Maternal Health Care Utilization Behavior, Local Wisdom, and Associated Factors Among Women in Urban and Rural Areas, Indonesia.

Purpose: Maternal mortality is one problem that still affects countries like Indonesia and others globally. The World Health Organization (WHO) notes that Southeast Asian countries have a high MMR. Indonesia's maternal mortality ranks third highest in Southeast Asia, with a 177 maternal mortality rate per 100,000 live births in 2017. In 2018, the maternal mortality rate reached 91.45 per 100,000 live births. Pregnant women's deaths can be caused inadequate medical care due to how frequently they seek treatment. This study intends to identify and analyze how knowledge, education, and myths affect pregnant women's attitudes toward seeking health services. Materials and Methods: The study involved 175 pregnant and postpartum women who visited 10 health public centers in two cities in East Java by accidental sampling. Data regarding intrapersonal, interpersonal, and local wisdom were collected through surveys with structured instruments and in-depth interviews. Data statistics used pathway analysis with a p-value of >0.05. Results: Intrapersonal, interpersonal, and local wisdom variables have a significant direct or indirect effect on utilizing health services. Knowledge was the variable with the greatest influence (t-value, 27.96). Conclusion: Myth and culture as local wisdom and intrapersonal factors significantly affect the pattern of utilizing health services.

Development of a Hospital-Stakeholder Collaboration Tool Using Mixed Methods to Assess Stakeholder Perspectives for Hospital Service Improvement.

Background: The purpose of this study was to develop the Hospital-Stakeholder Collaboration (HSC) Tool and Hospital Performance Factor (HPF) Tool to explore stakeholder perception and value for hospital service improvement. Methods: This exploratory mixed-method study involved three steps: initial tool development (Step 1), validity testing (Step 2), and module development (Step 3). In Step 1, qualitative data collection through literature reviews, focus group discussions, and interviews with hospital management experts led to the creation of the preliminary tools. Step 2 involved qualitative analysis by α 5-member expert panel, followed by quantitative analysis with 36 respondents for validity (Pearson correlation, α = 0.05) and reliability (Cronbach's Alpha, α = 0.6) tests. Step 3 encompassed the final module development. Results: The HSC tool contains 6 domains and the HPF tool contains 4 perspectives. The 6 HSC domains were: 1) stakeholder identification, 2) interactive dialogue, 3) commitment, 4) planning, 5) implementation, 6) change in action and behavior. The 4 HPF perspectives were: 1) stakeholder perspective, 2) financial perspective, 3) internal business process, and 4) staff and organizational capacity. The values of the HSC tool validity and reliability tests were around 0,0046 and around 0,995, respectively. Additionally, the values of the HPF tool validity and reliability tests were around 0,0062 and around 0,995, respectively. Conclusion: This study offers a practical tool for needs assessment for the improvement of service by analyzing direct feedback from hospital stakeholders and measuring hospital performance factors.

Internal factors affecting the mother's psychological capital in exclusive breastfeeding during the COVID-19 pandemic.

Background: During the pandemic, in terms of breastfeeding, most mothers experience anxiety and discomfort. The impact of this condition will decrease the production of breast milk. The purpose of this study was to determine the internal factors that affect the psychological capital of mothers when breastfeeding during the COVID-19 pandemic in Petiken Village, Gresik. Design and methods: This study was an analytical study with a cross-sectional approach. The population of this study was all breastfeeding mothers who had babies aged 6-12 months. The sampling technique used was simple random sampling involving 102 respondents. The independent variables were motivation, perception, and attitude. The dependent variable was psychological capital. Data were collected from June to July 2021. The data analysis was conducted using the logistic regression test to determine the variable with a significance level of p < 0.05. Results: The results of the multivariate analysis showed that the motivation variable was p = 0.036. Motivation had effect on psychological capital. While the perception variable was p = 0.056 (p > 0.05), the perception had no effect on psychological capital. The attitude variable p = 0.055 (p > 0.05), the attitude had no effect on psychological capital. The factor that affects the mother's psychological capital in relation to exclusive breastfeeding during the COVID-19 pandemic was motivation. Conclusion: It is expected that mothers have a high motivation which can affect the mother's psychological capital. It is needed to increase and succeed at providing exclusive breastfeeding.

The maternal referral mobile application system for minimizing the risk of childbirth.

Background: The maternal mortality rate in Surabaya is still quite high due to ineffectice referral health systems. Primary Health Care (PHC) has difficulty referring patients to hospitals which have available resources. The purpose of this study is to develop a mobile app system framework for the maternal referral system. Design and Methods: This study was developed based on the results of the Focus Group Discussion (FGD) with midwives, doctors and primary health care heads about the referral system regulation in Surabaya City. Results: A mobile app system can be used to communicate patients' conditions to the hospital. The hospital then will refer back to the PHC as a home care service after the birth. This mobile app has gone through a trial and a development process; it is currently in the process of structuring the mobile app based on the bugs that occur in the system. Conclusions: This mobile app still needs development, especially in minimizing system bugs, and providing faster, more accurate communication.

Exclusive breastfeeding village program increased the role of health cadres.

