Pretesting of Infographic as a Communication Tool on Pregnant Women During Covid-19 Period.

Purpose: This study was to analyze the responses of informants about Instagram infographics on Covid-19 prevention for pregnant women. Methods: This was a qualitative study that used Rapid Assessment Procedure (RAP) and used pretesting communication theory. The informant selection technique was purposive sampling that consist of three pregnant women as main informants, a midwifery lecturer and a visual graphic designer as key informants. One-to-one pretesting communication procedure was selected because the research was conducted at the beginning of the Covid-19 pandemic, so it had a difficulty in recruiting informants. The interview guideline was conducted by the research team and was examined in a field trial. Data collection was by semi-structured interview using voice call WhatsApp application. Data were analysed using thematic analysis. Results: In attraction aspect, this was considered quite interesting by the informants. In comprehension aspect, the messages were easily understood because of using brief, concise, and simple sentences. Furthermore, the messages were supported by images and comprehensive. In acceptance aspect, all the informants' opinions were identified that the messages of this infographic did not have a conflict with the existing norms. In self-involvement aspect, this infographic was in accordance with the current condition of the informants. In persuasion aspect, it had a good persuasive value as the informants were willing to share the infographic with others. Conclusion: The infographic still needed improvements from the attraction aspect such as consider using contrasting colour between the background and text, equalize the font size and change icons to become related to the text. As from the comprehension aspect consider using terms that are more popular in the community. There were no need improvements from acceptance, self-involvement, and persuasion aspects. However, evidence-based research is still needed on how this infographic is developed and implemented to optimize transfer of knowledge.

Health education to improve low-birthweight infant care practices in Central Jakarta, Indonesia.

This study aimed to assess the impact of health education on the caring practices of low-birthweight (LBW) infant mothers in Central Jakarta, Indonesia. A quasi-experiment design with a pretest-post-test control group model was conducted on 159 mothers (78 in the intervention group and 81 in the control group) of LBW infants treated in the perinatology ward of three hospitals in Central Jakarta. Provision of health education to mothers of LBW infants consisted of counselling sessions and one-on-one visits provided by primary health centre nurses. Data were collected four times consecutively over 6 weeks. A generalized estimating equation model with a linear link function was employed to examine LBW infant practice score changes due to intervention and other influential factors at four time points. Results: The LBW infant care practice scores were higher in the intervention group than in the control group at each measurement point. After controlling for maternal attitudes, LBW infant health education increased mothers' infant care practices at 2, 6 and 12 weeks by 2.179, 2.803 and 2.981 points, respectively, and reduced infant morbidity. Six weeks of health education had an effective impact on mothers' home LBW infant care practices and infant health status.

Pretesting a Poster on Recommended Stress Management During the COVID-19 Pandemic in Indonesia: Qualitative Study.

BACKGROUND: The COVID-19 Peritraumatic Distress Index (CPDI) is a self-report questionnaire developed to evaluate the frequency of anxiety and depression symptoms among individuals during the COVID-19 pandemic. A recent study in China showed high CPDI scores among individuals in the 18-30 years age group and those over 60 years. During the COVID-19 outbreak, people were expected to maintain their mental health conditions, especially stress levels. Therefore, many national governments actively published health promotion media in an effort to educate the public. One such media developed by the Ministry of Health, Republic of Indonesia, was a poster titled "Hindari Stres dan Tetap Optimis dengan Melakukan Aktivitas Sehari-hari dan Tetap Menjaga Jarak." OBJECTIVE: The aim of this study is to conduct a test on a stress management recommendation poster developed by the Ministry of Health, Republic of Indonesia, in response to the COVID-19 outbreak by using pretesting communication theory. METHODS: In-depth interviews were conducted among 8 key informants and 1 graphic design expert. RESULTS: Pretesting can identify the strengths and weaknesses of media. The large amount of text and the lack of illustrations made the poster less attractive to readers. Moreover, there was a discrepancy between the title and contents of the poster. The poster was not able to persuade the informants to change their behavior in the near future. CONCLUSIONS: The poster was understood and accepted by the informants, but there was still much to be improved considering the poster was a product of the Ministry of Health, Republic of Indonesia.

Kangaroo mother care knowledge, attitude, and practice among nursing staff in a hospital in Jakarta, Indonesia.

