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Biopsychosocial Factors Associated with Child Growth at Ngembal Kulon Community Health Center, Kudus Th. Catur Wulan Setyaningrum; Bhisma Murti; Dono Indarto
Journal of Epidemiology and Public Health Vol. 2 No. 2 (2017)
Publisher : Masters Program in Public Health

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Background: The first five years of life is widely acknowledged as a sensitive period for child growth. Any interruption exposing during this period may cause problems in child growth. Various internal and external factors can affect child growth. This study aimed to analyze the effects of biopsychosocial factors associated with child growth with life course perspective.Subjects and Method: This was an observational analytic study with cross-sectional design. It was conducted at Ngembal Kulon community health center, Kudus, Central Java, from December 2016 to February 2017. A total sample of 160 children aged 1 to 5 years old and their mothers were selected for this study by purposive sampling. The dependent variable was child growth as measured by weight for age (WAZ) and height for age (HAZ). The independent variables were birth weight, body length at birth, maternal height, number of children, and family income. The data was collected by a set of questionnaire. Child and maternal heights were measured by microtoise. Data on birthweight and body length at birth were obtained from maternal and child health book. Multiple linear regression was used for data analysis.Results: Child growth (WAZ) was associated with family income (b= 0.36; 95% CI= 0.22 to 0.49; p<0.001), birthweight (b= 0.42; 95% CI= 0.25 to 0.58; p<0.001), and number of children (b= -0.25; 95% CI= -0.42 to -0.08; p=0.004). Child growth (HAZ) was associated with family income (b= 0.26; 95% CI= 0.12 to 0.39; p<0.001), body length at birth (b=0.21; 95% CI= 0.12 to 0.30; p<0.001), and maternal height (b= 0.43; 95% CI= 0.27 to 0.58; p<0.001).Conclusion: Child growth (WAZ) is associated with family income, birthweight, and number of children. Child growth (HAZ) is associated with family income, body length at birth, and maternal height. Life course influences were demonstrated in this study.Keywords: child growth, WAZ, HAZ, birthweight, body length at birth, number of children, maternal height, family incomeCorrespondence: Th. Catur Wulan Setyaningrum. Academy of Midwifery Mardi Rahayu, Kudus. Email: theresia.akmr@yahoo.com. Mobile: 085641897987.Journal of Epidemiology and Public Health (2017), 2(2): 130-140https://doi.org/10.26911/jepublichealth.2017.02.02.04

Safe Sexual Behaviors for Early Detection and Prevention of HIV/AIDS Transmission among Queers in Tulungagung, East Java, Using Theory of Planned Behavior Widya Lusi Arisona; Argyo Demartoto; Bhisma Murti
Journal of Epidemiology and Public Health Vol. 2 No. 2 (2017)
Publisher : Masters Program in Public Health

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Background: Sexual intercourse is one of the primary modes of HIV transmission. Sexual activity among heterosexuals has the highest risk of HIV transmission. However, sexual activity among queers also contributed much of the HIV/AIDS case increase. The prevalence of HIV/AIDS infection was high among queers in Tulungagung, East Java. This study aimed to examine safe sexual behaviors for early detection and prevention of HIV/AIDS transmission among queers using Theory of Planned Behavior.Subjects and Method: This was a qualitative study with phenomenology approach. The study was carried out at queers’ peer group namely Aprikot basecamp, Tulungagung, East Java, from 23 April to 17 June, 2017. The informants in this study included queers with positive HIV status and those with negative HIV status. These informants consisted of queer commercial sex workers, queers with steady partner, queers who had recently been registered as Apricot members, queers who had become Apricot members for long, Cesmid NGO, program manager of Local Commision for AIDS Control, health personnels, and officers at District Health Office Tulungagung. The informants were selected by maximum variation sampling. The data were collected using in-depth interview, observation, and document review methods. The data were analyzed by interactive analysis method, including data collection, data reduction, data display, and verification.Results: Five queer informants who worked as commercial sex workers were HIV positive. A queer informant who owned beauty salon had a steady partner. In general, queers had positive attitude towards early detection and prevention of HIV by undertaking regular three monthly HIV tests. The subjective norm in the community was very influential such that all Apricot members always complied with every rule available in the community. As a result, the queers had a stronger intention to do HIV early detection and prevention.Conclusion: Subjective norm is an important determinant for HIV early detection and prevention among queers. It is suggested that the positive norm in the community pertinent to sexual behavior be capitalized and strengtened so as to increase adherence to healthy and safe sexual behaviors among the queers.Keywords: risky sexual behaviors, early detection, prevention, HIV/ AIDS, queerCorrespondence: Widya Lusi Arisona. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: widyalusi@gmail.com. Mobile: +6285646430617.Journal of Epidemiology and Public Health (2017), 2(2): 164-173https://doi.org/10.26911/jepublichealth.2017.02.02.07

