International Journal of Public Health Science (IJPHS)
The International Journal of Public Health Science (IJPHS), with p-ISSN 2252-8806 and e-ISSN 2620-4126, is an interdisciplinary journal that publishes papers on all aspects of public health science. This journal is published by Intelektual Pustaka Media Utama (IPMU). The IJPHS provides an ideal forum for authors and readers from all over the world to discuss more sophisticated public health research and practice. The focus is on originality and excellence. The journal welcomes high-impact original research, systematic reviews, methodological studies, and evidence-based perspectives addressing emerging issues across all aspects of public health science and practice. Areas of interest include, but are not limited to, epidemiology and disease surveillance; biostatistics, data science, and public health informatics; global, planetary, environmental, climate, and occupational health; infectious and noncommunicable diseases; mental health and behavioral medicine; nutrition and food systems; maternal, newborn, child, adolescent, family, reproductive, and geriatric health; health promotion and disease prevention; social and community health; health equity, health disparities, and social determinants of health; primary healthcare and rural and urban health; health services, health systems, quality, and patient safety; public health policy, governance, and management; health economics and financing; digital health and health technologies; implementation science, program evaluation, and intervention research; emergency preparedness, disaster and humanitarian health; One Health and emerging health threats; and public health education, ethics, law, and communication. This journal holds SINTA 2 accreditation from the Ministry of Education, Culture, Research, and Technology of the Republic of Indonesia. IJPHS is published quarterly, with issues released in March, June, September, and December. International Peer Reviewed • Open Access • Public Health Journal Advancing Global Public Health Through Research and Innovation Discover high-quality research that contributes to evidence-based public health practice and policy. IJPHS welcomes original research and review articles from researchers, academics, and practitioners worldwide. <a href="/index.php/IJPHS/about/submissions" style=" display:inline-block; background:#0B4F71; color:white; padding:12px 28px; border-radius:30px; margin:5px; font-weight:bold; font-size:14px; text-decoration:none; transition:.3s;" onmouseover="this.style.background='#083B55';this.style.transform='translateY(-3px)';this.style.boxShadow='0 8px 18px rgba(11,79,113,.3)'" onmouseout="this.style.background='#0B4F71';this.style.transform='translateY(0)';this.style.boxShadow='none'"> Submit Manuscript <a href="/index.php/IJPHS/issue/current" style=" display:inline-block; background:#36A9A5; color:white; padding:12px 28px; border-radius:30px; margin:5px; font-weight:bold; font-size:14px; text-decoration:none; transition:.3s;" onmouseover="this.style.background='#27827F';this.style.transform='translateY(-3px)';this.style.boxShadow='0 8px 18px rgba(54,169,165,.3)'" onmouseout="this.style.background='#36A9A5';this.style.transform='translateY(0)';this.style.boxShadow='none'"> Current Issue <a href="/index.php/IJPHS/about/editorialPolicies#focusAndScope" style=" display:inline-block; background:#F2A900; color:white; padding:12px 28px; border-radius:30px; margin:5px; font-weight:bold; font-size:14px; text-decoration:none; transition:.3s;" onmouseover="this.style.background='#C98700';this.style.transform='translateY(-3px)';this.style.boxShadow='0 8px 18px rgba(242,169,0,.3)'" onmouseout="this.style.background='#F2A900';this.style.transform='translateY(0)';this.style.boxShadow='none'"> Aims and Scope
Determinants of tuberculosis treatment adherence through information, motivation, and behavioural skills: a study of TB patients in Serdang Bedagai
Patient non-compliance in undergoing treatment can increase the risk of therapy failure, transmission, and drug resistance. To analyse the treatment adherence strategies of tuberculosis patients through the information, motivation, behavioural skills (IMB) approach. The research uses a quantitative approach with a cross-sectional design. The research sample consists of tuberculosis patients in Serdang Bedagai Regency who were selected using the cluster random sampling technique at several community health centers. Data were collected using a questionnaire based on the variables of information, motivation, and behavioural skills, and then analysed by using structural equation modelling (SEM). The indicators of non-compliance are divided into three main components. The information component includes understanding tuberculosis, increasing nutritional intake, and cough and sneeze etiquette; the motivation component includes exercise and sunbathing, social interaction, and family support; the behavioural skill component includes regular control, mask use, sputum disposal etiquette, and medication schedules. The main findings indicate that information and motivation influence behavioural skills, with the impact of information being stronger than that of motivation. This study concludes that the IMB approach can be used as a basis for strategies to improve medication adherence among tuberculosis patients through the reinforcement of accurate information, sustained motivation, and the formation of regular medication behaviour.
Copyright (c) 2026 Nixson Manurung, Sarida Surya Manurung, Rostinah Manurung http://creativecommons.org/licenses/by-sa/4.0
Post-flood morbidity and associated factors among flood-affected residents: a cross-sectional study in Dak Lak, Vietnam
Floods are among the most frequent natural disasters in Vietnam and may substantially affect community health. This study aimed to investigate post-flood diseases and associated risk factors among residents in Dak Lak Province. A community-based cross-sectional study was conducted among 183 adults in Hoa Le and Krong Kmar communes, Dak Lak Province. Participants were recruited using convenience sampling. Data were collected through face-to-face interviews using a structured questionnaire. Multivariable logistic regression was performed to identify factors associated with post-flood morbidity. Overall, 44.3% of participants reported at least one illness during the flood or within three days thereafter. Respiratory diseases were the most common (12.0%), followed by infectious (9.3%), dermatological (8.2%), gastrointestinal (6.6%), and ocular diseases (3.8%). Female sex (OR = 2.52; 95% CI: 1.31-4.83), emergency evacuation (OR = 5.42; 95% CI: 1.41-20.90), and disruption of essential services (OR = 2.06; 95% CI: 1.01-4.18) were significantly associated with post-flood illness. Flooding was associated with substantial morbidity, particularly respiratory and infectious diseases. Strengthening access to safe water, healthcare services, and disease surveillance may help reduce post-flood health risks in affected communities.
