiritual coping and grief after perinatal loss and bereavement care and institutional support. Participants described delayed risk recognition, inconsistent referral pathways and communication that priorities clinical information over emotional support. Mothers reported prolonged grief, guilt and spiritual searching, while fathers often experienced hidden distress and emotional suppression. Healthcare providers acknowledged emotional burden, limited training and the absence of structured bereavement protocols.

Conclusion: Perinatal loss care in Indonesia requires strengthening through trauma-informed approaches that integrate emotional, spiritual and social dimensions alongside clinical management. Developing consistent bereavement protocols and providing equitable psychosocial support for mothers and fathers are essential to improve family wellbeing and system responsiveness.

Exploring Ageism: The Lived Experiences of Older Adults in Community Settings, Bengkulu City, Indonesia

Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Ageism poses a serious threat to healthy aging and remains under-researched in low- and middle-income countries. In Indonesia cultural traditions emphasize deference to elders through rituals and honorific language. At the same time, older adults often find themselves sidelined when real decisions are made in families and community groups. This stark contrast between symbolic respect and practical exclusion necessitates a more in-depth examination of the mechanisms of ageism in daily life and the responses of elderly individuals to it. This study examined the ways in which ageism affects elders in Bengkulu City, Indonesia, and how they actively resist its impact.

Methods: This study is a qualitative phenomenological design using in-depth semi-structured interviews that are analyzed using Colaizzi’s seven-step method. Interview transcripts were analyzed using Colaizzi's seven-step method. Purposive sampling was used to determine the participants. The total number of participants involved was 20 people aged 61-75 years (mean = 67.75, SD = 3.78), with the majority of respondents being female in Bengkulu City, Indonesia (June–September 2024). Trustworthiness increased by credibility, dependability, transferability, and confirmability.

Results: This study produced four primary themes and sixteen sub-themes. Elders are venerated symbolically yet marginalized in home and community decision-making processes. Secondly, numerous individuals embrace silence and emotional suppression as a reaction to internalized ageist beliefs. Third, ageism connects with gender and socioeconomic disadvantage, exacerbating marginalization, especially for older women who serve as caretakers. Their aspirations for dignified aging highlight the necessity for dependable income, accessible healthcare, and legal protections against ageism.

Conclusion: Addressing ageism in this context requires action at multiple levels. Practitioners and policymakers should empower older adults in decision-making, promote intergenerational dialogue, design gender-sensitive social protections, integrate spiritual support into elder services, and introduce robust anti-ageism legislation. By moving beyond ceremonial respect to genuine inclusion, societies can honor older adult’s contributions and ensure their dignity.

Animated Educational Strategy to Enhance Contraceptive Awareness and Uptake Intention Among Women of Childbearing Age: A Quasi Experimental Study

Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Unmet contraceptive needs among women of childbearing age remain a challenge for family planning programs in Indonesia, mainly due to low levels of knowledge and interest. Animated videos have the potential to be an effective, engaging, and easy-to-understand educational tool for conveying reproductive health information. The aim of this research is to determine the effect of animated video media on contraceptive knowledge and interest among women of childbearing age with high unmet need.

Methods: A quasi-experimental pretest-posttest study with a control group was conducted on 86 respondents, divided into an intervention group (animated video) and a control group (flip chart). The research instruments were questionnaires on contraceptive knowledge and interest. The intervention was carried out for 3 weeks in two community health centers in the South Sorong region (Moswaren, Teminabuan). Data were analyzed using Chi-square, Wilcoxon, and Mann-Whitney tests. A quasi-experimental study was conducted among 86 women of childbearing age at Moswaren Health Center, divided into an intervention group (animated video, n = 43) and a control group (flip chart, n = 43). Pre- and post-test scores within groups were analyzed using Wilcoxon tests, with effect sizes (r) calculated for significant changes. Post-test scores between groups were compared using Mann-Whitney tests, and categorical outcomes were analyzed using Chi-square tests; nonsignificant results were explicitly reported to ensure interpretive transparency

Results: There was a significant increase in knowledge and interest scores after education using animated videos in the intervention group, compared with the control group, the difference was statistically significant (p = 0.001). Animated videos proved to be more interesting and easier to understand for women of childbearing age, and encouraged an increase in their intention to use contraception compared to flip charts, which are passive.

