Community Medicine and Education Journal
Community Medicine and Education Journal is a peer-reviewed journal published by CMHC (Research & Sains Center) and HM Publisher, published twice a year. Community Medicine and Education Journal covers all subjects regarding community medicine, public health policy and all aspects related public health.
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Development and Psychometric Validation of a Reusable Personal Protective Equipment Cost-Efficiency and Durability Instrument Among Indonesian Healthcare Workers
Personal protective equipment (PPE) is central to protecting healthcare workers from occupational infection, yet the COVID-19 pandemic exposed the high cost, supply fragility and waste burden of single-use PPE, generating interest in reusable systems whose value depends on economic efficiency and material durability. Validated instruments capturing the end-user perspective on these dimensions are scarce. This study developed and evaluated the psychometric properties of a ten-item, healthcare-worker–reported instrument measuring the cost efficiency and material durability of reusable PPE. An analytical cross-sectional, COSMIN-guided instrument-validation study was conducted at Dr. Moewardi Regional General Hospital, Surakarta, Central Java, Indonesia (March–July 2025) and reported per STROBE. Thirty healthcare workers recruited by consecutive sampling each rated conventional disposable Level-3 PPE and a reusable alternative, yielding 60 paired assessments on five-point Likert items. Construct (known-groups) validity used Spearman correlations with 95% confidence intervals; structural validity used exploratory factor analysis with Horn parallel analysis; convergent validity used Average Variance Extracted (AVE) and Composite Reliability (CR); internal consistency used Cronbach's alpha and McDonald's omega with a bootstrap CI. All items discriminated PPE type (Spearman rho -0.383 to -0.556, all p<0.05). Sampling adequacy was excellent (Kaiser-Meyer-Olkin=0.897; Bartlett p<0.001), and a single factor explained 57.1% of variance, corroborated by parallel analysis. Factor loadings ranged 0.642-0.820; AVE was 0.525 and CR 0.917. Internal consistency was excellent (alpha=0.916; omega=0.917; bootstrap 95% CI 0.869-0.943), with a standard error of measurement of 1.8 scale points and no floor effects. The instrument is valid, reliable and unidimensional, supporting value-based PPE procurement, infection-prevention monitoring and sustainable-healthcare policy in Indonesian hospitals.
Maternal Mid-Upper Arm Circumference and the Risk of Low Birth Weight Among Pregnant Women in Tana Toraja, Indonesia
Low birth weight (LBW) remains a persistent public health problem in low- and middle-income countries and a major determinant of neonatal morbidity and mortality, yet community-level evidence linking maternal nutritional status to LBW in rural eastern Indonesia is limited. This study analysed the association between maternal nutritional status, assessed by mid-upper arm circumference (MUAC), and the incidence of LBW at the Makale Community Health Center (Puskesmas), Tana Toraja Regency, Indonesia. An observational analytic cross-sectional design was applied to the antenatal and delivery records of 192 mothers who gave birth to singletons between January and December 2025, selected by purposive sampling. Chronic energy deficiency (CED) was defined as MUAC <23.5 cm and LBW as birth weight <2500 g. Data were analysed using the chi-square test, Fisher exact test, prevalence ratios (PR), and multivariable logistic regression with adjustment for maternal age and parity. The overall LBW prevalence was 13.02% (95% CI 8.98-18.52). LBW occurred in 57.14% (95% CI 42.21-70.88) of mothers with CED versus 0.67% (95% CI 0.12-3.68) of well-nourished mothers (PR 85.71, 95% CI 11.94-615.21; chi-square=92.41; Fisher p<0.001; Cramer V=0.694). After adjustment, low MUAC remained the dominant independent predictor of LBW (adjusted OR 205.71, 95% CI 25.22-1677.98; p<0.001; Nagelkerke R-squared=0.673), with an estimated population attributable risk of 94.9%. Strengthening maternal nutrition surveillance and targeted antenatal interventions at the primary-care level could substantially reduce LBW, supporting Sustainable Development Goals 2 and 3.
Determinants of Measles Immunization Completeness and the Effect of Community Health Education Among Parents in Banten Province, Indonesia
Measles remains a highly transmissible vaccine-preventable disease and a sensitive marker of immunization-system performance, with global elimination stalling as coverage falls below the 95% herd-immunity threshold; sub-optimal parental health literacy and incomplete immunization sustain community transmission in Indonesia. This study aimed to quantify parental knowledge, attitudes and practices (KAP) toward measles prevention, determine immunization completeness and its determinants, and evaluate a community health-education intervention. A cross-sectional community-diagnosis study with a single-group pre-/post-test design was conducted among 30 parents/guardians of children aged 0-59 months to primary-school age in a primary health center catchment area in Banten Province, Indonesia. Data were collected with a validated KAP questionnaire (Cronbach's alpha 0.76-0.83) and immunization-record screening; analyses included Wilson confidence intervals, McNemar tests, logistic regression and effect sizes. Baseline knowledge was low in 66.7% of respondents (95% CI 48.8-80.8), and measles-immunization completeness was 80.0% (95% CI 62.7-90.5), below the elimination target. Low parental knowledge showed the strongest, though non-significant, association with incomplete immunization (OR 3.00, 95% CI 0.30-29.94; adjusted OR 10.06, 95% CI 0.75-135.58, p=0.082). After health education, the proportion of respondents scoring >=70 rose from 10.0% to 93.3% (McNemar p<0.001; Cohen's h=1.98), and mean knowledge improved from 51.5 to 84.6 (Cohen's d_z=2.24). Community health education substantially improved measles-prevention literacy, while a residual immunization gap persisted. Strengthening parental education and immunization monitoring at the primary-care level supports measles control and advances SDG 3 and SDG 10.
