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Perceived importance of structural factors are associated with the selection of primary care by national health insurance participants Putu Nitya Nirmala; Pande Putu Januraga; Putu Ayu Indrayathi
Public Health and Preventive Medicine Archive Vol. 7 No. 2 (2019)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2019.v7.i2.p05

Abstract

Background and purpose: Primary care are the entry point for health services in an insurance-based health financing system, including the National Health Insurance Program or Jaminan Kesehatan Nasional (JKN) in Indonesia. This study aims to understand the association between structural factors in health service management with primary care selection among JKN participants. Methods: The study used a cross sectional analytic design, conducted with 273 self-paid JKN participants in Denpasar as respondents. The samples were selected using multistage random sampling. Data was collected from April to May 2018 with interviews using a questionnaire covering the characteristics of respondents and perceptions on the importance of health care facilities, the capabilities of health providers, service distance, operational time, availability of drugs and medical equipment. Data analysis was carried out with multinomial logistic regression to determine the structural factors of health service management associated with the selection of primary care. Results: Most respondents (65.9%) chose private clinics, 21.3% chose public health centres (PHCs) and 12.8% chose individual practicing physicians. Multivariate analysis showed that the variables which significantly associated with the selection of primary care among JKN participants were the perceived importance of the health care facilities at PHCs and private clinics, each with AOR=7.83 (95%CI: 2.72–22.54) and AOR=7.18 (95%CI: 2.76–18.68), the perceived importance of the capability of health workers in private clinics with AOR=0.29 (95%CI: 0.12–0.77), the perceived importance of health service time in private clinics with AOR=2.67 (95%CI: 1.05–6.74) and history of health services utilization at private clinics with AOR=4.51 (95%CI: 1.86–10.96). Conclusion: Structural factors are associated with the selection of primary care among JKN participants. Attention to the quality and quantity of structural factors in the management of health services is important to improve the equitable distribution of JKN membership in the registered primary care.
Relationship between institution status and the organizational culture of community health centres in Bali Maria Magdalena Zulian Puji Astuti; Ni Made Sri Nopiyani; Pande Putu Januraga
Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i2.p12

Abstract

Background and purpose: The adoption of an appropriate organizational culture model can be instrumental in ensuring the success of an institution. Currently, public health centres (PHCs) in Indonesia are being remodeled to function as independent units managed as regional public service agencies (BLUD). This study aims to determine whether there are differences in the organizational culture of BLUD PHCs with non BLUD PHCs. Methods: Survey was conducted with 142 staff from BLUD PHCs and with 109 staff from non BLUD PHCs, selected using stratified random sampling technique. Data were collected by completing the organizational culture assessment instrument (OCAI) according to the concept of Competing Values ​​Framework (CVF) and analyzed descriptively to determine aspects of the organizational culture. Results: Staff at the BLUD PHCs presented with lower education levels, were older and with an average longer working period compared to staff at the non BLUD PHCs. A hierarchical organizational culture was found in three BLUD PHCs and in one BLUD PHCs, while the other two non BLUD PHCs indicated a tendency towards a clan culture. It is hoped that in the next two years all PHC will adhere to a clan organizational culture model. Conclusions: Significant differences in age, education and number of working years between BLUD PHCs and non BLUD PHCs determine the organizational culture model adopted. The current adopted organizational culture is hierarchical whereas a transition to clan culture is desired.
The provision of promotive and preventative healthcare services by private primary care physicians in the era of the national health insurance program Ketut Ary Diana Artha; I Ketut Suarjana; Pande Putu Januraga
Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i2.p13