Conclusion: The use of animated video media in contraceptive education was proven to be effective in increasing knowledge and interest among reproductive aged women with a high unmet need for contraception. This media is recommended as an educational strategy in family planning programs in areas with limited access and low literacy.

Activating Community-Based Change Pathways for Stunting Prevention: Integrating Appropriate Technology and Primary Health Cadre Capacity in Rural Indonesia

Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Stunting continues to affect many children in rural areas of Indonesia. In these settings, households often face limited food access, constrained health services, and economic hardship. Programs that focus only on nutrition-specific interventions rarely address these broader conditions. Community-based approaches that combine appropriate technology, household food production, and strengthened roles of local health volunteers remain underexplored, particularly in village contexts.

Objective: This research examined changes in community knowledge, practical skills, and everyday practices after Women Farmer Groups (Kelompok Wanita Tani – KWT) and posyandu cadres received training in appropriate technology and nutrition education in Srikayangan Village, Kulon Progo.

Methods: A convergent mixed-methods approach was applied. The quantitative component used a quasi-experimental single-group pretest–posttest design involving 30 KWT members and 78 cadres. The qualitative component drew on field observations, focus group discussions, interviews, and documentation of program activities. Quantitative results were summarized descriptively and compared across time points, while qualitative materials were interpreted through thematic analysis and then considered together with the quantitative patterns. Anthropometric indicators such as HAZ/LAZ were not included; the evaluation centered on capacity building and shifts in community practice.

Results: Scores for knowledge rose markedly, with increases ranging from 40% to 86%. KWT participants also became more confident in using simple food-processing technologies, while cadres showed improvements in several aspects of nutrition service delivery. Field notes and interviews pointed to practical changes at the community level: greater use of locally available foods, growing interest in small-scale food enterprises, and more consistent child growth monitoring activities. Because the design did not include a comparison group, these patterns should be interpreted as observed improvements over time rather than direct causal effects.

Conclusion: Combining appropriate technology training with nutrition education appeared to strengthen several intermediate factors linked to child nutrition within households and the community. The study did not measure stunting prevalence, yet the approach offers a promising community model that may be adapted elsewhere. Further research is needed to examine longer-term outcomes.

Urban-Rural Differences in Food Beliefs and Practices in Indonesia: A Qualitative Study

Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Food beliefs and cultural practices have a significant influence on food choices, recommendations, and taboos, with variations shaped by the context of ecological, social, and local knowledge. Rural populations generally adhere to long-established traditional practices, whereas urban environments undergo more rapid dietary transitions driven by globalization and the commercial food industry. This cultural framework shapes individual interpretations of nutritional information, often leading to the rejection of health messages that contradict established belief systems. In Indonesia, considerable ethnic and geographical diversity gives rise to culturally embedded diets that can impact nutritional status; however, the dynamic interactions between food choices, recommendations, and taboos remain insufficiently studied. To address this gap, a qualitative study that explores regional variations in food beliefs and practices in Indonesia, focusing on urban–rural differences across diverse socio-ecological settings was conducted.

Methods: In-depth interviews with 28 respondents and focus group discussions with 42 respondents were conducted in four provinces (West Java, Central Sulawesi, East Kalimantan, and West Nusa Tenggara) under the Socio-ecological Model (SEM) framework to investigate how dietary choices, food recommendations, and food taboos are shaped. The study was conducted in 2022. Ethical approval was obtained and all participants provided consent.

Results: The findings reveal three main insights: (1) a paradoxical decoupling between dietary diversity and nutritional outcomes, wherein greater dietary diversity in Eastern Indonesia does not directly correlate with better nutrition outcomes; (2) food recommendations for mothers and infants vary, with urban areas favoring commercial products and rural areas relying more on local knowledge; and (3) food taboos persist across regions, particularly in rural Eastern Indonesia, often affecting infant and maternal nutrition.

Conclusion: This study contributes to a nuanced, culture-sensitive framework to inform health communication and nutrition policies in Indonesia. These findings highlight the need for culturally sensitive and context specific nutrition policies.