Case Study onMulti-Drug Resistance Tuberculosis in Grobogan, Central Java Gunawan Cahyo Utomo; Hermanu Joebagyo; Bhisma Murti
Journal of Epidemiology and Public Health Vol. 2 No. 3 (2017)
Publisher : Masters Program in Public Health

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Background: Tuberculosis is a communicable disease that remains a major public health issue worldwide. Tuberculosis epidemics have become a primary public health concern for the last few decades. The problem becomes aggrevated due to the emergence of Multiple Drugs Resistant Tuberculosis (MDR-TB). It is estimated there are 6,100 MDR-TB cases annually in Indonesia. Grobogan is one of the 6 districts in ex-residentialPatiin Central Java with the second highest MDR-TB cases after Kudus. Between 2011 and 2016 the annual incidence was 23 cases with case fatality rate of 52.17%. This study aimed to investigate the different roles of MDR-TB patients, families, TB progammers, and health providers, in the incidence of MDR-TB in Grobogan, Central Java.Subjects and Method: This was an analytic qualitative study with case study approach. The study was conducted in Grobogan, Central Java, from May to June 2017. A total of 26 informants were selected purposively for this study, consisting of 7 MDR-TB patients, 7 family members who served as drug-taking supervisor, 7 TB programmers at Community Health Centers, 1 TB programmer at District Hospital, 3 Community Health Center doctors, and 1 District Hospital doctor. The data were collected by in-depth interview, direct observation, and document review. Interactive analysis was used to analyze data, including data collection, reduction, presentation, and verification.Results: All MDR-TB patientshad favorable perceived susceptibility, perceived severity, and self-efficacy, that drove them to adhere to TB treatment. Most patients reported that the treatment was beneficial. The existing barrier was not of serious concern that made them to stop treatment.Families of the patients had positive attitude towards TB treatment so they provided the necessary support in acessing treatment and adherence to treatment. However, TB program management at District Hospital, was sub-optimal as it did not administer appropriately the standard DOTS-TB treatment guideline, despite the existence of TB standard operating procedure. Likewise, TB treatment management by hospital doctors and private practice doctors was inadequate, due to the lack of DOTS-TB training. The lack of adherence in implementing thestandard DOTS-TB treatment guideline was the dominant causal factor for the incidence of MDR-TB in Grobogan district, Central Java.Conclusion: Adequate DOTS-TB treatment management and quality health services at both primary and secondary level facilities are needed in the efforts to prevent MDR TB. It is suggested that the government through the District Health Office hold DOTS-TB promotion program and invest in developing skilled DOTS-TB providers.Keywords:multidrug resistance, tuberculosis, TB management program, adherence.Correspondence: Gunawan Cahyo Utomo. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: abuzahra_06@yahoo.com. Mobile: +6281390046456.Journal of Epidemiology and Public Health (2017), 2(3): 186-200https://doi.org/10.26911/jepublichealth.2017.02.03.01

Health Belief Model and PRECEDE PROCEED on the Risk Factors of Multidrug Resistant Tuberculosis in Surakarta, Central Java Vera -; Setyo Sri Rahardjo; Bhisma Murti
Journal of Epidemiology and Public Health Vol. 2 No. 3 (2017)
Publisher : Masters Program in Public Health

