Family Empowerment Strategies for Relapse Prevention in Individuals With Schizophrenia: A Scoping Review.

The current scoping review aimed to provide an overview of family empowerment strategies used in relapse prevention among individuals with schizophrenia. Three major topics were explored: (a) the family empowerment model used in relapse prevention among individuals with schizophrenia; (b) family intervention strategies; and (c) special considerations for integrating family empowerment in relapse prevention among individuals with schizophrenia. There is a need to identify and use family resources and strengths, such as acceptance of schizophrenia, development of spirituality, involvement in daily activities, and understanding of behaviors that exacerbate symptoms, to reduce relapse risk. The family empowerment paradigm incorporates new information and coping skills, family support, meaning-making, life objectives, self-reflection, and good family experiences. Families as agents of care at home should be provided with stress management and family psychoeducation to improve family resilience. Further research is needed to understand family empowerment and develop comprehensive guidelines regarding relapse prevention management among individuals with schizophrenia. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Development of a family resiliency model to care of patients with schizophrenia.

Families who care for schizophrenia suffer stress and lose the ability to treat. Family stress can be mediated by resilience. Objective: This study aimed to develop a family resilience model based on family-centred nursing for persons with schizophrenia. This study used a mixed-method cross-sectional approach. The population was a family of caregivers for persons with schizophrenia at Mental Hospital in Surabaya, Indonesia. The respondents were 137 families recruited by simple random sampling. Variables include family factors, risk factors, protective factors, patient factors, family stress, family resilience and family ability to care for persons with schizophrenia. The data were collected using questionnaires and then analysed with partial least squares. The statistical results afforded material for focus group discussions with six families and 10 health workers (psychiatrists, psychologists and nurses) in order to improve the model. The result showed family stress was influenced by family factors (path coefficient = -0.145; t = 2.26), risk factors (path coefficient = 0.753; t = 16.7) and patient factors (path coefficient = 0.159; t = 3.23). Family resilience is influenced by risk factors (path coefficient = 0.316; t = 2.60), protective factors (path coefficient = 0.176; t = 2.22) and family stress (path coefficient = 0.298; t = 2.54). Family resilience affects the family ability to treat persons with schizophrenia (path coefficient = 0.366; t = 5.36). The family resilience model increases family capability by 13.4%. The model helps families through stress management by controlling the burden and stigma so that families are able to survive, rise, growing stronger and be better at caring for persons with schizophrenia.

Indonesian nurses' perception of disaster management preparedness.

PURPOSE: Using a quantitative approach, this study aims to assess Indonesian nurses' perception of their knowledge, skills, and preparedness regarding disaster management. METHODS: This study was a descriptive comparison in design. The research samples are Indonesian nurses working in medical services and educational institutions. The variables of nurses' preparedness to cope with disaster victims were measured using the Disaster Preparedness Evaluation Tool (DPET), which was electronically distributed to all nurses in Indonesia. Data were analyzed using a statistical descriptive one-way Analysis of Variance (ANOVA) and t-test with a significance level of 95%. RESULTS: In total, 1341 Indonesian nurses completed this survey. The average scores of preparedness to cope with disasters, the ability to recover from disaster, and evaluation of disaster victims were 3.13, 2.53, and 2.46, respectively. In general, nurses surveyed in this study are less prepared for disaster management, and do not understand their roles both during the phase of disaster preparedness, and when coping with a post-disaster situation. CONCLUSION: Nurses' preparedness and understanding of their roles in coping with disasters are still low in Indonesia. Therefore, their capacity in preparedness, responses, recovery, and evaluation of disasters needs improvement through continuing education. The efforts needed are significant due to potential disasters in Indonesia and adequate nurses resources.

How to attract health students to remote areas in Indonesia: a discrete choice experiment.

BACKGROUND: Remote areas of Indonesia lack sufficient health workers to meet the health-care needs of the population. There is an urgent need for evidence regarding interventions to attract health workers and specifically health students to serve in remote areas. The aim of this research was to analyze the job preferences of health students to develop effective policies to improve the recruitment and retention of health students in remote areas. METHODS: A discrete choice experiment was conducted to investigate health students' preferences regarding job characteristics. This study was conducted in three different regions of Indonesia, with a total included 400 health students. Mixed logit models were used to explore the stated preferences for each attribute. RESULTS: Data were collected from 150 medical, 150 nursing and 100 midwifery students. Medical students gave the highest preference for receiving study assistance, while nursing students viewed salary as the most important. Midwifery students valued advanced quality facilities as an important attribute. CONCLUSIONS: This study confirmed the importance of combination interventions in attracting and retaining health workers in remote areas of Indonesia. Money is not the only factor affecting student preferences to take up a rural post; good management and better facilities were viewed as important by all health students. Addressing health student preferences, which are the candidate of future health workforce, would help the nation solve the recruitment and retention issues. Copyright © 2015 John Wiley & Sons, Ltd.