Copyright (c) 2026 Tinh Luu-Viet, Duc Cao-Tien, Nhu-Thao Nguyen-Le, Ngoc-Viet Tran, Duy-Vu Hoang http://creativecommons.org/licenses/by-sa/4.0
Occupational skin diseases: a cross-sectional survey analysis
Occupational skin diseases (OSDs) are among the most common occupational diseases worldwide, yet scientific data in Indonesia remain limited. This issue is important to study because workers across various sectors frequently encounter wet work, detergents, and chemical exposure. The present study aimed to assess individual and occupational risk factors associated with skin complaints/symptoms on the hands and forearms within the past 12 months and to test the feasibility of a simple prediction model in the Indonesian context. A cross-sectional study was conducted among 46 workers participating in health screening. Predictor variables included age, sex, type of occupation, length of employment, frequency of handwashing, shift work, and exposure status. Analysis was performed using Firth’s logistic regression with reporting of odds ratios (OR), 95% confidence intervals (CI), and significance testing. Model performance was evaluated using the Hosmer-Lemeshow test, AUC/ROC, and Nagelkerke’s pseudo-R². The prevalence of skin complaints reached 56.5%. Female workers had a 17-fold higher risk compared to males (OR = 17.20; 95% CI: 1.79-164.77; p = 0.014). The prediction model demonstrated good performance (AUC = 0.90; Hosmer-Lemeshow p = 0.307; Nagelkerke R² = 0.60). Female sex was identified as an important determinant of OSD in this population. The simple prediction model proved feasible for risk screening and could serve as a basis for prevention programs focusing on exposure control in Indonesia. Further studies with larger samples are needed to strengthen evidence across occupational categories.
Copyright (c) 2026 Ineke Winda Ferianasari, Reza Yuridian Purwoko, Evy Aryanti, Azizah Boenjamin, Silvan Saputra, Asmail http://creativecommons.org/licenses/by-sa/4.0
Structural and behavioral determinants of HIV among Indonesian MSM
HIV prevalence among men who have sex with men (MSM) remains disproportionately high in Indonesia. While behavioral risk factors have been widely studied, evidence integrating structural determinants remains limited. This study examined the role of structural and behavioral factors associated with HIV status among MSM in Jambi City, Indonesia. A cross-sectional study was conducted among 60 MSM recruited using non-probability sampling due to the hidden nature of the population. Data were collected using validated structured questionnaires and analyzed using multivariable logistic regression. Fifty percent of respondents were HIV-positive. Low educational attainment emerged as an independent structural determinant of HIV status (AOR = 5.51; 95% CI: 1.14-26.49), whereas behavioral factors showed significant crude associations but lost significance after adjustment. HIV vulnerability among MSM is shaped by structural inequalities beyond individual behaviors. Structural-focused interventions are essential to strengthen HIV prevention strategies in Indonesia.
Copyright (c) 2026 Neila Sulung, Adi Cahya Murfi, Efriza, Nurdin, Cici Apriza Yanti http://creativecommons.org/licenses/by-sa/4.0
Adolescents’ psychological well-being after parental divorce in Indonesia: an interpretative phenomenological analysis
Parental divorce has increased in Indonesia and may adversely affect adolescents’ psychological well-being. However, limited qualitative research has explored how adolescents interpret divorce within the Indonesian sociocultural context. This study aimed to explore adolescents’ experiences of psychological well-being following parental divorce and identify coping processes that foster resilience. A qualitative study using an interpretative phenomenological analysis (IPA) approach was conducted. Semi-structured interviews were carried out with five female adolescents aged 14-15 years who had experienced parental divorce. Participants were purposively recruited from a junior high school in Bekasi, Indonesia. Data were analyzed using IPA to examine lived experiences and meaning-making processes. Three themes emerged: i) self-acceptance and identity reconstruction, ii) relational ecosystems as double-edged support systems, and iii) transition from survival strategies to purposeful autonomy. Participants described grief, self-blame, academic disruption, and social stigma. However, supportive relationships with peers, extended family, and teachers promoted adaptive coping and resilience. These findings highlight that parental divorce affects adolescent psychological well-being, but supportive environments can mitigate negative outcomes. School-based mental health programs, anti-stigma initiatives, and culturally sensitive counseling services are recommended to support adolescents experiencing family transitions.
Copyright (c) 2026 Slametiningsih, Achir Yani S. Hamid, Imami Nur Rachmah, Mustikasari, Raden Irawati Ismail http://creativecommons.org/licenses/by-sa/4.0
Effectiveness of the anemia rematri m-health application on knowledge and attitudes toward anemia among adolescent girls: a quasi-experimental study
Adolescent girls are particularly vulnerable to anemia due to inadequate iron intake, increased physiological demands, and menstrual blood loss. Limited knowledge and unfavorable attitudes toward anemia prevention further exacerbate this problem. Mobile health (m-Health) interventions offer a promising approach to delivering health education tailored to adolescents. This study aimed to evaluate the effectiveness of the Anemia Rematri m-Health application in improving knowledge and attitudes regarding anemia among adolescent girls. A quasi-experimental study with a pretest-posttest control group design was conducted among 108 adolescent girls enrolled in private vocational secondary schools in Palangka Raya, Central Kalimantan, Indonesia. Participants were allocated to either an intervention group (n = 54), which received education through the Anemia Rematri application, or a control group (n = 54), which received educational booklets. Knowledge and attitudes toward anemia were assessed before and after the intervention. The findings revealed significant differences between the intervention and control groups in both knowledge (p < 0.001) and attitudes (p < 0.001). The mean increase in knowledge scores was higher in the intervention group (68.67) than in the control group (40.37). Likewise, the intervention group demonstrated a greater improvement in attitude scores (67.35) compared with the control group (41.65). These findings suggest that the Anemia Rematri m-Health application may contribute to improvements in anemia-related knowledge and attitudes among adolescent girls. The application has the potential to become an innovative strategy for strengthening anemia prevention efforts, particularly through integration into the School Health Program (Usaha Kesehatan Sekolah [UKS]), school-based health promotion initiatives, and digital iron supplementation programs.
