Community Medicine and Education Journal

Deconstructing Self-Medication: The Dominance of Attitude and Social Norms over Perceived Control in Non-Prescription Amoxicillin Use

Maria Regina Lusiana Kya — 2025-07-10

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.

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

Dewi Wijayanti — 2025-09-25

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.

Synergistic Undernutrition: The Metabolic Nexus Between Chronic Energy Deficiency and Anemia in Rural Balinese Pregnant Women

I Putu Adigama — 2025-12-12

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.