The Effectiveness of Diabetes Self-Management Education Program in Improving Self-Care among Patients with Type 2 Diabetes Mellitus

Background: Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and those at risk for developing the disease. It is necessary in order to prevent or delay the complications of diabetes and has elements related to lifestyle changes that are also essential for individuals with pre diabetes as part of efforts to prevent the disease. This study aimed to examine the effectiveness of diabetes self management education program in improving self-care among patients with type 2 diabetes mellitus. Subjects and Method: A randomized controlled trial study was carried out in 7 puskesmas (community health centers) in Tarakan, North Kalimantan, from March 28 to May 20, 2018. A sample of 126 diabetes patients was selected for this study by simple random sampling, comprising 63 patients as intervention group and 63 patients as control group. The dependent variable was diabetes self-management behavior. The independent variables were diabetes self-management education program (DSME). The data were collected by questionnaire. The difference between two groups was analyzed by t-test. Results: Self-management behavior in the DSME group (median= 26; SD= 6.62) was better than the control group (median= 21; SD= 4.55) with p<0.001. Conclusion: Diabetes self-management education program is effective to improve self-management behaviour among patients with type 2 diabetes mellitus. Keywords: diabetes self-management education, self-management behavior, type 2 diabetes mellitus patien

Path Analysis on the Relationship Between Bio-psychosocial Factors During Gestational Period and Birthweight, Stimulation and Development in Children Aged 1-3 Years in Salatiga

Background: Bio-psychosocial condition during gestational period, such as maternal nutritional status, stress, education, and family income, may have significant impact on fetal growth and development. The purpose of this study was to determine relationship between bio-psychosocial factors during gestational period and birthweight, and the relationship between stimulation and development in children aged 1-3 years.Subjectsand Method: This was an analytic and observational study with case control design. A sample of 120 children aged 1-3 years was selected by fixed disease sampling with case: control ratio= 1:2. The exogenous variables were gestational maternal education and current maternal education. The endogenous variables were gestational family income, gestational maternal stress, current family income, maternal nutritional status, birthweight, stimulation, and child development. The data were collected by a set of questionnaire and analyzed by path analysis on STATA 13.Results:Birthweight ≥ 2.500 gram(b= 0.96; 95%CI= –0.15-1.94; p=0.054) and stimulation (b= 0.43; 95% CI=– 0.30-0.89; p=0.067) had direct positive effect on child development. Gestational maternal education, family income, maternal stress, maternal nutritional status, had indirect effect on child development through birthweight.Maternal education and family income had indirect effect on child development through stimulation.Conclusion: Birthweight ≥ 2.500 gram and stimulation have direct positive effect on child development.Keywords: bio-psychosocial, gestational period, birthweight, stimulation, developmentCorrespondence: Vistra Veftisia. Faculty of Health Sciences, Ngudi Waluyo University, Ungaran, Central Java. Email: [email protected] of Epidemiology and Public Health (2016), 1(3): 154-163https://doi.org/10.26911/jepublichealth.2016.01.03.0

Relationship Between Knowledge and Family Support Regarding Hypertension with Blood Pressure Control in Elderly

Background: Hypertension is one of the degenerative diseases that have frequently been found among the group of elderly. If hypertension goes uncontrolled, then it might escalate and cause complication. The level of knowledge for both of patients and their families in terms of preventive actions toward hypertension complication is expected to be able to control blood pressure. Among the hypertension patients, the role of family support is very important in order to maintain and to control that the blood pressure will not increase and to return it to the normal state. In relation to this background, the objective in conducting this study was to analyze the relationship between knowledge and family support regarding hypertension with blood pressure control among the elderly with hypertension in the Sangkrah Center of Public Health, City of Surakarta.Subjects and Method: This was an analytic observational study with cross sectional design. This study was conducted in Sangkrah Community Health Center in the City of Surakarta on November 2016. A total sample of 147 elderly were selected for this study by purposive sampling. The dependent variables in this study was blood pressure and was measured by sphygnomanometer. The independent variables were knowledge and family support and were collected by a set of questionnaire. The data analyzed by logistic regression.Results: Family knowledge (OR= 0.38; 95% CI= 0.13 to 1.08; p= 0.070) increased the likelihood of blood pressure control. Elderly who came from family with good knowledge regarding hypertension had 0.4 times better blood pressure control in comparison to those who came from family with poor knowledge regarding hypertension. Family support (OR= 0.43; 95% CI= 0.18 to 1.02; p= 0.046) increased the likelihood of blood pressure control. Elderly with good family support had 0.4 times better blood pressure than those who had poor family support.Conclusion: Family knowledge and family support increase the probability of blood pressure control among elderly with hypertension.Keywords: knowledge, family support, blood pressure control, elderlyCorrespondence: Iin Kusumawardana. Masters Program in Family Medicine, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: [email protected] Journal of Medicine (2017), 2(1): 1-9https://doi.org/10.26911/theijmed.2017.02.01.0