Copyright (c) 2026 Greiny Arisani, Seri Wahyuni http://creativecommons.org/licenses/by-sa/4.0
Predictors of blood pressure among adults: the role of lifestyle and body composition
Hypertension is influenced by multiple biological and behavioral factors; however, the relative contributions of body age and body composition remain unclear. This study examined the associations of lifestyle behaviors, body age, and body composition with blood pressure among 167 adults in Indonesia using a cross-sectional design. Lifestyle score, body age, body mass index (BMI), skeletal muscle mass, total body fat percentage, and blood pressure were assessed using standardized procedures. Spearman correlation and multiple linear regression analyses were performed. Body age was the only significant predictor of systolic blood pressure (β = .311, p = .002). In contrast, skeletal muscle mass (β = .172, p = .030) and total body fat percentage (β = .248, p = .017) were significant positive predictors of diastolic blood pressure. Lifestyle score and BMI were not significant predictors in the regression models. These findings suggest that physiological aging and body composition are more strongly associated with blood pressure than lifestyle behaviors. Incorporating body age and body composition assessments into cardiovascular risk screening may improve hypertension prevention and early intervention strategies.
Copyright (c) 2026 Evelin Malinti, Yunus Elon, Mori Agustina br Perangin-angin http://creativecommons.org/licenses/by-sa/4.0
Health locus of control and health behaviour in Minangkabau metabolic disorder patients
Metabolic disorders require sustained health behaviors, yet the psychological predictors of such behaviors may operate differently across cultures. This cross-sectional study examined whether health locus of control (HLOC) predicts multidimensional health behavior among Minangkabau adults with self-reported metabolic disorders in West Sumatra, Riau, and Jambi. A total of 274 participants completed multidimensional HLOC and health behavior scales. Reliability testing, descriptive statistics, Pearson correlations, multiple linear regression, and one-way ANOVA based on dominant HLOC type were conducted. Internal and powerful-others HLOC positively predicted total health behavior, whereas chance HLOC was not significant; however, the overall explanatory power was small (R² = 0.048). Health behavior did not differ meaningfully across dominant HLOC types, with very small effect sizes across diet, sleep, smoking, risky beverage consumption, and exercise (η² < 0.02). These findings suggest that in a collectivistic Minangkabau context, health behavior may be shaped not only by personal control beliefs but also by family, authority, and community norms. The cross-sectional design and self-reported diagnoses limit causal and clinical inference. Family-based education, community leader involvement, and culturally adapted health campaigns are recommended.
Copyright (c) 2026 Rida Yanna Primanita, Alfian Yanda Putra, Puput Nofia Rahma http://creativecommons.org/licenses/by-sa/4.0
Association between sociodemographic factors and mental health status among secondary school students in Cambodia: a cross-sectional study using SDQ
Adolescent mental health significantly influences social well-being and academic achievement, yet empirical data remains scarce in Cambodia. This study examined the association between sociodemographic characteristics and mental health status among Cambodian secondary school students using the Strengths and Difficulties Questionnaire (SDQ). A cross-sectional survey was conducted from March to April 2024 across five major provinces and Phnom Penh. Using purposive sampling, 1,528 students from urban and rural schools were recruited. Abnormal mental health was reported by 50.56% of females and 52.33% of students whose mothers had only elementary education. T-test and ANOVA analyses revealed significant associations between mental health and gender, school location, school type, and maternal education (p < 0.001), while socioeconomic status showed no significant impact. Findings emphasize that gender and maternal education are primary correlates of psychological well-being. These results necessitate gender-responsive school health programs and decentralized mental health services in rural areas. Furthermore, community initiatives should prioritize maternal health literacy to empower mothers as central caregivers, fostering supportive home environments for student resilience.
Copyright (c) 2026 Sophealeaksmy Em, Keisuke Teramoto, Kohei Yamada, Chansean Mam http://creativecommons.org/licenses/by-sa/4.0
Effectiveness of a structured ball game stimulation program on gross motor development among preschool children: a quasi-experimental study in Indonesia
Gross motor development during ages 3-6 years is critical for children's independence and social confidence. This study induced a structured ball play stimulation program in Indonesian children using quasi-experimental design, testing the specific impact on gross motor indicators compared to local PAUD routine activities. This quasi-experimental pretest-posttest control group study assessed ball game stimulation for gross motor development in 143 preschool children in Mataram, Indonesia (intervention n = 72; control n = 71). The intervention delivered structured ball activities three times weekly for six months (August 2025-January 2026): ball introduction, throwing/catching, kicking, and group games. Controls followed the regular curriculum. Outcomes used a standardized gross motor tool. Baseline demographics were homogeneous (age p = 0.998; gender p = 0.921). Results demonstrated dramatic improvements in the intervention group, with the "Normal" category increasing from 9.72% to 94.44%, while the "Doubtful" category decreased from 83.33% to 5.56%, and "Delayed" reached 0%. Conversely, the control group showed deterioration, with "Normal" decreasing to 0% and "Delayed" increasing to 88.73%. Mann-Whitney U test confirmed statistically significant differences between groups at posttest (p = 0.000), with intervention group mean score of 1.00 versus control group 2.79. These findings provide empirical evidence that structured ball game stimulation effectively improves gross motor development in preschool children.
Copyright (c) 2026 Moh. Arip, Ely Mawaddah, Ade Wulandari, Mardiatun, Saskiyanti Ari Andini http://creativecommons.org/licenses/by-sa/4.0
Effectiveness of nursing-led microlearning with spaced reinforcement on sexual violence awareness among rural adolescents in Indonesia
Sexual violence among adolescents remains a major public health concern, particularly in rural areas where access to prevention education is limited. This study evaluated the effectiveness of a nursing-led microlearning intervention with spaced reinforcement in improving adolescents’ awareness of sexual violence. A repeated-measures experimental study was conducted among 120 adolescents aged 13-16 years from rural junior high schools. Participants received either microlearning with spaced reinforcement (n = 60) or leaflet-based education (n = 60). Awareness was assessed at baseline, post-intervention, and four-week follow-up. Data were analyzed using linear mixed-effects models and generalized estimating equations. Baseline awareness scores were comparable between groups. Compared with leaflet education, the microlearning group demonstrated significantly greater improvements immediately after the intervention (β = 9.1, 95% CI: 7.2-11.0, p < 0.001) and maintained higher scores at follow-up (β = 8.6, 95% CI: 6.5-10.7, p <0.001). Sensitivity analyses confirmed consistent findings. Nursing-led microlearning with spaced reinforcement was more effective than leaflet-based education in improving and sustaining adolescents’ awareness of sexual violence. This approach represents a feasible strategy for strengthening school.