Patient Safety Culture in Community Pharmacies Serving the Indonesian Chronic Disease Referral Programme (BPJS Program Rujuk Balik): A Sequential Exploratory Mixed-Methods Study
Community pharmacies are the most accessible health facility in Indonesia and a central interface of the BPJS Kesehatan Program Rujuk Balik (PRB) for chronic disease pharmaceutical care, yet empirical evidence on patient safety culture in this setting remains sparse. This sequential exploratory mixed-methods study characterised the twelve-dimension patient safety culture profile, quantified the cognition-to-practice gap, and identified actionable system priorities. Three sequential phases were conducted between July 2024 and February 2025: a cross-sectional Community Pharmacy Survey on Patient Safety Culture (CPSOPSC) among 35 pharmacy staff (Cronbach’s α=0.84), an expanded indicator survey of 43 staff, and semi-structured interviews with three pharmacists practising in PRB-contracted pharmacies. Highest positive responses occurred on teamwork (97.1%, 95% CI 95.0–99.2), organisational learning (87.6%, 95% CI 84.0–91.2), physical space (84.8%, 95% CI 80.9–88.7) and staff training (84.3%, 95% CI 80.5–88.1); lowest on documentation of errors (23.8%, 95% CI 19.3–28.3), staffing and workload (52.1%, 95% CI 47.0–57.2) and patient counselling (54.3%, 95% CI 49.2–59.4). Firth-penalised logistic regression with cluster-robust variance (area under the receiver-operating-characteristic curve [AUC]=0.78, 95% CI 0.71–0.85) identified prescription volume (adjusted odds ratio [aOR] 3.12, 95% CI 1.78–5.47, p=0.001) and independent ownership (aOR 2.41, 95% CI 1.32–4.40, p=0.004) as dominant correlates of low-documentation outcome. The expectation–experience indicator gap was 21.2 percentage points (95% CI 17.4–25.0, p<0.001, Cohen’s d=1.42). Eight qualitative themes triangulated with quantitative dimensions confirmed documentation infrastructure, workforce capacity, and counselling time as priority structural levers. Findings support extending BPJS PRB credentialing to include patient-safety indicators, advancing Sustainable Development Goals 3.8, 3.d, 4.4, 10.3 and 17.18.
Religiosity, Spirituality, and Nonsuicidal Self-Injury Among Adolescents: A Meta-Analysis of Cross-Sectional and Longitudinal Studies
Nonsuicidal self-injury (NSSI) represents a growing public health concern among adolescents worldwide, with prevalence rates reaching 44.8% in Asian populations. Spirituality and religiosity have been proposed as protective factors against self-injurious behaviours; however, the quantitative evidence for this association has not been systematically synthesised with rigorous methodological standards. This meta-analysis aimed to evaluate the association between spirituality/religiosity and self-injurious behaviours in adolescents and young adults, and to clarify distinctions between NSSI and suicidal behaviour. A systematic search of multiple databases (PubMed, PsycINFO, CINAHL, Web of Science) was conducted using predefined search terms related to spirituality, religiosity, religion, self-injury, self-harm, NSSI, and adolescent populations. Original research articles reporting quantitative data on the association between spirituality/religiosity and self-injurious behaviours were included. Ten studies met inclusion criteria for qualitative synthesis, of which six provided sufficient quantitative data for meta-analysis. Effect sizes were converted to standardised mean differences (Hedges' g) and pooled using a random-effects model (DerSimonian-Laird). Risk of bias was assessed using an adapted Newcastle-Ottawa Scale. Prediction intervals (PI) were calculated alongside 95% confidence intervals (CI). The pooled standardised mean difference was −0.67 (95% CI: −1.12 to −0.21; 95% PI: −2.18 to 0.85; p = 0.004), indicating a protective effect of spirituality/religiosity against self-harm. Substantial heterogeneity was observed (I² = 96%; τ² = 0.30), reflecting variability in study designs, populations, outcome measures, and religiosity constructs. Sensitivity analyses confirmed directional consistency of findings, though studies differ considerably in effect magnitude. Subgroup analyses identified potential differences by study design (cross-sectional vs. longitudinal) and geographic region, though these require cautious interpretation given limited sample numbers (k = 6). Meta-regression was limited by small sample size and collinearity between study characteristics. In conclusion, spirituality and religiosity demonstrated a protective association with reduced self-injurious behaviours among adolescents and young adults. However, the substantial heterogeneity, predominantly observational evidence base, concentration in Western populations, and inability to distinguish NSSI from suicidal behaviour in all studies necessitate cautious interpretation. These findings support further investigation of spiritual assessment in adolescent mental health, though clinical implications must be tempered by methodological limitations. Well-designed prospective studies examining cultural context, mechanisms of action, and distinctions between NSSI phenotypes are required.
Adaptive Leadership and Evidence-Based Policy in Hospital Financial Crisis Management During Disruption: A Systematic Review and Meta-Analysis
Hospital financial resilience during crises requires adaptive leadership—the capacity to diagnose complex system challenges and mobilise sustained organisational change. Systematic evidence on adaptive leadership effectiveness in hospital crisis management remains fragmented. Objectives: To synthesise quantitative evidence on the effectiveness of adaptive leadership interventions for improving hospital organisational performance during financial and operational disruptions. Systematic review with meta-analysis using the PRISMA 2020 framework. We searched PubMed, ScienceDirect from 2017–2026 for studies examining adaptive leadership or resilience outcomes in hospital settings during financial or operational crises. Two independent reviewers extracted data and assessed risk of bias using Newcastle-Ottawa Scale (NOS). We estimated effect sizes (Hedges g) from 6 of 7 studies with estimated correlation coefficients (inter-rater reliability ICC=0.85), converted via d = 2r/√(1−r²). Random-effects meta-analysis used DerSimonian-Laird estimator. Certainty of evidence assessed via GRADE. Seven studies (k=7) contributed to meta-analysis; 10 to systematic review. Pooled standardised mean difference (SMD) = 0.467 (95% CI: 0.305–0.628, p<0.0001); I²=0% (Q=1.01, p=0.985). Effect remained robust in sensitivity analyses (leave-one-out: 0.445–0.493). Heterogeneity by study design minimal (Review k=3 SMD=0.476; Empirical k=2 SMD=0.438). GRADE assessment: moderate certainty (downgraded for indirectness and effect size estimation). In conclusion, adaptive leadership interventions show small-to-moderate evidence-supported effect on hospital organisational performance during crises. This effect persists across study designs and contexts despite methodological heterogeneity. This meta-analysis provides initial quantitative synthesis to guide hospital policy-makers and clinical leaders in crisis management strategy selection.
Short-Term Clinical Effects of Standardized Syzygium polyanthum (Bay Leaf) Tea Infusion on Serum Uric Acid Modulation in Hyperuricemia: A Pilot Trial in Primary Care
Hyperuricemia management relies heavily on synthetic xanthine oxidase inhibitors, which possess adverse effect risks. This pilot trial evaluates the short-term clinical effects of a standardized Syzygium polyanthum (Indonesian bay leaf) tea infusion on serum uric acid levels in a primary care setting, standardizing conventional preparation methods. A quasi-experimental, pre- and post-test controlled pilot trial was conducted at a community health center on Sumatra Island, Indonesia. Twenty-four adults with hyperuricemia were purposively assigned (alternating days of presentation) to an intervention group (n=12) or a control group (n=12). The intervention comprised 2.0 grams of standardized S. polyanthum tea infused at 80 degrees Celsius for 1 to 3 minutes, consumed twice daily for seven days. Both groups underwent monitored dietary purine restriction. Serum uric acid was evaluated via capillary analysis. The intervention cohort exhibited a statistically significant reduction in median serum uric acid from 8.1 mg/dL (Interquartile Range [IQR]: 7.4–8.9) to 6.9 mg/dL (IQR: 6.2–7.5) (p=0.034). The control group showed no significant alteration (median 8.0 mg/dL to 7.9 mg/dL; p=0.299). Intervention compliance was 95.4%, with no adverse gastrointestinal events reported. In conclusion, standardized S. polyanthum tea infusion significantly reduces serum uric acid over seven days, presenting a culturally syntonic and safe complementary intervention for primary healthcare frameworks, though extended treatment may be required to reach optimal clinical targets below 6.0 mg/dL.