Quality of Life of Family Caregivers of Patients Undergoing Dialysis: A Literature Review.

Introduction: Dialysis is a long-term treatment for chronic kidney failure. Family caregivers play a significant role in the care of patients undergoing dialysis. The quality of life (QoL) of family caregivers is related to the quality of care provided to patients undergoing dialysis. Objectives: This recent literature review aimed to synthesize the QoL experienced by caregivers of family members undergoing dialysis. Method: This literature review employed four online databases, including SCOPUS, PubMed, ScienceDirect, and Web of Science. The extracted articles were further screened on the basis of the PRISMA guidelines. In this review, articles were selected on the basis of the following eligibility criteria: double-blind peer-reviewed articles, articles written in English language and published between 1 January 2013 and January 2023. This review used thematic synthesis. Results: Four analytical themes emerged, including physical capacity, social relations, psychological state, and environment. All of these themes correspond to the dimensions of QoL. Conclusion: The QoL of family caregivers of patients undergoing dialysis must be considered. A good QoL of these caregivers will improve the balance of life and further increase the ability and quality of care they provide for family members undergoing dialysis.

Early detection of diabetic neuropathy based on health belief model: a scoping review.

Introduction: Uncontrolled blood sugar levels may result in complications, namely diabetic neuropathy. Diabetic neuropathy is a nerve disorder that causes symptoms of numbness, foot deformity, dry skin, and thickening of the feet. The severity of diabetic neuropathy carries the risk of developing diabetic ulcers and amputation. Early detection of diabetic neuropathy can prevent the risk of diabetic ulcers. The purpose: to identify early detection of diabetic neuropathy based on the health belief model. Method: This research searched for articles in 6 databases via Scopus, Ebsco, Pubmed, Sage journal, Science Direct, and SpringerLink with the keywords "screening Neuropathy" AND "Detection Neuropathy" AND "Scoring Neuropathy" AND "Diabetic" published in 2019-2023. In this study, articles were identified based on PICO analysis. Researchers used rayyan.AI in the literature selection process and PRISMA Flow-Chart 2020 to record the article filtering process. To identify the risk of bias, researchers used the JBI checklist for diagnostic test accuracy. Results: This research identified articles through PRISMA Flow-Chart 2020, obtaining 20 articles that discussed early detection of diabetic neuropathy. Conclusion: This review reports on the importance of early detection of neuropathy for diagnosing neuropathy and determining appropriate management. Neuropathy patients who receive appropriate treatment can prevent the occurrence of diabetic ulcers. The most frequently used neuropathy instruments are the vibration perception threshold (VPT) and questionnaire Michigan Neuropathy Screening Instrument (MNSI). Health workers can combine neuropathy instruments to accurately diagnose neuropathy.

Spousal Involvement in Collaborative Management and Glycemic Behavior Change among Patients with Diabetes Mellitus: A Systematic Review.

Introduction: The marked increase in the number of individuals with diabetes mellitus (DM) worldwide each year has resulted in the importance of the spouse's contribution to the promotion and support of patient self-management programs. Objectives: This study aimed to systematically explore the role or involvement of spouses in collaborative management and glycemic behavior change in DM. Methods: Five databases including Scopus, PubMed, Cumulative Index of Nursing and Allied Health Literature, SAGE, and Web of Science were reviewed for relevant articles retrieved from 2017 to 2022. Literature search used keywords, including "Spouse," "Support," "Self-management," "Glycemic Control," and "Diabetes mellitus." The Joanna Briggs Institute guidelines were used for appraisal review of journals. The component of partner support in the self-management of patients with DM is associated with an increase in the patient's glycemic level. Results: Twenty-five studies were identified that describe the different spousal roles and strategies in the promotion and support of DM management. Overall, spouses' involvement positively impacted healthy diets, higher self-efficacy, improved quality of psychological well-being, increased perceived support, and changes in glycemic-influenced behavior. Adaptation in the spouse patient relationship including maintaining cohesiveness can result in positive coping is essential in normalizing and contextualizing the chronic condition of DM. Partner-based collaboration is important for diabetes management, overcoming management barriers, and generating communal coping. Conclusion: This systematic review observed that the involvement of a spouse is important in improving collaborative management and results in better glycemic behavior in patients with DM. A better understanding of the relationship between spousal involvement, coping strategies, and adherence in daily management and the subsequent use of this information are highly useful for creating targeted and effective interventions.