Copyright (c) 2026 Risnah, Muthahharah, Eka Hadrayani, Aisyah Bahar, Harmawati, Muhammad Irwan, Sudarman http://creativecommons.org/licenses/by-sa/4.0
E-cigarette knowledge and use among undergraduate students in Oman: a cross-sectional study
The increasing prevalence of electronic cigarette (e-cigarette) uses among youth globally, including in Oman, raises significant public health concerns. Despite a ban on the sale and marketing of e-cigarettes in Oman since 2015, their use remains legal and has increased among university students. This study aims to assess e-cigarette knowledge among students at Sultan Qaboos University (SQU) and examine its association with e-cigarette use. It addresses a gap in the Omani literature, where evidence on e-cigarette knowledge and use among university students remains limited despite existing regulatory restrictions. A cross-sectional survey was conducted to gather data on students' knowledge, and use of e-cigarettes. Among 449 university students, overall knowledge of e-cigarettes was relatively high, with most participants acknowledging their potential health risks and supporting regulatory measures; however, some misconceptions still remained. Students from scientific colleges showed significantly higher knowledge levels than those from humanities colleges (p < 0.05). Although only 12.7% reported ever using e-cigarettes, there was a significant negative correlation between knowledge and use (r = -0.245, p < 0.001), indicating that higher knowledge was associated with lower likelihood of e-cigarette use. The findings suggest the importance of strengthening health education and regulatory efforts to improve e-cigarette awareness and reduce use among university students in Oman.
Copyright (c) 2026 Wafa Al Jabri, Ali Bani Oraba, Sultan Bani Oraba, Lui Al Nadhiri, Osama Al Jamoudi http://creativecommons.org/licenses/by-sa/4.0
Biophysiological responses of premature infants in neonatal nursing care: a descriptive study of infant and maternal characteristics
Preterm infants are physiologically vulnerable and require continuous cardiorespiratory and thermal monitoring during neonatal nursing care. Evidence describing physiological indicators in relation to infant maturity and maternal sociodemographic characteristics remains limited. This study aimed to describe physiological indicators (heart rate, respiratory rate, oxygen saturation, and temperature) among preterm infants and examine their associations with infant and maternal characteristics. An observational descriptive study was conducted from August to December 2025 among preterm infants (<37 weeks of gestation) admitted to a neonatal unit using consecutive sampling. Infant and maternal data were obtained from clinical records, while physiological parameters were collected through routine monitoring. Descriptive statistics and generalized estimating equations were applied (p < 0.05). Of 124 eligible infants, 120 were included. Mean gestational age was 33.2 ± 2.4 weeks and mean birth weight was 1,860 ± 420 g. Mean heart rate was 148.6 ± 14.8 beats/min, respiratory rate was 46.2 ± 8.1 breaths/min, oxygen saturation was 95.1 ± 2.8%, and temperature was 36.6 ± 0.4 °C; 18.3% experienced mild hypothermia. Lower gestational age was associated with higher respiratory rate and lower oxygen saturation, whereas higher birth weight, maternal education, and better economic status were associated with improved oxygenation and thermal stability. These findings support individualized neonatal nursing surveillance and family-centered care. The study was limited by its single-center design and inability to establish causal relationships.
Copyright (c) 2026 Dwi Hastuti, Anggorowati, Zubaidah Zubaidah, Tri Nur Kristina, Siti Yuyun Rahayu Fitri http://creativecommons.org/licenses/by-sa/4.0
Effectiveness of virtual postpartum education classes on maternal knowledge and health-seeking behavior in Kupang City: a pre-post study
Postpartum maternal health services are routinely administered to postpartum mothers four times daily. In reaction to the COVID-19 pandemic, modifications have transpired in healthcare services, encompassing postpartum maternal health. Virtual homecare services facilitate remote interaction with patients without utilizing healthcare services. This study aims to assess the impact of virtual postpartum maternal classes on knowledge, early detection skills, and treatment-seeking behaviors. This study employs a quantitative methodology utilizing a quasi-experimental pretest-posttest design. A virtual postpartum mothers’ class program was conducted every two weeks for three months. The total population consists of 109 individuals, while the purposive sample comprises 32 individuals. Data acquisition through questionnaires (pre-tests and post-tests). Conduct an analysis of the data utilizing the Wilcoxon signed ranks test. The study's findings demonstrate a substantial impact of virtual postpartum mother class mentoring on knowledge levels (p = 0.000), early detection of complications by postpartum mothers (p = 0.001), and treatment-seeking behavior (p = 0.001). The introduction of virtual postpartum maternal classes significantly enhances postpartum mothers' knowledge, their capacity to identify postpartum complications, and their propensity to seek treatment.
Copyright (c) 2026 Ignasensia Dua Mirong, Dewa Ayu Putu Mariana Kencanawati, Odi L. Namangdjabar, Hasri Yulianti, Martina Fenansia Diaz, Diyan Maria Kristin http://creativecommons.org/licenses/by-sa/4.0
Association between exclusive breastfeeding and stunting among toddlers in a high-burden rural community of South Central Timor: a cross-sectional study
This cross-sectional study assessed the relationship between exclusive breastfeeding and stunting among toddlers in Batuputih, South-Central Timor, East Nusa Tenggara, Indonesia. Conducted in July 2025, it involved 52 children aged 6-59 months using total sampling. Exclusive breastfeeding history was obtained through caregiver interviews and verified with health records to reduce recall bias. Height-for-age z-scores were measured using WHO standards, and data were analyzed with Fisher’s exact test and penalized logistic regression with Firth correction to address the small sample size. Stunting prevalence was 59.6%, while exclusive breastfeeding coverage reached 82.7%. All toddlers who were not exclusively breastfed were stunted. Regression analysis confirmed a strong protective effect of exclusive breastfeeding against stunting (OR 0.05; 95% CI 0.003-0.92; p = 0.012), which remained significant after adjusting for birth weight, sex, recent illness, and maternal education. These findings highlight exclusive breastfeeding as a critical protective factor in high-burden rural settings. Yet, the persistence of stunting despite high coverage underscores the need for integrated strategies at the primary health-care and district levels. Strengthening breastfeeding counseling must be complemented by maternal nutrition, infection prevention, and sanitation improvements within broader stunting prevention frameworks tailored to rural Timorese communities.