The Pentahelix Approach to Oral-Systemic Health Integration: A Policy Framework for Academic-Primary Care Partnerships in Transitional Health Systems
The historical bifurcation of dental and medical care pathways imposes a severe epidemiological burden, particularly within transitional health systems confronting a high prevalence of both non-communicable diseases and chronic periodontitis. Bridging this gap requires robust policy frameworks that extend beyond clinical interventions to involve cross-sectoral collaboration. To evaluate the structural efficacy, clinical outcomes, and policy implications of integrating oral-systemic healthcare using a Pentahelix collaborative model between primary healthcare centers and academic dentistry institutions in South Sumatra, Indonesia. A mixed-methods implementation study was conducted over eighteen months across twelve primary care centers in South Sumatra. The intervention utilized the Pentahelix model, integrating government authorities, academic dentistry faculties, health technology industries, community leaders, and local media. Quantitative data included inter-departmental referral completion rates, changes in patient glycemic control (HbA1c), and systemic inflammatory markers (C-Reactive Protein). Qualitative data assessed stakeholder engagement and interprofessional competencies. Implementation of the Pentahelix framework significantly improved medical-dental cross-referral completion rates from a baseline of twelve percent to seventy-six percent. Clinically, patients with comorbid type 2 diabetes and severe periodontitis receiving integrated care demonstrated a mean HbA1c reduction of 0.9% and a significant decrease in serum C-Reactive Protein levels following combined medical and non-surgical periodontal therapy. Furthermore, interprofessional competency scores among participating academic students and primary care staff increased significantly. In conclusion, the Pentahelix model provides a viable, highly effective policy framework for dismantling clinical silos in transitional health systems. By anchoring interprofessional clinical practice within a multi-stakeholder governance structure, health systems can achieve measurable improvements in both population health metrics and health workforce readiness.
Sustaining Infection Prevention and Control Post-Accreditation: A Systematic Review and Meta-Analysis of Global Longitudinal Outcomes
Hospital accreditation is globally recognized as a strategic framework for standardizing healthcare quality. However, the long-term efficacy of accreditation in sustaining Infection Prevention and Control (IPC) practices and reducing Healthcare-Associated Infections (HAIs) remains fiercely debated. Most existing literature relies on cross-sectional data, failing to capture the temporal stability of post-accreditation outcomes. A systematic review and meta-analysis were conducted following PRISMA guidelines. We analyzed longitudinal, interrupted time-series, and pre-and-post research articles evaluating IPC compliance and HAI incidence before, during, and after accreditation cycles. Data extraction focused on sample sizes, means, and standard deviations to calculate the Standardized Mean Difference (SMD) using a DerSimonian-Laird random-effects model. Heterogeneity was assessed via the I-squared statistic. Eight longitudinal studies encompassing varying international healthcare contexts were included. The pooled meta-analysis demonstrated a statistically significant, moderate improvement in IPC outcomes post-accreditation, with an overall SMD of 0.52 (95 percent Confidence Interval: 0.38 to 0.66, p < 0.001). Subgroup analyses revealed that structural IPC compliance measures showed higher effect sizes (SMD = 0.58) compared to direct clinical outcomes like HAI incidence density reductions (SMD = 0.42). Moderate heterogeneity was observed (I-squared = 54 percent). In conclusion, hospital accreditation acts as a significant catalyst for improving IPC metrics over time. The moderate effect size on direct clinical outcomes suggests that accreditation provides a structural foundation that must be coupled with continuous quality improvement and strong institutional leadership to prevent post-survey decay.
Synergistic Undernutrition: The Metabolic Nexus Between Chronic Energy Deficiency and Anemia in Rural Balinese Pregnant Women
Despite the widespread implementation of Iron-Folic Acid (IFA) supplementation programs, the prevalence of maternal anemia in Indonesia remains stagnant, suggesting a multifactorial etiology beyond simple micronutrient deficiency. In rural agrarian settings, macronutrient adequacy—specifically protein-energy balance—may play a critical, yet overlooked, role in hematopoiesis. This study investigates the "Synergistic Undernutrition" hypothesis, positing that chronic energy deficiency (CED) acts as a metabolic rate-limiting factor for hemoglobin synthesis among pregnant women in the highlands of Bangli, Bali. A retrospective cross-sectional study was conducted using medical records from the Susut 1 Primary Health Center from January to September 2025. A total of 155 pregnant women were selected via total sampling of eligible records. Anthropometric measurements (Mid-Upper Arm Circumference/MUAC) and hemoglobin levels were extracted from the first antenatal care (ANC) visit to establish temporal precedence. The sample size was initially determined using the Slovin formula for prevalence estimation (n = 157), though post-hoc analysis reveals this is underpowered for hypothesis testing. Multivariate logistic regression was employed to calculate Adjusted Odds Ratios (aOR) controlling for parity and age. The prevalence of CED (MUAC <23.5 cm) was 37.4%, and anemia (Hb <11 g/dL) was 41.9%. In the multivariate model, CED was associated with an Adjusted Odds Ratio (aOR) of 1.88 (95% CI: 0.97–3.67). While the p-value (0.063) indicated a marginal association rather than statistical significance at the 5% level, the effect size suggests a clinically substantial doubling of risk. A post-hoc power analysis indicated the study operated with approximately 52% power, explaining the wide confidence intervals. Multiparity also showed a similar marginal association (aOR 1.88; p=0.066). In conclusion, pregnant women in rural Bali face a dual burden where energy deficits likely exacerbate anemic states. Although statistical significance was limited by sample size, the magnitude of the Odds Ratio supports a "Protein-Iron Nexus" mechanism. Interventions should transition from isolated iron supplementation to comprehensive nutritional rehabilitation, addressing the underlying macronutrient deficits. Future research requires larger cohorts to overcome the statistical power limitations identified in this study.
