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All Journal Archive of Community Health Buletin Udayana Mengabdi ISM (Intisari Sains Medis) : Jurnal Kedokteran Udayana Journal of Social Sciences and Humanities (UJoSSH) Journal of Health Sciences and Medicine Bali Dental Journal Public Health and Preventive Medicine Archive Journal of Global Research in Public Health Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Ni Made Sri Nopiyani
Program Studi Ilmu Kesehatan Masyarakat, Fakultas Kedokteran Universitas Udayana
Humanities Biochemistry, Genetics & Molecular Biology Dentistry Education Health Professions Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Public Health Social Sciences

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Readiness to change towards accredited public health centres (PHCs) in West Lombok I Made Santiana; Ni Made Sri Nopiyani; Dyah Pradnyaparamita Duarsa
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.p08

Abstract

Background and purpose: The 2016 Report of Performance Accountability of Government Agencies, Ministry of Health of Indonesia showed only a small proportion of public health centres (PHCs) are accredited. In West Lombok District, some PHCs are not accredited. This study aims to examine factors associated with PHC’s staff readiness for accreditation. Methods: A cross-sectional survey was employed involving seven non-accredited PHCs. A total of 165 out of 310 PHC’s staff were recruited using a systematic random sampling. Data was collected from February to March 2017. Self-administered questionnaire was used to collect data on socio-demographic characteristics, duration of service, content, process, and context changes, individual attributes, and readiness to change. Logistic regression was applied to examine the association between readiness to change with independent variables. Results: As many as 72.1% of respondents are ready to change. From the change efficacy and appropriateness dimensions, as many as 46.1% and 97.0% of respondents are ready to change. Multivariate analysis shows an association between readiness to change with administrative systems (AOR=4.47;95%CI:2.05-9.74) and working procedure (AOR=2.95; 95%CI: 1.19-7.30). There is no significant association between readiness to change with technological improvement, promotional strategy, staff engagement, organisational commitment and managerial support from health offices. Conclusions: The readiness to change among PHC’s staff is high. The availability of working procedure and administrative systems improves PHC’s staff readiness for the accreditation. These findings suggest the importance of inclusion of all PHC’s staff during the accreditation processes.
Implementation of quality function deployment to identify priority needs of customers and health providers of child-friendly community health centre Ni Nyoman Ariani; Ni Made Sri Nopiyani; I Putu Ganda Wijaya
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.p03

Abstract

Background and purpose: The efforts to increase quality of service is critical in public services. Service providers should be able to identify customer needs and expectations. As one of health providers, community health centre are required to develop mechanisms for identifying needs of customers and staff. Needs assessment of clients and staff at Blahbatuh II Health Centre is never been conducted. This study aims to identify priority needs of customer and staff to improve the quality of service at Blahbatuh II Health Centre. Methods: A quantitative study was conducted at Blahbatuh II Health Centre. Data was collected through interviews guided by a structured questionnaire. A total of 97 customers were consecutively selected and were interviewed. Eight staff of child-friendly community health centres were purposively recruited. Data was analysed using quality function deployment method and presented in the House of Quality (HoQ) matrix. Results: There were 16 and 13 expectations from customers and staff respectively. The house of quality matrix showed that respondents ranked several expectations as the most important that include friendly staff, quick and on-time services, and effective treatment. Health staff on the other hand expected the centre to implement performance-based reward system, to provide training program and to follow the standard operating procedures. Conclusions: Expectations from customers and health staff are different. In order to meet these expectations, health centre should design and implement a quality improvement program to address these diverse quality issues.
Barriers and opportunities for implementing prevention of mother to child transmission (PMTCT) in Bangli District Ketut Espana Giri; Ni Made Sri Nopiyani; Ketut Tuti Parwati Merati
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.p14

Abstract

Background and purpose: HIV testing among pregnant women can reduce the risk of mother to child HIV transmission. The implementation of prevention of mother to child transmission (PMTCT) program in Bangli District is suboptimal. This study aims to explore challenges and opportunities for implementing PMTCT program from both user and provider perspectives. Methods: A qualitative approach was conducted in Bangli District between April and May 2016. Data were collected using in-depth interviews with 18 informants. All informants were purposively selected and covered of 10 pregnant women, two counsellors, two laboratory analysts, two head of public health centres, one disease control officer from Bangli District Health Office and one officer from Bangli District AIDS Commission. Data were analysed using thematic method. Results: Pregnant women chose to have ANC service at private midwife and obstetrician instead of public health centre. From health providers’ perspectives barrier of PMTCT implementation included lack of health human resources and a high level of stigma and discrimination related to HIV/AIDS in the community. This study revealed that there was an opportunity for PMTCT implementation in Bangli District due to positive attitudes and supports from husband and health provider toward HIV testing. Another opportunity is toinvolve village health cadres and community leaders in promoting HIV testing among pregnant women. Conclusions: Implementation of PMTCT program in health centre should include network of private practitioner and enhance village health cadres’ and community leaders’ participation.
Association between nursing care performance with perception of financial rewards, career development and supervision Ayu Ratih Cempakasari; Ni Made Sri Nopiyani; Dyah Pradnyaparamitha Duarsa
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.p02