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Background: Tuberculosis (TB) is one of the lethal infectious diseases in the world. One of the current biggest challenges of Tuberculosis control is the widespread emergence of Multidrug Resistant Tuberculosis (MDR-TB). There are several potential risk factors of MDR-TB that can be explained by Health Belief Model and PRECEDE PROCEED model framework. This study aimed to analyzed factors associated with MDR-TB using Health Belief Model and PRECEDE PROCEED.Subjects and Method: This was an analytic observational study with case control design. The study was conducted at Dr. Moewardi Hospital and BBKPM, Surakarta, from September to November 2017. The study subjects were selected using fixed disease sampling, consisting of 76 MDR-TB patients and 228 TB patients. The dependent variable was MDR-TB. The independent variables were educational level, self-efficacy, drug-taking adherence, smoking, nutritional status, perceived of susceptibility, perceived barrier, perceived severity, perceived benefit, and drug-taking supervisor. The data were collected using questionnaire and analyzed by path analysis. Results: The risk of MDR-TB was increased by lack of drug-taking adherence (b= -1.69; 95% CI= -2.28 to -1.09; p <0.001), poor nutritional status (b= 1.32; 95% CI= 0.72 to 1.92; p<0.001), and smoking (b= 1.32; 95% CI= 0.72 to 1.92; p <0.001). Drug-taking adherence was increased by perceived susceptibility (b= 0.91; 95% CI= 0.18 to 1.63; p=0.015), perceived severity (b= 1.01; 95% CI= 0.28 to 1.74; p=0.007), perceived benefit (b= 1.69; 95% CI= 0.97 to 2.41; p<0.001), drug-taking advisor (b= 2.16; 95% CI= 1.44 to 2.88; p<0.001), self efficacy (b= 1.58; 95% CI= 0.86 to 2.31; p<0.001), and low perceived barrier (b= -1.10; 95% CI= -1.82 to -0.38; p=0.003). Conclusion: The risk of MDR-TB is increased by the lack of drug-taking adherence, poor nutritional status, and smoking.Keyword: Health belief model, PRECEDE-PROCEED, MDR-TBCorrespondence: Vera. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: vera21210@gmail.comJournal of Epidemiology and Public Health (2017), 2(3): 241-254https://doi.org/10.26911/jepublichealth.2017.02.03.06

Path Analysis on Life Course Factors Affecting Overweight and Obesity in Children Aged 2 to 5 Years Old in Surakarta Uyunun Nudhira; Cri SP Wekadigunawan; Bhisma Murti
Journal of Epidemiology and Public Health Vol. 2 No. 3 (2017)
Publisher : Masters Program in Public Health

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Background: Globally, prevalence of obesity in children under 5 years old has been increasing from 32 million in 1990 to 42 million in 2014. Indonesia ranks highest in the number of obesity cases in South East Asia with prevalence of 11.5% in 2013. However, child overweight and obesity have not been the focus of health problems in Indonesia. Early intervention and prevention of child obesity can reduce long-term risk of chronic diseases in adulthood. This study aimed to analyze the life course factors affecting overweight and obesity in children aged 2 to 5 years old in Surakarta.Subjects and Method: This was an analytic observational study with case control design. The study was conducted in 5 community health centers, Surakarta, from September to October, 2017. A total sample of 150 children aged 2 to 5 years old was selected using fixed disease sampling. The dependent variable was overweight or obesity. The independent variables were nutrition intake, exclusive breastfeeding, starting age of complementary feeding, physical activity, birthweight, age of gestation, sectio cesarea labor, maternal body mass index, and maternal job. Physical activity data was measured using Pre PAQ questionnaire. Other data were collected using a set of questionnaire and maternal and child health monitoring book. The data were analyzed by path analysis.Results: Overweight and obesity in children aged 2 to 5 years old were positively affected by over nutrition intake (b= 1.9; 95% CI= 0.15 to 3.60; p=0.033), high maternal body mass index (b= 2.0; 95% CI= 0.51 to 3.42; p=0.008), and sectio cesarean birth (b= 2.1; 95% CI= 0.56 to 3.73; p=0.008). Overweight and obesity in children aged 2 to 5 years old were negatively affected by normal birthweight (b= -2.2; 95% CI= -4.28 to -0.19; p=0.032), exclusive breastfeeding (b= -2.0; 95% CI= -3.60 to -0.39; p=0.015), timely starting age of complementary feeding (b= -1.3; 95% CI= -2.80 to 0.11; p=0.072), and high physical activity (b= -3.0; 95% CI= -4.63 to -1.37; p=0.001). Birthweight was positively affected by age of gestation (b= 4.2; 95% CI= 1.99 to 6.32; p=0.001) and was negatively affected by maternal body mass index (b= -1.1; 95% CI= -2.11 to -0.13; p=0.025). Exclusive breastfeeding was negatively affected by working outside the house (b= -1.4; 95% CI= -2.10 to -0.72; p= 0.001).Conclusion: Overweight and obesity in children aged 2 to 5 years old are positively affected by over nutrition intake, high maternal body mass index, and sectio cesarean birth. Overweight and obesity in children aged 2 to 5 years old are negatively affected by normal birthweight, exclusive breastfeeding, timely starting age of complementary feeding, and high physical activity.Keyword: life course factors, overweight, obesity, path analysis.Correspondence: Uyunun Nudhira. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: uyununnudhira14@gmail.com. Mobile: +6285253781714Journal of Epidemiology and Public Health (2017), 2(3): 267-283https://doi.org/10.26911/jepublichealth.2017.02.03.08