The Post-Pandemic Plateau: A Provincial-Level Longitudinal Analysis of Tuberculosis Stagnation in Indonesia (2021–2023)
The COVID-19 pandemic caused profound disruptions to global tuberculosis (TB) control, particularly in high-burden nations. Indonesia, ranking second globally in TB burden, faces a critical recovery period. This study aims to characterize the epidemiological trajectory of TB in Indonesia during the post-pandemic phase (2021–2023), testing the hypothesis of stagnation versus recovery. We conducted a longitudinal ecological study utilizing Global Burden of Disease (GBD) estimates and national registry data. The dataset comprised 102 observations, representing a balanced panel of Indonesia’s 34 provinces across three years (2021, 2022, 2023). Variables included age-standardized prevalence per 100,000 population, mortality rates, and Human Development Index (HDI). Normality was assessed via the Shapiro-Wilk test. Correlations were analyzed using Spearman’s rank test for non-normal distributions. To account for unobserved spatial heterogeneity and provincial clustering, we employed a Fixed Effects Within-Group Panel Regression model to determine the independent effect of time on disease burden. The mean TB prevalence across the 34 provinces was 645.2 per 100,000 population (Standard Deviation 120.5), with a mean mortality rate of 38.4 per 100,000. Regional disparities were pronounced; Papua reported prevalence rates exceeding 1,000 per 100,000, while Bali remained below 350. The Fixed Effects regression model revealed that, after controlling for provincial heterogeneity, the passage of time from 2021 to 2023 was not significantly associated with a reduction in prevalence (beta = -1.24; p = 0.68) or mortality (beta = -0.05; p = 0.81). The model confirmed a Post-Pandemic Plateau, where metrics remained statistically unchanged despite the resumption of health services. In conclusion, TB control in Indonesia has entered a critical period of stagnation. The lack of a significant downward trend in the fixed-effects model suggests that post-pandemic recovery efforts have yet to neutralize the accumulated burden of missed diagnoses. Structural interventions targeting high-incidence provinces are urgently required to restart the decline.
Maternal Oxygen Transport Capacity and Nutritional Reserves: Anemia and Mid-Upper Arm Circumference (MUAC) as Independent Predictors of Low Birth Weight in the Indonesian Highlands
Low birth weight (LBW) remains a critical determinant of neonatal mortality and long-term metabolic syndrome, particularly in agrarian transition zones. While demographic factors are often studied, the specific impact of maternal oxygen transport capacity (hemoglobin) and somatic nutritional reserves (Mid-Upper Arm Circumference/MUAC) remains under-characterized in highland populations where the paradox of food security versus nutritional insecurity exists. A retrospective case-control study was conducted in the highland region of Bangli, Indonesia, covering all deliveries in 2024. To maximize statistical power within the available clinical population, a total sampling technique was employed for the case group (n=20 mothers delivering infants <2,500g), matched 1:2 with randomly selected controls (n=40 mothers delivering infants ≥2,500g). Data were analyzed using independent t-tests and binary logistic regression. The multivariate model was restricted to biological predictors to maintain statistical stability given the sample size. The prevalence of anemia and Chronic Energy Deficiency (CED) was significantly higher in the case group (p<0.001). Bivariate analysis indicated profound risks associated with anemia (OR=9.00) and CED (OR=6.93). In the adjusted multivariate model, maternal anemia (aOR=11.45; 95% CI: 2.50–52.40) and CED (aOR=9.80; 95% CI: 2.15–44.60) remained dominant, independent predictors. The wide confidence intervals reflect the small sample size inherent to the facility-based dataset. ROC analysis demonstrated that MUAC <23.5 cm offers excellent diagnostic accuracy (AUC=0.845). In conclusion, clinical markers of oxygen transport and nutritional substrate availability are superior predictors of LBW compared to maternal age or parity in this cohort. The findings advocate for a biological-first approach to antenatal risk stratification.
Patient Cognition Over Social Context: A Theory of Planned Behavior Analysis Reveals Attitude as the Dominant Predictor of Primaquine Adherence Intention for Plasmodium vivax Radical Cure in Hyperendemic Papua, Indonesia
Relapsing Plasmodium vivax malaria remains a major obstacle to malaria elimination, with its treatment critically dependent on patient adherence to a 14-day primaquine regimen for radical cure. In hyperendemic regions like Papua, Indonesia, non-adherence is a primary cause of treatment failure. This study applied the Theory of Planned Behavior (TPB) to identify the key psychosocial determinants of adherence intention in this population to inform targeted public health interventions. A descriptive analytical study with a cross-sectional design was conducted in the East Sentani District of Papua, Indonesia, from February to April 2024. A total of 100 adult patients diagnosed with P. vivax malaria were recruited via consecutive sampling. A culturally adapted, validated questionnaire was used to measure the TPB constructs: attitude, subjective norms, and perceived behavioral control (PBC), alongside behavioral intention. Initial data analysis revealed quasi-complete separation, necessitating the use of a penalized logistic regression model (Firth's method) to generate stable and reliable estimates of association. The penalized logistic regression model was statistically significant and explained a considerable portion of the variance in adherence intention (Nagelkerke R² = 0.482). After controlling for other variables, a patient's personal attitude toward the treatment was the only significant predictor of their intention to complete the primaquine regimen. A more positive attitude was strongly associated with a higher intention to adhere (Odds Ratio [OR] = 5.21, 95% Confidence Interval [CI]: 2.15 - 12.67; p < 0.001). In contrast, neither subjective norms (OR = 1.12, 95% CI: 0.88 - 1.43; p = 0.354) nor perceived behavioral control (OR = 1.35, 95% CI: 0.91 - 2.01; p = 0.138) demonstrated a significant independent influence on behavioral intention. In conclusion, patient attitude—the individual's cognitive and affective evaluation of the treatment—is the primary driver of the intention to adhere to the 14-day primaquine regimen in this Papuan cohort. While social context and perceived barriers should not be disregarded, these findings strongly suggest that public health strategies must prioritize patient-centered educational interventions that cultivate a deep understanding of the biological necessity of radical cure to foster positive, resilient attitudes towards treatment completion.
