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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 Vistra Veftisia; Didik Tamtomo; Muhammad Akhyar
Journal of Epidemiology and Public Health Vol. 1 No. 3 (2016)
Publisher : Masters Program in Public Health

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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: chan_viez@yahoo.comJournal of Epidemiology and Public Health (2016), 1(3): 154-163https://doi.org/10.26911/jepublichealth.2016.01.03.02

The Association Between Maternal Education, Family Income, House Sanitation, and the Incidence of Acute Respiratory Tract Infection in Children Under Five Anita Sri Sulistyo; Didik Tamtomo; Ambar Mudigdo
Journal of Epidemiology and Public Health Vol. 1 No. 3 (2016)
Publisher : Masters Program in Public Health

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Background: It was estimated that the incidence of Acute Respiratory Tract Infection (ARTI), including pneumonia, was 10-20% in children under five in Indonesia. Therefore ARTI in children under five is a public health important that calls for control and prevention. The purpose of this study was to determine the association between maternal education, family income, house sanitation, and the incidence of ARTI in children under five.Subjects and Method: This was an analytic observational study with case control design. This study was conducted in Wonogiri 1 and Kismantoro Health Centers, Wonogiri, Central Java, from September to October, 2016. A total sample of 200 children under five were selected for this study by fixed disease sampling, consisting of 100 children with ARTI and 100 children without ARTI. The dependent variable was pneumonia. The independent variables were maternal education, family income, house component, and house sanitation. The data were collected by a set of questionnaire, checklist, and medical record at the health centers. The data were analyzed by multiple logistic regression.Results: Maternal education ≥senior high school (OR=0.09; 95% CI= 0.03 to 0.22; p<0.001), house component meeting the required standard (OR=0.27; 95% CI= 0.13 to 0.57; p<0.001), and good house sanitation (OR=0.15; 95% CI= 0.06 to 0.38; p<0.001) were associated with decreased risk of pneumonia in children under five, and they were statistically significant. The association between family income and the risk of pneumonia was not statistically significant (OR=0.87; 95% CI= 0.42 to 1.79; p=0.703).Conclusion: Maternal education ≥senior high school, house component meeting the required standard, and good house sanitation are associated with decreased risk of pneumonia in children under five.Keywords: maternal education, family income, house sanitation, pneumonia, children under five Correspondence: Anita Sri Sulistyo. District Health Office Wonogiri, Central Java. Email: anitasrisulistyowati@yahoo.comJournal of Epidemiology and Public Health (2016), 1(3): 195-202https://doi.org/10.26911/jepublichealth.2016.01.03.06