Effect of Structured Parental Education on Parental Support and Quality of Life of Children with Thalassemia in Indonesia: A Quasi-Experimental Study

Wuri Utami, Mohd Nazri, Khalid Bin Mokti, Putra Agina Widyaswara Suwaryo — Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Thalassemia is a lifelong hereditary blood disorder that requires continuous treatment and family involvement. Parents play an important role in supporting medical adherence and emotional stability in affected children. However, limited knowledge and coping difficulties may reduce the consistency and quality of parental support. This study explored whether a structured parental education program based on the Health Belief Model could improve parental support and children’s quality of life.

Methods: A quasi-experimental pretest–posttest control group design was used. Fifty-six parents of children with thalassemia were included and divided into an intervention group (n = 28) and a control group (n = 28). Participants were recruited through random sampling at a regional referral hospital between June and December 2023. The intervention involved structured face-to-face education sessions addressing disease information, emotional support strategies, communication skills, and home care practices. Parental support was measured using a validated multidimensional questionnaire, and children’s quality of life was assessed with a standardized instrument. Data were analyzed using Wilcoxon Signed-Rank and Mann–Whitney tests with a significance level of p < 0.05.

Results: After six weeks, parental support scores increased in the intervention group from a median of 31.50 to 37.00 (p < 0.001), while the control group showed no significant change (p = 0.069). Children’s quality of life scores also improved significantly in the intervention group compared with the control group (p < 0.001). The magnitude of improvement was greater among parents who received the educational program.

Conclusion: Structured parental education was associated with improved parental support and better quality of life in children with thalassemia. Integrating parent-focused education into routine care may strengthen family involvement and support more holistic management of chronic conditions.

The Association between Nutrition Education Based on Local Wisdom with Family Nutrition Knowledge in West Lombok, Indonesia

Wulandari Dewi Susilawati, Muhammad Nawawi, Musparlin Halid — Thu, 02 Apr 2026 00:00:00 +0700

Introduction: In West Lombok Regency, particularly in Rumak Village, Kediri, there are various traditional practices related to food and health that have been passed down from generation to generation. These practices reflect local understanding of nutrition and health, which can be used as a basis for designing educational approaches that are more relevant and acceptable to the community. The study aims to analyse factors related to the level of family nutrition knowledge through a local wisdom-based nutrition education approach.

Methods: This study used a cross-sectional design involving 263 family respondents selected proportionally in Rumak Village, West Lombok. Analysis was performed using Chi-square tests and logistic regression to determine the dominant factors associated with family nutrition knowledge.

Results: The study results indicate that of the 263 respondents, 60.5% had good nutritional knowledge. The analysis results show that there was a significant association between gender (p=0.004), highest level of education (p=0.012), employment (p=0.002), income (p=0.002), source of nutritional information (p=0.019), frequency of attending local nutrition education (p=0.031), suitability of materials to local culture (p=0.001), active family participation (p=0.029), and understanding of local nutrition messages (p=0.001) with family nutrition knowledge. Furthermore, family understanding of local nutrition messages (p=0.001) was the most dominant factor influencing family nutrition knowledge.

Conclusions: Nutrition education based on local wisdom has proven to play an important role in improving family nutrition knowledge. These findings indicate that nutrition education tailored to local culture and involving active family participation is an effective strategy for sustainably improving community nutrition knowledge.

Peer Group Discussion–Based Reproductive Health Education and Adolescents’ Attitudes Toward Early Marriage: A Quasi-Experimental Study

Diadjeng Setya Wardani, Rafi’ Andyah Arum Kedaton, Nabila Sinta Devi — Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Early marriage is defined as marriage occurring before the age of 19 years. The incidence of early marriage remains high in East Java, Indonesia. Early marriage is associated with limited educational attainment, increased health risks, and emotional instability among adolescents. Adolescence is a critical developmental period during which attitudes and decision-making are strongly influenced by peers. Peer group discussion-based reproductive health education provides an interactive learning approach that may enhance adolescents’ understanding of puberty, reproductive rights, and marriage readiness. This study aimed to analyze changes in adolescents’ attitudes toward early marriage after receiving peer group discussion-based reproductive health education at SMPN 2 Singosari, Malang, East Java.