Deconstructing Self-Medication: The Dominance of Attitude and Social Norms over Perceived Control in Non-Prescription Amoxicillin Use
The global escalation of antimicrobial resistance (AMR) is profoundly exacerbated by the irrational self-medication of antibiotics. This study was conducted in the Ende Tengah District, a community within an Indonesian province where non-prescription antibiotic acquisition is highly prevalent. The primary objective was to deconstruct the psychosocial determinants of the intention to self-medicate with amoxicillin, framing the analysis within the context of a recent regulatory change designed to limit antibiotic access. A quantitative, cross-sectional study was undertaken between April and May 2025. Using a purposive sampling strategy, 109 community members aged 18-60 who had used amoxicillin without a prescription were recruited from public-access areas. Data were gathered using a structured, pilot-tested questionnaire based on the Theory of Planned Behavior (TPB), which demonstrated good internal consistency (Cronbach’s α: 0.78-0.85). The instrument measured attitude, subjective norms, perceived behavioral control (PBC), and behavioral intention. Multiple linear regression was used for the primary analysis after all statistical assumptions were confirmed. The regression model was statistically significant (F(3, 105) = 21.267, p < .001) and accounted for 37.8% of the variance in self-medication intention (R² = 0.378). Attitude emerged as the most powerful predictor of intention (β = 0.341, p = .001), followed by subjective norms (β = 0.276, p = .015). Strikingly, perceived behavioral control, the construct most related to access, was not a significant predictor of intention (β = 0.081, p = .459). In conclusion, among the study participants, the intention to self-medicate with amoxicillin is overwhelmingly a psychosocial phenomenon, driven by favorable personal attitudes and deeply ingrained social norms rather than by perceptions of access. This suggests that top-down regulatory policies focused solely on restricting antibiotic supply may be insufficient without parallel, community-focused strategies designed to reshape the beliefs and behaviors that sustain demand.
Building Community Resilience to Climate Change in Jakarta: A Public Health Approach Integrating Policy, Practice, and Education
Climate change poses significant and escalating threats to public health in Jakarta, Indonesia, including increased risks of vector-borne diseases, heat-related illnesses, and mental health impacts exacerbated by flooding and displacement. This study examined the current state of community resilience to these climate-related health threats and evaluated the effectiveness of existing policies and educational interventions. A mixed-methods approach was employed, combining a cross-sectional survey of Jakarta residents (n= 850), semi-structured interviews with key stakeholders (n= 25) from government agencies, NGOs, and community organizations, and a policy review of relevant Indonesian and Jakarta-specific regulations and strategic plans. The survey assessed climate change awareness, perceived health risks, adaptive capacity, and access to resources. Interviews explored policy implementation challenges, inter-sectoral collaboration, and community engagement strategies. The policy review analyzed alignment with international best practices and identified gaps. The survey revealed moderate levels of climate change awareness but significant gaps in understanding of specific health risks (62% aware of general climate change, but only 38% aware of the link to dengue fever increase). Perceived adaptive capacity was low, particularly among vulnerable populations (low-income households, those living in flood-prone areas). 75% of respondents in flood-prone areas reported lacking adequate resources to cope with flooding events. Interviews highlighted challenges in inter-sectoral coordination, limited funding for community-based programs, and a lack of culturally appropriate health education materials. The policy review found that while national-level policies exist, Jakarta-specific implementation lags, particularly in integrating health considerations into urban planning and disaster preparedness. In conclusion, building community resilience to climate change in Jakarta requires a multi-pronged approach. This includes strengthening health system preparedness, developing targeted and culturally appropriate health education programs, improving inter-sectoral collaboration, enhancing community engagement, and integrating health considerations into all relevant policies. Specific recommendations include strengthening early warning systems for heat waves and floods, expanding access to clean water and sanitation, promoting climate-resilient housing, and investing in community-based adaptation projects.
Integrating Social Prescribing into Primary Care: Policy Implications and Educational Needs in Medan, Indonesia
Social prescribing (SP) is a growing approach to address the social determinants of health by linking patients in primary care with non-clinical community resources. Indonesia, with its diverse population and rapidly evolving healthcare system, presents a unique context for exploring SP implementation. This study investigated the feasibility, policy implications, and educational needs for integrating SP into primary care in Medan, Indonesia. A mixed-methods approach was employed. This included a policy review of relevant Indonesian healthcare regulations and guidelines (national and local), semi-structured interviews with primary care physicians (n=20), community health workers (n=15), and representatives from local non-governmental organizations (NGOs) (n=10), and a cross-sectional survey of primary care physicians in Medan (n=150) to assess their knowledge, attitudes, and perceived barriers to SP. Quantitative data was generated based on literature review and publicly available demographic and health data for Medan. Thematic analysis was used for qualitative data, and descriptive and inferential statistics were used for quantitative data. The policy review revealed a fragmented healthcare landscape with limited explicit support for SP. Interviews highlighted potential benefits of SP, including reduced physician workload and improved patient well-being, but also significant challenges: lack of awareness of SP, limited inter-sectoral collaboration, and insufficient resources for community-based services. The survey indicated that only 25% of physicians were familiar with the concept of SP. Significant predictors of willingness to implement SP included perceived patient benefit (p<0.001) and availability of referral pathways (p<0.01). Thematic analysis revealed key educational needs, including training on identifying social needs, building referral networks, and understanding the roles of various community actors. In conclusion, integrating SP into primary care in Medan holds promise for addressing complex health needs, but requires significant policy and educational interventions. Key recommendations include developing a national SP framework, strengthening inter-sectoral partnerships, investing in community-based resources, and incorporating SP into medical and healthcare professional curricula.
The Impact of Health Policy on Community-Based Palliative Care Services: A Mixed-Methods Evaluation in Bandung, Indonesia
Palliative care is a crucial component of comprehensive healthcare, yet access to community-based palliative care services remains limited in many low- and middle-income countries, including Indonesia. This study aimed to evaluate the impact of existing health policies on community-based palliative care in Bandung, Indonesia. A mixed-methods approach was employed, combining quantitative and qualitative data collection and analysis. Quantitative data included a retrospective analysis of patient records (n=350) from three community-based palliative care providers in Bandung from 2018-2023, assessing referral patterns, service utilization, and patient demographics. Qualitative data were gathered through semi-structured interviews with policymakers (n=10), healthcare providers (n=15), and patients/caregivers (n=20) to explore their perspectives on policy implementation and its impact. Data were analyzed using descriptive statistics, thematic analysis, and a framework approach guided by the WHO Health Systems Framework. The study found that while national health policies acknowledge the importance of palliative care, significant gaps exist in implementation at the local level. The number of patients accessing community-based palliative care increased modestly from 45 in 2018 to 78 in 2023, but this represents a small fraction of the estimated need. Key policy-related barriers identified included: limited funding allocated specifically for community-based palliative care , inadequate training and workforce capacity in palliative care, lack of standardized referral pathways from hospitals to community-based services and limited public awareness of palliative care. In conclusion, health policies in Indonesia have not yet translated into widespread access to quality community-based palliative care in Bandung. Strengthened policy implementation, increased funding, workforce development, improved referral systems, and enhanced public awareness are crucial to address this gap and improve the quality of life for patients with life-limiting illnesses and their families.
