Development and validation of the adolescent behavioural change Counselling Assessment Tool in Indonesia.

BACKGROUND: Primary care provides an important context to engage adolescents and their families in healthy lifestyles with the goal of reducing future behaviour-related health problems. Developing a valid tool to assess health professionals' skills in behavioural change counselling is integral to improving the quality of clinical care provided to adolescents in Indonesia. METHODS: This work was nested within a project to develop a training program to enhance the behaviour-change counselling of adolescents and their parents by Indonesian primary care professionals. Initial item development was based on the content of the training module and the domain structure of the Behavioral Change Counselling Index (BECCI), a commonly used tool to assess counselling quality in healthcare settings. Expert panels were used to test content validity, while face validity was assessed by a group of trained psychologists. Inter-rater agreement was calculated prior to tests of construct validity and reliability, which involved psychologists rating 125 audio-taped counselling sessions between the health professional and adolescent patients, together with a parent. RESULTS: An initial 13-item tool was developed using a 1-5 Likert scale. Validity and reliability testing resulted in the decision to use a 14-item tool with a 0-3 Likert scale. The scale was found to have a Cronbach's α coefficient of 0.839 (internal consistency), and there was strong inter-rater agreement (0.931). CONCLUSION: The assessment tool known as the Adolescent Behavioural Change Counselling Assessment Tool, is a valid and reliable instrument to measure Indonesian health professionals' behavioural-change counselling skills with adolescent patients. The tool provides an evaluation framework for future interventions that aim to improve health professionals' skills in addressing adolescent behaviour-related health problems.

Development of an internet-based intervention to improve health professionals' counseling skills around adolescent weight management in Indonesia.

BACKGROUND: Obesity is a growing public health and clinical concern, worldwide. In many countries, including Indonesia, health professionals lack the capacity to promote behavior change around obesity prevention and management, especially with adolescents for whom a wider set of communication skills are required. This study describes the theoretical basis, approach to development of content, use and satisfaction of an internet-based educational intervention designed to improve the quality of health professional weight management counseling with adolescents in Indonesia. METHODS: This study is part of an exploratory sequential mixed methods design which was undertaken from 2020 to 2022. Following a needs analysis, an internet-based training resource was developed, informed by constructive alignment theory and active learning principles. Using both synchronous and asynchronous approaches over a four-week pilot study, a weekly interactive session was held online, using multifaceted training materials housed on a website (https://ramahremaja.id). The training resource was then tested in a two-arm study involving health professionals from 17 of 34 provinces across Indonesia. RESULTS: Sixty-four primary health professionals were recruited for the two-arm study. The completion rate for reviewing all materials and assignments on the website was 72% and the online meeting participation rate was 78%. Participants were highly positive about the clarity of the training material and the appropriateness of the delivery methods. The main challenges related to poor internet literacy and interrupted internet connectivity. CONCLUSION: Designed to support weight management in adolescents, this internet-based training program shows potential for enhancing Indonesian health professional behavior-change counseling skills.

A Qualitative Exploration of Parenting Adolescents in Indonesia.

OBJECTIVE: To explore how parents of Indonesian adolescents conceptualize adolescence and to identify the challenges faced in parenting adolescents, focusing on parents from different sociodemographic backgrounds. METHOD: Focus group discussions (FGD) were undertaken with parents of adolescents aged 10-18 years old from different sociodemographic backgrounds (urban high socioeconomic; urban low socioeconomic; rural low socioeconomic) using a semi-structured interview guide. Content and thematic analysis were assisted by Nvivo version 12.6.0. RESULTS: Forty-three parents participated in four FGD. All parents recognized that adolescence was a distinct developmental stage, reflected in changing behaviors, escalation of peer influences and sexual development. Parents from poor, rural backgrounds had relatively limited understanding of the emerging capabilities of adolescents and had a narrow repertoire of responses to challenging behaviors, with heavy reliance on religious rules and punishment. Parents from higher socioeconomic backgrounds displayed a wider range of warmer, more engaging approaches that they reported using to shape their children's behaviors. CONCLUSION FOR PRACTICE: These findings highlight opportunities to enhance parenting skills, which appear most warranted in parents of adolescents from disadvantaged backgrounds. Embedding basic adolescent parenting information within community programs appears indicated, and enhancing religious leaders' understanding of different approaches to parenting could be helpful in more religious communities.

"What is already known on this subject? Parenting practices play an important role in adolescent health, development, and well-being. Parenting practices are influenced by socio-economic, demographic and cultural determinants. The evidence for how Indonesian parents conceptualize adolescence and how parenting practices might differ across diverse sociodemographic contexts is scarce."What this study adds? While parents from different sociodemographic groups had a common conceptual understanding of some aspects of adolescence, there were substantial differences in their approaches to parenting. There are opportunities to enhance parenting skills, especially in more disadvantaged regions.

The barriers of home environments for obesity prevention in Indonesian adolescents.

