KEPEMIMPINAN KEPALA PUSKESMAS DENGAN TEMPAT PERAWATAN DAN PENGARUHNYA TERHADAP KINERJA PEGAWAI PUSKESMAS DENGAN TEMPAT PERAWATAN DI KABUPATEN KUNINGAN JAWA BARAT

Background:This research is grounded on the fact that thetarget of the health service performance of UPTD PuskesmasDTP has not been reached as shown on the result of theevaluation in 2004. Based on the study at theories, there are acouple at sub-problems which influence the effectiveleadership and the optimal staff’s performance.Methods:  The objective of this research is to look for analternative solution to promote the staff’s performance throughrealizing the effective leadership.This research use descriptive analytical method with crosssectionalsurvey design. The independent variables at theresearch are the leadership style and the leadership situation,while the dependent variable is the staff’s performance. Theresearch measuring instrument use questioners disseminatedto 42 respondents in 6 UPTD Puskesmas DTP throughoutKuningan Regency. The data analysis uses the method at pathanalysis and multiple regressions.Result and conclusion: The research findings that leadershipstyle applied by Heads UPTD Puskesmas DTP are mixed one’swhich consist of directive style, supportive style, delegativestyle, and participative style (multicratic leadership style).Leadership situation covering quality dimension of leader-staff’srelationship, degree of task structure, amount of powerposition, ability of leader, and staff’s maturity is at good category.The staff’s performance of UPTD Puskesmas DTP coveringwork ability (knowledge and skills), initiative, communication,cooperation, planning and organizing, work productivity, worksatisfaction, and rewards is good category.It is suggested that in the effort to promote the staff’sperformance of UPTD Puskesmas DTP, leadership style shallto be applied by Heads of UPTD Puskesmas DTP use styleleadership of mixture among directive leadership style,supportive leadership style, delegative leadership style, andparticipative leadership style, and with interest using manyparticipative leadership style and should be adjusted with thesituation, the level at the staff’s maturity, the gaining ofinformation for problem solving, the time available, andsupported by the management resource and goodcommunication.Keywords: leadership style, leadership situation, personalcharacters of the leaders, staff’s performanc

Multilevel Analysis of Community Health Center, Performance of Health Personnel: Evidence from Ngawi, East Java

Background: Quality health services are one of the priorities and development goals in the health sector. Community Health Center as the first-line public services in the health sector are expected to provide quality services for the community. The quality of health services in community health center can be seen from the performance of the health personnel. This study aims to determine the factors that determine the performance of health personnel in health centers.Subjects and Method: This study used an observational analytic method with a cross sectional approach. The study was conducted in 24 community health center in Ngawi, East Java on June-July 2019. The total sample of 216 health personnel of the community health center was selected based on proportional random sampling. The dependent variable of this study was the perform­ance of health personnel. The independent variables in this study were accreditation status, edu­cation, income, work length, motivation, satisfaction, and workload. The data collections used questionnaires and were analyzed using multilevel linear regression test with Stata 13.Results: The performance of health personnel significantly improved with good accreditation status (b = 2.87; 95% CI= 0.03 to 5.71; p= 0.048), high education (b= 0.63; 95% CI = 0.13 to 1.13; p= 0.013), and high workload (b= 0.86; 95% CI= 0.34 to 1.39; p= 0.001). There was a contextual effect of the performance health personnel (ICC= 53.69%).Conclusion: Good accreditation status, higher education and high work responsibilities increase the performance of the health personnel. There was a contextual effect of health centers on the health personnel.Keywords: performance of health personnel, community health center, multilevel linear regressionCorrespondence:Rahayu Zulaikah, Ngawi Health Office, Jl. S. Parman 25 A, Ngawi, East Java. Email: dokter­[email protected]. Mobile phone: 081946059306Journal of Health Policy and Management (2020), 5(1): 13-22https://doi.org/10.26911/thejhpm.2020.05.01.0

Multilevel Analysis on Factors Affecting Measles Rubella Immunization Uptake among Toddlers in Pekanbaru, Indonesia

