Pengukuran Kemampuan Belajar Mandiri pada Mahasiswa Pendidikan Profesi Dokter

Self directed learning is autonomy of learners to control their learning process. Capacity to perform self-directed learning can be developed during the learning process. Previous studies showed potential barriers to performing self-directed learning among medical students. This study aimed to analyse difference of self-directed learning capacity among medical students before and after undergoing professional education program in a certain clinical department. This study was an observational study with comparative cross-sectional approach. The subjects were medical students on the professional education program at a certain clinical department at a teaching hospital Surakarta city. Thirty-three students underwent the 4-weeks program from August to September 2012, were selected by purposive sampling. We used the instrument from Fischer, King and Tague, which was further translated into Bahasa Indonesia and validated. Data was analysed using t-test statistical test. The study found no statistically significant difference on average self-directed learning capacity before (149.6) and after (151.9) following the professional education program at a certain clinical department (p=0.47). More studies are needed particularly to investigate alternatives of interventions to increase self-directed learning in the professional phase of medical education. Keywords: Self-directed learning, medical professional education, medical students

Pengaruh kemampuan metakognitif terhadap kemampuan pemecahan masalah pada mahasiswa program akademik dan profesi Fakultas Kedokteran

Problem solving ability is one of several competences that should be mastered by medical graduates. Metacognitive skill, which refers to skills of thinking about thinking, is presumed in the literature to have some relation with problem solving ability. This study aims to investigate the effect ofmetacognitive skill on problem solving ability among medical students of academic and professional programmes at the Faculty of Medicine. This study is analytic and observational, conducted at the Faculty of Medicine, Sebelas Maret University. The study subjects are medical students currentlyundertaking academic or professional programme at the Faculty of Medicine, Sebelas Maret University. Subject were selected purposively by distinguishing sub populations undertaking academic and professional programmes. From each sub population, 20 subjects were selected atrandom to result in a total of 40 subjects for this study. The data were collected by use of a questionnaire that has been previously designed by researchers abroad. The questionnaire was translated from English to Indonesian, modified accordingly, and subsequently tested for its validityand reliability, before use. The data were analyzed employing multiple linear regression model. The results of the regression analysis show that one score in metacognitive skill increases 0.71 score in problem solving ability (?= 0.71; 95%CI 0.37 to 1.06). In addition, students at the professional programme on average have problem solving ability 11.36 scores higher than those at the academic programme (?= 11.36; 95%CI 2.00 to 20.71). This study concludes that there is a statisticallysignfificant effect of metacognitive skill on problem solving ability among medical students at the Faculty of Medicine. After controlling for confounding factors such as learning stages, age, and sex, an increase in metacognitive skill will signficantly increase problem solving ability

Effects of Training and Supervision on Work Performance among Health Workers in Hospital: Meta-Analysis

Background: Performance in an organization is carried out by all existing human resources, both leaders and workers. There are several factors that can affect human resources in carrying out their performance, both factors that come from within human resources and those that come from outside themselves. The purpose of this study was to analyze the effect of training and supervision on the performance of health workers in hospitals, using a meta-analysis of primary studies conducted by previous authors. Subjects and Method: This article was prepared using a systematic review and meta-analytic study. This research was conducted using the PICO model. The meta-analytic study was carried out by searching for articles from databases in electronic form using Google scholar, PubMed, Science direct, and Springerlink. An article search was conducted from 1 to 18 February 2023. The keywords used were “Performance” AND “Training” AND “supervision” AND “health workers” AND “Multivariate” AND “Cross-Sectional”. The inclusion criteria for this study were complete articles using cross-sectional research, published years from 2013-2023. Analysis of the articles in this study used RevMan 5.3 software. Results: A total of 10 cross-sectional studies from Africa and Asia were selected for systematic review and meta-analysis. The results of the meta-analysis show that training can improve performance and supervision can improve performance. Health workers who received training had a large influence on improving performance by 1.68 compared to those who did not receive training (aOR= 1.68; 95% CI= 1.37 to 2.05; p= 0.001). Supervised health workers had an influence on improving performance 2.38 times compared to unsupervised health workers (aOR= 2.38; 95% CI= 1.57 to 3.61; p= 0.009). Conclusion: Training can improve performance and supervision can improve health worker performance.   Keywords: Performance, training, supervision, health workers   Correspondence: Antina Luturmas, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: antinaluturmas@g­mail.com­­. Mobile: +628238720408