Abstract

Background and purpose: In addition to their duties in addressing the curative and rehabilitative needs of the community, private primary care physicians (PCP) play an important role in providing promotive and preventative healthcare services. This study aims to determine the behaviours, enabling and inhibiting factors involved with the provision of promotive and preventative services by PCP in the era of national health insurance (JKN) implementation. Methods: This research is a mix method study using a combination of quantitative and qualitative approaches. Quantitative surveys were conducted with all PCPs already in working collaboration with the Social Security Administering Agency (BPJS) in the Denpasar City area (61 people). Data analysis techniques used descriptive techniques in order to explore the kinds of promotion and preventative services provided by PCPs. Qualitative research was conducted through in-depth interviews of 8 informants selected by purposive sampling and analyzed thematically to discover the enabling and inhibiting factors of the provision of promotive and preventative services by PCPs. Results: The results showed that 91.8% of PCPs did perform promotive and preventative services in their practice site. PCPs who did not carry out promotive and preventative services demonstrate perceptions, beliefs and motivations categorized as low and weak as well as attitudes that do not support the implementation of such services. Enabling factors of promotion and preventative services by PCPs, include among others, quality of facilities and infrastructure, the receipt of awards from BPJS and capitation systems that benefit physicians financially. Inhibiting factors include a low willingness of the patient to carry out doctor's advice, limitations in the PCPs work time and limited funds to perform preventative/promotive services. Conclusions: Promotive and preventative services are not being optimally carried out by PCPs in Denpasar. This is due to the low willingness of the patients, the limited time of the doctor, and the limited allocated funds for promotive and preventative services and low capitation.
The role of communication contact in capitation implementation at public health centres in Denpasar Ni Putu Purlimaningsih; I Ketut Suarjana; Pande Putu Januraga
Public Health and Preventive Medicine Archive Vol. 5 No. 2 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i2.p15

Abstract

care is the contact between the provider and the recipient (communication contact). Targets set regarding communication contacts are often not achieved which in turn results in consequent cuts in the capitation rates received by the public health centres (PHCs). The purpose of this research is to understand the implementation, inhibiting and enabling factors of supporting communication contact in the era of National Health Insurance (Jaminan Kesehatan Nasional/JKN). Methods: This study used a qualitative explorative design through in-depth interviews and focus group discussion (FGD) with 22 informants consisting of heads of PHCs, PHCs staff, Head of Denpasar Health Office, Head of Social Security Administering Agency (BPJS) Denpasar Branch and JKN members. This research was conducted at 11 PHCs in Denpasar City from April to July 2017. The informants were chosen purposively and the data were analysed thematically to explore aspects of implementation, the inhibiting and enabling factors of communication contact. Results: Communication contacts can be assessed both inside and outside the PHCs buildings. The inhibiting factor of communication contact implementation related to difference in understanding of the concept of PHCs working area, the absence of a standard operational procedure (SOP) for communication contact, heavy workload of PHCs service providers, lack of optimal means of supporting application of pcare convoluted and confusing information from BPJS, and lack of understanding from JKN enrolees on the particulars of the administration and desire for speedy service. Supporting factors are the availability of media, training and orientation for the implementing staff and the feedback from BPJS to PHCs staff. Driving factors are the effective authority of the PHCs head, commitment and motivation from government agencies and cross-sectoral support. Conclusions: Implementation of communication contact is influenced by both inhibiting and enabling factors, from the BPJS stakeholders and the members of the BPJS. Achieving the target of communication contact requires synergy of central government policy and BPJS managers.
Achieving ideal mentoring: working patterns among clinical instructors, nurses, and nursing students Ayu Sugiantari; Komang Ayu Kartika Sari; Pande Putu Januraga
Public Health and Preventive Medicine Archive Vol. 6 No. 1 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i1.p09