BACKGROUND: Kangaroo mother care (KMC) has been proven to decrease rates of morbidity and mortality among premature and low-birth-weight infants. Thus, this study aimed to obtain baseline data regarding KMC knowledge, attitudes, and practices (KAP) among nursing staff caring for mothers and newborns in a hospital in Indonesia. METHODS: This cross-sectional study included 65 participants from three hospital wards at Koja District Hospital, North Jakarta. Participants included 29 perinatal ward nurses, 21 postnatal ward nurses and midwives, and 15 labor ward midwives. Data on KAP of KMC were collected using a self-administered questionnaire with closed-ended questions. Each questionnaire can be completed in approximately 1 hour. RESULTS: Among the included nursing staff, 12.3% (8/65) were determined to have received specific training on KMC, whereas 21.5% (14/65) had received more general training that included KMC content. About 46.2% of the nursing staff had good knowledge concerning KMC, 98.5% had good knowledge of KMC benefits, and 100% had a positive attitude toward KMC. All perinatal ward nurses had some experience assisting and implementing KMC. Some KAP that were observed among the nursing staff included lack of knowledge about the eligible infant weight for KMC and weight gain of infants receiving KMC, lack of education/training about KMC, and concerns regarding necessary equipment in KMC wards. CONCLUSIONS: This study identified several issues that need to be addressed, including knowledge of feeding and weight gain, workload, incubator use, and the need for well-equipped KMC wards. We recommend that hospitals improve their nursing staff's knowledge of KMC and establish well-equipped KMC wards.

Feasibility of Kangaroo Mother Care (KMC) Implementation in Depok City, Indonesia.

Background: The infant and neonatal mortality rate in Depok City is still high, with low birth weight (LBW) and premature births being one of the main causes. In 2018, 14 out of 41 cases of early neonatal death were due to LBW. Studies show that Kangaroo Mother Care (KMC) can prevent or reduce LBW deaths caused by hypothermia, but the implementation is still not evenly distributed. Objective: Describe KMC feasibility as a supporting material for a KMC policy umbrella at Depok City. Method: Qualitative research was conducted with a Rapid Assessment Procedure (RAP) design. A total of 56 informants were divided into 8 discussion groups, 7 in-depth interviews and 2 Focus Group Discussions (FGD). The types of informants were families and inter-sectoral officers. Thematic analysis was used to analyze the data. Results: KMC implementation feasibility in Depok City in terms of facilities and infrastructure was still limited and the quality was insufficient. The number of human resources was still limited, and the competency was still not evenly distributed. LBW family readiness can be maintained if provided with complete and accurate knowledge; therefore, a strong commitment may develop to continue KMC at home. The potential sources of KMC financing are found at health facilities and inter-sectoral; however, to use it, a legal umbrella at the city district level is necessary. Conclusions: The factors of potential financing sources need to be followed up into a priority. This is to overcome the constraints of KMC feasibility implementation.

How to improve the effectiveness and efficiency of Kangaroo Mother Care: a literature review of equipment supporting continuous Kangaroo Mother Care.

OBJECTIVE: The objective of this study was to provide an overview of the equipment supporting Kangaroo Mother Care (KMC). METHOD: The review adopted a five-stage methodological framework that included research question identification, relevant study identification and selection, and data charting, collating, summarizing, and reporting. We conducted reviews to analyze the current research on the design of KMC-supporting devices. Publications were identified from January 2008 to July 2020. RESULTS: Using the inclusion criteria, 17 relevant studies were identified that concerned the design of supporting equipment for KMC. Five types of equipment improved the comfort of the mothers performing KMC, another five monitored the health and development of the infants, and four served as therapy for the infants. Three equipment types showed no significant effect in supporting KMC. CONCLUSIONS: This study provides information on equipment that effectively and efficiently improves the quality of KMC.

Pretesting a poster that communicates principles of COVID-19 prevention at educational institutions in Depok City, Indonesia.

The Ministry of Health of the Republic of Indonesia has developed a COVID-19 prevention poster for use in educational institutions. The poster was pretested to determine the reactions of individuals at educational institutions in Depok City in relation to various aspects of communication, such as attraction, comprehension, acceptability, self-involvement and persuasion. The research was descriptive and qualitative, and informants were selected by purposive sampling. The six research informants were teachers and students from a junior high school and a senior high school. Data were collected by using in-depth virtual interviews, and data were analysed using thematic analysis. According to our findings, both teachers and students found the information, images and words of the poster interesting, while the language and terms used were easily understood. In addition, the information was useful and appropriate to the situation and needs. However, titles should be more attractive and specific. In conclusion, according to the input from teachers and students, the COVID-19 prevention poster for educational institutions needs minor revisions. An additional recommendation was that the Indonesian Ministry of Health logo should be added to confirm the source and credibility of the poster.