Path Analysis on The Biological and Social Life Course Factors Affecting Childs Speech and Language Development Delay

Background: The development in children occurs once during the period of their life. The la­ngu­age ability is an indicator of all the development. The lack of stimulation can cause speech and la­ngu­­age disorders and this disorder can persist. This study aimed to determine the effects of bio­lo­gi­cal and social life course factors on delayed speech and language development.Subjects and Method: This study was an observational analytic with cross-sectional approach, conducted in 25 integrated health posts (posyandu) located in Sleman Regency, Yogyakarta in March to April 2019. The total sample of 225 toddlers was chosen using fixed exposure sampling. The dependent variable was delayed speech and language development. The independent variables we­re income, employment, nutritional status, birth weight, history of toxoplasma, rubella, CMV and TORCH, history of infection, duration of gadget use, language, frequency of posyandu visit, and early childhood education (PAUD). Data collection on delayed speech and language de­ve­lop­ment were measured by Denver II. The data were analyzed by path analysis.Results: Speech and language delayed development was directly decreased with normal birth weight (b= -2.19; 95% CI= -3.58 to -0.79; p= 0.002), employed mother (b = -1.32; 95% CI = -2.38 to -0.27; p = 0.013), good nutritional status (b = -2.14; 95% CI = -3.37 to -0.91; p = 0.001), re­gu­lar­ly attend integrated health post (b = -1.29; 95% CI = -2.31 to -0.26; p = 0.013 ), mono language (b = -1.02; 95% CI = -1.99 to -0.04; p = 0.041), low duration of gadget use (b = -1.59; 95% CI = 0.23 to 2.33; p = 0.017). Speech and language delayed development was directly increased with history of di­sease (b = 1.37; 95% CI = 0.34 to 2.40; p= 0.009), and did not attend Pre-school (b = 1.28; 95% CI = -2.65 to -0.53; p = 0.003). It was indirectly affected by number of children, income, and history of TORCH.Conclusion: Delays in speech and language development are directly influenced by birth weight, infection history, employment, nutritional status, frequency to posyandu (integrated health posts), long usage of gadgets, PAUD (pre-school) and indirectly influenced by income and the number of children.Keywords: the development of speech and language, the use of gadgetsCorrespondence: Merlita Indriasih. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir.Sutami 36A Surakarta 57126, Central Java, Indonesia. Email: [email protected]. Mobile: 085­641097941.Journal of Maternal and Child Health (2019), 4(6): 11-22https://doi.org/10.26911/thejmch.2019.04.06.0

Determinants of Stunting and Child Development in Jombang District

Background: Stunting is a very short body state in children that goes beyond the 2 SD deficit below the child population height. Worldwide stunting affects about 162 million children under five. Indonesia is included in 17 countries that have three nutritional problems in children under five: stunting, wasting, and overweight. This study aimed to investigate the determinants of stunting and child development in children under five.Subjects and Method: This was a retrospective cohort study conducted at Mayangan and Jarak Kulon Community Health Centers, Jombang, East Java, in Januari 2018. A total sample of 58 children were selected for this study by fixed exposure sampling. The dependent variables were stunting and child development. The independent variables were birth-length, maternal age, maternal height, maternal education, and family income. The data were collected by questionnaire. Data on birth length was taken from maternal and child record at community health center. The data were analyzed by path analysis model.Results: The likelihood of good child development increased with maternal education (b= 1.08; 95% CI= 0.41 to 1.75; p= 0.001) and decreased with stunting (b= -0.78; 95% CI= -1.46 to -0.10; p=0.025). The risk of stunting decreased with birth-length (b= -0.90; 95% CI= -1.60 to -0.21; p=0.011) and maternal height (b=-0.92; 95% CI= -1.69 to -0.16; p=0.018). The risk of stunting increased with maternal age <20 y.0. or ≥35 y.o. at pregnancy (b= 0.73; 95% CI= -0.03 to 1.46; p=0.051). The likelihood of maternal age <20 y.0. or ≥35 y.o. at pregnancy decreased with higher education (b=-0.75; 95% CI= -1.44 to -0.06; p=0.033). Birth-length  increased with maternal height (b= 1.07; 95% CI= 0.28 to 1.86; p= 0.008) and higher family income (b=0.93; 95% CI = 0.29 to 1.57; p=0.004). Birth-length decreased with maternal age <20 y.0. or ≥35 y.o. at pregnancy (b=-0.74; 95% CI= -1.48 to -0.01; p=0.047).Conclusion: The likelihood of good child development increases with maternal education and decreases with stunting. The risk of stunting decreases with birth-length and maternal height, and increases with maternal age <20 y.0. or ≥35 y.o. at pregnancy.Keywords: child development, stunting, birth-length, maternal age at pregnancy, maternal education, and family incomeCorrespondence: Vivin Eka Rahmawati. Masters Program in Public Health, Univesitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: [email protected] of Maternal and Child Health (2018), 3(1): 68-80https://doi.org/10.26911/thejmch.2018.03.01.0