Abstract

Background and purpose: The relationships between those responsible for clinical training, clinical instructors (CIs) and nurses, and the nursing students, have a great impact upon student learning during clinical placements. The present study investigates the pattern of working relationships among CIs, nurses, and student nurses, and analyses the extent to which they achieve ideal mentoring practices. Methods: Qualitative study employing in-depth interviews with CIs (n=3), nurses (n=8), and nursing students (n=8) on a clinical placement was undertaken from June-July, 2017, at Badung District Hospital, Denpasar, Bali. Content analysis was conducted to identify the key themes that emerged from these interviews and formed the basis of the findings. The results are presented narratively in order to highlight the patterns of the working relationships identified and perceived by CIs, nurses, and nursing students, with the aim of developing improved mentoring practices. Results: Analysis of the in-depth interviews identified three main themes: (i) perceptions on the hospital’s mentoring practices, (ii) the role(s) and behaviour in the mentoring process, and (iii) the patterns of working relationships between those involved in the mentoring process. In general, participants defined mentoring in terms of the provision of guidance and instruction to students. Participant’s contrasting perceptions of their role(s) affected how they behaved in the mentoring process. Furthermore, participant’s perceptions of their own’s roles and their behaviour provides a detailed overview of the working relationships pattern of the nursing students, nurses and CIs. Specifically, working relationships between CIs and nurses tend to fit an employee-employer type pattern, whereas those between CIs/nurses and nursing students do not appear to reflect typical mentor-mentee relationships. Conclusions: The pattern of working relationships identified between CIs/nurses and nursing students do not, in fact, reflect a typical mentor-mentee relationship. Furthermore, this paper highlights the impact that suboptimal mentoring may have on nursing students’ achievement of medical competence, as well as on the quality of nursing care provided to patients in teaching hospitals.
Perception of nursing staff towards the application of Professional Nursing Care Model and job satisfaction at Sanjiwani Hospital, Gianyar Gusti Ayu Krisma Yuntari; Pande Putu Januraga; I Ketut Suarjana
Public Health and Preventive Medicine Archive Vol. 6 No. 1 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i1.p12

Abstract

Background and purpose: Several hospitals in Indonesia have developed a model of nursing care known as MAKP (Professional Nursing Care Model) to improve the quality of nursing services. Sanjiwani Hospital, Gianyar has applied this model. The aim of this study is to explore the perception of nurses towards this approach and assess its association with job satisfaction. Methods: A cross-sectional survey was conducted with 92 nurses working at the inpatient ward at Sanjiwani Hospital, Gianyar. Data were collected from July-August 2017 by interview using questionnaires. Data collected included the characteristics of respondents (age, gender, education, and employment status), nurses’ perception towards the application of MAKP, and nurses’ job satisfaction. Results: Nursing staff demonstrated perception score of ≥15 on leadership elements (68.5%), communication (72.2%), coordination (84.8%), delegation (80.4%), and supervision (66, 3%). Nursing staff with a score of ≥15 in coordination perception (AOR=4.48; 95%CI: 1.14-17.54), delegation (AOR=4.00; 95%CI: 1.21-13.23) and supervision (AOR=3.35; 95%CI: 1.25-8.88) expressed higher job satisfaction. While aspects of leadership (AOR=0.98; 95%CI: 0.29-3.79) and communication (AOR=0.76; 95%CI: 0.19-3.05) were not significantly associated with job satisfaction. Conclusions: The majority of nurses have a positive perception towards the MAKP approach. The better perception on coordination, supervision and delegation are found to increase job satisfaction. The results imply that coordination, supervision and delegation should be considered in order to increase job satisfaction in other hospitals.
Why do HIV-positive pregnant women discontinue with comprehensive PMTCT services? A qualitative study Putu Emy Suryanti; Komang Ayu Kartika Sari; Pande Putu Januraga; Dinar Lubis
Public Health and Preventive Medicine Archive Vol. 6 No. 1 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i1.p13