Copyright (c) 2026 Roslin E. M. Sormin, Emanuel Gerald Alan Rahmat http://creativecommons.org/licenses/by-sa/4.0
Comparative study of hospital stay duration among cesarean section patients using ERACS and conventional care in Lampung, Indonesia
This study is important to evaluate the impact of the effectiveness of the enhanced recovery after cesarean section (ERACS) method compared to conventional care on the length of hospital stay in cesarean patients in Lampung, Indonesia, considering the increasing number of cesarean sections and the need to optimize patient recovery and reduce care costs. This research is a quantitative study using a retrospective observational design. The total population was 210, with 102 samples (51 ERACS groups: 51 conventional groups) taken using purposive sampling. The research was conducted from March to September 2025 at Anugerah Medical Center and Yukum Medical Center Hospital Lampung. Inclusion criteria included cesarean patients aged ≥18 years, with written consent, ERACS, and conventional eligible. Exclusion criteria were complications, previous surgery, and chronic medical conditions. The ERACS group had a mean length of stay of 1.10 days (86.3% stayed 1 day), while the conventional method had a mean length of stay of 2.20 days (78.4% stayed 2 days). The test showed p-value of 0.000, indicating a significant difference between the two groups. The ERACS method proved more effective in reducing length of stay, which is expected to improve hospital quality and performance. This study contributes to health practice by advocating for the adoption of ERACS protocols, which may lead to better resource allocation and more efficient healthcare delivery in the context of increasing cesarean rates.
Copyright (c) 2026 Anita Anita, Muhammad Abduh Musyaffa http://creativecommons.org/licenses/by-sa/4.0
Multimodal non-hormonal intervention with phytoestrogen nutrition and Damask rose aromatherapy improves quality of life in early menopausal women: a quasi-experimental study
Early menopause and perimenopause are increasingly recognized as critical women’s health issues due to their substantial hormonal instability, heightened symptom burden, and negative impact on quality of life. Safe non-hormonal interventions remain limited, particularly in community settings, despite growing evidence supporting phytoestrogens and mind body therapies. This study aimed to evaluate the effectiveness of a 12-week holistic intervention integrating phytoestrogen nutrition, Damask rose aromatherapy, and guided relaxation on hormonal regulation, metabolic markers, menopausal symptoms, and quality of life among early menopausal and perimenopausal women. Using a quasi-experimental design, 44 participants received soy-based dietary supplementation, nightly aromatherapy, and structured relaxation practices, with pre-post assessments of estradiol, lipid profile, fasting glucose, Menopausal Rating Scale (MRS), and Menopause-Specific Quality of Life Questionnaire (MENQOL). The intervention produced significant improvements across all domains, including increased estradiol (p < 0.001), reduced low-density lipoprotein (LDL) and fasting glucose (p = 0.001-0.003), and substantial reductions in menopausal symptoms and psychological distress (p < 0.001). Early menopausal women exhibited greater improvements, reflecting their higher biological sensitivity to multimodal interventions. These findings demonstrate the potential of integrated, non-hormonal strategies to address complex menopausal changes, with practical implications for community-based women’s health programs. Study limitations include the modest sample size and quasi-experimental design, highlighting the need for larger controlled trials.
Copyright (c) 2026 Putri Dewi Anggraini, Ratih Kumala Dewi, Luluk Khusnul Dwihestie, Benedicta Audrey Putri Trisnadewi, Ratih Paramastuti http://creativecommons.org/licenses/by-sa/4.0
Physical-maturation with health education on the incidence of anemia among adolescents who married at a young age
Physical maturity and the incidence of anemia in adolescents who marry at a young age have an impact on the biological and physiological unpreparedness of the adolescent body that is not yet fully mature against the increased risk of anemia, especially in early pregnancy. The solution in this paper provides health education and increased awareness of the dangers of early marriage to physical health, especially the risk of anemia. Nutrition intervention programs and iron supplements for adolescent girls. The purpose of this study was to evaluate the effect of physical maturity on the incidence of anemia in adolescents who marry at a young age. Quantitative research method with quasi-experimental pre-post test design with control group. The population of the study was 54 young women who were married at a young age. The sample size of 44 respondents. Sampling was done using the accidental technique. Data were analyzed using the Chi-square test. The difference in mean hemoglobin levels in adolescents before and after the intervention was analyzed using the paired t-test. Based on the results of statistical test, a p-value of 0.000 was obtained (p-value ≤ 0.05), which indicated that the difference was statistically significant.
Copyright (c) 2026 Desta Ayu Cahya Rosyida, Nyna Puspita Ningrum, Nina Hidayatunnikmah, Solichatin http://creativecommons.org/licenses/by-sa/4.0
Impact of lower limb elevation on blood pressure in cesarean patients: a quasi-experimental study
Among the available anesthetic techniques, spinal anesthesia remains the preferred method for cesarean section procedures, because of its rapid onset and safety profile; however, it is frequently associated with hypotension that may compromise maternal and fetal stability. This study was conducted to assess the influence of lower limb elevation as a non-pharmacological intervention on blood pressure following spinal anesthesia. A one-group pretest-posttest quasi-experimental design was implemented to evaluate 90 cesarean section patients who met the inclusion criteria. Blood pressure values, including systolic and diastolic parameters, were obtained at baseline and at the 5th, 10th, and 15th minutes after spinal anesthesia, and the data analysis using paired t-tests indicated significant increases in systolic and diastolic blood pressure over time, with mean systolic pressure rising from 87.59 mmHg to 97.89 mmHg and mean diastolic pressure increasing from 59.56 mmHg to 67.21 mmHg at minute 15 (p < 0.001). This study provides context-specific clinical evidence on the hemodynamic effects of lower limb elevation among post-spinal anesthesia cesarean section patients in a clinical setting. However, the non-inclusion of a control group and randomization reduce the strength of causal interpretation. These findings provide support for the notion that lower limb elevation may enhance potential benefits as a supportive intervention for post-spinal hypotension and warrant further controlled studies to confirm its efficacy.