Comparison Between Hospital Inpatient Cost and INA-CBGs Tariff of Inpatient Care in the National Health Insurance Scheme in Solo, Boyolali and Karanganyar Districts, Central Java Indriyati Oktaviano Rahayuningrum; Didik Tamtomo; Arief Suryono
Journal of Health Policy and Management Vol. 1 No. 2 (2016)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: Hospital has an important referral system role in the implementation on the National Health Insurance (NHI) Scheme. BPJS Kesehatan (NHI Implementing Agency) pays hospitals by Indonesian Case Based Groups (INA-CBGs) method. This payment method may potentially cause loss or profit to the hospital, when there is discrepancy between hospital inpatient cost and INA-CBGs tariff of inpatient care. This study aimed at investigating the discrepancy between hospital inpatient cost and INA-CBGs tarif of inpatient care and the determinants of hospital inpatient cost.Subjectsand Method: This was an analytic and observational study cross sectional approach. This study was conducted in 2 publichospitals and 2 private hospitals, from October to December 2016. A total sample of 100 inpatients was selected at random for this study. The dependent variables were hospital inpatient cost and INA-CBGs tariff. The independent variables included hospital type, inpatients class, disease severity, use of ICU, and length of stay. The data were analyzed by a multiple linear regression model.Results:Averagehospital inpatient cost (mean= Rp. 2,280,000; SD=1,690,000) was lower than average INA-CBGs (mean=Rp. 3,060,000). There were negative relationships between hospital type, inpatient class, disease severity, and hospital inpatient cost. Private hospital inpatient cost(b=-5.66;95% CI= -1.20 to 0.06; p= 0.078) was lower than public hospital inpatient cost. Class 2 inpatient care (b= -0.34; 95% CI=-1.09 to 0.41, p =0.371), class 3 inpatient care (b =-0.50; 95% CI =-1.23 to 0.23, p=0.177), had lower hospital inpatient cost than class 1 inpatient care.Severe disease (b=-0.12; 95% CI= -1.95 to 1.71; p= 0.894) had lower hospital inpatient cost than mild disease, although it was not statistically significant. There were positive relationships between use of ICU, disease severity, length of stay, and hospital inpatient cost. Using ICU (b= 1.58; 95% CI= 0.76 to 2.4; p= <0.001) had higher hospital inpatient cost than not using ICU. Moderate disease severity (b= 0.55; 95% CI = -0.20 to 1.30; p= 0.150) had higher hospital inpatient cost than mild disease. Longer stay (b= 0.27; 95% CI= 0.08 to 0.45; p= 0.005) had higher hospital inpatient cost than shorter stay. Conclusion:Average hospital inpatient cost was lower than average INA-CBGs tariff. Hospital type, use of ICU, and length of stay, are important determinants of hospital inpatient cost.Keywords: hospital inpatient cost, INA-CBGs tariff, determinantCorrespondence: Indriyati Oktaviano Rahayuningrum. Faculty of Medicine, Muhammadiyah University Surakarta. Email: indriyatioktaviano@yahoo.comJournal of Health Policy and Management 1(2): 102-112https://doi.org/10.26911/thejhpm.2016.01.02.05

Context, Input, Process, Product Analysis in the Implementation of Iron Supplementation Program in Banyumas, Central Java Purwati -; Didik Tamtomo; Endang Sutisna Sulaeman
Journal of Health Policy and Management Vol. 1 No. 2 (2016)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: Iron supplementation program has been implemented in Banyumas, District, Central Java, but the prevalence of anemia in pregnant women remains as high as 55.37%. The Banyumas District Health Office has launched an ad hoc (temporary) iron supplementation program, namely Hemafort, in order to reduce anemia prevalence. This study aimed to investigate the factors that determine the effectiveness of the iron supplementation program for pregnant women in Banyumas, Central Java.Subjects and Method: This was a qualitative study with case study approach, and CIPP (context, input, process, product) framework. This study was conducted Wangon II and South Purwokerto Health Centers from October to November 2016. Informants were selected by purposive sampling including midwives, nutritional program managers, pharmacists, head of nutrition section, and pregnant women. The data were collected by in-depth interview, observation, and archival review. The data were analyzed by a multiple case study. The data were validated by data source triangulation.Results: The iron tablets coverage for pregnant women reached 94.88% and 89.26% in 2014 and 2015, respectively, in Banyumas. The minimal target of iron coverage for pregnant women was 90%. There was no local government policy or standard operating procedure (SOP) that regulated the efforts to tackle anemia problems in pregnant women. The number of health personnel in charge of nutrition and their competence were sufficient. But reliable budget to tackle anemia problem did not exist. Spending district budget was an exit strategy to take when there was deficiency in central budget allocation. The number of iron supplementation tablets was not guaranteed.Conclusion: The effectiveness of iron supplementation program for pregnant women depends on the existence of relevant policy, SOP, allocation of sufficient and reliable budget, as well as adequate supply of iron tablets.Keywords: iron supplementation tablets, pregnant women, local government, budgetCorrespondence: Purwati. Faculty of Health Sciences, Muhammadiyah University at Purwokerto, Central Java. Email: watix_1006@yahoo.com. Mobile: +6285735145236.Journal of Health Policy and Management (2016), 1(2): 113-120https://doi.org/10.26911/thejhpm.2016.01.02.06