Abstract

Background and purpose: Prevention of mother to child transmission (PMTCT) is a government program aimed at preventing mother-to-child transmission of HIV. A comprehensive PMTCT program involves the implementation of HIV testing up to antiretroviral (ARV) treatment for mothers with positive HIV test results. Coverage of comprehensive PMTCT remains low, with many HIV-positive pregnant women who discontinued ARV treatment. This study aims to explore the reasons of HIV-positive pregnant women to discontinue with the comprehensive PMTCT program. Methods: A qualitative study was carried out in Badung District, Bali Province, with seven respondents: one HIV-positive pregnant woman who did not continue the ARV treatment, two HIV-positive women who gave birth the previous year and did not take ARV, three public health centre (PHC) providers, and one head of PHC. Respondents were selected using a purposive sampling technique. Data were collected through in-depth interviews and analyzed thematically. The results presented narratively to illustrate the reasons why HIV-positive pregnant women discontinued with the comprehensive PMTCT program. Results: The emerging themes related to the reasons of HIVpositive pregnant women discontinued with the comprehensive PMTCT program included the lack of comprehensive PMTCT-related information, the lack of health provider assistance, and the high stigma towards people living with HIV (PLHIV). These barriers were affecting the willingness of HIV-positive pregnant women to continue with the program. Conclusions: Lack of comprehensive PMTCT-related information, lack of assistance by health care providers, and high public stigma impacts upon HIV-positive pregnant women’s willingness to continue with comprehensive PMTCT program. There is a need for a minimum service standard in the implementation of comprehensive PMTCT services and comprehensive information on HIV infection in order to reduce the stigma towards PLHIV.
Barriers to mental health services at public health centers: Providers’ perspectives Putu Aryani; Pande Putu Januraga; Komang Ayu Kartika Sari; Lisanne Gerstel; Willem F Scholte
Public Health and Preventive Medicine Archive Vol. 7 No. 1 (2019)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2019.v7.i1.p13

Abstract

Background and purpose: The disparity between the increasing prevalence of mental health (MH) illness and the availability of treatment in Indonesia remains high, despite the campaign to provide MH services at public health centers (PHCs) initiated by the government in 2014. This study explored barriers to MH service provision at PHCs in Denpasar, Bali, Indonesia in order to identify priorities for service improvement. Methods: This explorative qualitative study was conducted from March to December 2015 and employed in-depth interviews and focus group discussions (FGDs). In-depth interviews were conducted with the Head of Denpasar City Health Office and with general practitioners (GPs) from four PHCs in Denpasar, to explore the perspective of policy and service management and experiences in PHC clinics, respectively. To further explore MH service implementation in the community, two FGDs were conducted with MH program managers and community health workers (CHWs). The interviews and FGDs were recorded, and verbatim transcripts were analyzed using thematic framework analysis. Results: Barriers to MH service provision identified in our study are poor dissemination of the national policy to the local government and PHCs; low prioritization of MH issues; organization workforce issues; funding concerns; poor coordination and supervision; poor management and recording system; scarcity of ancillary facilities and other resources such as psychotropic medicines. Conclusion: The findings of this study highlight the importance of national policy dissemination and collaboration between local government, health providers and CHWs to overcome the barriers in providing MH services at PHC level.
Barriers for people who inject drug (PWID) to access voluntary counselling and testing (VCT) at the health centres in East Lombok Dany Karmila; Pande Putu Januraga; Ni Wayan Septarini
Public Health and Preventive Medicine Archive Vol. 5 No. 1 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i1.p06

Abstract

Background and purpose: Utilisation of voluntary counselling and testing (VCT) by people who inject drug (PWID) in East Lombok is low. This study aims to explore barriers for PWID to access VCT service from community health centres in East Lombok, West Nusa Tenggara. Methods: A qualitative study was conducted in East Lombok. Data were collected using in-depth interviews. Nine participats were purposively selected consisted of five HIV negative PWID who repeatedly tested for HIV, one non-governmental organization official, one field worker, one VCT counsellor and one medical doctor. Data were inductively analysed. Results: This study found that PWID preferred to use mobile VCT rather than VCT at health centres because of scared of getting caught by police. They also felt uncomfortable of using VCT service at the health centres due to stigma and discrimination. In addition, lack of human resources at the health centre was also found to be a significant barrier. This led to increased workload thus limited attention was given to quality of VCT service. Conclusions: Barriers to access VCT service at the health centre include high stigma and discrimination from health provider and living arrangements of PWID. To improve VCT access for PWID, effective collaboration between health centres, private health institutions and village cadres are required.
Readiness of girls aged 10-12 years for an early menarche: a transtheoretical model of behavioural change analysis Ni Made Diaris; Rina Listyowati; Pande Putu Januraga
Public Health and Preventive Medicine Archive Vol. 5 No. 1 (2017)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2017.v5.i1.p10