Copyright (c) 2026 Suryanto, Widigdo Rekso Negoro, Sindu Sintara, Annes Rindy Permana, Muhammad Rodli, Reko Priyonggo http://creativecommons.org/licenses/by-sa/4.0
Effectiveness and acceptability of a digital early warning system for gestational diabetes management: a quasi-experimental study in Lampung Province
Despite growing evidence supporting digital health interventions for gestational diabetes mellitus (GDM), no study has evaluated the acceptability and effectiveness of such interventions across geographically heterogeneous healthcare settings in low-resource contexts, where disparities in infrastructure and connectivity may critically influence outcomes. This study addresses this gap by introducing and evaluating the Early Warning System for Gestational Diabetes Mellitus (EWSDMG), a novel digital application uniquely designed to function across diverse geographical conditions. A quasi-experimental one-group pre-test post-test design was employed with 200 GDM-diagnosed pregnant women across four sites in Lampung, Indonesia, representing urban, remote, coastal, and rural settings. Technology acceptability was measured using the System Usability Scale (SUS), while knowledge, adherence, and glycemic profiles were assessed before and after 8 weeks of intervention. The overall SUS score was 77.9 ± 6.4 (Good/Acceptable), with urban settings scoring highest (82.4 ± 5.2). Knowledge and adherence scores increased significantly by 26.27 and 24.35 points, respectively (p < 0.001). Fasting and 2-hour post-prandial glucose decreased by 13.3 mg/dL (p = 0.002) and 22.2 mg/dL (p = 0.001), respectively. SUS scores strongly correlated with glycemic improvement (r = 0.642, p < 0.001). This study provides the first evidence that a single digital GDM intervention can achieve consistent acceptability and clinical effectiveness across heterogeneous geographical settings, offering a scalable model for equitable GDM management in resource-limited regions.
Copyright (c) 2026 Aprina Aprina, Anita Anita, Titi Astuti http://creativecommons.org/licenses/by-sa/4.0
Psychological safety as mediator of patient safety culture
Preventable adverse events continue to undermine patient safety globally, yet the psychosocial pathways shaping safety culture remain poorly understood in non-Western hospital settings. This cross-sectional study examines how burnout, job stress, and perceived organizational support influence patient safety culture, with psychological safety as a mediating variable, among 347 healthcare professionals across three Type C hospitals in Jakarta, Indonesia. PLS-SEM results confirm that burnout (β = -0.293) and job stress (β = -0.323) significantly erode psychological safety, while perceived organizational support strengthens it (β = 0.440). Psychological safety, in turn, is the strongest predictor of patient safety culture (β = 0.468) and mediates all three antecedent relationships, with indirect effects of -0.137, -0.151, and +0.206 respectively. The model explains 46.5% of variance in patient safety culture. These findings identify psychological safety as the critical mechanism through which workplace conditions reach safety outcomes, and call for hospital interventions targeting supportive leadership, workload management, and non-punitive reporting environments.
Copyright (c) 2026 Erick Evander, Hendra Achmadi, Timotius William Yusuf http://creativecommons.org/licenses/by-sa/4.0
Association between postoperative pain severity and oxygen saturation: a retrospective cross-sectional study in surgical patients
Postoperative pain is a common clinical problem that may compromise physiological stability and delay recovery, potentially reducing oxygenation, increasing infection risk, and prolonging hospitalization. This study aimed to examine the correlation between postoperative pain intensity and oxygen saturation levels. This study employed a quantitative correlational analytic design with a cross-sectional approach using retrospective medical record data. Data were collected at a single time point, with both postoperative pain intensity and oxygen saturation (SpO₂) measured simultaneously at approximately 12 hours after surgery when patients were clinically stable in the postoperative ward. A total of 208 eligible patients were included using total sampling. Data were analyzed descriptively and using the Chi-square test, with statistical significance set at p < 0.05. The results showed that 74% of patients experienced severe pain and 26% mild pain, while 49.5% presented with reduced oxygen saturation. A statistically significant association was identified between pain intensity and oxygen saturation (p < 0.001). Patients with low oxygen saturation were 25.5 times more likely to report severe pain (OR = 25.505; 95% CI: 6.379-101.979). In conclusion, postoperative pain intensity is significantly associated with oxygen saturation levels. These findings support the integration of subjective pain assessment with objective physiological monitoring, and future prospective studies are recommended to clarify causal relationships.
Copyright (c) 2026 Ircham Saifudin, Widigdo Rekso Negoro, Annes Rindy Permana, Agus Budi Prasetyo, Muhammad Rodli, Sindu Sintara http://creativecommons.org/licenses/by-sa/4.0
Nutritional profile and immunomodulatory potential of a polyherbal honey formulation for stunted children
Stunting remains a major public health challenge in Indonesia and has been linked to immune dysregulation, including increased pro-inflammatory TNF-α and reduced anti-inflammatory IL-4 activity. Nutrient-dense polyherbal supplementation may provide a complementary strategy to support nutritional status and immune function. This experimental study investigated the nutritional composition and immunomodulatory activity of polyherbal honey (PHH) formulated with curcuma xanthorrhiza, black cumin seeds, and honey. Vitamins, minerals, and bioactive constituents were characterized using laboratory assays. The immunomodulatory effects of PHH were subsequently evaluated in HTB-183 cells by measuring IL-4 and TNF-α expression after exposure to different formulation concentrations. The analysis confirmed the presence of vitamins A, C, and E; calcium and potassium; and several bioactive compounds in the PHH formulation. PHH exposure increased IL-4 expression and reduced TNF-α expression relative to untreated cells, although the magnitude of these responses varied across concentrations. These findings demonstrate that PHH contains nutritional and phytochemical constituents with potential immunomodulatory activity. Further preclinical and clinical investigations are required to determine its efficacy and safety as complementary nutritional support for children with stunting.