Kangaroo mother care practices for low birthweight newborns in a district hospital in Indonesia.

PURPOSE: Kangaroo mother care (KMC) was introduced in Indonesia 30 years ago, but the extent of its use has not been fully documented. Therefore, this study aimed to examine the use of KMC and evaluate the characteristics of infants who received KMC at Koja District Hospital in North Jakarta, Indonesia. This retrospective cohort study recorded the characteristics of infants with birthweights less than or equal to 2,200 g at the above-mentioned hospital. METHODS: Data collected from infant registers included gestational age, birthweight, Apgar score, number of complications, history of neonatal intensive care unit treatment, and KMC status. Cox regression analysis was conducted. RESULTS: This study found that 57.7% of infants received KMC. Infants with birthweights over 1,500 g were 2.16 times (95% CI: 1.20-3.89) more likely to receive KMC. CONCLUSION: Efforts to promote KMC are recommended, specifically for infants with birthweights greater than 1,500 g. KMC for infants with other conditions can also be considered based on the infants' stability.

How to improve the effectiveness and efficiency of Kangaroo Mother Care: a literature review of equipment supporting continuous Kangaroo Mother Care

Objective: The objective of this study was to provide an overview of the equipment supporting Kangaroo Mother Care (KMC). Method: The review adopted a five-stage methodological framework that included research question identification, relevant study identification and selection, and data charting, collating, summarizing, and reporting. We conducted reviews to analyze the current research on the design of KMC-supporting devices. Publications were identified from January 2008 to July 2020. Results: Using the inclusion criteria, 17 relevant studies were identified that concerned the design of supporting equipment for KMC. Five types of equipment improved the comfort of the mothers performing KMC, another five monitored the health and development of the infants, and four served as therapy for the infants. Three equipment types showed no significant effect in supporting KMC. Conclusions: This study provides information on equipment that effectively and efficiently improves the quality of KMC. (AU)

Knowledge and perceptions of kangaroo mother care among health providers: a qualitative study.

BACKGROUND: Indonesia is one of the countries with the highest preterm birth rate. Preterm infants are more likely than term and normal weight infants to experience neonatal mortality and morbidity due to acute respiratory, gastrointestinal, immunologic, central nervous system, hearing, and vision problems. Kangaroo mother care (KMC) is a proven cost-effective intervention to help reduce mortality rates among preterm infants; however, it has not been fully implemented in hospitals. PURPOSE: Assess KMC knowledge and perceptions among health providers. METHODS: This qualitative study was conducted from December 2015 to April 2016 and consisted of 21 in-depth interviews and 3 focus group discussions (FGDs). The 3 categories of health personnel in the study were clinical providers, hospital management representatives, and Indonesian Midwife Association members. RESULTS: Most health providers know about the benefits of KMC including stabilizing temperatures, weight gain, and maternal-infant bonding and reducing human resources and labor costs. They were also aware of which newborns were eligible for KMC treatment. Their knowledge was mostly gained from observation or obtained from pediatricians and personal experience. They believed that a low birth weight infant in an incubator could not be treated with KMC and that it could only be practiced if a special gown was used when holding the baby. This perception could be caused by a lack of formal KMC training, leading to misunderstanding of its aspects. CONCLUSION: In conclusion, KMC knowledge of clinical providers in the 2 hospitals was sufficient, primarily due to their health-related educational background. Some perceptions could be potential barriers to or facilitate the implementation of KMC practice. These perceptions should be considered in future KMC training designs.

