Management of Hypertension Using a Plant-Based Diet Among Farmers: Protocol for a Mixed Methods Study.

BACKGROUND: Farmers in Indonesia have a high risk for hypertension owing to their lifestyle and working environment. Diet management is a solution to reduce hypertension, and Indonesia has natural resources in the agricultural sector that could help manage hypertension. Optimizing vegetable and fruit intake in a plant-based diet (PBD) could help maintain blood pressure among farmers in Indonesia. OBJECTIVE: This study aims to explore the health problem of hypertension and the characteristics of local food sources to formulate a PBD menu for treating hypertension, as well as assess the prevalence of hypertension, level of acceptability of a PBD, and associated sociodemographic factors. Further, we want to examine the effectiveness of a community-based nursing program for managing hypertension using a PBD. METHODS: We will use the exploratory sequential mixed methods approach. There will be a qualitative study (phase I) in 2022 and a quantitative study (phase II) in 2023. We will analyze data using a thematic framework in phase I. In phase II, the study will involve (1) questionnaire development and validation; (2) examination of the prevalence of hypertension, the level of acceptability of a PBD, and the associated factors; and (3) a randomized controlled trial. We will recruit farmers with hypertension who meet the study criteria. Moreover, in phase II, we will invite expert nurses and nutritionists to assess the face and content validity of the questionnaire. We will use multiple logistic regression models to estimate the associated sociodemographic factors and the level of acceptability of a PBD. Furthermore, a linear generalized estimating equation will be used to estimate the parameters of a generalized linear model with a possible unmeasured correlation between observations from different time points for systolic and diastolic blood pressure. RESULTS: A model PBD for hypertension management is expected to be developed. In 2022, we will collect information on hypertension and the characteristics of local food sources for managing hypertension, and will formulate a PBD menu to treat hypertension among farmers. In 2023, we will develop a questionnaire to assess the acceptability of a PBD to manage hypertension among farmers, the prevalence of hypertension, and the sociodemographic factors associated with hypertension among farmers. We will implement a community-based nursing program for managing hypertension using a PBD among farmers. CONCLUSIONS: The PBD model will not be readily available for other agricultural areas since validation of local food variation is required to design the menu. We expect contributions from the local government to implement the intervention as one of the policies in the management of hypertension for farmers in the agricultural plantation areas of Jember. This program may also be implemented in other agricultural countries with similar problems, so that hypertension can be optimally treated among farmers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/41146.

Family structure and function in relation to adolescent reproductive health in developing countries: A scoping review.

AIM: The study purpose was to explore the relationships between family structure and function and adolescent reproductive health in the context of family systems in developing countries. BACKGROUND: The structures and functions of family are important elements for adolescent reproductive health. However, few studies discuss their relationships with the reproductive health of adolescents. DESIGN: This study employed a scoping review design. DATA SOURCES: The search was conducted for literature published from 2010 until 2020 using the electronic databases PubMed, CINAHL, Scopus, and Science Direct sourcing full-text papers in English. Original research papers that focused on family structures, family functions, and adolescent reproductive health were included. REVIEW METHODS: Data extraction and analysis were completed on all retrieved studies. Content analysis was used for data analysis. RESULTS: Fifteen articles were included. The nature of the relationship between the family structures and functions on adolescent reproductive health were explained in the categories of (i) family process and life cycle, (ii) family norms and values, (iii) family communication patterns and processes, (iv) family roles and connectedness, and (v) family coaching and guidance. CONCLUSION: Findings of this study suggest that the relationships between family functions and structures and adolescent reproductive health were explained in multiple constructs. Further studies are needed to examine those constructs on reproductive health in adolescent in developing countries.

Nursing competency inventory and professional competence of graduating students in six Asian countries: A cross-sectional study.