Type II Diabetes Mellitus, Physical Activity, Injury, and The Risk of Osteoarthritis

Background: Osteoarthritis (OA) is a major public health problem. It is a source of pain and functional disability, therefore has a very important social and professional impact. This study aimed to analyze the associations of type 2 diabetes mellitus (DM), physical activity, and history of knee injury, with the risk of OA. Subjects and Method: A cross-sectional study was conducted at Dr. Moewardi Hospital, Surakarta, Central Java, in June 2018. A sample of 200 patients was selected by fixed disease sampling, comprising 50 patients with knee OA and 150 patients without knee OA. The dependent variable was knee OA. The independent variables were type 2 DM, history of injury, and physical activity. Data on knee OA were obtained from medical record. The other variables were measured by questionnaire. The data were analyzed by a multiple logistic regression. Results: Knee OA was associated with high physical activity (OR= 2.18; 95% CI= 1.06 to 4.48; p= 0.03), DM (OR= 3.76; 95% CI= 1.83 to 7.74; p<0.001), and history of knee injury (OR= 3.35; 95% CI= 1.63 to 6.90; p=0.001). Conclusion: Knee OA is associated with high physical activity, DM, and history of knee injury. Keywords: knee osteoarthritis, physical activity, diabetes mellitus, history of knee injur

The Asssociations Between Accreditation Status, Patient Socio-Economic Factors, Insurance Type, Patient Perceived Quality of Service, and Satisfaction at Community Health Center

Background: Being one of the most important elements in healthcare system, Community Health Center has been promoted to improve its quality and capacity of services. Accreditation is a method that can be used to improve and measure the quality of health service. Quality service improvement is expected to enhance patient satisfaction. This study aimed to investigate the asssociations between accreditation status, patient socio-economic factors, insurance type, patient perceived quality of service, and satisfaction at Community Health Center.Subjects and Method: This was an analytic observational study with cross-sectional design. This study was conducted at Community Health Center in Surakarta, Central Java from June to July 2017. A total of 8 Community Health Centers with different accreditation status (not accredited, lowest, medium, and highest) were selected for this study. A sample of 200 patients were selected from the 8 Comunity Health Centers by proportional random sampling. The independent variables were accreditation status, patient education level, family income, and insurance type. The dependent variables were perceived quality of service and patient satisfaction. The data were collected by a set of pre-tested questionnaires. Accreditation status was identified from the record at District Health Office. Data were analyzed by path analysis.Results: Patient satisfaction was associated with Commuity Health Center acrreditation status (b=0.39; SE=0.22; p=0.069), perceived quality of service (b=0.05; SE=0.02; p=0.022), patient education level (b=-1.16; SE=0.48; p=0.017), and insurance type (b=0.61; SE=0.31; p=0.044). Perceived quality of health services was associated by accreditation status (b=2.22; SE=0.74; p=0.003), patient education level(b=-4.51; SE=1.68; p=0.007), and insurance type (b=2.79; SE=1.06; p=0.008). Family income did not show statistically significant association with perceived quality of health service (b=-0.17; SE=0.11; p=0.123).Conclusion: Patient satisfaction is associated with Commuity Health Center acrreditation status, perceived quality of service, patient education level, and insurance type. Perceived quality of health services is associated with accreditation status, patient education level, and insurance type.Keywords: patient satisfaction, perceived quality of service, accreditation status, Commuity Health CenterCorrespondence: Farahdila Mirshanti. Masters Program of Public Health, Sebelas Maret University, Jl. Ir. Sutami 36A, Surakarta, Central Java. Email: [email protected]. Mobile: +628121534393.Journal of Health Policy and Management (2017), 1(1): 91-101https://doi.org/10.26911/thejhpm.2017.02.01.0

Evaluation of Community Health Center Management Information System (SIMPUS), Primary Care (P Care), and Bridging Data System in Sukoharjo District