BACKGROUND: Obesity and its related cardiovascular-metabolic diseases are growing public health concerns. Despite global attention to obesity, its prevalence is steeply increasing in developing countries, especially in children and adolescents. Eating behaviours and physical activity are modifiable risk factors for obesity that can variably be shaped by families. Eating behaviours and physical activity are especially important during adolescence, given its significance as a foundational period for developing healthy lifestyles. This qualitative study aimed to explore barriers and opportunities around creating healthy lifestyles among adolescents in Indonesia, focussing on family environments from diverse socio-demographic backgrounds. METHOD: In-depth interviews using a semi-structured guide were undertaken with consecutively recruited 10-18-year-old adolescents with overweight or obesity, and their parents, from three different sites: urban (Jakarta, the capital city of Indonesia), peri-urban (West Java Province) and rural (Banten Province). Thematic analysis was used to identify patterns of meaning. RESULTS: Nineteen dyads were interviewed. Thematic analysis revealed four themes: limited knowledge of healthy lifestyles; healthy lifestyles not a concern of daily life; limited parenting skills, including inequity around gender roles; and aspects of availability and accessibility. These interconnected barriers influenced lifestyle practices at home within the context of daily preferences and decisions around food and activities. Gender role inequity and healthy food accessibility were more prominent in rural families than in those from urban or peri-urban settings. CONCLUSIONS: Healthy lifestyles in adolescence may be supported by strategies to enhance parenting skills, build individual motivation, and support the development of more enabling environments.

Adolescents' mental health status and influential factors amid the Coronavirus Disease pandemic.

Background The preventive measure of Coronavirus Disease pandemic, such as nationwide lockdown, might lead to stress, depression, and anxiety, prominently in adolescents. Many factors were indicated to influence its severity. This study aimed to investigate the magnitude of COVID-19-related mental health problems in adolescents and the associated factors. Methods This cross-sectional study gathered 2018 adolescents throughout Indonesia from April 22nd-28th 2020. The questionnaire was spread through social media and included Kessler-10 Psychological Distress scale and closed-ended questions about the risk and protective factors. The results were analyzed using Mann-Whitney U test, Kruskal-Wallis test, and Logistic Regression. Results The participants were mostly males (91.8%) with a median age of 19. The results showed 54.1% experienced varying degrees of distress. All variables were significantly related with psychological distress during Mann-Whitney-U and Kruskal-Wallis test. The logistic regression analysis showed maintaining or improving dietary pattern and sleep quality was found to be protective against psychological distress (OR = 0.497,95%CI = 0.34-0.725 and OR = 0.515,95%CI = 0.372-0.714, respectively), while others were risk factors, i.e.: Not having a confidant (OR = 1.539,95%CI = 1.226-1.931), frequent argument with parents (OR = 1.735,95%CI = 1.343-2.24), feeling worried (OR = 2.364, 95%CI1.528-3.656), chronic diseases (OR = 2.601,95%CI = 1.468-4.606), and mental illnesses (OR = 9.866,95%CI = 3.855-25.249). Conclusion More than half of adolescents experienced distress. The findings called for initiatives by experts in providing psychosocial support for adolescents.

Understanding of Young People About COVID-19 During Early Outbreak in Indonesia.

To control the spread of COVID-19 transmission, Indonesia government has broadcasted information about the pandemic. The aim of this study is to evaluate the understanding of young people, about COVID-19 during the early outbreak in Indonesia. An online-based cross-sectional data collection was conducted from adolescents aged 10 to 25 years, based on 10 questions regarding general COVID-19 information. There were 355 subjects from 25 out of 34 Indonesian provinces who participated in the study, with mean age of 19.93 ± 2.91 years. Better understanding was found in the female and higher-income population. Largely, the subjects got the information from social media, instead of the official government site for COVID-19. Lack of understanding about crucial preventive measures was found, such as handwashing and physical distancing. In conclusion, the participants have an overall moderate-good initial understanding toward COVID-19 during the early outbreak in Indonesia. These results can be used as baseline data for development of awareness measurement tools.

Barriers to exclusive breast-feeding in Indonesian hospitals: a qualitative study of early infant feeding practices.

OBJECTIVE: Although initiating breast-feeding is common in Indonesia, rates of exclusive breast-feeding are low. Our objective was to identify early barriers to exclusive breast-feeding in Indonesian hospitals. DESIGN: Qualitative. Semi-structured interviews were conducted in April-June 2015. The data were analysed using thematic analysis. SETTING: Indonesian provinces of Jakarta, Banten and West Java. SUBJECTS: Fifty-four participants including public health officials, hospital administrators, health-care professionals and parents. RESULTS: Five themes were identified as contributing to low rates of early exclusive breast-feeding in Indonesian hospitals: (i) quality and quantity of breast-feeding education; (ii) marketing and influence of infant formula manufacturers; (iii) hospital infrastructure; (iv) policy, legislation and protocols; and (v) perceived need for infant formula supplementation. Participants noted that providers and mothers receive inadequate or incorrect education regarding breast-feeding; manufacturers promote infant formula use both inside and outside hospitals; constraints in physical space and hospital design interfere with early breast-feeding; legislation and protocols designed to promote breast-feeding are inconsistently enforced and implemented; and providers and mothers often believe infant formula is necessary to promote infant health. All participants identified numerous barriers to early exclusive breast-feeding that related to more than one identified theme. CONCLUSIONS: Our study identified important barriers to early exclusive breast-feeding in Indonesian hospitals, finding that participants consistently reported multifaceted barriers to early exclusive breast-feeding. Future research should examine whether system-level interventions such the Baby-Friendly Hospital Initiative might improve rates of exclusive breast-feeding by improving breast-feeding education, reducing manufacturer influence, modifying existing infrastructure and providing tools needed for protocols and counselling.