Multilevel Analysis on the Biosocial and Economic Determinants of Exclusive Breastfeeding

Background: Exclusive breastfeeding is provided to infants from birth to 6 months of age without supplementary or substitution food and drink. Breastmilk contains nutrients and protective factors that can reduce morbidity and mortality risks of children. This study aimed to determine the effect of maternal nutritional status, parity, employment status, family income, health personnel support, subjective norm, and stratification status of community health center (posyandu), on exclusive breastfeeding in Banjarsari Sub-District, Surakarta.Subjects and Method: This was an analytic observational study with cross sectional design. The study was conducted in Banjarsari sub-district, Surakarta, Central Java, from October 17 to November 7, 2017. Twenty five posyandus were selected by stratified random sampling. Of the posyandus selected, 200 lactating mothers were selected by simple random sampling. The dependent variable was exclusive breastfeeding. The independent variables were maternal nutritional status, parity, employment status, family income, subjective norm, and health personnel support. The data were collected using a set of questionnaire and analyzed by multilevel logistic regression in Stata 13.Results: The likelihood of exclusive breastfeeding increased with better maternal nutritional status (b= 1.65; 95% CI= 0.14 to 3.17; p= 0.032), multi parity (b= 1.72; 95% CI= 0.57 to 2.86; p= 0.003), working outside the house (b= -2.94; 95% CI= -3.99 to -1.88; p= 0.001), higher family income (b= -1.94; 95% CI= -3.13 to -0.76; p= 0.001), strong health personnel support (b= 1.13; 95% CI= 0.02 to 2.25; p= 0.046), and positive subjective norm (b= 1.20; 95% CI= 0.14 to 2.25; p= 0.025). Posyandu showed strong contextual effect on exclusive breastfeeding with intra-class correlation (ICC)= 28.87%.Conclusion: The likelihood of exclusive breastfeeding increases with better maternal nutritional status, multi parity, working outside the house, higher family income, strong health personnel support, and positive subjective norm.Keyword: exclusive breastfeeding, multilevel analysis, maternal nutritional status, parity, employment status, family income, health personnel support, subjective norm, and posyanduCorrespondence: Prabawati Sinta. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A Surakarta. Email: [email protected] of Maternal and Child Health (2017), 2(4): 356-370https://doi.org/10.26911/thejmch.2017.02.04.06

Multilevel Analysis: Factors Associated with Overweight and Obesity in Primary School Children in Surakarta, Central Java