Background: Measles-Rubella (MR) immunization is a way to prevent measles and rubella, because the disease cannot be treated and the treatment given to patients is only supportive. Measles and rubella are spread in almost all provinces in Indonesia, so it needs a high and evenly coverage of at least 95% to break the chain of transmission. This study aimed to analyze the determinants of MR immunization uptake in infants.Subjects and Method: This was a cross-sectional study conducted in 25 community health posts (posyandu) in Pekanbaru, Indonesia, from April to May 2019. A sample of 200 mothers who had children aged 9-59 months was selected by stratified random sampling. The dependent variable was Rubella-Measles immunization. The independent variables were maternal education, maternal knowledge, family support, perceived susceptibility, perceived severity, perceived benefit, perceived barrier, cues to action, and self-efficacy. The data were collected by questionnaire and analyzed by a multilevel multiple logistic regression.Results: Measles-Rubella immunization uptake increased with high maternal education (b= 0.66; 95% CI= -0.07 to 1.41; p= 0.080), high maternal knowledge (b= 0.90; 95% CI= 0.14 to 1.65; p= 0.020), strong family support (b= 0.71; 95% CI= -0.05 to 1.48; p= 0.068), high perceived susceptibility (b= 1.24; 95% CI= 0.33 to 2.14; p= 0.007), high perceived severity (b= 1.19; 95% CI= 0.36 to 2.03; p= 0.005), strong perceived benefit (b= 0.93; 95% CI= 0.19 to 1.66; p= 0.013), high cues to action (b= 0.96; 95% CI= 0.19 to 1.73; p= 0.014), and high self efficacy (b= 1.45; 95% CI= 0.59 to 2.31; p= 0.001). It decreased with strong perceived barrier (b= -1.05; 95% CI= -1.81 to -0.29; p= 0.007). Posyandu had a contextual effect on Rubella-Measles immunization with ICC= 10.53%.Conclusion: Measles-Rubella immunization uptake increases with high maternal education, high maternal knowledge, strong family support, high perceived susceptibility, high perceived severity, strong perceived benefit, high cues to action, and high self efficacy. It decreases with strong perceived barrier. Posyandu has a contextual effect on Rubella-Measles immunization.Keywords: Measles, Rubella, immunization, health belief model, multilevel analysisCorrespondence: Wahyuni Rosadi. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: 085271819193.Journal of Maternal and Child Health (2019), 4(6): 448-460https://doi.org/10.26911/thejmch.2019.04.06.06

Effect of Leadership Style of the Head of the Community Health Center and Other Determinants on the Health Personnel Performance in Boyolali, Central Java

Background: Leadership in health services is needed to utilize resources efficiently, design management processes, and encourage health workers to work towards achieving common goals. The purpose of this study was to analyze the effect of leadership style of the head of community health center and other determinants on the performance of health personnel.Subjects and Method: This was an analytic observational study with a cross sectional design. The study was conducted in Boyolali, Central Java, from June to July 2019. A sample of 206 health personnel from 22 community health centers was selected for this study. The dependent variable was the performance of health personnel. The independent variables were perceived transforma­tional leadership, perceived income, type of community health center, accre­ditation status, educa­tion level, tenure, training, community health center, and employee status. The data were collected by questionnaire and analyzed by a multilevel multiple linear regression run on Stata 13.Results: Health personnel performance increased with transformational leadership style (b= 2.23; 95% CI= 0.94 to 3.52; p <0.001), type of health workers (b= 1.80; 95% CI= 0.10 to 3.49; p = 0.037), and accreditation status (b= 3.01; 95% CI= 0.58 to 5.44; p= 0.015). Health personnel performance increased with education ≥Diploma III (b= 0.55; 95% CI= -1.46 to 2.56; p= 0.592), tenure ≥3 years (b= 0.05; 95% CI= -1.49 to 1.59; p = 0.947), adequate income (b= 1.16; 95% CI= -0.10 to 2.42; p= 0.072), and had attended training (b= 0.67; 95% CI= -0.68 to 2.03; p= 0.329), but they were statistically non-significant. Health personnel performance decreased with the status of civil servant (b= -1.32; 95% CI= -3.82 to 1.16; p= 0.298) and treatment status of community health center with hospitalization (b= -2.97; 95% CI = -5.03 to -0.91; p = 0.005).Conclusion: Health personnel performance increases with transformational leadership style, type of health workers, accreditation status, educa­tion ≥Diploma III, tenure ≥3 years, adequate income, and had attended training. Health personnel performance decreases with the status of civil servant and treatment status of community health center with hospitalization.Keywords: transformational leadership style, health personnel, performance.Correspondence:David Marwandi. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: +6281348789393Journal of Health Policy and Management (2020), 5(1): 74-84https://doi.org/10.26911/thejhpm.2020.05.01.0