Improving the utilization of health services among high-risk pregnant women through community health nurse assistance

Objective: The objective of this study was to identify the impact of implementing community health nurse assistance for high-risk pregnant women on utilization of health services. Method: The study was quasi experimental with a control group design. The sample included high-risk pregnant women in 10 community health centers in Indonesia who were selected by consecutive sampling. The total sample included 66 women in both the intervention and the control groups. The high-risk pregnant women in the intervention group received nurses' assistance during the third trimester and until giving birth. Before and after the intervention, the knowledge, attitudes, and behavior of the women were measured. Results: The average scores for the knowledge, attitudes, and behavior of women in the intervention group increased. Differences were found in health care utilization between the two groups. All women in the intervention group received antenatal care during the third trimester more than once and were assisted by skilled health personnel during childbirth, while in the control group 10.6% of respondents were assisted by a paraji shaman (traditional birth attendant). All women in the intervention group accepted family planning, and the contraceptive choice varied. Conclusions: The assistance of community health nurses improves the knowledge, attitudes, and behavior of high-risk pregnant women and positively impacts the rate of health care utilization

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The three waves in implementation of facility-based kangaroo mother care: a multi-country case study from Asia.

BACKGROUND: Kangaroo mother care has been highlighted as an effective intervention package to address high neonatal mortality pertaining to preterm births and low birth weight. However, KMC uptake and service coverage have not progressed well in many countries. The aim of this case study was to understand the institutionalisation processes of facility-based KMC services in three Asian countries (India, Indonesia and the Philippines) and the reasons for the slow uptake of KMC in these countries. METHODS: Three main data sources were available: background documents providing insight in the state of implementation of KMC in the three countries; visits to a selection of health facilities to gauge their progress with KMC implementation; and data from interviews and meetings with key stakeholders. RESULTS: The establishment of KMC services at individual facilities began many years before official prioritisation for scale-up. Three major themes were identified: pioneers of facility-based KMC; patterns of KMC knowledge and skills dissemination; and uptake and expansion of KMC services in relation to global trends and national policies. Pioneers of facility-based KMC were introduced to the concept in the 1990s and established the practice in a few individual tertiary or teaching hospitals, without further spread. A training method beneficial to the initial establishment of KMC services in a country was to send institutional health-professional teams to learn abroad, notably in Colombia. Further in-country cascading took place afterwards and still later on KMC was integrated into newborn and obstetric care programs. The patchy uptake and expansion of KMC services took place in three phases aligned with global trends of the time: the pioneer phase with individual champions while the global focus was on child survival (1998-2006); the newborn-care phase (2007-2012); and lastly the current phase where small babies are also included in action plans. CONCLUSIONS: This paper illustrates the complexities of implementing a new healthcare intervention. Although preterm care is currently in the limelight, clear and concerted country-led KMC scale-up strategies with associated operational plans and budgets are essential for successful scale-up.

Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate.

OBJECTIVE: To assess whether early self-diagnosis and treatment of bacterial vaginosis (BV) could lower the preterm birth rate among a group of Indonesian women. METHODS: A randomized controlled trial of 331 pregnant women (14-18 weeks) was conducted. Participants were randomly assigned to either the active model group (n=176) or the control group (n=155). Women in the active model group were equipped with a kit to self-evaluate vaginal pH; those with a positive test result were treated with a twice daily dose of 500 mg of metronidazole for 7 days. The primary end point was preterm birth rate. RESULTS: There were 6 (3.8%) and 8 (5.4%) preterm births in the active model and control groups, respectively (P=0.468). No spontaneous abortions were recorded in either group. When compared with the gold standard (Gram staining), the vaginal acidity test had low ability to detect BV, with 88.7% specificity and 36.9% sensitivity. The positive predictive value of the test was 35.0% PPV, while the negative predictive value was 89.4%. CONCLUSION: Early self-diagnosis and treatment of BV did not reduce the preterm birth rate of the study group. ClinicalTrial.govnumber:NCT01232192.

Progress in the implementation of kangaroo mother care in 10 hospitals in Indonesia.

Kangaroo mother care (KMC) is an effective and safe method of caring for low-birthweight infants. This article describes the results of a health systems strengthening intervention in KMC involving 10 hospitals in Java, Indonesia. Implementation progress was measured with an instrument scoring hospitals out of 100. Hospital scores ranged from 28 to 85, with a mean score of 62.1. One hospital had not reached the level of 'evidence of practice'; five hospitals had reached the expected level of 'evidence of practice' and two hospitals already scored on the level of 'evidence of routine and integration'. The two training hospitals were on the border of 'evidence of sustainable practice'. The implementation of KMC is a long-term process that requires dedication and support for a number of years. Some items in the progress-monitoring tool could be used to set standards for KMC that hospitals must meet for accreditation purposes.