Background: Life course studies have shown that early onset obesity is a risk factor for morbidity and mortality later in life. In both sexes, rates of diabetes, coronary heart disease, atherosclerosis, hip fracture, and gout were increased in those who were overweight as adolescents. Contextual factor at higher level such as school may have indirect effect on the incidence of overweight or obesity through eating behavior. However, studies into factors affecting child obesity in Indonesia using multilevel approach are lacking. This study aimed to examine factors associated with overweight and obesity in primary school children in Surakarta, Central Java, using multilevel analysis.Subjects and Method: A case control study was conducted at 25 primary schools in Surakarta, Central Java, from March to April 2018. A sample of 225 primary school children was selected by fixed disease sampling, consisting of 75 children with overweight or obesity and 150 children with normal weight. The variables of children were placed at the first level of the multilevel model. The potential contextual effect of school was determined at the second level. The dependent variable was overweight or obesity. The independent variables were maternal education, maternal body mass index (BMI), physical activity, family income, and school environment. The data were collected by questionnaire and analyzed by a multilevel logistic regression run on Stata 13.Results: Child overweight or obesity was positively associated with maternal BMI ≥25 (b= 0.11; 95% CI= 0.04 to 0.18; p= 0.002) and high family income (b= 0.04; 95% CI= 0.02 to 0.06; p< 0.001). Child overweight or obesity was negatively associated with high physical activity (b= -0.03; 95% CI= -0.05 to -0.01; p= 0.009). School environment had a negligible contextual effect on child obesity with ICC= 5.08%.Conclusion: Child obesity is positively associated with maternal BMI ≥25 and family income, and is negatively associated with physical activity. School environment has a negligible contextual effect on child obesity.Keywords: obesity, primary school children, maternal body mass index, physical activityCorrespondence: Arum Kusuma Rini. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami No. 36 A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: +6282133044191.Journal of Epidemiology and Public Health (2019), 4(1): 1-8https://doi.org/10.26911/jepublichealth.2019.04.01.0

Are the Leadership Style and Motivation Influence the Work Performance of Health Center Personnel?

Background: The performance of an orga­nization is largely determined by the human resources in it. If the human resources are highly motivated, creative and innovative and are led by leaders who are responsible and have good leadership skills, their performance will be good. This study aims to analyze the influ­ence of the leadership style of the head of the puskesmas and the work motivation of the em­ployees on the performance of the employees of the Puskesmas Ciamis District.Subjects and Method: This study was con­ducted using a cross sectional research design. The study was conducted in Ciamis Regency in November – December 2020. Sampling was carried out using random sampling with a total of 200 puskesmas employees in Ciamis Regen­cy. The dependent variable is employee per­form­ance. The independent variables include leadership style, work motivation, job satisfac­tion, education, treatment status, employee status, length of work. Data were collected by questionnaire and analyzed using a multi­level multiple logistic regression.Results: Good leadership style (b=3.58; 95% CI= 1.11 to 3.80; p= 0.000), high work moti­va­tion (b=3.12; 95% CI= 0.83 to 3.65; p= 0.002), have job satisfaction (b= 2.89; 95% CI= 0.67 to 3.53; p= 0.004), higher education (b= 2.89; 95% CI= 0.60 to 3.13; p= 0.004), inpatient care status (b= 2.66; 95% CI= 0.47 to 3.12; p= 0.008), health personnel status (b=3.68; 95% CI= 1.46 to 4.80; p= 0.000), and length of ser­vice 3 years (b=2.07; 95% CI= 0.78 to 2.76; p= 0.038) increase the possibility of the perform­ance of puskesmas employees. Variations at the puskesmas level show that there is a contextual effect on employee performance (ICC= 11.75%).  Conclusion: There is a positive and statis­tically significant effect on leadership style, work motivation, job satisfaction, educa­tion, treatment status, employee status, length of work on the performance of puskesmas employees. Variations at the puskesmas level show that there is a contextual effect on employee performance.Keywords: employee performance, leadership style, health center, Correspondence: Latty Indriastuti.Masters Program in Public Health, Universitas Sebelas Maret, Surakarta, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: +628999976544.Journal of Health Policy and Management (2021), 06(03): 168-181https://doi.org/10.26911/thejhpm.2021.06.03.02 

Analysis of Inputs in the Sexually Transmitted Infection Screening with Voluntary Counselling and Testing Program for Female Prisoners at Class II A Jail, in Malang