Biopsychosocial Determinants of Multi Drug Resistant Tuberculosis in Surakarta Lina Alfiyani; Setyo Sri Rahardjo; Bhisma Murti
Journal of Epidemiology and Public Health Vol. 2 No. 3 (2017)
Publisher : Masters Program in Public Health

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Background: Tuberculosis is an infectious disease that poses serious threat to population health worldwide. Tuberculosis control enterprise becomes more complicated due to increasing number of Multi Drug Resistant Tuberkulosis (MDR-TB) cases. Globally there are approximately 580,000 cases of MDR-TB, with only 125,000 cases (20%) resolved. Indonesia ranks tenth in the world by the number of MDR-TB cases after Angola, Azerbaijan, Bangladesh, Belarus, Cina, Korea, Kongo, Etiopia, and India. This study aimed to analyzed the bio-psychosocial determinants of MDR-TB in Surakarta.Subjects and Method: This was an analytic observational study with case control design. The study was conducted in Dr. Moewardi Hospital and BBKPM, Surakarta, from September to November 2017. A sample consisting of 76 MDR-TB patients and 228 non MDR-TB patients were selected for this study by fixed disease sampling. The dependent variable was MDR-TB. The independent variables were age, drug-taking adherence, depression, comorbidity, drug side-effect, drug-taking supervisor, and family income. The data were collected using a set of questionnaire and analyzed by path analysis.Results: MDR-TB was affected by lack of drug-taking adherence (b= -1.7; 95% CI= -2.23 to -1.07; p=0.001) and comorbidity (b= 1.5; 95% CI= 0.76 to 2.30; p=0.001). Drug-taking adherence was affected by depression (b= -1.7; 95% CI= -2.60 to -0.79; p=0.001), drug side effect (b= -1.5; CI 95%= -2.10 to -0.86; p=0.001), and drug-taking supervisor (b=2.5; 95% CI= 1.84 to 3.06; p=0.001). Comorbidity was affected by age (b= 0.86; 95% CI= 0.12 to 1.61; p= 0.022).Conclusion: MDR-TB is directly affected by lack of drug-taking adherence and comorbidity. MDR-TB is indirectly affected by drug-taking supervisor, depression, and drug side effect.Keyword: bio-psychosocial determinants, MDR-TBCorrespondence: Lina Alfiyani. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta, Central Java. Email: linabbt@gmail.com.Journal of Epidemiology and Public Health (2017), 2(3): 255-266https://doi.org/10.26911/jepublichealth.2017.02.03.07