Methods: This study employed a pre-experimental one-group pretest-posttest design without a control group. The research was conducted from November to December 2024. The population consisted of all seventh-grade students (n-256). Using purposive sampling based on inclusion criteria, 72 adolescents were selected as participants. Respondents completed a questionnaire assessing attitudes toward early marriage before and after the intervention. The intervention consisted of structured peer group discussions on reproductive health, facilitated over several scheduled sessions. Data were analyzed using descriptive statistics and the Wilcoxon to assess differences in pretest and posttest attitude scores.

Results: The majority of respondents were 13 years old, female and Javanese ethnicity. Some respondents had parents or relatives who married at an early age. Prior to intervention, most adolescents demonstrated a moderate attitude toward early marriage. However, after the intervention, the majority demonstrated a good attitude. The Wilcoxon test yielded a p-value < 0,05 indicating a statistically significant improvement adolescents’ attitudes.

Conclusion: Peer group discussion-based reproductive health education significantly improves adolescents’ attitudes toward early marriage. Future research is recommended to include a control group, a longer follow-up and a larger sample size.

The Influence of the Participatory Learning Approach (PLA) on Mothers' Knowledge and Awareness in Stunting Prevention: A Quasi-Experimental Study

Alamsyah Lukito, Zaim Anshari — Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Mothers play a crucial role in ensuring proper family nutrition to prevent stunting. Although various educational and counseling programs have been implemented to improve maternal knowledge, many remain conventional and one-directional, limiting active participation and impact. The Participatory Learning Approach (PLA) has been developed to promote engagement, deeper understanding, and awareness related to stunting prevention.

Methods: This study examined the effect of the Participatory Learning Approach on maternal knowledge and awareness of stunting prevention using a quasi experimental design with intervention and control groups. Mothers participated in a community based stunting prevention program, in which the intervention group received participatory learning activities, while the control group received conventional education. Changes in knowledge and awareness were assessed before and after the intervention using appropriate statistical analyses. Unlike previous studies that employed prolonged participatory interventions, this study provides empirical evidence that a short, one day participatory learning program can effectively enhance maternal awareness of stunting prevention in a community based setting.

Results: Most participants had high school education and were married. Knowledge scores increased significantly in the intervention group (12.59 ± 2.76 to 13.67 ± 3.22; p = 0.001) and in the control group (14.13 ± 2.65 to 15.43 ± 1.73; p = 0.002), with Independent t-tests indicated no statistically significant difference in knowledge gains between the intervention and control groups, although the participatory approach demonstrated meaningful improvements in maternal awareness. Maternal awareness of prenatal check-ups rose from 66.6% to 88.8%, and all participants acknowledged the importance of exclusive breastfeeding and dietary diversity after PLA.

Conclusion: This study demonstrates that a short duration, community based Participatory Learning Approach (PLA) can effectively enhance maternal knowledge and, more importantly, maternal awareness related to stunting prevention. Although knowledge gains were comparable between participatory and conventional education, PLA showed added value in strengthening awareness of key preventive practices, including antenatal care, exclusive breastfeeding, and dietary diversity. These findings provide preliminary evidence that even a one day participatory learning intervention can serve as a feasible and contextually appropriate strategy for community based stunting prevention programs in resource-limited settings.

Integrating Health Belief Model and Theory of Planned Behavior to Explain Complementary Therapy Use in Type 2 Diabetes: A Cross-Sectional Study in Denpasar, Indonesia

Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Complementary therapy (CT) is widely practiced among individuals with type 2 diabetes mellitus (T2DM) in Indonesia. However, the psychosocial determinants influencing CT adoption and its safe integration into biomedical care remain insufficiently understood. This study aimed to determine the prevalence and psychosocial determinants of CT use among patients with T2DM using an integrated Health Belief Model (HBM) and Theory of Planned Behavior (TPB) framework. We hypothesized that stronger psychosocial constructs specifically self-efficacy, subjective norms, and positive attitudes would be positively associated with CT use, whereas higher levels of CT-specific rational knowledge would be inversely associated with CT adoption.