Effectiveness of an Integrative Empowerment Intervention for Families on Caring and Prevention of Relapse in Schizophrenia Patients.

Introduction: Patients with schizophrenia require extended treatment and recovery, leaving their families and support systems feeling helpless. Integrative empowerment is a strategy that utilizes outside-in and inside-out empowerment to increase the ability of families to care for their loved ones and prevent relapse. Objective: This study aimed to investigate the impact of integrative empowerment intervention on enhancing the family's ability to care for and prevent relapse in patients with schizophrenia. Methods: The study employed a quasi-experimental with a pre-test and post-test control group design. The research sample was comprised of 70 individuals from nuclear families residing in Semarang, all of whom were responsible for the care of individuals with schizophrenia. The participants were divided into two groups: the treatment group, consisting of 35 individuals, and the control group, also comprising 35 individuals. Participant selection was carried out using purposive sampling. Module and booklet were produced as an intervention tools. The integrative empowerment intervention program spanned a period of 5 weeks, involving one session per week, each lasting approximately 60-90 min. Data analysis was conducted through the utilization of the Wilcoxon and Mann-Whitney tests. The significance level for the study was set at p<.05. Results: There was a significant change in the family's ability to care for patients with schizophrenia before and after the integrative empowerment intervention (p<.001), while there was no change in the control group's ability to care for patients with schizophrenia (p>.05). Integrative empowerment had a significant impact on increasing the family's ability to care for and prevent relapse in patients with schizophrenia (p<.001). Conclusions: Nurses can help families strengthen their positive caregiving experiences through the home visit program by utilizing integrative empowerment. This study's findings highlight the importance of integrative empowerment in enhancing the family's ability to care for and prevent relapse in patients with schizophrenia.

Potential Methods to Improve Self-management in Those with Type 2 Diabetes: A Narrative Review.

Context: The ability of self-manage was important for type 2 diabetes mellitus (T2DM) patients and it was supported and depend on the method used. We aimed to summarize the potential method of self-management to improve self-empowerment. Evidence Acquisition: To obtain the related data, 5 databases, including Scopus, Science Direct, ProQuest, CINAHL, and SAGE, were comprehensively searched. The search was done in advance using the Boolean operator. The full texts of articles presenting data on self-management methods were screened and retrieved. Results: A total of 22 studies were included in this review. Various self-management techniques were covered with primary and secondary outcomes. Primary outcomes included blood pressure, fasting blood glucose (FBG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Secondary outcomes included knowledge, self-efficacy, lifestyle habits, physical activity, diet, smoking, medical treatment, support, and health behavior. A goal-setting-oriented approach was effective in setting targets and gaining support from family members. A family-centered approach was effective in taking care of and taking good care of patients with T2DM. Strength training exercises provide patients with a choice of physical activity that can help them manage their blood sugar and blood pressure. Acceptance and commitment therapy (ACT) is a stress-reduction technique. The patient's acceptance of the disease and treatment for diabetes is aided by education. Conclusions: A successful self-management method was one which balances and adapts to the patient's condition. Regardless of the age of the patients, the overall findings from the review suggest that self-management methods can help patients become healthier and improve their quality of life by controlling their hemoglobin A1c (HbA1c) level.

Effect of Early Mobilization on Hip and Lower Extremity Postoperative: A Literature Review.

Introduction: The incidence of fracture and surgery of the hip and lower extremities is still high. Long postoperative bed rest can potentially increase the incidence of various complications that may increase patients' morbidity and mortality rate after hip and lower extremities surgery. This literature review aimed to identify the effects of early mobilization on hip and lower extremity postoperative. Methods: Search for articles on several databases such as ProQuest, ScienceDirect, CINAHL, Medline, Wiley Online, and Scopus, using the Boolean operator tools with "AND" and "OR" words by combining several keywords according to the literature review topic, with inclusion criteria of those published in the last three years (2019-2021), using a quantitative design, written in English and full-text articles. A total of 435 articles were obtained, screened, and reviewed so that there were 16 (sixteen) eligible articles. Results: There were 11 (eleven) effects of early mobilization, that is, shorter the length of stay, lower postoperative complication, lower the pain, increase walking ability, increase quality of life, decrease the rate of readmission, decrease mortality rate, lower the total hospitalization cost, higher number of physical therapy sessions prior to discharge, increase in satisfaction, and no fracture displacement or implant failure. Conclusion: This literature review showed that early mobilization is safe and effective in postoperative patients to reduce the risk of complications and adverse events. Nurses and health workers who care for patients can implement early mobilization and motivate patients to cooperate in undergoing early mobilization.