Effect of Family Hope Program on Maternal Health Behavior and Children Under Five Nutritional Status in Poor Families, Jombang, East Java

Background: Family Hope Program, or internationally referred to as Conditional Cash Transfer (CCT), is a government poverty allevation initiative by provision of conditional cash money that induces healthy behavior so as to achieve strong generation. This study sought to examine the effect of Family Hope Program on maternal health behavior and children under five nutritional status in poor families, Jombang, East Java.Subjects and Method: This was an analytic observational study with retrospective cohort design. This study was conducted in Jombang District, East Java, from November to December 2017. A total sample of 210 mothers and their children under five were selected for this study by fixed exposure sampling. The dependent variables were maternal health behavior and child nutritional status. The independent variables were birthweight, history of illness, maternal education, family income, family support, government Family Hope Program,  and access to health service. The data were collected by maternal and child book record and questionnaire. The data were analyzed by path analysis.Results: The likelihood of good nutritional status of children under five increased with good nutritional intake (b= 1.9; 95% CI= 1.1 to 2.8; p <0.001), normal birthweight (b= 2.5;  95% CI= 0.9 to 4.1; p= 0.002), rare frequency of illness (b= 1.3; 95% CI= 0.5 to 2.1; p= 0.001), and strong family support (b= 1.5; 95% CI= 0.6 to 2.3; p<0.001). The likelihood of maternal healthy behavior increased with Family Hope Program (b= 4.1; 95% CI= 3.1 to 5.0; p <0.001) and higher maternal education (b= 1.9; 95% CI= 0.9 to 2.8; p<0.001). Good nutritional intake increased with maternal healthy behavior (b= 0.4; 95% CI= - 0.04 to 0.85; p = 0.074) and strong family support (b= 0.6; 95% CI = 0.2 to 1.1; p= 0.004).Conclusion: The likelihood of good nutritional status of children under five increases with good nutritional intake, normal birthweight, no history of illness over the past three months, and strong family support. Family Hope Program induces maternal health behavior, increases child nutritional intake, and eventually improves child nutritional status.Keywords: child nutritional status, maternal health behavior, Family Hope ProgramCorrespondence: Sintya Rosalina. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: [email protected]. Mobile 085732761747.Journal of Maternal and Child Health (2018), 3(1): 33-43https://doi.org/10.26911/thejmch.2018.03.01.0

Implementation of Context Input Process Product Model on Healthy Indonesia Program Policy with a Family Approach