Methods: A cross-sectional survey of 300 adult outpatients with T2DM was conducted at four community health centers in Denpasar, Indonesia, selected through multistage cluster sampling from May to July 2025. Interviewer-administered questionnaires collected sociodemographic and clinical characteristics, CT-specific rational knowledge, and HBM/TPB constructs. Data were analyzed using chi-square and Mann–Whitney U tests for bivariate comparisons, and backward stepwise binary logistic regression to identify independent predictors of CT use.

Results: CT use within the past six months was reported by 43.3% of participants. Usage was significantly associated with treatment type (?²=9.458, p=0.024) and check-up consistency (?²=5.999, p=0.014). CT users demonstrated higher scores across all HBM and TPB constructs (all p<0.001) but lower rational knowledge (p<0.001). In multivariate analysis, self-efficacy (OR=13.46, p=0.002), subjective norms (OR=9.20, p=0.005), and attitudes (OR=3.86, p=0.021) independently predicted CT use, while rational knowledge was inversely related (OR=0.395, p<0.001).

Conclusion:CT use among patients with T2DM was prevalent and predominantly influenced by psychosocial rather than demographic or knowledge-related factors. Strengthening culturally tailored communication, CT-specific health literacy, and provider readiness is crucial to promote safe, integrative diabetes management.

Integrating Primary Health Care and WASH Indicators for Spatial Prioritization of Diarrhoeal Disease Risk in Rural Eastern Indonesia

Thu, 02 Apr 2026 00:00:00 +0700

Introduction: The objective of this study is to map the distribution of diarrhoeal disease and identify priority sub-districts for targeted prevention in Manggarai District through integration of diarrhoea incidence rate and WASH indicators. The integration of these indicators into a spatial risk framework provides a practical basis for strengthening diarrhoea prevention at the primary care level.

Methods: This study employed a descriptive quantitative approach with spatial mapping using Quantum Geographic Information System (QGIS) application. Data of diarrhoea incidence rate and poor WASH indicators (access to improved sanitation, clean water coverage, and handwashing with clean water behavior) from 12 sub-districts from Manggarai Health Profile 2023 and Manggarai Health Office Report 2023 were used. The sub-districts were classified into low, moderate, and high-risk priority level using scoring system and equal interval classification method.

Results: West Cibal, North Rahong, and Cibal were classified into high-priority sub-districts characterized by high diarrhoea incidence rate (?4.12 cases per classification range) and poor WASH indicators. Conversely, Langke Rembong, North Satar Mese, and Wae Ri’i exhibited low diarrhoea incidence rate with optimal WASH coverage. Anomalies were found in Lelak, where high diarrhoea incidence persisted despite good WASH access, indicating possible hidden risk factors.

Conclusion: The observed spatial patterns showed that inadequate water and sanitation infrastructure, combined with poor hygiene practices, are key drivers of diarrhoeal transmission. The coexistence of high disease burden and weak WASH conditions highlights inequalities in primary health care and environmental service provisioin. By integrating epidemiological, environmental, and behavioral data, this study provides a spatial framework to support targeted diarrhoea prevention and strengthen primary health care planning in resource-limited areas.

The Effectiveness of Psychoeducation Based Behavior Modification in Improving School Well-Being among Elementary School Students in Semarang City

Wening Wihartati, Ari Yuniastuti, Irwan Budiono, Yuni Wijayanti — Thu, 02 Apr 2026 00:00:00 +0700

Introduction: This study aims to test the effectiveness of the “RELAKS” psychoeducation program, which is based on behavior modification and combines relaxation techniques, self-efficacy, and assertive behavior reinforcement to improve the school well-being of elementary school students.

Methods: The study uses a quantitative experimental method with a pre-test and post-test control group design. The study subjects consisted of 50 students, including 25 experimental group students from SD Bringin 01 and 25 control group students from SD Bringin 02 in Semarang City. The research instrument used the school well-being scale questionnaire. Data analysis was conducted using the Independent Sample T-Test and Paired Sample T-Test.