Background: The increasing incidences of Sexually Transmitted Infection (STI) and Human Immonodeficiency Virus (HIV) infection are becoming serious public health concerns in Indonesia and other countries. These issues are of concern  that call for close attention not only for general public but also for male and female prisoners. As studies have shown the prevalences of HIV and syphilis were 1.1% and 5.1% in male prisoners, respectively, 6% and 8.5% in female prisoners. For those reasons,  at some  jails  Voluntary Counseling and Testing (VCT) have been provided  for HIV/AIDS control and prevention. The success of the screening program with VCT would depend on  the provision of supplies, equipment, infrastructure, health personnel, and fund. This study aimed to analyze the adequacy of various inputs in the STI screening program with VCT for prisoners at the Class II A female jail, in Malang, East Java.Subjects and Method: This was a qualitative study with evaluation approach. This study was conducted at the Class II A female jail, in Malang, East Java. The study applied CIPP (Context, Input, Process, Product) evaluation model. Key informants for this study included health personnels at the Class II A female jail clinics, in Malang, East Java, the STI mobile health care team from Arjuno Community Health Center Malang, and female prisoners, who were known as Warga Binaan Pemasyarakatan (WBP)Results: Average monthly visits at the VCT clinic were 21 female prisoners, which amounted to only a few of the total number of female prisoners. The health care team involved in the STI screening with VCT program, included skilled health personnel from the jail and the mobile STI team from Arjuno Community Health Center, Malang. The sources of fund for these programs came from the international as well as domestic funding agencies. The international funding came from the Global Fund. The domestic funding came from the Ministry of Law and Human Civil Rights, and the Municipality Health Office Malang, which provided reagents and medicine. Supplies, equipments, and infrastructure, were provided by Arjuno Community Health Center Malang and the Class II A female jail clinics, in Malang. The laboratory was provided by the health center. The reagents were sufficiently provided by the municipality health office, although there was a supply delay in February 2016.Conclusion: Inputs of the STI screening with VCT program at the Class II A female jail clinics, in Malang, East Java, which included supplies, equipment, infrastructure, health personnel, and funding, are sufficiently provided.    Keywords: analysis, input, screening, STI, VCTCorrespondence: Rosyidah Alfitri. Diploma III School of Midwifery, Dr. Soepraoen Hospital, Malang. Email: [email protected] of Epidemiology and Public Health (2016), 1(2): 118-124https://doi.org/10.26911/jepublichealth.2016.01.02.05Â

Factors Affecting Early Detection and Stimulation by Mothers and their Impact on Receptive Language Skills of Children Age 4 to 6 Years

Background:  Language is a communication tool used by humans since birth. Receptive langu­age can be interpreted as the ability to com­mu­nic­ate symbolically both visual and auditory. Through early detection measures, parents can find out the problem of child growth and deve­lop­­ment early, so that prevention, stimu­lation, heal­ing, and recovery efforts can be given with clear in­di­ca­tions at critical times of the child's growth and development process. Stimulation of child growth and development is carried out by mothers and fathers who are the closest people to children, other family mem­bers, and community groups in their respective households and in everyday life. This study aims to analyze the relationship bet­ween early detection and early stimulation with the receptive language skills of preschool children using the Health Belief Model (HBM) theory. Subjects and Method: This research was con­duc­ted using a cross-sectional research design in Surakarta, from December 2019 - January 2020. A sample of 200 children was selected using a fix­ed disease sampling tech­ni­que. The dependent va­riable is receptive langua­ge ability. The inde­pen­dent variables are per­ception of vulnerability, perception of serious­­­ness, cues to action, and self-efficacy. The intermediate variables are early detection and early stimulation. Data collection using questionnaires and Receptive One-Word Picture Vocabulary Test(ROWPVT), data were analyzed using path analysis with Stata 13.Results: Receptive language skills are improved with mothers who do early detection (b= 0.83 units; 95% CI= 0.19 to 1.47; p= 0.011) and early stimulation (b= 0.87 units; 95% CI= 0.28 to 1.47; p= 0.004).Conclusion: Children's receptive language skills increase with mothers who do early detec­tion and early stimulation. Children's receptive language skills are indirectly affected by per­cep­tion of vulnerability, perception of serious­­ness, cues to action, and self-efficacy through early detection or early stimulation by the mother.Correspondence: Anggi ResinaPutri. Masters Program in Public Health. Universitas Sebelas Maret, Jl. Ir. Su­tami 36A, Surakarta, Central Java, Indo­nesia, 57126. Email: anggiresina­putri­@­gma­il.com. Mo­­bile: 085727387689Journal of Maternal and Child Health (2020), 5(3): 235-242https://doi.org/10.26911/thejmch.2020.05.03.02