Background: Community health center (puskesmas) management information system or often referred to as SIMPUS is a local health system aimed at providing health information at primary health care level. P Care (Primary Care) application is an information system that is designed to serve BPJS patients. The bridging system links SIMPUS with P care application. These three systems have been used in all puskesmas in Sukoharjo district since 2017. This study aimed to evaluate the implementation of community health center management information system (Simpus), Primary Care (P Care), and bridging data system, in Sukoharjo District, Central Java. Subjects and Method: This was a qualitative study. The study was conducted in Sukoharjo, Kartasura, Bendosari, Mojolaban community health centers, in Sukoharjo District, Central Java, from October to December, 2017. Four community health centers were selected randomly from 13 community health centers in Sukoharjo. The dependent variables were information service, performance, efficiency, and security. The independent variable was health information system (SIMPUS, P care, and bridging system). The data were collected by in-depth interview, direct observation, and document review. Data credibility was checked by triangulation method.Results: Three health information systems (SIMPUS, P care, and bridging system) have been implemented in Sukoharjo District. However, their performance is yet to be improved. Loading time was lengthy and error often occured. Patients often complained of the lengthy service. Some items in the information system form were left blank. Data entry occasionally was inconsistent with examination outcome. Security system of the health information existed, but sometimes unauthorized individuals can access and use that information. There was a lack of human resources and hardware. The health information system had not met the information need.Conclusion: Three health information systems (SIMPUS, P care, and bridging system) have been implemented in Sukoharjo District. However, their performance is yet to be improved. Some obstacles have yet to be resolved.Keyword: evaluation, SIMPUS, P care application, bridging systemCorrespondence: Agung Kurniawan. Masters Program of Public Health, Jl. Ir. Sutami No. 36A Surakarta 57126, Jawa Tengah. E-mail: [email protected]. Mobile +6285257292206.Journal of Health Policy and Management (2017), 2(2): 157-164https://doi.org/10.26911/thejhpm.2017.02.02.0

Relationship between Knowledge and Family Support Regarding Hypertension with Blood Pressure Control in Elders

Background: Hypertension is one of the degenerative diseases that have frequently been found among the group of elders. If hypertension goes uncontrolled, then it might escalate and cause complication. The level of knowledge for both of patients and their families in terms of preventive actions toward hypertension complication is expected to be able to control blood pressure. Among the hypertension patients, the role of family support is very important in order to maintain and to control that the blood pressure will not increase and to return it to the normal state. In relation to this background, the objective in conducting this study was to analyze the relationship between knowledge and family support regarding hypertension with blood pressure control among the elders with hypertension in the Sangkrah Center of Public Health, City of Surakarta. Subjects and Method: This was an analytic observational study with cross sectional design. This study was conducted in Sangkrah Community Health Center in the City of Surakarta on November 2016. A total sample of 147 elders were selected for this study by purposive sampling. The dependent variable in this study was blood pressure and was measured by sphygnomanometer. The independent variables were knowledge and family support and were collected by a set of questionnaire. The data analyzed by logistic regression. Results: Family knowledge (OR= 0.38; 95% CI= 0.13 to 1.08; p= 0.070) increased the likelihood of blood pressure control. Elders who came from family with good knowledge regarding hypertension had 0.4 times better blood pressure control in comparison to those who came from family with poor knowledge regarding hypertension. Family support (OR= 0.43; 95% CI= 0.18 to 1.02; p= 0.046) increased the likelihood of blood pressure control. Elders with good family support had 0.4 times better blood pressure than those who had poor family support. Conclusion: Family knowledge and family support increase the probability of blood pressure control among elders with hypertension. Keywords: knowledge, family support, blood pressure control, elder

Health Belief Model for the Analysis of Factors Affecting Hypertension Preventive Behavior Among Adolescents in Surakarta