AIMS: To investigate graduating nursing students' nursing and professional competencies and the predictors of their competencies. BACKGROUND: Across Asian countries, there is a paucity of literature that explores graduating nursing students' competency and professional competence during the ongoing COVID-19 pandemic. DESIGN: Descriptive, cross-sectional, and predictive approaches. METHOD: Convenience sampling was used among graduating nursing students from the six Asian countries (n = 375). The STROBE guidelines for cross-sectional studies were used. Two self-report instruments were utilized to collect data. We conducted multiple linear regression analyses to assess the predictors of nursing competency and professional competence domains. RESULTS: Country of residence and general point average (GPA) showed statistically significant multivariate effects. Value-based nursing care and critical thinking and reasoning domains recorded the highest in professional competence and competency inventory for nursing students, respectively. Country of residence, GPA, and preferred nursing major were significant predictors of graduating nursing students' nursing competency and professional competence domains. CONCLUSION: Our study's findings revealed a high level of diversity among nursing students regarding ethical care obligations, caring pedagogies, and lifelong learning, all of which may be ascribed to their distinct culture, background, and belief systems.

Mecanismos de enfrentamento e qualidade de vida entre idosos com hipertensão: um estudo transversal / Estrategias de afrontamiento y calidad de vida en adultos mayores con hipertensión: un estudio transversal / Coping strategies and quality of life among older people with hypertension: a cross-sectional study

RESUMO Objetivo analisar as diferenças nos mecanismos de enfrentamento e na qualidade de vida entre idosos com hipertensão em casas de repouso da Indonésia. Método foi realizado um estudo transversal entre 71 idosos durante dezembro de 2018 em casas de repouso. Foi utilizado um questionário autoadministrado foi para identificar as características dos participantes e a qualidade de vida dos idosos, ao mesmo tempo em que o esfigmomanômetro foi usado para medir a pressão arterial. A análise de dados foi feita com teste qui-quadrado. Resultados houve diferenças significativas entre os mecanismos de enfrentamento e a qualidade de vida dos idosos com hipertensão (X2=4,15; p=0,041). Os idosos que usavam mecanismos de enfrentamento focando nos problemas eram mais propensos a ter uma qualidade de vida moderada (OR=2,86; 95% IC=1,02-7,97). Conclusão os mecanismos de enfrentamento de idosos com hipertensão devem ser aprimorados para que alcancem qualidade de vida por meio de cuidado e aconselhamento.

RESUMEN Objetivo analizar las diferencias entre estrategias de afrontamiento y calidad de vida en adultos mayores con hipertensión que viven en asilos de Indonesia. Método se llevó a cabo un estudio transversal con 71 individuos de edad avanzada que viven en asilos durante el mes de diciembre de 2018. Se utilizó un cuestionario autoadministrado para identificar características de los participantes y de la calidad de vida en adultos mayores; mientras que, para medir la presión arterial, se empleó un esfigmomanómetro. Se realizó una prueba de chi-cuadrado para analizar los datos. Resultados se registraron diferencias significativas entre las estrategias de afrontamiento y la calidad de vida de adultos mayores con hipertensión (X2=4,15; p=0,041). Los adultos mayores que emplearon estrategias de afrontamiento enfocándose en problemas fueron más propensos a tener una calidad de vida moderada (OR=2,86; IC 95%=1,02-7,97). Conclusión en consecuencia, deberían mejorarse las estrategias de afrontamiento de los adultos mayores con hipertensión para que logren una buena calidad de vida a través de atención y asesoramiento en salud.

ABSTRACT Objective to analyze the differences of coping strategies and quality of life among older people with hypertension in nursing homes of Indonesia. Method a cross-sectional study was conducted among 71 older people during December 2018 in nursing homes. A self-administered questionnaire was used to identify characteristic of participants and quality of life for older people, while Sphygmomanometer was used to measure blood pressure. A Chi-quare test was performed to analyse the data. Results there were significant differences between coping strategies and quality of life of older people with hypertension (χ2=4.15; p=0.041). Older people who used coping strategies by focusing on problems have more likely moderate quality of life (OR=2.86; 95% CI=1.02-7.97). Conclusion therefore, coping strategies of older people with hypertension should be improved to achieve their quality of life through caring and counselling.