Results: The primary outcome was the improvement of school well-being scores. The results showed significant differences (p < 0.05) across all dimensions of school well-being between the experimental and control groups, indicating the positive effect of the intervention. Furthermore, a significant increase (p < 0.05) was observed in the experimental group's scores from pre-test to post-test, confirming the effectiveness of the “RELAKS” program. The Psychoeducation program improved school well-being scores across all dimensions. In the experimental group, the Being score rose from 30.32±3.26 to 36.72±3.29 with an average difference of 6.40, falling within the 95% CI range of 5.51–7.29. The Loving dimension increased by 5.04 points (95% CI 3.22–6.86), Health increased by 4.84 points (95% CI 4.80–5.35) and Having dimension, the increase reached 2.48 points (95% CI 0.79–4.16). The effect size indicates a moderate to large category, especially in the Being dimension, which reflects the strongest impact of the intervention.

Conclusion: In conclusion, our study demonstrates that the psychoeducation program effectively improves school well-being among elementary school students by integrating behavior modification techniques. This research offers valuable insights for developing supportive educational interventions.

Knowledge, Attitudes and Practice toward the Disposal of Unused Expired Medicines and Associated Factors: A Cross-Sectional Survey in Yogyakarta Primary Health Care

Thu, 02 Apr 2026 00:00:00 +0700

Introduction: The accumulation and inappropriate disposal of unused and expired drugs lead to significant risks to public health and the environment. Unsafe disposal behaviors contribute to the water and soil contamination and increase the potential for drug misuse. Recognizing community knowledge, attitudes, and practices (KAP) is essential for developing effective health promotion strategies to improve pharmaceutical waste management at primary care level. This study primarily aimed to assess the public’s KAP toward disposal of unused and expired drugs and its implications for health promotion in Indonesian primary health care settings.

Methods: A cross-sectional survey was conducted among 358 participants selected through purposive sampling at Banguntapan II, Danurejan II, and Mlati II primary healthcare centers in the Special Region of Yogyakarta, Indonesia. Data were technically collected using a prior validated questionnaire. Descriptive statistics, Chi-square tests, Spearman correlation and multivariate logistic regression were used to analyse data.

Results: 89.3% of participants reported they had unused or expired drugs stored in their home, and the main reason for storage was better health (52%) or excess medicine (43%). Although 64% have reported excellent knowledge and 98.3% positive attitudes, only 27.7% practiced proper disposal. (p < 0.05) Knowledge and attitudes were significantly influenced by, education income and medical history In addition, knowledge and attitude were significantly associated with disposal practices (p < 0.05).

Conclusion: While public awareness, understanding and attitude were favorable, there are deficiencies in disposal practices. The implementation of pharmacist-led education, drug take-back programs and primary care services for health promotion should be strengthened in the community to raise awareness of CS use, reduce inappropriate disposal practices and protect public health through improved environmental conditions.

Reducing Ergonomic Risk and Musculoskeletal Complaints through Participatory Ergonomics in an Informal MSME Food-Processing Enterprise: A Quasi-Experimental Case Study

Thu, 02 Apr 2026 00:00:00 +0700

Introduction: Informal micro and small-scale enterprises in developing countries frequently operate under suboptimal occupational safety and health conditions, exposing workers to significant ergonomic risks and musculoskeletal disorders (MSDs). This study examined whether a participatory ergonomics (PE) intervention was associated with reductions in ergonomic risk and musculoskeletal complaints in small-scale milkfish processing enterprises in Indonesia.

Methods: A quasi-experimental, one-group, pretest-posttest design was implemented over three months, involving 12 workers. Ergonomic risk was assessed using the Rapid Entire Body Assessment (REBA), musculoskeletal complaints were evaluated using the Nordic Musculoskeletal Questionnaire (NMQ), and workplace hazards were identified using the ILO-PATRIS checklist with Delphi-based prioritization.

Results: Following the intervention, the mean REBA score decreased from 9.25 (high risk) to 4.75 (moderate-low risk), representing a 48.6% reduction. The prevalence of lower back complaints declined from 91% to 46%, shoulder complaints from 78% to 35%, and wrist complaints from 63% to 28% after the intervention. Perceived work comfort increased by 46.4 percentage points. These changes suggest meaningful ergonomic improvements associated with participatory interventions and low-cost workstation modifications.

Conclusion: The findings indicate that participatory ergonomics may offer a feasible and contextually adaptable strategy for mitigating ergonomic risks and promoting worker well-being in informal MSME food-processing environments.