Structural Model of Family Caregiver for Elderly with Dementia.

Background: The number of older people with dementia was continuously increasing globally. Unfortunately, many of them had received inappropriate medical treatment to overcome the dementia they suffered. This current research aimed to analyze the factors that affected family-based caregiver empowerment. Materials and Methods: An analytic observational method with a cross-sectional approach was applied. The population was all families with dementia elderly in East Java, Indonesia, in 2021, who met the inclusion and exclusion criteria. The sample size was determined to be 100 respondents. Results: The results showed that the factors (i.e., elderly factors, family factors, health service factors, family's filial value, family assessment, and the need for care) had significant effects directly or indirectly on the family's ability to do home care. Conclusions: Factors that influenced directly (i.e., elderly factors, family factors, family assessment, and care needs) and indirectly (i.e., health service factors) were essential in constructing a structural model of family care for the elderly with dementia.

Development of an integrative empowerment model to care for patients with schizophrenia disorder.

Background: The main factor that causes a family the inability to care for patients with schizophrenia disorder is inadequate family-centered empowerment. Nevertheless, the family-integrated empowerment model has not been developed yet. This study aims to develop a integrative empowerment model to care for patients with schizophrenia disorder. Design and methods: The mixed methods research design was divided into two stages. The first stage used a cross-sectional method with a questionnaire to 135 families who cared for patients with schizophrenia disorder using purposive sampling. Data analysis was obtained using Partial Least Squares (PLS). The second stage is a focused group discussion (FGD) conducted with six families, seven health workers, and six social workers, and discussions with two experts for model development. Results: The integrative empowerment-based family empowerment model is developed from Outside-in empowerment (path coefficient = 0.309; t = 3.292) and Inside-out empowerment (path coefficient = 0.478; t = 4.850). Family factors is the most potent variable in shaping Inside-out empowerment (path coefficient = 0.217; t = 2.309). Moreover, re-meaning of caregiving is the strongest indicator that builds the Inside-out empowerment variable (t = 42.643). The value of Q2 is 0.433 indicates that this model can be generalized, since 61% of family ability to provide care for schizophrenia patients. Conclusions: Re-meaning of caregiving is the most potent indicator in shaping Inside-out empowerment, which is the strongest factor forming this model. Nurses assist families to be able to find activities that can generate positive meaning when caring for patients with schizophrenia disorder.

Psychoneuroimmunological Markers of Psychological Intervention in Pediatric Cancer: A Systematic Review and New Integrative Model.

PURPOSE: Pediatric cancer is a serious problem and still becomes a global challenge today. Various complex stressors due to diagnosis, disease symptoms, and various side-effects from the treatment that children with cancer undergo will cause problems in the child's psychoneuroimmunological aspects. Psychological interventions designed to modulate the stress response include psychoneuroimmunological markers. Unfortunately, there is little evidence to support the effect of psychological interventions on psychoneuroimmunological markers. This systematic review aims to assess the effectiveness of psychological interventions on psychoneuroimmunological markers in children with cancer and to provide a new integrative model for further research. METHODS: This systematic review uses four main databases (Scopus, PubMed, ScienceDirect, and ProQuest). The guideline used Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Selecting articles used the Rayyan application. The quality study was conducted using Joanna Briggs Institute (JBI)'s critical appraisal tools. The data were analyzed using the population, intervention, comparison, outcome, and study design (PICO) Synthesis based on similarities and differences in study characteristics to interpret the results. RESULTS: The search results in this systematic review found 1653 articles, 21 of which matched the predetermined inclusion and exclusion criteria. Most of the designs used were randomized controlled trials (57.1%). Massage therapy was the most common type of psychological intervention (14.2%). Almost half of the studies measured psychological responses (38.0%), and psycho-physiological responses (42.9%), and only a small proportion assessed the effectiveness of psychological interventions on neuroimmunological markers in pediatric cancer. CONCLUSIONS: We recommend the use of psychological interventions as an additional intervention in managing psychoneuroimmunological markers of pediatric cancer. This study offers a new integrative model demonstrating the interaction between stress and psychological intervention involving neuroendocrine and immune mechanisms. However, future researchers need to test all domains of these new integrative models. This will reveal the complex interactions among these components and understand their relevance to health outcomes.