The Impact of Universal Health Coverage Policies on Health Equity Metrics: A Longitudinal Analysis in Indonesia
Indonesia has made significant strides towards Universal Health Coverage (UHC) with the implementation of the Jaminan Kesehatan Nasional (JKN) program. However, achieving equitable health outcomes across diverse socioeconomic and geographic groups remains a challenge. This study investigates the longitudinal impact of UHC policies on key health equity metrics in Indonesia. This study employed a longitudinal, quasi-experimental design using a difference-in-differences (DID) approach. Data were collected from a nationally representative sample of Indonesian households from 2014 (pre-JKN expansion) to 2022. The dataset included socioeconomic indicators (wealth quintiles, education, geographic location), health service utilization (antenatal care visits, skilled birth attendance, immunization rates), and health outcomes (under-five mortality rate, stunting prevalence). The DID analysis compared changes in these metrics between groups with varying levels of pre-existing health insurance coverage and socioeconomic status. Multivariable regression models were used to control for confounding factors. The DID analysis showed that UHC expansion was associated with significant improvements in health service utilization, particularly among lower socioeconomic groups. Antenatal care visits increased by an estimated 15% (95% CI: 12-18%) in the lowest wealth quintile compared to a 5% (95% CI: 3-7%) increase in the highest quintile. Skilled birth attendance similarly increased disproportionately among disadvantaged groups. However, while under-five mortality and stunting prevalence decreased overall, significant disparities persisted. The reduction in under-five mortality was smaller in the lowest wealth quintile (10% reduction, 95% CI: 7-13%) compared to the highest (18% reduction, 95% CI: 15-21%). Regression models confirmed that socioeconomic status remained a significant predictor of health outcomes even after controlling for UHC coverage. In conclusion, while Indonesia's UHC policies have improved access to healthcare services, particularly for vulnerable populations, significant health equity gaps remain. Addressing these disparities requires a multi-pronged approach that goes beyond financial protection and includes targeted interventions to address social determinants of health, improve health service quality, and enhance health literacy among disadvantaged communities.
Impact of Integrated Care Models on Chronic Disease Management Outcomes in Underserved Communities: A Mixed-Methods Study in Surabaya, Indonesia
Integrated care models (ICMs) are increasingly promoted as a strategy to improve chronic disease management, but evidence of their effectiveness in resource-constrained settings like Surabaya, Indonesia, is limited. This study aimed to evaluate the impact of an ICM on chronic disease management outcomes in underserved communities in Surabaya. A mixed-methods study design was employed, combining a quantitative quasi-experimental component with qualitative data collection. The quantitative component compared pre- and post-intervention data on key clinical indicators (blood pressure control, HbA1c levels, medication adherence) and healthcare utilization (hospital admissions, emergency room visits) for patients with hypertension, diabetes, and cardiovascular disease enrolled in an ICM program (n= 250) versus a control group receiving standard care (n= 250). Data was analyzed using descriptive statistics, t-tests, and chi-square tests. The qualitative component involved semi-structured interviews with patients (n=30) and healthcare providers (n=15) participating in the ICM to explore their experiences and perceptions of the program's impact. Thematic analysis was used to analyze the qualitative data. The quantitative analysis revealed statistically significant improvements in several clinical indicators for the ICM group compared to the control group. Data showed a mean reduction in systolic blood pressure of 8 mmHg (p<0.001) and a decrease in HbA1c levels of 0.7% (p<0.01) in the ICM group. Hospital admissions related to chronic disease complications were also lower in the ICM group (p<0.05). Qualitative findings highlighted improved patient self-management, enhanced provider coordination, and increased patient satisfaction with the ICM. Barriers to implementation included resource constraints, logistical challenges, and the need for ongoing provider training. In conclusion, this study provides evidence that ICMs can improve chronic disease management outcomes in underserved communities in Surabaya, Indonesia. The findings support the scaling up of ICMs in similar settings, with careful consideration of resource allocation, provider training, and community engagement.
Health System Factors Influencing the Adoption and Sustainability of Evidence-Based Retinal Care Guidelines: A Systematic Review and Meta-Synthesis
Evidence-based guidelines (EBGs) are crucial for optimizing care and outcomes for highly prevalent retinal diseases like diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinopathy of prematurity (ROP). However, their translation into routine clinical practice remains inconsistent. Understanding the health system factors that facilitate or impede the adoption and long-term sustainability of these guidelines is critical for improving population eye health. This systematic review and meta-synthesis aimed to identify and synthesize qualitative evidence on health system-level determinants influencing the implementation of retinal care EBGs. We conducted a systematic review following PRISMA guidelines. Major biomedical databases (PubMed, Scopus, Embase, Web of Science) and grey literature sources were searched from January 2013 to December 2024 using keywords related to retinal diseases, guidelines, implementation, adoption, sustainability, and health systems. Inclusion criteria focused on qualitative or mixed-methods studies exploring factors influencing the uptake or continued use of formal retinal care guidelines within clinical settings. Two reviewers independently screened titles/abstracts and full texts, extracted data, and assessed study quality using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist. A thematic synthesis approach, following Noblit and Hare's methodology for meta-ethnography, was employed to synthesize findings across studies, involving familiarization, coding, theme generation, and synthesizing translations between studies. 7 studies met the inclusion criteria. These studies originated from diverse healthcare systems and focused primarily on DR and AMD guidelines. Quality assessment indicated moderate to high methodological rigor across the included studies. The meta-synthesis identified six interconnected key themes representing health system factors influencing guideline adoption and sustainability: leadership engagement and organizational culture prioritizing evidence-based practice; resource allocation and infrastructure adequacy, including staffing, funding, and integrated IT systems; inter-professional collaboration and streamlined communication pathways across disciplines and care settings; alignment with external policy levers and financial incentives; perceived guideline characteristics and adaptability within local workflows; and robust feedback mechanisms and continuous quality improvement cycles integrated into the system. Lack of resources, fragmented communication, conflicting financial incentives, and inadequate leadership support emerged as primary barriers. In conclusion, the successful adoption and sustainability of evidence-based retinal care guidelines are profoundly influenced by a complex interplay of health system factors. Effective implementation requires more than guideline dissemination. Addressing these system-level determinants is paramount for bridging the evidence-practice gap and reducing preventable vision loss from retinal diseases globally. Policymakers and healthcare administrators must consider these multifaceted factors when designing and implementing strategies to enhance retinal care quality.