Effect of Doctor’s Personality, Job Characteristic, Payment Method, Facility, on Performance and Quality of Doctor Service Heni Hastuti; Didik Tamtomo; Endang Sutisna Sulaeman
Journal of Health Policy and Management Vol. 2 No. 1 (2017)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: Doctors generally do not work permanently at hospitals. Doctors are expected to deliver quality medical service at the hospitals. However, hospitals often find it difficult to exercise efective managerial control over the quality of medical services. This study aimed to investigate the effect of doctor’s personality, job characteristic, payment method, facility, on performance and quality of doctor service.Subjects and Method: This was an analytic observational study using cross-sectional design. The study was carried out at Dr. Moewardi Hospital and PKU Muhammadiyah Hospital, Surakarta, from March to May 2017. A sample 182 study subjects consisting of 26 doctors, 26 nurses, and 130 patients, were selected for this study by simple random sampling. The dependent variable was quality of doctor service. The independent variables were doctor’s personality (extrovert vs. introvert), doctor’s carefulness, proactive attitude, self-efficacy, autonomy, performance feedback, supervisor support, payment method, work site (private vs. public), and performance. Questionnaire was used to collect data. Path analysis was employed to analyze the data.Results: Good quality of doctor service was directly affected by good performance (b=0.64, SE=0.11, p<0.001), private work site (b= 2.85, SE=0.66, p<0.001), and strong self-efficacy (b=0.21, SE=0.07, p=0.006). Good work performance was affected by extrovert personality (b=0.08, SE= 0.06, p=0.186), careful attitude (b=0.30; SE=0.09; p=0.001), proactive personality (b=−0.17; SE=0.05; p=0.001), strong self-efficacy (b=0.27; SE=0.07; p<0.001), autonomy (b=0.16; SE=0.06; p=0.015), performance feedback (b=0.43; SE=0.13, p<0.001), supervisor support (b=0.14, SE=0.06, p=0.018), payment method (INA CBGs) (b= −2.29; SE= 0.66; p<0.001), and private work site (b= -0.26, SE= 0.68, p=0.696).Conclusion: Good quality of doctor service is directly affected by good performance, private work site, and strong self-efficacy.Keywords: quality, doctor’s service, performance, path analysisCorrespondence: Heni Hastuti. Masters Program in Public Health, Sebelas Maret University, Surakarta. Email: henihastuti.1988@gmail.com Mobile: +6281904534310.The Journal of Health Policy and Management (2017), 2(1): 42-55https://doi.org/10.26911/thejhpm.2017.02.01.04

Health Belief Model: Determinants of Hypertension Prevention Behavior in Adults at Community Health Center, Sukoharjo, Central Java Ratna Setiyaningsih; Didik Tamtomo; Nunuk Suryani
Journal of Health Promotion and Behavior Vol. 1 No. 3 (2016)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: According the WHO the estimated of age standarized prevalence of High blood presure in adults age 25+ years in Indonesia in 2008 was 42.7% in men and 39.2% in women. Hypertension deaths in Indonesia reached 42.226 or 3.02% of total deaths in 2014. Age-adjusted death rate was 25.26 per 100.000 of population (ranked 29 in the world). The prevalence of hypertension in Sukoharjo, Central Java, was 36.827 cases in 2015. This study aimed to examine the determinants hypertension prevention behavior using Health Belief Model.Subjects and Method: This was an analytic and observational study with cross sectional design. This study was conducted in Sukoharjo, Central Java, Indonesia, from September to October 2016. A total of 160 patients visiting Sukoharjo Community Health Center, Sukoharjo, Central Java, was selected for this study by simple random sampling. The sample consisted of 83 (51.9%) patients aged <35 years and 77 (48.1%) patients aged ≥35 years. The exogenous variables were perceived vulnerability, perceived seriousness, cues to action, perceived benefits, perceived barrier, and self efficacy. The endogenous variables were perceived threat and hypertension prevention behavior. The data were collected by questionnaire and analyzed by path analysis.Results: The path model showed goodness of fit with indices as follows: CMIN= 9.03, p=0.172, GFI= 0.99, NFI= 0.99, CFI= 1.00, and RMSEA= 0.06. Self-efficacy (b= 0.11; p<0.001; β=0.31), perceived benefit (b=0.12; p=0.005), and perceived threat (b=-0.10; p<0.001), had positive and statistically significant effect on hypertension prevention behavior. Perceived barrier (b=-0.10; p<0.001) had negative and statistically significant effect on hypertension prevention behavior. Perceived vulnerability (b=0.35; p<0.001), perceived of seriousness (b=0.48; p<0.001), and cues to action (b=0.33; p<0.001) had indirect positive effects on hypertension prevention behavior.Conclusion: Self-efficacy, perceived benefit, and perceived threat, have positive effect on hypertension prevention behavior. Perceived barrier have negative effect on hypertension prevention behavior. Perceived vulnerability, perceived of seriousness, and cues to action have indirect positive effects on hypertension prevention behavior.Keyword: hypertension, prevention behavior, health belief model.Correspondence: Ratna Setyaningsih. School of Nursing Bhakti Mulia, Sukoharjo, Central Java. Email: ratnaa_ zeitiyanie@yahoo.co.id.Journal of Health Promotion and Behavior (2016),1(3): 161-171https://doi.org/10.26911/thejhpb.2016.01.03.03