Mecanismos de enfrentamento e qualidade de vida entre idosos com hipertensão: um estudo transversal / Estrategias de afrontamiento y calidad de vida en adultos mayores con hipertensión: un estudio transversal / Coping strategies and quality of life among older people with hypertension: a cross-sectional study

RESUMO Objetivo analisar as diferenças nos mecanismos de enfrentamento e na qualidade de vida entre idosos com hipertensão em casas de repouso da Indonésia. Método foi realizado um estudo transversal entre 71 idosos durante dezembro de 2018 em casas de repouso. Foi utilizado um questionário autoadministrado foi para identificar as características dos participantes e a qualidade de vida dos idosos, ao mesmo tempo em que o esfigmomanômetro foi usado para medir a pressão arterial. A análise de dados foi feita com teste qui-quadrado. Resultados houve diferenças significativas entre os mecanismos de enfrentamento e a qualidade de vida dos idosos com hipertensão (X2=4,15; p=0,041). Os idosos que usavam mecanismos de enfrentamento focando nos problemas eram mais propensos a ter uma qualidade de vida moderada (OR=2,86; 95% IC=1,02-7,97). Conclusão os mecanismos de enfrentamento de idosos com hipertensão devem ser aprimorados para que alcancem qualidade de vida por meio de cuidado e aconselhamento.

RESUMEN Objetivo analizar las diferencias entre estrategias de afrontamiento y calidad de vida en adultos mayores con hipertensión que viven en asilos de Indonesia. Método se llevó a cabo un estudio transversal con 71 individuos de edad avanzada que viven en asilos durante el mes de diciembre de 2018. Se utilizó un cuestionario autoadministrado para identificar características de los participantes y de la calidad de vida en adultos mayores; mientras que, para medir la presión arterial, se empleó un esfigmomanómetro. Se realizó una prueba de chi-cuadrado para analizar los datos. Resultados se registraron diferencias significativas entre las estrategias de afrontamiento y la calidad de vida de adultos mayores con hipertensión (X2=4,15; p=0,041). Los adultos mayores que emplearon estrategias de afrontamiento enfocándose en problemas fueron más propensos a tener una calidad de vida moderada (OR=2,86; IC 95%=1,02-7,97). Conclusión en consecuencia, deberían mejorarse las estrategias de afrontamiento de los adultos mayores con hipertensión para que logren una buena calidad de vida a través de atención y asesoramiento en salud.

ABSTRACT Objective to analyze the differences of coping strategies and quality of life among older people with hypertension in nursing homes of Indonesia. Method a cross-sectional study was conducted among 71 older people during December 2018 in nursing homes. A self-administered questionnaire was used to identify characteristic of participants and quality of life for older people, while Sphygmomanometer was used to measure blood pressure. A Chi-quare test was performed to analyse the data. Results there were significant differences between coping strategies and quality of life of older people with hypertension (χ2=4.15; p=0.041). Older people who used coping strategies by focusing on problems have more likely moderate quality of life (OR=2.86; 95% CI=1.02-7.97). Conclusion therefore, coping strategies of older people with hypertension should be improved to achieve their quality of life through caring and counselling.

Human papillomavirus vaccine acceptability among healthcare workers, parents, and adolescent pupils: a pilot study in public health centers of Bali, Indonesia.