Abstract

Background and purpose: Studies have revealed that girls are now having menarche much younger. An early menarche put young girls at higher risk for physical and psychological problems. This study aims to explore stages of readiness of girls aged 10-12 years for an early menarche. Method: A qualitative study was conducted in Denpasar City. A total of 20 students both from primary school and junior high school aged between 10 and 12 years were purposively selected to participate in the study. Ten students had menarche while the other 10 were yet to have menarche. Data were collected through in-depth interviews at the schools after approval from parents was obtained. Data were analysed using a thematic approach. Results: All informants have conceded the pre-contemplation and contemplation stages. Most of them were at the preparation stage. Some children were at the action stage though some were just entered the action stage. In-depth interviews revealed that the majority of informants understood the basic knowledge of menstruation. Their mother provided information and supports after they had menarche. However, some informants stated that they were panic, ashamed, and anxious during their menarche. They also believed that several activities including washing hair, drinking icy beverages, and eating sweets were forbidden. Conclusion: Some girls are not fully at the action stage leading to fear and shame when they had menarche. This suggests that a more comprehensive education program and psychological supports especially from mother should target younger girls to prepare them for an early menarche.
Co-Authors - Suarjawa Adiatma Siregar, Adiatma Ajeng Diantini Andrew Paul Anton, Sri Sulistyawati Aree Jampaklay Aree Jampaklay Ariwidyastuti, Cokorda Istri Artha, Ketut Ary Diana Astuti, Maria Magdalena Zulian Puji Ayu Sugiantari Bella Riezka Aristianti Putri Benny Tjahjono Candradewi, Anak Agung Sagung Oka Nur Citra Mutiarahati, Ni Luh Cokorda Bagus Jaya Lesmana, Cokorda Bagus Jaya Cokorda Istri Ariwidyastuti Crosita, Yessi Dany Karmila Desak Nyoman Widyanthini Desak Putu Yulita Kurniati Devi, Ade Dwita Nia Sita Dewa Ayu Agung Dwita Arthaningsih Dewa Nyoman Wirawan Dewa Nyoman Wirawan, Dewa Nyoman Dewi Aprelia Meriyani Dewi, Ni Made Ayu Kemala Dewi, Ni Made Umi Kartika Diaris, Ni Made Dinar Lubis Dinar Lubis Donny Hardiawan Duara, I Ketut Dusita Phuengsamran Dusita Phuengsamran Dwipayana, I Ketut Dyah Pradnyaparmita Duarsa Gde Ngurah Idraguna Pinatih Gede Bagus Parmadi Wijaya Gede Benny Setia Wirawan Gerstel, Lisanne Gusti Ayu Krisma Yuntari Gustina, Ni Luh Zallila Handayani, Miasari Harjana, Ngakan Putu Anom Hertog Nursanyoto I Desak Ketut Dewi Satiawati I Gede Diki Sudarsana I Gusti Agung Komang Diafari Djuni Hartawan I Gusti Ayu Agung Putri Krismayanthi I Gusti Ngurah Edi Putra I Gusti Ngurah Edi Putra I Gusti