Background: The Healthy Indonesia Program with a Family Approach started in 2017, has now reached the first visit coverage rate of 26.80% as of October 3, 2018, with a Healthy Family Index (IKS) value of 0.165. This figure is still far below the expected target, namely in 2019 it is expected that the visit coverage rate has reached &gt;90% so that in 2019 an intervention plan at the com­mu­nity health center (puskesmas) level can be carried out in accordance with the roadmap of the Ministry of Health. This study aimed to investigate the implementation of the context input process product (CIPP) model in the healthy Indonesia program policy with a family approach.Subjects and Method: This research is a qualitative descriptive study using a sample of policy makers and implementers of the Healthy Indonesia program with a Family Approach (PIS – PK), namely: Head of Public Health Center, Head of Health Service Division of Karanganyar District Health Office, Person in Charge of Healthy Indonesia Program, implementer of PIS – PK visits, and the surrounding community. The research was conducted in August 2021. Data were collected by means of document review, in-depth interviews, focus group discussions (FGD), and partici­patory observations. Data is presented in analytical descriptive form.Results: Data were collected from 16 research respondents. In the input aspect, the implemen­tation of PIS PK is supported by sufficient human resources, although there are still gaps in the fulfillment of types of positions. Financial support, infrastructure, methods, implementation time and cross-sectoral support look very good and in accordance with the mandate of the Minister of Health 39 of 2019 concerning PIS PK. There are still problems in the application of healthy families, making the PIS PK output results not in accordance with manual calculations, so that family interventions both individually and in groups cannot be carried out optimally. Not all puskesmas have also implemented total coverage in the implementation of PIS PK, nor have all puskesmas used IKS value data as one of the inputs in planning puskesmas in the form of RUK and RPK.Conclusion: The Healthy Indonesia Program (PIS PK) in Karanganyar Regency can be imple­mented well in terms of context, input and process, but it is still not optimal in the aspect of output because of obstacles in the application of healthy families and the output of PIS PK has not been fully used as a basis for planning at the puskesmas level.Keywords: : context, input, process, product, Healthy Indonesia ProgramCorrespondence: Ninawati. Masters Program in Public Health, Universitas Sebelas Maret. Jalan Ir. Sutami 36A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: 08112632356.Journal of Health Policy and Management (2022), 07(01): 34-45https://doi.org/10.26911/thejhpm.2022.07.01.04.

Associations of Self-efficacy, Family Support, Peer Support, and Posyandu Facility, with Mothers Visit to Posyandu in Karanganyar, Central Java

Background: Integrated service delivery has been defined as the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money. In Indonesia, the integrated service delivery at the village level is called as posyandu (integrated health post) with the support of community health workers working together with formal primary health care workers. This study aimed to examine the associations of self-efficacy, family support, peer support, and posyandu facility, with mothers visit to posyandu in Karanganyar, Central Java.Subjects and Method: This was an analytic observational study with a cross-sectional design. The study was conducted at 25 posyandus in Karanganyar, Central Java, from April 16 to May 15, 2018. A sample of 200 mothers was selected by simple random sampling. The dependent variable was mothers visit to posyandu. The independent variables were self-efficacy, family support, peer support, and posyandu facility. The data were collected by questionnaire and analyzed by a multilevel logistic regression using Stata 13 program.Results: Mothers visit to posyandu was positively associated with self-efficacy (b= 1.90; 95 CI= 0.43 to 3.36; p= 0.011), family support (b= 2.24; 95% CI= 0.81 to 3.67; p= 0.002), peer support (b= 1.98; 95% CI= 0.63 to 3.34; p= 0.004), and posyandu facility (b= 3.86; 95% CI= 1.93 to 5.80; p<0.001). Posyandu had a contextual effect on mothers visit to posyandu with ICC 24.79%.Conclusion: Mothers visit to posyandu is positively associated with self-efficacy, family support, peer support, and posyandu facility. Posyandu has a considerable contextual effect on mothers visit to posyandu.Keywords: integrated health post, mothers visit, self-efficacy, family support, multilevel analysisCorrespondence: Ernawati. Vocational High School of Empat Lima Surakarta, Nursing Academy Insan Husada Surakarta. Email: [email protected] of Maternal and Child Health 2018, 3(3): 233-241https://doi.org/10.26911/thejmch.2018.03.03.0

Meta-analysis on The Effects of Hypertension, Type II Diabetes Mellitus, and Smoking on the Risk of Stroke among Asian Young Adult Population

Background: The incidence of stroke at a young age is reported to increase. Stroke at a young age is still often found in classic risk factors that can be changed such as hypertension, dyslipidemia, and type II diabetes mellitus (type II DM). Control of the right risk factors will affect the incidence of stroke. This study aims to analyze stroke risk factors in young populations in Asia.Subjects and Method: This study is a meta-analysis carried out using PRISMA systematic guide­lines. The article is a study conducted between 2000 until 2019. The process of searching articles using a search engine database consisting of PubMed, Clinical Key, and Google Scholar using the keywords "risk factor", "stroke", "adult", "young adult ", And "Asia". The analysis was done with the Review Manager (RevMan) software 5.3.Results: The results showed eight articles fulfilled the criteria which contained 26,360 samples. The results showed that hypertensive young adults, type II DM, and smoking had a stroke risk at a young age of 6.6 times (OR 6.66; 95% CI 6.10 to 7.27), 3.7 times (OR 3.72; 95% CI 3.17 to 4.38), and 2.6 times (OR 2.64; CI 95% 1.77 to 3.93) higher, than those without hypertension, type II DM, and smoking, and was statistically significant.Conclusion: hypertension, type II diabetes, and smoking are risk factors for stroke at a young age.Keywords: young, adult, stroke, risk factor, meta-analysisCorrespondence: Windhy Monica. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: 082221223355Journal of Epidemiology and Public Health (2019), 4(4): 296-306https://doi.org/10.26911/jepublichealth.2019.04.04.0