INTRODUCTION: Knowledge and acceptability of HPV vaccination should be identified for supporting the HPV vaccine program in public health centers. Qualitative research approach is one approach that can be developed for increasing the acceptance and use of HPV vaccines in the community. Perceptions of health workers, parents, teachers, and adolescents related to HPV immunization can be explored in depth. This study was performed to explore the perception and meaning of the HPV vaccine acceptability among healthcare professionals, parents, and adolescent pupils in Bali, Indonesia. METHODS: A mixed method study was conducted among 176 elementary school children. In-depth interviews were performed with five of the parents and eight of the teachers. Then, four focus group discussions among 19 health professionals were performed for supporting data. A self-administered questionnaire was used to measure knowledge of HPV and acceptability of HPV vaccine among participants. An interview of standard guidelines was performed to identify the perception of the HPV vaccine. RESULTS: The study identified that perception about HPV knowledge and HPV vaccine was low among adolescents and teachers for all of the questions. However, knowledge on HPV and HPV vaccine among parents and healthcare professionals were higher. Meanwhile, the acceptability of the HPV vaccine and the personal experience of women were more positive for the healthcare professionals. CONCLUSIONS: Knowledge and perception regarding HPV and HPV vaccination among adolescents and teachers in Indonesia, particularly in Denpasar, Bali, are still insufficient. However, the perception of vaccine administration is acceptance for parents and healthcare professionals. Therefore, socialization of HPV vaccine programs in school and community are needed to improve health promotion about the importance of the HPV vaccine.

Caring for Adolescents Based on the Wisdom of Indonesian Pandalungan Culture: An Ethnonursing Pilot Study.

PURPOSE: This study aimed to explore the caring of families with adolescents based on the local wisdom values in Pandalungan families in the Eastern region of Java Island, Indonesia. DESIGN AND METHOD: A pilot study with ethnonursing design was performed to identify the domain of inquiry of Pandalungan local wisdom deeply related to how cultural aspects influence families caring for adolescents. The data collection involved 4 months of participants observation in the community and in-depth interviews with the key informants. Then, focus group discussion was performed until data saturation with 92 informants (consisting of key informants, adolescents, and parents). We used Leininger's four phases of analysis for qualitative data to develop a thematic structure of this study. RESULTS: Fourteen patterns generated four themes through the analysis of all data. The local wisdom of Pandalungan was integrated into spiritual value in their family. The spiritual value was used to structure their family lives. Then, local wisdom was internalized to functionalize their family function to care for adolescents. Family structuring and functionalizing based on local wisdom of Pandalungan were used to achieve family life cycle development with adolescents. CONCLUSIONS: The local wisdom values were internalized in the family spirituality, structure, function, and task development in Pandalungan families caring of their adolescents children in Indonesia. PRACTICE IMPLICATIONS: A cross-cultural approach with an emphasis on cultural sensitivity issues can be used to identify the family as a whole system regarding the local wisdom of Indonesia.

Presenteeism among Chinese workers in Japan and its relationship with mental health and health-promoting lifestyles.

This study aimed to investigate factors related to presenteeism among Chinese workers residing in Japan by assessing their mental state and health-promoting lifestyles. An anonymous, self-reported questionnaire was administered to 450 Chinese workers living in Hiroshima Prefecture, of whom, 313 completed it in its entirety. Results showed that 40.6% reported suffering from depression (Center for Epidemiologic Studies Depression Scale, CES-D). Sociodemographic characteristics such as being female, having a lower educational background, being widowed/divorced, having fewer years of residence, fluency in basic-level Japanese, being employed part-time, being an engineer, and workplace environment (having no health education in the workplace) increased the likelihood of depression. Path analysis indicated that marital status (being married) was negatively associated with presenteeism on the Work Limitations Questionnaire-Chinese version via work-related stress. There was a positive correlation between work-related stress and presenteeism through mental health (CES-D). Health-promoting lifestyles (Health-Promoting Lifestyle Profile II) showed a negative correlation with presenteeism, via work-related stress and mental health. Furthermore, health-promoting lifestyles showed a direct negative association with presenteeism. Thus, health education that emphasizes mental health was a significant factor for improving presenteeism. Furthermore, the provision of health education shortly after Chinese workers had arrived in Japan is important.