Copyright (c) 2026 Akrom, Titiek Hidayati, Arif Budi Setianto, Laela Hayu Nurani, Ikhwan Dahlan Rais, Nurkhasanah, Lukman Hardia, Prasasti Bintarum, Muslih Anwar http://creativecommons.org/licenses/by-nc/4.0
Campus life adaptation and dietary patterns among first-year health science students in Indonesia: a cross-sectional study
Adaptation to campus life can be a challenging process for new students and may influence health-related behaviors, including dietary patterns. A preliminary study involving five first-year students showed that they experienced difficulties managing their dietary patterns during their first semester. However, evidence regarding the relationship between adaptation to campus life and dietary patterns among first-year health students in Indonesia remains limited. This study employed a correlational design with a cross-sectional approach and involved 36 respondents. Data were collected using the Student Adaptation to College Questionnaire (SACQ) and the Adolescent Food Habits Checklist (AFHC) and were analyzed using Spearman’s rho correlation test. Most respondents were female (81%), and 69% were in the adolescent age group. The majority of respondents demonstrated a moderate level of adaptation to campus life (92%) and reported healthy dietary patterns (92%). A significant positive correlation was found between adaptation to campus life and dietary patterns (p < 0.001, r = 0.734), indicating that students with higher levels of adaptation tended to have healthier dietary patterns. These findings suggest that institutions should provide campus-based health promotion programs, including student services, counseling, stress management programs, and dietary education.
Copyright (c) 2026 Rukmoyo Endrawan, Daning Widi Istianti http://creativecommons.org/licenses/by-sa/4.0
Red spinach flour substitution in cookies: effects on iron content, antioxidant activity, and sensory acceptability for anemia prevention
Iron deficiency anemia affects approximately 30% of Indonesian women of reproductive age, underscoring the urgent need for affordable, iron-rich food interventions. This study investigated the effect of red Amaranth (Amaranthus tricolor L.) flour substitution on iron content, antioxidant activity, and sensory acceptability of composite flour cookies. A completely randomized design was employed with five substitution levels (0%, 10%, 20%, 30%, and 40%), each with three replications, yielding 15 experimental units of cookie batches. Iron content was determined using atomic absorption spectrophotometry, antioxidant activity via the DPPH method, and sensory acceptability through hedonic testing by 30 semi-trained panelists. Results demonstrated that iron content increased significantly (p < 0.05) with higher substitution levels, while antioxidant activity improved from very weak to moderate categories. However, sensory acceptability declined significantly at substitution levels of 30% and above, particularly in color and taste attributes. The 20% substitution level emerged as the optimal formulation, achieving substantially elevated iron content contributing meaningfully toward the recommended dietary allowance per serving, enhanced antioxidant capacity, and maintained good sensory acceptability across all attributes. These findings suggest that red Amaranth-substituted cookies represent a feasible, community-level dietary strategy for complementing existing iron deficiency anemia prevention programs in Indonesia.
Copyright (c) 2026 Yeni Tutu Rohimah, Dwi Retna Prihati, Titik Lestari http://creativecommons.org/licenses/by-sa/4.0
Integrative functional annotation of rheumatoid arthritis risk genes using a multi-database bioinformatics approach
Rheumatoid arthritis (RA) is an autoimmune disease involving the interaction of genetic and immunological factors. Genome-wide association studies (GWAS) have identified many RA risk loci, but the biological mechanisms linking genetic variation to disease pathogenesis are not yet fully understood. This study aims to prioritize RA candidate genes through a multi-database bioinformatics approach. SNPs significantly associated with RA were obtained from the GWAS catalog, followed by linkage disequilibrium (LD) screening and functional annotation to identify missense variants. The data were integrated with cis-expression quantitative trait loci (cis-eQTL) information, gene ontology (GO) annotation, and Kyoto Encyclopedia of Genes and Genomes (KEGG) molecular pathway mapping. Genes with a total score ≥2 were classified as RA risk genes. A total of 3.145 RA-significant SNPs were identified, of which 58 were missense variants that could potentially affect protein function. The integration of cis-eQTL and functional annotation resulted in a number of candidate genes with the highest scores (score = 4), where TYK2, IL23R, and IRAK1 were identified as priority RA genes in the main immune pathways, namely JAK-STAT signaling, IL-23/Th17 axis, and Toll-like receptor-NF-κB signaling. These findings demonstrate that this multi-database-based bioinformatics approach successfully identifies RA candidate genes with strong biological relevance.
Copyright (c) 2026 Muhammad Nuh, Lolita http://creativecommons.org/licenses/by-sa/4.0
Microplastic exposure in anchovies: baseline evidence from small-island waters of Indonesia
Microplastics are emerging contaminants in aquatic environments and may enter human exposure pathways through seafood consumption. However, baseline exposure data for small pelagic fish in small-island settings remain limited, particularly in Indonesia. Anchovy (Stolephorus spp.), which is commonly consumed whole, may represent a direct dietary exposure pathway. This study aimed to quantify and characterize microplastic contamination in anchovy collected from Dendun Island waters. A descriptive cross-sectional study was conducted in 2025 using 100 anchovy samples obtained from local catches. Microplastics were extracted using oxidative digestion followed by density separation, filtration, and stereomicroscopic observation. Data were analyzed descriptively. A total of 109 microplastic particles were identified, with a mean abundance of 1.09 particles per individual. Fibres dominated (67.0%), followed by films (20.2%) and fragments (12.8%). Various colours were observed, indicating heterogeneous particle characteristics. This study provides baseline evidence of microplastic contamination in anchovy from a small-island coastal setting, highlighting its potential as a dietary exposure pathway. These findings support the need for routine monitoring and strengthened plastic pollution control strategies to protect seafood safety and public health.