Palliative care learning model based on transformational learning theory in palliative care of nursing students in Indonesia.

INTRODUCTION: Palliative care competence is one of the competencies that must be possessed by generalist nurses. For this reason, strategies for developing palliative care learning models need to be carried out to ensure nursing students have palliative care competencies. Therefore, this study was structured to develop a transformation theory-based palliative care learning model that prioritizes the active participation of students to deal with palliative care in future practice. METHODS: This study was a cross-sectional study involving 189 nursing students as participants. The proposed model involves six variables, namely student characteristics, educator characteristics, learning media, palliative care competencies, transformative learning theory (TLT)-based palliative learning, and competency achievement. Data were collected using a questionnaire that was tested using the Structural Equation Modeling (SEM) technique. RESULTS: SEM analysis showed that the R2 value of TLT-based palliative care learning was 0.707 or 70.7%. These results indicate that the diversity of TLT-based palliative care learning variables can be explained by the variables of students, educators, palliative competencies, and learning media by 70.7%. Each construct has a value of Q2 > 0, which means the model is satisfactory. The path coefficient value of 0.627 indicates that the characteristics of educators have the most significant contribution to the TLT-based palliative care learning model. CONCLUSION: It can be concluded that the teaching-learning process based on TLT is a promising strategy to support nursing students to achieve palliative care competence.

Work-related stress among nurses in the COVID-19 pandemic: What are the contributing factors?

OBJECTIVE: To analyze the contributing factors of work-related stress among nurses in the COVID-19 pandemic. METHODS: A cross-sectional study was conducted with 101 nurse practitioners from two hospitals in West Java, Indonesia. We distributed an online questionnaire to evaluate work-related stress and the data were analyzed using ordinal logistic regression. RESULTS: More than half of the nurses experienced moderate work-related stress. The study revealed that nurses aged over 35 years old had a lower likelihood of experiencing work-related stress (AOR: 0.173; 95%CI: 0.038-0.782). Married nurses had a higher likelihood (AOR: 7.156; 95% CI: 1.456-35.163). Additionally, nurses with low and moderate workloads had a lower likelihood (AOR: 0.003; 95%CI: 0.000-0.051) and (AOR: 0.025; 95%CI: 0.005-0.116), respectively. CONCLUSION: The consideration of age, marital status, and workload is essential in effectively addressing work-related stress among nurse practitioners.

[The effect of family caregiver empowerment interventions on family caregiver capabilities in self-management of type 2 diabetes mellitus in Indonesia]. / Efecto de las intervenciones de empoderamiento de los cuidadores familiares sobre las capacidades de estos para gestionar la diabetes mellitus tipo 2 en Indonesia.

OBJECTIVE: Empowering family caregivers is one of the strategies to increase the family caregiver's capability in T2DM self-management. The adequate capability of family caregivers in T2DM self-management can improve T2DM management, impacting people's health status with T2DM. This study aimed to examine the effect of family caregiver empowerment intervention on the family caregiver's T2DM self-management capability. METHODS: This study is an experimental study with a randomized control group pre-test post-test design. The sample size is 60 respondents by simple random sampling, which is divided into two groups randomly. The treatment group (n=30) received 10-session intervention in 10 weeks (six education and training sessions and four mentoring sessions), and the control group (n=30) received standard care. Data were collected using a questionnaire, twice, before and after the intervention (12 weeks after the last intervention session) and analysed descriptively and statistically (One way-ANOVA test, dependent t-test, and independent t-test). RESULTS: The empowerment intervention significantly increased the family caregiver's T2DM self-management capability, including diet management (t=4.070; p<.001), physical activity management (t=9.493; p<.001), medication management (t=4.021; p<.001), self-monitoring blood glucose levels (t=2.789; p<.001), and foot care skills (t=6.835; p<.001). CONCLUSION: Family caregiver empowerment interventions can improve the capability of family caregivers in self-management of T2DM, including increasing the capability to manage diet, physical activity, medication, self-monitoring blood glucose levels, and foot care. Nurses can empower family members as family caregivers to improve self-management of T2DM.

Determination of factors affecting post-partum depression in primary healthcare during the COVID-19 pandemic.