Relación entre la función cognitiva y la calidad de vida de personas mayores en una residencia de ancianos / The Relationship Between Cognitive Function and Quality of Life Among Elderly at Nursing Home

Introduction: The decreasing of cognitive function can cause the elderly depends on their daily activities and affect the quality of life among elderly. Objective: This study want to examine the cognitive function status and quality of life among elderly at Nursing Home of Jember, Indonesia. Methods: The study was conducted a cross-sectional design during October December 2018. Among 82 of elderly involved using convenience sampling. Short Portable Mental Status Questionnaire and World Health Organization Quality of Life-BREF were performed to measure congnitive function and quality of life, respectively. Data were analyzed using Chi square test. Results: Among 82 of elderly identified intact intellectual functioning status (43,90 percent) and severe cognitive impairment (2,40 percent). Meanwhile, 70,70 percent and 8,50 percent elderly were moderate and low of quality of life, respectively. Furthermore, cognitive function significantly related to quality of life (X2= 8,685; p-value= 0,003). The elderly who have intact cognitive function was prevent for decreasing quality of life (OR= 0,210; 95 percent CI= 0.071-0.621). Conclusions: Cognitive function is related to quality of life among elderly. Therefore, health promotion program, including physical activity could develop in nursing home to improve the cognitive function and quality of life among elderly(AU)

Introducción: La disminución de la función cognitiva puede causar que los ancianos dependan de sus actividades diarias y afecten su calidad de vida. Objetivo: Examinar el estado de la función cognitiva y la calidad de vida entre los ancianos del Hogar de Ancianos de Jember, Indonesia. Métodos: Estudio de diseño transversal durante octubre y diciembre de 2018. En 82 personas de la tercera edad involucradas, se usó una muestra de conveniencia. Se realizó un breve cuestionario portátil sobre el estado mental y calidad de vida-BREF de la Organización Mundial de la Salud para medir la función cognitiva y la calidad de vida. Los datos se analizaron mediante la prueba de Chi cuadrado. Resultados: De los 82 ancianos se identificó el estado de funcionamiento intelectual intacto en 43,90 por ciento y deterioro cognitivo severo en 2,4 por ciento. Mientras, el 70,7 por ciento y el 8,5 por ciento de los ancianos tenían moderada y baja calidad de vida, respectivamente. Además, la función cognitiva se relacionó significativamente con la calidad de vida (X2 = 8,685; valor p = 0,003). Las personas de edad avanzada que tenían una función cognitiva intacta evitaron la disminución de la calidad de vida (OR = 0,210; IC del 95 por ciento = 0,071-0,621). Conclusiones: La función cognitiva está relacionada con la calidad de vida entre los ancianos. Por lo tanto, el programa de promoción de la salud, incluida la actividad física, podría desarrollarse en un hogar de ancianos para mejorar la función cognitiva y la calidad de vida entre los ancianos(AU)

Characteristics of heart failure patients incurring high medical costs via matching specific health examination results and medical claim data: a cross-sectional study.

OBJECTIVE: We describe the characteristics of patients with high medical costs by matching specific annual medical examination results and medical claim data. Clarifying the relationships between examination items and high medical costs allows the screening of high-risk persons. DESIGN: A cross-sectional study. SUBJECTS: Subjects were persons insured by national health insurance in Hiroshima City, Hiroshima Prefecture, from April 2016 to March 2017. To identify true heart failure (HF) patients, the disease name listed in the medical claim data was compared with drugs prescribed for HF, with extraction of only subjects whose comparative data matched. DATA COLLECTION AND ANALYSIS: The specific health examination includes a questionnaire on areas such as lifestyle habits, anthropometry, blood pressure, blood tests and urine tests. The percentage of the total medical costs related to the medical care of subjects with HF was described using Pareto analysis. For specific health examination items, we compared the high-cost and low-cost groups. The normality and homoscedasticity of each variable was checked and Student's t-tests and χ² tests were applied. Finally, multiple logistic regression analysis was used to detect factors in the health examination items related to high medical costs. RESULTS: Pareto analysis showed that 80% of all medical costs were paid by 30% of the HF patient population. The fees for cardiovascular surgery accounted for 54% of the total surgical cost, 64% of which included preventable diseases. Levels of creatinine (Cr) and γ-glutamyl transpeptidase (γ-GTP) and a history of smoking were found to be related to high medical costs. CONCLUSION: Analysis of specific health examination results for HF patients revealed the association between high medical costs, γ-GTP, Cr, and smoking. These results can thus serve as a reference for screening persons at high risk of HF and help prevent the exacerbation of HF.