Application of Path Analysis on Incidence of Anemia in Female Adolescents

 The aim of the study was to analyse the direct and indirect effects of knowledge, attitudes, and eating behavior on anthropometry status and anemia incidence in female adolescents. This observational study employed case-control design and involved a total with total of female adolescents 117, classified into case groups (n=39) and control groups (n=78). The data were collected using questionnaires on knowledge and attitude about nutrition of anemia and eating behaviors, 2x24 hour food recall, Food Frequency Questionnaire (FFQ), anthropometry, and also Hb level measurement by Cyanmethemoglobin method. The data were analysed using path analysis. The results showed that there was a significant relationship (p&lt;0.05) and direct effects between eating behavior on anthropometry status and incidence of anemia, which accounted for 66% and 22% respectively. There was no relationship (p&gt;0.05) and indirect effects between attitude and incidence of anemia with value 4.1%. Eating behavior had a strong effect on anemia incidence through anthopometry in female adolescents

Does the Integrated Health Post have Contextual Effect on Tertiary Preventive Behavior among Hypertensive Patients? A Multilevel Analysis Evidence from Surakarta

Background: The Indonesian Ministry of Health has launched a community-based non-com­mu­nicable disease (PTM) control program through the non-communicable disease Integrated Deve­lopment Post (Posbindu PTM). One of the non-communicable disease which is a very serious health problem is hypertension which is called the silent killer. The purpose of this study was to analyze the contextual effect of integrated development posts on the tertiary prevention behavior of patients with hypertension using Theory of Planned Behavior.Subjects and Method: A cross sectional study was conducted at 25 integrated health post in Surakarta, from September to October 2019. A sample of 200 hipertensive patients was selected by stratified random sampling. The dependent variable was tertiary prevention behavior. The inde­pendent variables were education, attitude, subjective norm, perceived behavior control, intention, cadre support, and peer support. The data were collected by questionnaire and analyzed by multi­ple logistic regression run on Stata 13.Results: Tertiary prevention behavior in patients with hypertention increased with education level ≥Senior high school (b= 1.22; 95% CI= 0.37 to 2.08; p= 0.005), positive attitude (b= 1.51; 95% CI= 0.54 to 2.48; p= 0.002), supportive subjective norm (b= 1.38; 95% CI= 0.46 to 2.29; p= 0.003), strong perceived behavioral control (b= 1.10; 95% CI= 0.17 to 2.03; p= 0.020), strong intention (b= 0.97; 95% CI= 0.13 to 1.82; p= 0.023), strong integrated development post cadre support (b= 1.57; 95% CI= 0.69 to 2.46; p<0.001), and strong peer support (b= 1.46; CI 95% = 0.57 to 2.35; p = 0.001). Integrated development post had a contextual effect on tertiary prevention behavior of hypertension with intra-class correlation (ICC)= 16.03%Conclusion: Education, attitude, subjective norm, perceived behavior control, intention, cadre support, and peer support increased tertiary prevention behavior of hypertension.Keywords: Tertiary prevention of hypertension, Theory of Planned BehaviorCorrespondence: Angga Ferdianto, Institute of Health Science Ngudia Husada Madura, Jl. RE. Martadinata No. 45 Mlajah, Bangkalan 69116. East Java, Indonesia. Email: [email protected]. Mobile: +628574­6555354Journal of Health Promotion and Behavior (2019), 4(3): 224-234https://doi.org/10.26911/thejhpb.2019.04.03.0