Ngurah Edi Putra I Ketut Duara I Ketut Dwipayana I Ketut Surya Negara I Made Ady Wirawan I Made Edy Listartha I Made Suarjana I Nyoman Dharma Wiasa I Nyoman Mangku Karmaya I Wayan Gede Artawan Eka Putra I Wayan Gede Artawan Eka Putra, I Wayan Gede Artawan Eka Ida Ayu Agung Dewi Sawitri Ida Ayu Putri Widhiastuti Indraswari, Ni Luh Astri Indrayani, Putu May Jampaklay, Aree Juwita, Mery Nurma K. Budiartha Kadek Suranugraha Kadek Tresna Adhi Kardiwinata,, Made Pasek Karmila, Dany Ketut Ary Diana Artha Ketut Suarjana Komang Ayu Kartika Sari Kowara, Mellysa Krismayanthi, I Gusti Ayu Agung Putri Kurniati, Desak Putu Y Kusumajaya, Anak Agung Ngurah Laszlo Robert Koloszvari Laurensius Patrick Lisanne Gerstel Luh Putu Sinthya Ulandari Luh Seri Ani Made Ayu Devi Pita Loka Made Pasek Kardiwinata Manuaba, I.B.G. Fajar Maria Magdalena Zulian Puji Astuti Maria Salestina Sekunda Maria Salestina Sekunda Mas Manik Astawastini, I Dewa Ayu Meriyani, Dewi Aprelia Monika Sri Yuliarti Monika Sri Yuliarti, Monika Sri Muchamad Zaenal Arifin, Muchamad Zaenal Murniati, Ni Nengah Narendra Suputra, I Dewa Gede Agung Ngakan Made Ari Mahardika Ni Kadek Ari Arniti Ni Kadek Esilia Septigar Pranati Ni Ketut Sri Lestari Ni Ketut Sutiari Ni Komang Yudi Sri Astari Ni Luh Putu Suariyani Ni Made Ayu Kemala Dewi Ni Made Dian Kurniasari Ni Made Diaris Ni Made Mas Dwi Purwaningrat Ni Made Parwati Ni Made Sri Nopiyani Ni Made Sri Nopiyani Ni Nengah Murniati Ni Nyoman Sri Budayanti Ni Putu Purlimaningsih Ni Putu Widarini Ni Wayan Arya Utami, Ni Wayan Arya Ni Wayan Septarini Ni Wayan Trisnadewi, Ni Wayan Nirmala, Putu Nitya Octaviana, Betty Olwin Nainggolan P. Muliawan P. Muliawan Panithee Thammawijaya Panithee Thammawijaya Pemayun, Cokorda Istri Mita Phuengsamran, Dusita Pradnyani RS, I Gusti Ayu Indah Pradnyawati, Luh Gede Pradnyawati, Luh Gede Prawinegara, Rozar Purlimaningsih, Ni Putu Putra, I Gusti Ngurah Edi Putu Aryani Putu Ayu Indrayathi Putu Emy Suryanti Putu Erma Pradnyani Putu Nitya Nirmala Rai Riska Resty Wasita Rina Listyowati Rina Listyowati Rina Listyowati, Rina Rofingatul Mubasyiroh rosida, Anik Rudi Wisaksana S.Pd. M Kes I Ketut Sudiana . Sagitariani, Sayu Kade Alit Santosa, Karina Samaria Sari, Komang Ayu Kartika Sawitri, Anak Agung Sagung Sawitri, Ida Ayu Agung Dewi Sayu Kade Alit Sagitariani Scholte, Willem F Suandana, Iwan Abdi Sudewi, Ni Made Ayu Sri Ratna Sudikno Sudikno Sugiantari, Ayu Sulaiman, Nurjannah Suranugraha, Kadek Surya Negara, Surya Suryanti, Putu Emy Susila, I Made Dwie Pradnya Swapatni, Ni Made Adi Thammawijaya, Panithee The Angela Prisilia Taroreh Ulandari, Luh Putu S Utami, Kadek Cahya Valerie, Ivy Cerelia Wati, Putu Ayu Wayan Citra Wulan Sucipta Putri Wibawa, I Komang Gede Sentanu Widhiastuti, Ida Ayu Putri Widowati, I Gusti Ayu Rai - Willem F Scholte Wirawan, Ady Yudi Ardiana Yudi Ardiana, Yudi Yuntari, Gusti Ayu Krisma