Quality of Life People Living with HIV/AIDS and Its Characteristic from a VCT Centre in Indonesia.

BACKGROUND: The quality of life (QoL) construct has also contributed to understanding the comprehension of factors involved in the existence of people infected by the HIV/AIDS. The objective of this study is to assess the quality of life (QoL) of people with HIV/AIDS (PLWHA) in Wonogiri District, Indonesia. METHODS: A cross-sectional study was conducted from September to November 2017. Convenience sampling method was employed to recruit 39 people living with HIV/AIDS (PLWHA) at Voluntary Counselling and Testing (VCT) of Wonogiri, Indonesia. Research data were collected using a self-administered questionnaire of WHOQOL-HIV BREF. The data were further analysed using a t-test and a Chi-square test, while linear regression was used to evaluate factors that correlate with the PLWHAs' quality of life. RESULTS: The results showed that the gross mean score of social relationships domain is 13.59; psychological domain is 13.31; environment domain is 13.28; spiritual/personal beliefs domainis 13.15; physical domain is 13.10; and level of independence domain is 13.77. The symptom of HIV is associated with quality of life (B = 7.611, ß = 0.362, t = 2,046, p value = 0.049). CONCLUSION: Healthcare provider should increase providerinitiated testing and counselling (PITC) to contracting group, high risk group, susceptible group, and the community. The PLWHA are recommended to actively participate in peer support groups (PSGs) so that they can improve their quality of life.

Validation of the relationship consciousness of Japanese Patients with type 2 diabetes scale.

OBJECTIVES: The management of type 2 diabetes mellitus can be improved for individuals by developing relationships with other patients with diabetes. We created the Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale to measure the relationship consciousness of type 2 diabetes mellitus patients for other patients based on the Health Belief Model. METHODS: This was a cross-sectional study of Japanese patients with type 2 diabetes mellitus (n = 289). Data were analyzed via exploratory factor analyses, reliability tests, concurrent validity. RESULTS: The final scale obtained for the Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale comprised a six-factor structure with 36 items. All 36 items had a Cronbach's α coefficient of 0.893 and explained 59.38% of the total variance. The scale was significantly correlated with a related reciprocity consciousness scale. CONCLUSIONS: The Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale may be an important tool for nurses to assess the relationship consciousness of patients with type 2 diabetes mellitus. In addition, by understanding patients' relationship consciousness for others who share their disease, nurses can begin to recommend ways to establish relationships between patients that suit patients' particular relationship. consciousness levels and to provide better care in their clinical practice.

Promoting Children Growth and Development: A community-based cluster randomized controlled trial in rural areas of Indonesia.

OBJECTIVE: This study examined the influence of the Promote Children's Growth and Development (PCGD) intervention on children's growth and development in rural areas in Indonesia. DESIGN AND SAMPLE: A community-based nonblinded cluster randomized controlled trial was conducted. Twelve clusters of villages were matched based on population and randomly assigned to intervention group (six clusters and 72 caregivers dyads) or control group (six clusters and 72 caregivers dyads) with inclusion criteria age 0-72 months and attending integrated health centers (Posyandu). The intervention was conducted for 14 weeks with caregivers. MEASURES: The weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), weight-for-height Z-score (WHZ), and body mass index-for-age Z-score (BAZ) were calculated using World Health Organization Anthro-Plus version 1.0.3. A prescreening developmental questionnaire (PSDQ) measured the development of children before and after the intervention. RESULTS: The proportion of stunting of HAZ, wasting of WHZ, and deviation development of PSDQ were higher in the control group compared to the intervention group, respectively (22.2% vs. 37.5%), (9.7% vs. 4.2%), and (12.5% vs. 2.8%). Caregivers were more confident promoting children's growth and development after attending 12 sessions of the PCGD intervention. CONCLUSION: The 12 session PCGD intervention is effective for promoting the growth and development of children of 0-72 months. The PCGD could be considered for implementation in community health centers.