Postpartum depression is a phenomenon that occurs in the first postpartum days. Symptoms of postpartum depression peak on days 3 to 5 postpartum with a duration ranging from a few hours to several days. Of course, this will be different during the Covid-19 pandemic. The aim of this study was to analyze the determinants that influence the incidence of post-partum depression in primary health during the pandemic. The method in this research is descriptive analysis with cross sectional approach with a total sample of 100 respondents. The research instrument used a standard instrument, namely the EPDS (Edinburgh Postnatal Depression Scale) instrument. The results of the study were the determinant factors of parity in primigravida and attitudes. From the results of this study, it can be concluded that the dominant factors that greatly influence the risk of post-partum depression in women in primary health during the pandemic are parity (primigravida) and the attitude of women who take it for granted when they know that they are at risk of post-partum depression.

The Impact of COVID-19 on Psychological and Social Stigma for Indonesian Nurses: A Cross-Sectional Survey.

Introduction: Nurses are on the front line and are at high risk of experiencing a mental health crisis during the pandemic due to the psychological impact and stigma. The aim of this study was to identify the role of psychological status and social stigma in anxiety, fear, depression, and mental health crises during the pandemic. Materials and Methods: A cross-sectional design during December 2020-August 2021. A total of 2,156 nurses who work in health facilities, either hospitals, or communities based on the criteria of nurses who interact directly with COVID-19 patients, work at least 3 months, age 20-54 years, are literate, have internet access, and have the ability to access the electronic form. The eligible participants filled in online questionnaires that were sent to them via WhatsApp. Data were analyzed using Spearman rho correlation test with statistically significant p value < 0.05. Results: A total of 2,156 respondents responded to the questionnaire, and the response rate was 100%. The psychological status of nurses was 78.4% moderate, 18.5% experienced social stigma, 44.0% showed an anxiety response, 53.5% fear, 64.5% depression in the very severe category, and 63.5% fell into a mental health crisis. The results of the inferential analysis showed that all P < 0.05 which indicated that psychological status and social stigma had a significant relationship with anxiety, fear, depression, and mental health crisis in nurses. Conclusion: The psychological status and social stigma experienced by nurses during the COVID-19 pandemic indicate a bad situation and lead to a mental health emergency crisis.

Early detection to prevent foot ulceration among type 2 diabetes mellitus patient: A multi-intervention review.

Foot ulceration is one of the biggest complications experienced by type 2 diabetes patients. The severity and prevention of new wounds can be overcome through early detection interventions. This systematic review aims to explain and provide a comparison of various interventions that have been developed to prevent the occurrence of Diabetes Foot Ulcers (DFU). We searched Scopus, Science Direct, PubMed, CINAHL, SAGE, and ProQuest for English, experimental studies, published between 2016-2021 that tested early detection for preventing diabetic foot ulcers in diabetic patients. The Joanna Briggs Institute guidelines were used to assess eligibility, and PRISMA quality and a checklist to guide this review. 25 studies were obtained that matched the specified inclusion criteria. The entire article has an experimental study design. Majority of respondents were type 2 diabetes patients who have not experienced ulceration. Based on the results of the review, there were 3 main types of interventions used in the early detection of DFU. The types of intervention used are 1) conventional intervention/physical assessment, 2) 3D thermal camera assessment system, and 3) DFU screening instrument. The three types of interventions have advantages and disadvantages, so their use needs to be adjusted to the conditions and needs of the patient. the development of DFU risk early detection intervention needs to be developed. Integration with modern technology can also be done to increase the accuracy of the results and the ease of examination procedures.

Effectiveness of a Social Marketing Mix Intervention on Changing the Smoking Behavior of Santri in Traditional Islamic Boarding Schools in Indonesia.

OBJECTIVES: This study investigated the effectiveness of the social marketing mix approach in increasing students' knowledge about smoking, promoting positive attitudes toward smoking cessation, and decreasing smoking behavior. METHODS: This quantitative research study incorporated a quasi-experimental method with a pretest-posttest non-equivalent group design. Using the purposive sampling technique, 152 smoking students were selected as participants. They were divided into 2 equal groups, with 76 students in the control group and 76 in the intervention group. The data were collected using questionnaires and analyzed with the chi-square test, independent t-test, Wilcoxon signed-rank test, and Mann-Whitney U-test. RESULTS: The social marketing mix intervention was effective in increasing the students' knowledge about smoking (p<0.001), improving their attitude toward smoking cessation (p<0.001), and reducing their smoking behavior (p=0.014). CONCLUSIONS: This approach should be implemented by local governments to reduce smoking behavior in the community, especially among teenagers, in addition to instituting a smoking ban and applying fines.