Exploring the Global Landscape of Nurses' Knowledge, Attitude and Competence in Palliative Care: A Scoping Review

Ayu Hardanti, Erna Rochmawati — Thu, 02 Apr 2026 00:00:00 +0700

Introduction: In palliative care, nurses have essential roles in addressing complex needs of patients with palliative care needs that include physical, psychological, social and spiritual needs. Knowledge and competence are deeply interconnected, as both are critical to provide quality care to patients with life-limiting conditions. However, a comprehensive exploration of nurses’ knowledge, attitude and competence in palliative care across regions remains lacking. The aim of this scoping is to systematically map the existing evidence regarding palliative care knowledge, attitude and competence among nurses.

Method: This review followed scoping review framework from Arskey and O’Malley. The PCC framework (population, concept and context) was applied; Population – nurse; Concept- knowledge, competence and attitude; and Context – palliative care. A comprehensive search was conducted in several data bases: PubMed, SCOPUS, Science Direct, and ProQuest. The search criteria were restricted to studies published in English between 2000 and 2024. Thematic analysis was used to map themes.

Results: Thirty studies were included in review, demonstrate a consistent pattern of nurses’ insufficient knowledge and self-perceived competence in palliative care, particularly in psychological and spiritual domains. Across studies, assessment approaches were methodologically homogeneous, with a predominant reliance on cross-sectional designs and self-administered instruments. The Palliative Care Knowledge Test (PCKT)) and the Palliative Care Quiz for Nurses (PCQN emerged as the most frequently used tools to measure knowledge, while the Palliative Care Nursing Self-Competence Scale was commonly employed to assess competence.

Conclusion: The review identified nurses’ knowledge ranged from low to moderate with lower competence reported in specific areas such as spiritual care. The findings emphasized the need to equip nurses with adequate knowledge and competencies in palliative care to ensure quality care for patients and family caregivers in palliative care setting.

Pesticide Exposure and the Incidence of Type 2 Diabetes Mellitus Among Farmers: A Literature Review

Dyah Pramesti Puspawardaya, Suhartono Suhartono, Onny Setiani — Wed, 01 Apr 2026 00:00:00 +0700

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia resulting from insulin resistance or inadequate insulin secretion. While lifestyle factors are established contributors, prolonged exposure to environmental chemicals is also implicated in its etiology. The intensification of agricultural practices has led to the widespread application of various pesticides, including fungicides, insecticides, and herbicides. Consequently, hazardous compounds from these pesticides can accumulate in the human body, either through direct occupational exposure, as seen in farmers, or indirectly via the consumption of contaminated food and water.

Methods: This study employed a PRISMA-guided systematic literature review of peer-reviewed observational studies published between 2015 and 2025. Relevant articles were retrieved from Google Scholar, ScienceDirect, and the Undip E-Journal using predefined keywords related to pesticide exposure, farming populations, type 2 diabetes mellitus, and cholinesterase activity. Studies were included if they assessed occupational pesticide exposure among farmers and reported T2DM-related outcomes, while experimental, animal, review articles, and studies lacking relevant exposure or outcome data were excluded. The PRISMA-based selection process yielded 10 studies for qualitative synthesis.

Results: The review identified several occupational factors significantly associated with an increased risk of T2DM. These include a long working period (over 10 years), inadequate use of Personal Protective Equipment (PPE), gender, and the application of more than one type of pesticide. The underlying mechanism involves certain pesticide compounds, particularly Persistent Organic Pollutants (POPs) like organochlorines (e.g., DDE) and organophosphates, which act as endocrine disruptors. Exposure to these chemicals is linked to reduced cholinesterase enzyme levels and pancreatic beta-cell dysfunction, leading to insulin resistance and glucose intolerance.

Conclusions: There is a significant relationship between pesticide exposure and the incidence of T2DM among farmers. Key risk factors are prolonged exposure, unsafe work practices, and the use of specific pesticide types. Mitigation efforts, such as strict enforcement of PPE usage and farmer education on the risks of pesticide handling, are crucial as preventive measures to reduce the burden of T2DM in this vulnerable group.