Performance of Public Health Nurses and Coverage of the Nursing Care Program by Community Health Centers in Jember, Indonesia.

BACKGROUND: The coverage of the nursing care program by PHCs in the category of vulnerable families, community groups, and self-care empowerment was 48.28%, 44.87%, and 49.50%, respectively. The average coverage (low vs. high) by CHCs in the category of vulnerable families, community groups, and self-care empowerment was 50.0% versus 50.0%, 52.0% versus 48.0%, and 52.0% versus 48.0%, respectively. A significant correlation was found between the pre-defined targets and the coverage of the nursing care program by PHCs in vulnerable families (r=0.488; P<0.001), nursing care in communities' groups (r=0.316; P=0.026), and empowerment of families' self-care (r=0.531; P<0.001). METHODS: A cross-sectional study based on secondary analysis, obtained from the Health Department of Jember District (East Java, Indonesia), was conducted in 2016. The data included quality improvement initiatives and outcomes of the nursing care program, which had been collected from 50 CHCs in Jember. The performance of PHNs and the coverage of the nursing care program by CHCs were evaluated based on three categories, namely nursing care for vulnerable families, nursing care for community groups, and family self-care empowerment. The data were analyzed using the SPSS statistical software (version 22.0). RESULTS: The coverage of the nursing care program by PHCs in the category of vulnerable families, community groups, and self-care empowerment was 48.28%, 44.87%, and 49.50%, respectively. The average coverage (low vs. high) by CHCs in the category of vulnerable families, community groups, and self-care empowerment was 50.0% versus 50.0%, 52.0% versus 48.0%, and 52.0% versus 48.0%, respectively. A significant correlation was found between the pre-defined targets and the coverage of the nursing care program by PHCs in vulnerable families (r=0.488; P<0.001), nursing care in communities' groups (r=0.316; P=0.026), and empowerment of families' self-care (r=0.531; P<0.001). CONCLUSION: The results showed that 50% of the CHCs did not meet the required program coverage. The performance of PHN to achieve target of PHCs was correlated with the program coverage of PHCs. The competence of PHNs in providing care to the families and the community, particularly in rural areas, should be improved through an integrated training program.

Development and Testing of the Family Structure and Family Functions Scale for Parents Providing Adolescent Reproductive Health Based on the Friedman Family Assessment Model.

BACKGROUND AND PURPOSE: To describe the development and testing of a psychometric of Family Structure and Functions (FSF) that measures parents' ability to provide adolescent reproductive health (ARH). METHODS: A cross-sectional study of Indonesian parents (n = 525). Multifactors FSF-ARH were examined using construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]) and content validity (Content Validity Index [CVI]). Internal consistency was explored using Cronbach's α coefficient. RESULTS: EFA revealed nine factors with 26 items accounting for 61.64% of explained variance and CFA validity testing fit for the construct validity of FSF-ARH. The CVI indicated adequate content validity (0.80-0.10) and acceptable internal consistency (0.70). CONCLUSIONS: FSF-ARH contains valid, reliable, and robust measures although some subscales performed moderate reliability, establishing the purpose for further research.

Social stigma, adherence to medication and motivation for healing: A cross-sectional study of leprosy patients at Jember Public Health Center, Indonesia.