Path Analysis on the Determinants of the Use of Integrated Health Post and the Application of Theory of Planned Behavior Yuni Fitriani; Didik Tamtomo; Endang Sutisna Sulaeman
Journal of Health Promotion and Behavior Vol. 1 No. 4 (2016)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: Integrated health post (Posyandu) is a strategy for community empowerement. It has an important role to reduce maternal mortality rate (MMR) and infant mortality rate (IMR). The intergrated health post monitors the health of infants, children, pregnant women, lactating women, and women of reproductive age. Weighing coverage of children under five was only 80.4% in Central Java, in 2014. Weighing coverage of children under five was only 78.4 % in Tegal District, in 2015, which was lower than the expected target of 80%. This study aimed to investigate the determinant of of the use of integrated health post and the application of Theory of Planned Behavior (TPB).Subjects and method: This was an analytic observational study with case control design. This study was conducted in Tegal District, Central Java, from 25 September to 25 October 2016. A total sample of 135 mothers with their respective children aged 6-59 months were selected for this study by fixed disease sampling. The dependent variables were intention and use of the integrated health post. The independent variables were constructs of TPB, including attitude toward behavior, subjective norm, and perceived behavior control. The data were collected by a pre-tested set of questionnaire. The data were analyzed by path analysis using IBM SPSS AMOS 22.Results: The path model showed goodness of fit with CMIN=4.24; p=0.120; GFI=0.99; NFI=0.99; CFI=0.99; and RMSEA=0.09. Intention had direct positive and statistically significant effect on the use of the integrated health post (b=0.29; p<0.001). All of the three TPB constructs, including attitude toward behavior (b=0.27; p<0.001), subjective norm (b=0.27; p=0.046), and perceived behavior control (b=0.34; p=0.007) had indirect positive and statistically significant effect on the use of the integrated health post.Conclusion: Intention has direct positive effect on the use of the integrated health post. All of the three TPB constructs, i.e. attitude toward behavior, subjective norm, and perceived behavior control has positive and indirect effect on the use of the integrated health post.Keywords: integrated health post, theory of planned behaviorCorrespondence: Yuni Fitriani. School of Health and Sciences, STIKes Bhakti Mandala Husada Slawi. Email: yfitriani85@yahoo.co.id.Journal of Health Promotion and Behavior (2016), 1(4): 228-237https://doi.org/10.26911/thejhpb.2016.01.04.02