Factors Influencing the Difference between Indonesian Case-Based Group Reimbursement and Medical Cost for Patients with Chronic Renal Disease Cases in Kasih Ibu Hospital, Surakarta Mardhatillah -; Didik Tamtomo; Bhisma Murti
Journal of Health Policy and Management Vol. 2 No. 2 (2017)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Backgorund: JKN program has stipulated the INA CBGs reimbursement for the payment of treatment in referral health facilities, including for chronic renal disease which is a disease burden. This study aimed to analyze factors influencing the difference between Indonesian case-based group reimbursement and medical cost for patients with chronic renal disease cases in Kasih Ibu Hospital, Surakarta.Subjects and Method: The study design was an analytic observational with cross sectional design. The study was conducted in Kasih Ibu Hospital Surakarta in August-October, 2017. With a total of 231 subjects sample which was selected by using proportional random sampling. The dependent variable was the difference between Indonesian case-based group reimbursement and medical cost. The independent variables were length of stay, type of class, medical treatment/ surgery, ICU treatment, and medication use. The data were analyzed using multiple linear regression.Result: INA CBGs reimbursement (mean= Rp 6,120,000; SD= Rp 2,330,000) paid by BPJS Kesehatan was lower than actual hospital’s medical care cost (mean= Rp 7,070,000; SD= Rp 4,650,000). Factors profitable for hospitals were medical treatments/ surgery (b= 0.032; p= 0.552). Factors that inflicted financial loss were class 1 care (b= -0.104; p= 0.094), class 2 care (b= -0.033; p= 0.590) compared to class 3 care, length of stay (b= -0.541; p<0.001), medication use in accordance with national formulation (b= -0.183; p= 0.008) and the use of ICU (b= -0.045; p= 0.543). Patients who upgraded the class type (mean= Rp 5,526,074; SD= Rp 1,449,621) was higher than hospital’s medical cost for class 2 (mean= Rp 3,933,767; SD= Rp 1,887,900).Conclusion: Mean of INA CBGs reimbursement on inpatient care of chronic renal disease is lower than the mean of hospital’s medical care cost. Length of stay and doctors’ compliance in using national medication formulation are important determinants to increase medical care cost. Hospital obtains profit from patients who upgrade type of class.Key words: care cost, INA CBGs reimbursement, chronic renal diseaseCorrespondence: Mardhatillah. Kasih Ibu Hospital, Surakarta, Central Java. Email: mardhatillah.bws@gmail.com. Mobile: 089510610891.Journal of Health Policy and Management (2017), 2(2): 117-127https://doi.org/10.26911/thejhpm.2017.02.02.03

Biopshychosocial and Economic Determinants of Personal Hygiene in the Prevention of Diarrheal Diseases in Sragen District, Central Java Hervindita Dinda Siswandwika; Bhisma Murti; Ruben Dharmawan
Journal of Health Promotion and Behavior Vol. 2 No. 1 (2017)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Background: Poor environmental sanitation and personal hygiene have been shown to be associated with increased risk of diarrheal disease. Poor personal hygiene that is associated with an increased risk of diarrheal disease may be explained by the constructs of Health Belief Model, such as perceived susceptibility and perceived seriousness. This study aimed to examine biopshychosocial and economic determinants of personal hygiene in the prevention of diarrheal diseases.Subjects and Method: This was an analytic observational study with case control design. This study was conducted at Mondokan, Gesi, and Sambungmacan Health Centers, Sragen District, Central java, from January to March, 2017. A sample of 150 subjects, consisting of 50 cases of diarrheal disease during the past month and 100 subjects without diarrheal disease, was selected in this study by purposive sampling. The dependent variable was prevention behavior of diarrheal disease. The independent variable included perceived susceptibility, seriousness, threat, benefit, barrier, cues to action, and self-efficacy. The data was collected using a pre-tested questionnaire, and analyzed by path analysis model. Results: There were positive, and statistically significant effects of perceived seriousness (b= 0.26; SE=0.06; p= <0.001), threat (b= 0.29; SE=0.06; p= <0.001), benefit (b= 0.21; SE= 0.06; p= <0.001), barrier (b= -0.12; SE= 0.08; p= 0.032), cues to action (b= 0.17; SE= 0.07; p= 0.003), and self-efficacy (b= 0.28; SE= 0.14; p= <0.001) on prevention behavior of diarrheal disease. There were positive, indirect, and statistically significant effect of perceived susceptibility (b= 0.55; SE= 0.06; p= <0.001), seriousness (b= 0.34; SE= 0.06; p= <0.001), and benefit (b= 0.12; SE= 0.07; p= 0.025) on prevention behavior of diarrheal disease, via perceived threat.Conclusion: Perceived seriousness, threat, benefit, barrier, cues to action, and self-efficacy, are direct determinants of prevention behavior of diarrheal disease. Perceived susceptibility, seriousness, and benefit, are indirect determinants of prevention behavior of diarrheal disease.Keyword: Biopshychosocial and economy, personal hygiene, Health Belief ModelCorrespondence: Hervindita Dinda Siswandwika. Masters Program in Public Health, Sebelas Maret University. Email: vindy_7@yahoo.com. Mobile: +6282136242777.Journal of Health Promotion and Behavior (2017), 2(1): 1-14https://doi.org/10.26911/thejhpb.2017.02.01.01