OBJECTIVES: Social stigma surrounding leprosy patients (LPs) in the community is still related to the adherence of these patients to medication and to their internal motivation for healing. Unfortunately, the leprosy case programme has not been optimally established in public health centres (PHCs). The aim of this study was to assess the social stigma towards adherence to medication and motivation for healing among LPs in PHCs in Indonesia. METHODS: A cross-sectional study was conducted from March to May 2017 at PHCs in Jember, Indonesia. Data were collected using a self-administered questionnaire, and secondary data related to medical treatment was assessed from PHCs' medical records. The data were analysed using a t-test and a Chi-square test, while linear regression was used to evaluate factors that could influence LPs' adherence to medication and their motivation for healing. RESULTS: Among the 35 LPs in this study, 25.7% and 74.3%, respectively, had paucibacillary and multibacillary types of leprosy. The type of leprosy was associated with the length of time patients were infected with the disease, their adherence to medication and their motivation for healing. The factors that influenced adherence to medication and motivation for healing were the time period that the LP remained infected and the type of leprosy. CONCLUSIONS: Infection period and type of leprosy were associated with adherence to medication and motivation for healing in the community. Efforts should be made to find active cases of leprosy at PHCs. Activities at PHCs should include self-care groups to improve LP adherence to medication and their motivation for healing in the community.

First Aid Guideline (FAG): A first aid education application for children aged 11-14 years in Indonesia.

OBJECTIVES: In Indonesia, the prevalence of injuries among children aged 5-14 years is high. Such injuries are generally caused by unsafe school-related factors and a lack of education about first aid. Thus, it is necessary to optimize the role of children by introducing first aid education using the First Aid Guideline (FAG) application. The purpose of this study was to develop a first aid education application for Indonesian children based on the Android operating system. METHODS: The application was developed in several stages. The initial stage was the selection of the content that would be included in the application. The second and third stages were the making and testing of the application, respectively. The researchers worked with information technology experts during the development of this application. The application feasibility test included experts in the fields of emergency and medical-surgical medicine as well as information technology. The experts assessed the application by completing a questionnaire on learning media. The results were then analysed by kappa tests to assess the experts' perceptions. RESULTS: The application contains emergency call menus, and information on the treatment of choking, burns, wounds, and bleeding. The application provides pictures and video tutorials, making it easier for users to learn about first aid. Statistical analysis showed a sufficient match between Experts 1 and 3 (mean 3.85 ± SD 0.369; kappa = 0.615; p = 0.035) and Experts 1 and 2 (mean 3.85 ± SD 0.369; kappa = 0.615; p = 0.035). Experts 2 and 3 showed good suitability (mean 3.80 ± SD 0.422; kappa = 0.615; p = 0.035). CONCLUSIONS: FAG is a breakthrough application for first aid education for children aged 11-14 years. This application can be used as a medium for learning about first aid. However, further research in larger populations is required.

Local-food-based complementary feeding for the nutritional status of children ages 6-36 months in rural areas of Indonesia.

PURPOSE: This study aimed to evaluate a pilot project of the Nursing Feeding Center "Posyandu Plus" (NFCPP) through local food-based complementary feeding (LFCF) program designed to improve the nutritional status of children aged 6-36 months at community health centers in Indonesia. METHODS: A quasi-experimental design was used to obtain data regarding the nutritional status of 109 children who participated in the project from 6 rural areas. The NFCPP was conducted for 9 weeks, comprising 2 weeks of preintervention, 6 weeks of intervention, and one week of postintervention. The LFCF intervention consisted of 12 sets of recipes to be made by mothers and given to their children 4 times daily over 6 weeks. The weight-for-age z score (WAZ), height-for-age z score (HAZ), weight-for-height z score (WHZ), and body mass index-for-age z score (BAZ) were calculated using World Health Organization Anthro Plus version 1.0.3. RESULTS: LFCF intervention significantly increased WHZ, WAZ, and BAZ scores but decreased HAZ scores (P<0.001). Average scores of WHZ (0.96±0.97) and WAZ (0.45±0.72) increased; BAZ increased (1.12±0.93) after 6 weeks of LFCF. WAZ scores postintervention were 50.5% of normal, and WHZ scores were 77.1% of normal. However, the HAZ score decreased by 0.53±0.52, which indicated 57.8% had short stature. CONCLUSION: The NFCPP program with LFCF intervention can improve the nutritional status of children in rural areas. It should be implemented as a sustained program for better provision of complementary feeding during the period of lactation using local food made available at community health centers.