Background: Hypertension is an important public health issue in developed and developing countries. The incidence of hypertension continues to rise to a serious level. Raising awareness of the seriousness of hypertension among peer groups may be an important factor for preventive health behavior. This study aimed to examine the used of health belief model for the analysis of factors affecting hypertension preventive behavior among adolescents.Subjects and Method: This study was an observational analytic study with cross sectional design. It was conducted at 5 Vocational High Schools (SMK) in Surakarta from April to May, 2017. A sample of 200 class X and XI SMK students aged 15-17 years was selected for this study by stratified random sampling. The dependent variable was hypertension preventive behavior. The independent variables were perceived susceptibility, perceived seriousness, perceived benefit, perceived barriers, cues to action, and self efficacy, with perceived threat as a mediating variable. The data were collected by a set of pre-tested questionnaire. Path analysis was employed for data analysis using SPSS AMOS 22.Results: Perceived threat (b=0.24, SE=0.07, p=0.002), perceived benefit (b=0.24, SE=0.10, p=0.021), self efficacy (b=0.40, SE=0.23, p=0.084), and cues to action (b=0.45, SE=0.15, p=0.003) showed direct positive effects on hypertension preventive behavior. Perceived barrier (b=-0.26, SE=0.10, p=0.015) showed direct negative effect on hypertension preventive behavior. Perceived susceptibility (b= 0.27, SE= 0.09, p=0.005), perceived seriousness (b=0.29, SE=0.09, p<0.001), and cues to action (b=0.34, SE=0.13, p=0.008) showed indirect positive effects on hypertension preventive behavior.Conclusion: Hypertension preventive behavior is positively and directly affected by perceived threat, perceived benefit, self, and cues to action. The preventive behavior is negatively and directly affected by perceived barrier. Perceived susceptibility, perceived seriousness, and cues to action indirectly and positively affect on hypertension preventive behavior.Keywords: health belief model, hypertension, preventive behavior, adolescentsCorrespondence: Rumeyda Chitra Puspita. Masters Program in Public Health, Sebelas Maret University, Surakarta. Email: [email protected]. Mobile: +6287736044472.Journal of Health Promotion and Behavior (2017), 2(2): 183-196https://doi.org/10.26911/thejhpb.2017.02.02.0

Health Belief Model on The Determinants of Self Care among Patients with Type 2 Diabetes Mellitus

Background: Promoting self-care and self-management behaviors among patients with type 2 diabetes mellitus related have been associated with improved clinical outcomes, fewer complications, enhanced glycaemic control, and quality of life. This study aimed to analyze the determinants of self care among patients with type 2 diabetes mellitus, using Health Belief Model. Subjects and Method: This was a cross sectional study carried out at Dr. Moewardi Hospital, Surakarta, Central Java, from March to April 2018. A sample of 200 type 2 diabetes mellitus patients was selected by total sampling. The dependent variable was self preventive care. The independent variables were perceived severity, perceived susceptibility, and cues to action. The data were collected by questionnaire and analyzed by a multiple logistic regression. Results: Self preventive care in type 2 diabetes mellitus increased with strong perceived susceptibility (OR= 2.56; 95% CI= 1.11 to 5.91; p= 0.027), strong perceived severity (OR= 6.56; 95% CI= 3.03 to 14.22; p<0.001), and cues to action (OR= 4.38; 95% CI= 1.81 to 10.56; p<0.001). Conclusion: Self preventive care in type 2 diabetes mellitus increases with perceived susceptibility, perceived severity, and cues to action. Keywords: type 2 diabetes mellitus, self preventive care, health belief mode

Factors Associated with Quality of Health Services and The Contextual Effect of Community Health Center

Background: The quality of the employees’ workplace environment impacts on their motivation level and hence performance. When employees have the desire, physically and emotionally to work, then their performance shall be increased. Work performance in turn affects the quality of health service. This study aimed to determine factors associated with quality of health service at Puskesmas (community health center) taking account of the contextual effect of Puskesmas as the workplace. Subjects and Method: This was a cross sectional study conducted at Puskesmas Surakarta and Karanganyar, Central Java, from June to July 2018. A total of 25 Puskesmas was selected for this study. A sample of 225 patients was selected for this study. The dependent variable was quality of health service. The independent variables were patient income, health insurance status, educational status, work motivation of the doctor, work satisfaction of the doctor, experience of the doctor, and accreditation of Puskesmas. The data were collected by questionnaire and analyzed by a multilevel logistic regression. Results: The quality of health service in Puskesmas increased with patient income (b= 0.39; 95% CI= 0.19 to 0.59; p<0.001), health insurance status (b= 0.39; 95% CI= 0.22 to 0.64; p<0.001), educational status (b= 0.26; 95% CI= 0.15 to 0.36; p<0.001), work satisfaction of the doctor (b= 0.08; 95% CI= 0.04 to 0.12; p<0.001), and accreditation of Puskesmas (b= 1.90; 95% CI= 1.60 to 2.20; p<0.001). The effects of doctor’s motivation and experiences were not statistically significant. Puskesmas had a substantial contextual effect on the quality of health service with intraclass correlation (ICC) = 34.31%. Conclusion: The quality of health service in Puskesmas increases with patient income, health insurance status, educational status, work satisfaction of the doctor, and accreditation of Puskesmas. Keywords: contextual factor, motivation, work satisfaction, accreditation, quality of health service, Puskesma