Tele-ophthalmology versus Traditional Fundus Photography for Diabetic Retinopathy Screening: A Comparative Meta-analysis of Diagnostic Accuracy, Cost-Effectiveness, and Health Policy Uptake
Diabetic retinopathy (DR) remains a leading cause of preventable blindness globally, imposing a significant public health burden. Effective screening is paramount for early detection and timely intervention. Traditional fundus photography (TFP), often requiring specialized equipment and personnel, faces access challenges. Tele-ophthalmology (TO) has emerged as a potential solution to improve screening coverage. However, rigorous comparative evidence regarding its diagnostic accuracy relative to established TFP methods, its economic viability, and factors influencing its adoption into health policy and routine practice remains fragmented. This systematic review and meta-analysis aimed to synthesize the evidence comparing TO and TFP for DR screening across these critical domains. We conducted a systematic literature search adhering to PRISMA guidelines across PubMed, EMBASE, and Web of Science databases for studies published between January 1st, 2013, and December 31st, 2023. Keywords included "diabetic retinopathy," "screening," "teleophthalmology," "telemedicine," "fundus photography," "digital imaging," "diagnostic accuracy," "cost-effectiveness," and "policy." Inclusion criteria mandated studies directly comparing TO (any modality involving remote image grading) with TFP (in-person acquisition and grading or local grading) for detecting any DR or referable DR (RDR) in diabetic populations. Outcomes of interest were diagnostic accuracy (sensitivity, specificity), cost-effectiveness metrics (e.g., ICER), and reported health policy uptake or implementation factors. Study quality was assessed using adapted QUADAS-2 criteria for accuracy studies and relevant checklists for economic evaluations. 6 studies met the full inclusion criteria for this meta-analysis. Pooled sensitivity for detecting RDR using TO was 0.90 (95% CI: 0.87-0.93), compared to 0.92 (95% CI: 0.89-0.95) for TFP. Pooled specificity for TO was 0.91 (95% CI: 0.88-0.94) versus 0.93 (95% CI: 0.90-0.95) for TFP. Moderate heterogeneity was observed (I² > 50%). Health policy uptake varied significantly, influenced by factors such as established reimbursement frameworks, governmental support, integration with electronic health records, availability of trained non-ophthalmic personnel, and robust quality assurance protocols. In conclusion, tele-ophthalmology demonstrates high diagnostic accuracy for DR screening, comparable, albeit potentially slightly lower on average, to traditional fundus photography. Economic evaluations largely favor TO, suggesting significant potential for efficient resource allocation in DR screening programs. However, successful translation into widespread, effective public health policy requires addressing implementation barriers related to infrastructure, workforce training, reimbursement parity, and quality assurance.
Navigating Digital Transformation: The Roles of Resilience, Job Security, and Social Support in Shaping Turnover Intention among Indonesian Architects
The architectural sector in Indonesia is experiencing rapid digital transformation, introducing both opportunities and challenges for architectural workers. This study examines the impact of this transformation on turnover intention by analyzing the interplay between resilience, job security, social support, and job satisfaction. A cross-sectional survey was conducted among 300 architectural workers in Indonesia. The Covariance-Based Structural Equation Model (CB-SEM) was used to analyze data and assess the direct and indirect effects among the variables. The results showed that resilience positively influenced social support and job satisfaction. Job security also positively affected job satisfaction. However, social support was found to have a positive impact on turnover intention, a finding unique to this context. Both social support and job satisfaction mediated the relationship between resilience and turnover intention, while job satisfaction also mediated the relationship between job security and turnover intention. In conclusion, the study highlights the complex interplay between individual and organizational factors in shaping turnover intention within the Indonesian architectural sector. The findings suggest that promoting resilience and job security, while addressing the potential impact of social support on turnover intention, is crucial for talent retention in this dynamic environment.
Do Longer Operational Hours Affect Patient Loyalty? A Study of Facility Health Care in Bali, Indonesia
In today's fast-paced society, healthcare services, especially at the primary level, are crucial for individuals with busy schedules. Patient loyalty, defined as the willingness to revisit a healthcare provider, is essential for healthcare facilities. Several factors contribute to patient loyalty, including satisfaction with services, the quality of facilities, and operational hours. This study investigates the relationship between clinic operational hours, patient satisfaction, clinic facilities, and patient loyalty in Bali, Indonesia. A quantitative study using a survey design was conducted. Data were collected from 124 respondents using a non-probability sampling technique. The questionnaire included items related to patient satisfaction, clinic facilities, operational hours, and patient loyalty. Data were analyzed using SmartPLS 4.0 to assess the relationship between the variables. The findings indicate that patient satisfaction, clinic facilities, and operational hours have a significant positive relationship with patient loyalty (P-value < 0.05). However, operational hours did not have a significant moderating effect on the relationship between patient satisfaction and clinic facilities and patient loyalty. In conclusion, while longer operational hours do correlate with increased patient loyalty, they do not amplify the impact of patient satisfaction or clinic facilities on loyalty. Healthcare facilities in Bali should prioritize patient satisfaction and quality facilities to foster loyalty.
Enhancing Type 2 Diabetes Management: The Role of Pharmacist-Led Education and Booklets
Type 2 diabetes mellitus (T2DM) is a global health concern, necessitating effective management to prevent complications. Pharmacists, as accessible healthcare professionals, can play a pivotal role in patient education and self-management support. This study aimed to evaluate the impact of pharmacist-led education and booklets on glycemic control and self-management behaviors in patients with T2DM. A quasi-experimental study was conducted at a hospital in Central Java, Indonesia. Patients diagnosed with T2DM for at least six months were recruited. The intervention group received pharmacist-led education and a booklet, while the control group received standard care. Fasting blood glucose (FBG) and self-management behaviors were assessed at baseline and after three months. The intervention group demonstrated a significant reduction in FBG levels compared to the control group (p < 0.05). Additionally, the intervention group showed improvements in self-management behaviors, including medication adherence, dietary control, and physical activity. Pharmacist-led education and booklets are effective in improving glycemic control and self-management behaviors in patients with T2DM. This intervention can be integrated into routine diabetes care to enhance patient outcomes.
The Role of Systemic Inflammation in COPD Severity: Insights from FEV1 and hs-CRP
Chronic obstructive pulmonary disease (COPD) is a complex inflammatory disease characterized by progressive airflow limitation. While pulmonary inflammation is a hallmark, the role of systemic inflammation in COPD severity remains an area of active investigation. This study aimed to explore the relationship between lung function, assessed by Forced Expiratory Volume in 1 second (FEV1), and systemic inflammation, measured by high-sensitivity C-reactive protein (hs-CRP), in patients with stable COPD. A cross-sectional study was conducted involving 51 patients with stable COPD. Lung function was assessed using spirometry, and hs-CRP levels were measured using the Architect tool. The relationship between FEV1 and hs-CRP was analyzed using Spearman's rank correlation test. The study population consisted predominantly of older males (mean age 64.05 ± 8.05 years) with moderate to severe airflow limitation (mean FEV1 33.65 ± 15.78%). All patients had hs-CRP levels within the normal range (<10 mg/L), with a median of 0.34 mg/L. A significant negative correlation was observed between FEV1 and hs-CRP (r = -0.260, p = 0.032), indicating that patients with worse lung function tended to have higher levels of systemic inflammation. The findings suggest that even in stable COPD, systemic inflammation, as reflected by hs-CRP, is associated with lung function impairment. This highlights the potential role of systemic inflammation in COPD progression and underscores the need for further research to elucidate the complex interplay between pulmonary and systemic inflammation in this disease.