Background: Exclusive Breastfeeding Village Program was launched by Government in 2016 to increase public awareness on the need to feed babies exclusively with breast milk. The purpose of this study was to determine the effect of the exclusive breastfeeding village program in increasing the role of health cadres to promote breastfeeding practices. Design and Methods: The design of this study was pre experimental with one group pre-post design with 102 cadres chosen by simple random sampling techniques. A Wilcoxon signed rank test with a significance level α=0.05 was used to measure the effectiveness of the program. Results: The results showed that the value of P<0.05, it means that exclusive breastfeeding village program increased the role of health cadres and this is expected to be reflected in the improvement of the health of mothers and babies. The program has a strategic role to increase the knowledge and skills of support groups, make mothers understand the benefits of proper breastfeeding, and encourage eating good foods in order to maintain adequate nutrition. Conclusions: The breastfeeding village program has the ability to improve the knowledge and skills of health cadres.

Determinants of family independence in caring for hebephrenic schizophrenia patients.

Background: Schizophrenic patients are very susceptible to recurrent incidences, therefore the family plays a key role in providing care as a part of the recovery team. This study aimed to determine the relationship between knowledge, perceptions, attitudes and support with family independence in caring for hebephrenic schizophrenic patients. Design and Methods: It was used a correlational analytic design with cross sectional approach, and consecutive sampling technique was used, which attained 57 respondents. The independent variables were knowledge, perceptions, attitudes, and support, while independence was the dependent variable, and both were measured using questionnaires, and Spearman rank test was used for data analysis. Results: The results indicate the presence of a relationship between knowledge, perceptions, attitudes, as well as support and family independence in caring for hebephrenic schizophrenia. In addition, the spearman rank test showed P-values of 0.008, 0.011, 0.032, and 0.027 in family knowledge, perception, attitudes and support, respectively, at <0.05. Conclusions: This study indicates the importance of family support in attempts to improve the self-esteem of schizophrenic patients. Based on this data, the hospital is expected to improve the family-based patient recovery program.

The impact of social capital, demographic factors, and coping strategies on community adaptation in supporting people with severe mental illness.

Background: People with severe mental illness have the ability to live a satisfactory and independent life with the help of the community. Their adaptation to life's challenges is a dynamic process, and the community plays an important role. This research, therefore, aims to address the question of how social capital, demographic factors, and coping strategies affect the community's ability to adapt to people with severe mental illness. Design and methods: The multi-stage random sampling was used to obtain data from 137 respondents from rural society using an analytic observational design and cross-sectional approach. In addition, the Somers' D test was used to measure the effect of social capital, demographic factors, and coping strategies on community adaptation. Results: The results showed a significant effect of social capital, demographic factors, and the coping strategy of community adaptation (P<0.05). Based on empirical research, access to social capital is critical in fostering community adaptation through its social participation, network, trust, coping strategies, and cooperation. Conclusions: In conclusion, social capital, demographic factors, and coping strategies are significant factors in developing community adaptation of people with severe mental illness.

People equity model as an effort to increase employees' intention to stay.

Background: The high turnover rate in the healthcare industry needs serious attention since it influences hospital service quality. So, there is a need to develop a new framework known as people equity, that can be used to manage intangible assets and reduce employees' intention to leave. The purpose of this study therefore was to develop a model of people equity as a strategy for enhancing employees' intention to stay. Design and methods: An analytical cross-sectional design was used to measure the associations between variables. 154 respondents were selected from stratified random sampling technique. Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to analyze the measurement model. Results: The results indicated that people equity was influenced by organizational factors (P=0.210), individual factors (P=0.183), and occupational factors (P=0.141). In addition to this, predictors for employees' intention to stay were people equity (P=0.432), individual factors (P=0.308), and environmental factors (P=0.117). Conversely, working and marital status, environment, and workload have no significant effect on people equity and intention to stay. Conclusions: People equity was influenced by organizational, individual, and occupational factors through the implementation of the Human Resources System. People equity model increased employees' intention to stay by improving organizational factors.

Integrated Information System for Early Detection of Maternal Risk Factors Based on Continuum of Care Approach of Mother and Toddler Cohorts.

OBJECTIVES: The aim of this study is to demonstrate how an integrated information system of mother and toddler cohorts can be developed as a basis of the continuum of care approach that subsequently can be used as the basis of early detection of risk factors of maternal mortality. METHODS: This research was carried out qualitatively. The data was collected through three techniques: in-depth interviews, focus group discussion, and document studies at six public health centers located in four sub-districts of Surabaya, Indonesia. This research was conducted from 2016 to 2018. RESULTS: The data collected from this research has become a basis input data requirement analysis for an integrated mother and toddler cohort information system. The system accommodates all the variables in each period of pre-marriage, pregnancy, labor, infancy and toddlerhood. The system facilitates healthcare workers to retrieve data and information related to mother and toddler health status. CONCLUSIONS: The availability of various pieces of information enables the health status of mothers and toddlers to be monitored thoroughly throughout their long-life cycle. This continuum of care approach is beneficial in the early detection and management of risk factors of maternal mortality, such as pregnancy complications as well as childbirth and postpartum complications.