Copyright (c) 2026 Veronika Amelia Simbolon, Erpina Santi Meliana Nadeak, Demsa Simbolon, Ristina Rosauli Harianja http://creativecommons.org/licenses/by-sa/4.0
Association between occupational NO₂ exposure and hypertension risk: a PRISMA-based systematic review with risk-of-bias assessment
Nitrogen dioxide (NO₂) is a major air pollutant generated from fossil fuel combustion in transportation and industrial activities and is associated with adverse health effects. Prolonged exposure to NO₂ may induce chronic inflammation and endothelial dysfunction, which contribute to the development of hypertension. This study aimed to systematically review the association between NO₂ exposure and the incidence of hypertension among workers. The review was conducted in accordance with PRISMA guidelines, with literature searches performed in Google Scholar, PubMed, and ScienceDirect for publications from 2020 to 2025. Inclusion criteria comprised full-text articles in English or Indonesian employing observational study designs (cross-sectional, cohort, case-control, or ecological) and involving workers in both formal and informal sectors. Eligible studies examined NO₂ exposure as the independent variable and hypertension as the outcome. Of 2,051 records identified, five studies met the inclusion criteria, originating from China and Nigeria. Risk of bias was assessed using the office of health assessment and translation (OHAT) risk of bias tool. The findings demonstrated a consistent association between NO₂ exposure and an increased risk of hypertension, particularly in poorly ventilated work environments. These results underscore the importance of improving workplace air quality management, strengthening exposure monitoring, and implementing preventive occupational health strategies.
Copyright (c) 2026 Ayudhia Rachmawati, Morrin Choirunnisa Thohira, Muhammad Aidil Fitrah, Vivi Filia Elvira http://creativecommons.org/licenses/by-sa/4.0
Empowering disaster volunteers through a web-based information system for health workforce and logistics coordination
Digital transformation plays a critical role in strengthening disaster management systems, particularly in disaster-prone countries such as Indonesia. Despite the availability of several government-led digital platforms, limited systems integrate volunteer coordination, health workforce mapping, and logistics tracking within a unified framework. This study aimed to develop and evaluate a web-based information system designed to empower disaster volunteers by integrating volunteer profiling, healthcare human resource availability, logistics documentation, and public education features. A mixed-methods descriptive analytical design was employed. Qualitative data were collected through in-depth interviews to identify system requirements and operational challenges, while quantitative data were obtained from structured questionnaires completed by 71 of 75 health-background from TAGANA Rajawali Indonesia Foundation members and at least one disaster respon experience. Descriptive non-parametric analysis informed system design and feature prioritization. Results showed that 100% of respondents supported the development of a digital coordination platform, 94.7% preferred WhatsApp integration for communication, and 86.7% were willing to contribute as digital resource persons for public education. The developed system integrates real-time manpower mapping, logistics tracking, donation management, multimedia documentation, and reporting dashboards. This model addresses a critical gap in volunteer-centered digital disaster management and strengthens community-based preparedness by improving coordination efficiency, transparency, and public health resilience.
Copyright (c) 2026 Emmelia Kristina Hutagaol, Afif Wahyudi Hidayat, Nico Suwarno, Nurali, Joao Manuel Correia Ximenes http://creativecommons.org/licenses/by-sa/4.0
NFC technology improving depressive symptoms in adolescents with depression: quasi-experimental study
Depression is a critical global mental health problem that occurs frequently in adolescent in Thailand and can lead to severe consequences, including suicide. Near field communication (NFC) provides a new way for accessing user to data of mental health care. The objectives this study was to determine the effects of NFC on depressive symptoms. A quasi-experimental two-group pretest-posttest was designed. The provincial school was randomly allocated to the control group CON, NFC groups. Each group consisted 50 participants aged 16-18 years who had depression scores 22 on the Center for Epidemiological Studies-Depression Scale (CES-D). The NFC group used NFC-enabled smartphones and NFC tags for four weeks in their home environment. The first paticipants were assigned developing self awareness, the second were assigned emotional expression, third were assigned coping strategies, the finally the participants were recieved reflection activity, and SC group received standard care and followed their normal daily routines. After completing intervention, participans responded CES-D. The results indicated that depressive symptoms in the NFC group significantly decreased post-intervention compared to the baseline p < .05. Furthermore, the NFC group demonstrated significantly lower depression scores than the control group after completing the program p < .05. In conclusion, NFC technology is an effective decreasing depressive symptom in adolescents with depression.
Copyright (c) 2026 Susaree Prakhinkit, Adjara Titawattanaku http://creativecommons.org/licenses/by-sa/4.0
Bridging the gap: simulation-based training in Nigeria (2015-2025)
Medical education in Nigeria is transitioning from traditional apprenticeship-based training toward competency-based approaches. Simulation-Based Training (SBT) is increasingly recognized as a critical strategy for enhancing clinical competence and patient safety; however, its adoption across Nigeria remains fragmented and under-documented. This review aimed to map the extent, effectiveness, barriers, and future directions of Simulation-Based Training in Nigeria between 2015 and 2025. A PRISMA-ScR-guided systematic scoping review was conducted using peer-reviewed literature published between 2015 and 2025. Fifty-four eligible studies examining the implementation of SBT, outcomes, and contextual challenges across undergraduate and postgraduate health professional education in Nigeria were included. Data were synthesized narratively. Evidence indicates that SBT significantly improves technical skills, clinical decision-making, and learner confidence, particularly in high-risk areas such as neonatal resuscitation, surgical skills training, and obstetric emergencies. Institutional capacity has expanded through early adopters, including the University of Ilorin, the University of Lagos, and the University of Port Harcourt, and was reinforced by a 2025 federal initiative to establish eight national simulation centers. However, key barriers persist, such as high procurement costs (55%), unstable power supply (32%), and a shortage of trained simulation faculty (33%). Innovative low-cost approaches, including mobile virtual reality (mVR) and AI-enabled simulation platforms, emerged as promising alternatives to traditional infrastructure-heavy models. Simulation-based training demonstrates substantial educational value in Nigeria, but remains constrained by financial, infrastructural, and human resource limitations. National policy integration, mandatory simulation hours within MBBS and nursing curricula, and a structured “Training-the-Trainer” program leveraging digital and mobile simulation technologies are essential to achieving sustainable scale-up and improving patient safety outcomes in Nigeria and the wider West African region.
Copyright (c) 2026 Raphael Folorunsho Oluwasina Babatola, Evelyn Funke Folorunsho http://creativecommons.org/licenses/by-sa/4.0