Path Analysis on the Effectiveness of Exclusive Breastfeeding Advocacy Program on Breastfeeding Practice using Theory of Planned Behavior Valentina Dili Ariwati; Didik Tamtomo; Endang Sutisna Sulaeman
Journal of Health Promotion and Behavior Vol. 1 No. 3 (2016)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: Exclusive breastfeeding coverage was 52.30% in 2015, which was below the national target of 80%. For the past few years Klaten local government has launched the Exclusive Breastfeeding Advocacy Program with the objective to increase exclusive breastfeeding coverage. This study aimed to determine the effectiveness of Exclusive Breastfeeding Advocacy Program using Theory of Planned Behaviour framework.Subjects and Method: This was an analytic observational study with retrospective cohort design. This study was conducted from 2 August to 16 September 2016 in Klaten and Magelang, Central Java, Indonesia. A total of 200 lactating mothers of infants aged 6 to 12 months was selected for this study by multi-stage random sampling. The dependent variables were exclusive breastfeeding and intention. The independent variables were exclusive breastfeeding advocacy program, attitude, subjective norm, and perceived behavior control. The data were collected using a set of questionnaire, and analyzed by path analysis.Results: The path model showed Goodness of Fit indices as follows: CMIN=4.24, p=0.374, GFI=0.99, NFI=0.99, CFI=1.00, RMSEA=0.017. Strong intention (b=0.15; p <0.001) had direct effect on exclusive breastfeeding. Positive atittude (b = 0.27; p<0.001), positive subjective norm (b=0.26; p <0.001), strong perception of behavior control (b=0.25; p<0.001), and exclusive breastfeeding advocacy program (b=0.36; p<0.001), had positive effects on intention.Conclusion: Intention has direct effect on exclusive breastfeeding. Atittude toward exclusive breastfeeding, subjective norm, and perception of behavior control, have positive effects on intention. Exclusive breastfeeding advocacy program is effective in increasing the likelihood of providing exclusive breastfeeding.Keywords: exclusive breastfeeding advocacy program, attitude, subjective norm, perceived behavior control, intention, exclusive breastfeeding behavior.Correspondence: Valentina Dili Ariwati. Masters Program in Public Health, Sebelas Maret University.Journal of Health Promotion and Behavior (2016), 1 (3): 149-159https://doi.org/10.26911/thejhpb.2016.01.03.02

Effect of Sexual Knowledge and Attitude, Exposure to Electronic Media Pornography, Peer Group, and Family Intimacy, on Sexual Behaviors among Adolescents in Surakarta Yeni Wardhani; Didik Tamtomo; Argyo Demartoto
Journal of Health Promotion and Behavior Vol. 2 No. 2 (2017)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: Globalization has tremendous impact on adolescent behaviors, including sexual behavior. Sexual behaviors that exceed socially accepted norms may result in undesireable impact adolescent health. Many factors can affect the sexual behavior of adolescents, both from within and from outside the adolescent self. This study aimed to investigate the effect of sexual knowledge and attitude, exposure to electronic media pornography, peer group, and family intimacy, on sexual behaviors among adolescents.Subjects and Method: This was an analytic observational study using cross-sectional design. The study was conducted at SMA Negeri Kota Surakarta, Central Java, from March to April 2017. A sample of 100 students were selected for this study by multi-stage sampling. The dependent variable was sexual behaviour. The independent variables were sexual knowledge, attitude toward sex, exposure to electronic pornography, peer group, and family intimacy. The data were collected by a set of pre-tested questionnaire. Path analysis was employed for data analysis.Results: Adolescent sexual behavior was affected by sexual knowledge (b=0.16; SE=0.05; p=0.006), attitude toward sex (b=0.18; SE=0.06; p= 0.005), exposure to electronic pornography (b=-0.13; SE=0.05; p=0.026), peer group (b=0.06; SE=0.03; p= 0.042), and family intimacy (b=0.07; SE=0.03; p=0.038). Sexual knowledge was affected by exposure to electronic pornography (b=-0.20; SE=0.09; p=0.037), and peer group (b=0.14; SE=0.05; p=0.005). Attitude toward sex was affected by exposure to electronic pornography (b=-0.21; SE=0.08; p=0.013), sexual knowledge (b=0.14; SE=0.08; p=0.110), and group (b=0.12; SE=0.05; p=0.009). Conclusion: Sexual behavior of adolescents is directly affected by their sexual knowledge, attitude toward sex, exposure to electronic pornography, peer group, and family intimacy.Keywords: sexual behavior, exposure to electronic pornography, PRECEDE PROCEED model, path analysisCorrespondence: Yeni Wardhani. Masters Program in Public Health, Sebelas Maret University, Surakarta. Email: ynwardhani@gmail.com. Mobile: +6285244390776.Journal of Health Promotion and Behavior (2017), 2(2): 138-147https://doi.org/10.26911/thejhpb.2017.02.02.04

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