Association Between Cigarette Advertisement, Peer Group, Parental Education, Family Income, and Pocket Money with Smoking Behavior among Adolescents in Karanganyar District, Central Java Windiarti Dwi Purnaningrum; Hermanu Joebagio; Bhisma Murti
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: Adolescents are susceptible to positive and negative influences from the social environment. One of the negative influences is smoking behavior. Smoking in adolescents can have deleterous effect on health and academic achievement. This study aimed to determine the association between cigarette advertisement, peer group, parental education, family income, and pocket money on smoking behavior among adolescents.Subjects and Method: This was an analytic observational study using cross-sectional design. This study was carried out in Colomadu Sub district, Karanganyar District, Central Java. A sample of 100 teenagers was selected for this study. The dependent variable was smoking behavior. The independent variables were exposure to cigarette advertisement, peer group, parental education, family income, and pocket money. The data were collected by a set of questionnaire. The data were analyzed by logistic regression.Results: Smoking behavior in adolescents was associated with exposure to cigarette advertisement (OR=22.58; 95% CI =2.42 to 210.69; p=0.006), peer group (OR=44.00; 95% CI =3.99 to 485.33; p=0.002), parental education (OR= 36.92; 95% CI =3.12 to 427.81; p=0.004), family income (OR=0.09; 95% CI= 0.01 to 0.97; p=0.047), and pocket money (OR=10.56; 95% CI=1.22 to 91.56; p=0.032).Conclusion: Smoking behavior in adolescents was associated with exposure to cigerrete advertisement, peer group, parental education, family income, and pocket money.Keywords: cigarette advertisement, peer group, parental education, family income, pocket moneyCorrespondence: Windiarti Dwi Purnaningrum. Health Polytechnics, Ministry of Health, Surakarta. Email: windiartidwi@gmail.com. Phone: +628562995373.Journal of Health Promotion and Behavior (2017), 2(2): 148-158https://doi.org/10.26911/thejhpb.2017.02.02.05

Effectiveness of Practical Integrative Module in Empowering Family Empowering Family of Children with Cerebral Palsy Linda Harumi; Eti Poncorini Pamungkasari; Bhisma Murti
Journal of Health Promotion and Behavior Vol. 2 No. 2 (2017)
Publisher : Masters Program in Public Health, Sebelas Maret University

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Bacground: There is a lack of health care services for children with cerebal palsy (CP) in Indonesia. In addition, family of the children with CP are lacking in skills of CP services. A simple, practical, easily readable modul of CP services for families of children with CP has been developed. This study aimed to analyze effectiveness of practical integrative module in empowering family empowering family of children with CP.Subject and Method: This was a quasi experimental study, consisting of intervention and control groups without randomization. The study was conducted at Child Growth Clinic Dr. Soedjarwadi hospital, Klaten, and YPAC, Surakarta, Central Java. A sample of 100 families of children with CP was selected for this study by purposive sampling. The sample was divided into two groups: 50 families in the intervention group and 50 families in the control group. The independent variable was practical integrative module of CP handling, i.e. the intervention under study. The dependent variables were knowledge, attitude, and level of family empowerment in CP services. The data were collected by a set of questionnaire and analyzed by linear regression.Results: After controlling for knowledge before intervention, average knowledge in the intervention group was 0.84 points higher than the control group (b=0.84; 95% CI= 0.33 to 1.86; p = 0.002). The average attitude in the intervention group was 2.48 points higher than the control group (b=2.48; 95% CI= 0.85 to 4.10; p= 0.003). The average level of family empowerment in the intervention group was 3.41 points higher than the control group (b=3.41; 95% CI= 1.34 to 5.48; p = 0.001).Conclusion: The integrative module of CP handling under study is effective in improving knowledge, attitude, and level of family empowerment in families with CP children.Keywords: knowledge, attitude, empowerment, family, cerebral palsy, children, integrative module, cerebral palsy handlingCorrespondence: Linda Harumi. Department of Occupational Therapy, Health Polytechnics, Ministry of Health, Surakarta. Email: lindaharumi@ymail.com. Mobile : +68170628006Journal of Health Promotion and Behavior (2017), 2(2): 173-182https://doi.org/10.26911/thejhpb.2017.02.02.07

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