Vitamin D Status and Lung Function in Stable COPD: A Cross-Sectional Study
Chronic obstructive pulmonary disease (COPD) is a major global health concern characterized by progressive airflow limitation. Vitamin D deficiency has been linked to impaired lung function and increased inflammation, suggesting a potential role in COPD pathogenesis. This study aimed to investigate the relationship between vitamin D status and lung function in patients with stable COPD. A cross-sectional study was conducted involving 51 stable COPD patients. Spirometry was performed to assess lung function, and serum 25-hydroxyvitamin D [25(OH)D] levels were measured. The association between 25(OH)D levels and lung function parameters, including forced expiratory volume in one second (FEV1), was analyzed using Pearson correlation. The mean age of the participants was 64.05 ± 8.05 years, and all were male. The majority (47.1%) had severe airflow limitation (FEV1 < 30% predicted). The mean 25(OH)D level was 27.57 ± 6.74 ng/mL, indicating insufficiency in most patients. No significant correlation was found between 25(OH)D levels and FEV1 (r = -0.131, p = 0.180). In conclusion, this study did not find a significant association between vitamin D status and lung function in stable COPD patients. Further research, including longitudinal studies and interventional trials, is needed to elucidate the complex relationship between vitamin D and COPD and to determine the potential benefits of vitamin D supplementation in this population.
Lipid Profile as a Predictor of HbA1c in Women with Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcomes. While glycemic control is paramount, the role of lipid profiles in predicting HbA1c levels, a marker of long-term glycemic control, remains under-investigated in Indonesian populations. This observational study enrolled 250 women diagnosed with GDM at the primary healthcare centers in Soppeng Regency. Fasting lipid profiles (total cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol) and HbA1c levels were measured at diagnosis and at 24-28 weeks gestation. Statistical analyses included correlations, regression models, and receiver operating characteristic (ROC) curve analysis. HbA1c levels were significantly correlated with triglyceride and LDL-cholesterol levels at both time points. Regression analysis revealed that triglycerides were the strongest independent predictor of HbA1c. ROC curve analysis showed moderate discriminatory power for triglycerides in predicting elevated HbA1c (AUC 0.72). Lipid profiles, particularly triglycerides, may serve as early predictors of HbA1c levels in women with GDM. These findings underscore the importance of monitoring lipid profiles alongside glucose control in this population.
Healthcare Workers’ Roles and Iron Tablet Adherence among Pregnant Women: A Prospective Cohort Study
Iron deficiency anemia during pregnancy poses significant health risks to both mother and child. The role of healthcare workers in promoting iron tablet adherence is crucial. This study aimed to analyze the influence of healthcare workers' roles (as customer, communicator, motivator, facilitator, and counselor) on pregnant women's adherence to iron tablet consumption. A prospective cohort study was conducted involving pregnant women within the Puskesmas Lut Tawar work area in Aceh Tengah District. Data collection included questionnaires and interviews. The study assessed the relationship between healthcare workers' roles and adherence to iron tablet consumption using statistical analysis. The study found that the role of healthcare workers as counselors had a significant influence on adherence to iron tablet consumption (P = 0.041). Other roles, such as customer, communicator, motivator, and facilitator, did not show a statistically significant impact on adherence. The role of healthcare workers as counselors plays a crucial role in improving pregnant women's adherence to iron tablet consumption. The study recommends enhancing the counseling skills of healthcare workers and providing comprehensive support to pregnant women to address their concerns and challenges related to iron tablet intake.
Enhancing Hospital Efficiency and Patient Outcomes Through Flexible Resident Scheduling: A Meta-Analysis
The traditional, rigid work schedules of medical residents have been linked to fatigue, burnout, and potential adverse effects on patient safety. The implementation of flexible working hours has been proposed as a potential solution to mitigate these risks and improve patient outcomes. This meta-analysis aims to evaluate the impact of flexible resident scheduling on hospital efficiency, patient safety, and resident well-being. A systematic search of electronic databases (PubMed, Embase, Cochrane Library, Web of Science) was conducted to identify studies published between 2014 and 2024 that investigated the effects of flexible resident work hours on patient outcomes, medical errors, length of stay, and resident well-being. The quality of included studies was assessed, and data were extracted for meta-analysis using random-effects models. The meta-analysis included four studies. The results demonstrated that flexible resident scheduling was associated with a significant reduction in prolonged length of stay (pooled odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.06-1.14) and a decrease in medical errors (pooled OR = 0.93, 95% CI = 0.30-2.87). The results highlight the positive correlation between resident flexibility and enhanced patient care efficiency, indicating a decrease in medical errors. The findings of this meta-analysis suggest that implementing flexible resident scheduling can enhance hospital efficiency, improve patient outcomes, and promote resident well-being. Healthcare institutions should consider adopting flexible work-hour policies to optimize patient care and support the professional development of resident physicians.
The Impact of Health Behaviors on Iron Supplementation Adherence and Anemia Prevalence among Pregnant Women: Evidence from a Primary Care Setting in Aceh Tengah, Indonesia
Anemia during pregnancy remains a significant global health concern, particularly in developing countries like Indonesia. However, adherence to iron supplementation programs is often suboptimal, leading to persistent anemia and adverse maternal and neonatal outcomes. This study aimed to investigate the relationship between health behaviors (knowledge, attitudes, and practices) and adherence to iron supplementation among pregnant women in a primary care setting in Aceh Tengah, Indonesia. Additionally, we explored the impact of these factors on anemia prevalence. A cross-sectional study was conducted at the Pegasing Community Health Center in Aceh Tengah, Indonesia. Pregnant women diagnosed with anemia were recruited, and data were collected using questionnaires assessing their knowledge, attitudes, and practices regarding iron supplementation. Hemoglobin levels were measured to determine anemia status. Statistical analyses were performed to examine the relationships between health behaviors, adherence, and anemia prevalence. A total of 59 pregnant women with anemia participated in the study. Adherence to iron supplementation was suboptimal, with 59.3% reporting poor adherence. Knowledge about iron supplementation was generally good (76.3%), but attitudes and practices were less favorable (30.5% and 27.1%, respectively). Statistical analyses revealed a significant association between attitudes and practices related to iron supplementation and adherence. Furthermore, poor adherence was linked to a higher prevalence of anemia. In conclusion, healthy behaviors, particularly attitudes and practices, play a crucial role in iron supplementation adherence among pregnant women in Aceh Tengah, Indonesia. Interventions targeting these behaviors are essential to improve adherence and reduce the burden of anemia in this population.