Abstract

Background and purpose: The performance of nurses in providing care to patients is an important component for patient satisfaction and healing. Nurse's performance is determined by many factors. This study aims to determine the association between nurse performance in providing nursing care with education, nurse perceptions of financial rewards, career development opportunities, and supervision of the ward head. Methods: A cross-sectional survey was conducted on all nurses (164 people) at inpatient wards of Tabanan General Hospital. Data collection was carried out using a self-administered questionnaire in April 2018. Bivariate analysis was performed using chi-square test, and multivariate analysis was conducted using multiple logistic regression to determine the adjusted odds ratios. Results: The results showed that the mean score of nursing care performance was 70.17 from a maximum score of 80. All independent variables were found to be associated with nurse performance, namely perceptions of career development opportunities (AOR=1.6; 95%CI: 1.03-1.3; p=0.01), financial rewards (AOR=1.1; 95%CI: 1.01-1.2; p=0.03) and supervision of the ward chief (AOR=1.1; 95%CI: 1.01-1.2; p=0.02). Conclusion: Nurses' perceptions of financial rewards, career development opportunities, and supervision of the ward chief are associated with nursing care performance. Provision of rewards, career development and supervision need to be considered in the efforts to improve nurse performance.
Hospital facilities, occupational safety environment and self-efficacy as predictors of healthcare-associated infections prevention and control compliance in nurses of inpatient care units Luh Yulia Adiningsih; Ni Made Sri Nopiyani; Made Ady Wirawan
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p04

Abstract

Background and purpose: The implementation of healthcareassociated infections (HAIs) prevention and control program in hospitals remains sub-optimal. The present study aims to determine the relationships between nurse’s self-efficacy, hospital’s occupational safety environment, and the availability of facilities, with the compliance on HAIs prevention and control in hospital inpatient care units. Methods: Cross-sectional survey was conducted with 128 nurses selected using systematic random sampling at Buleleng District Hospital’s inpatient care units. Data collection was conducted in March 2018 using self-administered questionnaires. The questionnaire consisted of five sections including characteristics of respondents, HAIs prevention and control practices, self-efficacy, occupational safety environment and the availability of facilities. Bivariate analysis was conducted to calculate the Pearson correlation coefficients between variables. Multivariate analysis was performed with multiple linear regressions to examine self-efficacy, occupational safety environment and availability of facilities as predictors of the compliance on HAIs prevention and control. Results: The study shows that 56.2% of nurses reported good compliance on HAIs prevention and control practices. Bivariate analysis shows a significant correlation between HAIs prevention and control compliance scores and self-efficacy (r=0.45; p=0.00), occupational safety environment (r=0.53; p=0.00), and the availability of facilities (r=0.65; p=0.00). Multivariate analysis shows that the availability of facilities is a significant predictor of HAIs prevention and control compliance (β=0.49; p<0.01) while self-efficacy and the occupational safety environment are also found to be significant predictors, although with lower standardized coefficients: β=0.16 (p=0.03) and β=0.17 (p=0.04), respectively. Conclusion: The significant predictors of compliance on HAIs prevention and control are availability of facilities, self efficacy and hospital’s occupational safety environment. This study highlights the importance of optimizing the availability of facilities, improving the occupational safety environment, and enhancing nurses’ self-efficacy in order to reduce the incidence of HAIs in hospitals.
Association between participation in a chronic disease management program, medication adherence and decrease of blood pressure I Ketut Indra Wiguna Cakera; Ni Made Sri Nopiyani; I Made Ady Wirawan
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p08

Abstract

Background and purpose: The prevalence of hypertension is increasing globally. A comprehensive approach is necessary including a community based chronic disease management program which has been implemented in public health centres in Indonesia. Only few studies have been published in Indonesia that evaluate the program, especially regarding the management of hypertension in primary care settings. This study aims to examine the association between participation in a chronic disease management program,medication adherence and decrease of blood pressure. Methods: A cross-sectional study was conducted in public health centres in Tabanan District. A total of 136 patients with hypertension were recruited at five groups that participate in the community based chronic disease management program called Program Pengelolaan Penyakit Kronis (Prolanis). The prolanis groups were purposively selected based on the size of participants in the program. One group was selected at urban area and four groups at rural areas. Data were collected from May to June 2017 by conducting interviews, blood pressure measurements, and secondary data extraction from the medical record of the prolanis database. The logistic regression analysis was used to determine the association between participation in a chronic disease management program, medication adherence and decrease of blood pressure. Results: As many as 75.7% of respondents actively participated in the prolanis program, and 81.6% were found with decreased blood pressure. Our study found a significant association between blood pressure decrease and active participation in the prolanis program with an adjusted odds ratio (AOR) of 6.38 (95%CI: 1.96–20.79), the good adherence towards medication with AOR=11.94 (95%CI: 3.60–39.56), and routine physical activities with AOR=3.84 (95%CI: 1.16-12.73). Conclusion: Active participation in the prolanis program, good adherence to medication and routine physical activities are independent factors of decreased blood pressure. These findings suggest the need for scaling up the prolanis program and increasing its coverage.
Pharmacist counseling intervention to improve patient antibiotic compliance I Gusti Ayu Rai Widowati; I Made Ady Wirawan; Ni Made Sri Nopiyani; Komang Ayu Kartika Sari
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p10

Abstract

Background and purpose: Reported microbial resistance to antibiotics is increasing. One of the main factors is patient noncompliance in use of antibiotics. The purpose of this study was to determine the effectiveness of pharmaceutical counseling in a pharmacy setting to increase compliance with antibiotic use. Methods: A randomized controlled trial was conducted on 104 adult patients aged 18 years and over who purchased antibiotics by prescription at a pharmacy in Denpasar City, Bali Province. Subjects were divided into intervention and control groups using block randomization method. The intervention group was provided with pharmaceutical counseling by a pharmacist, while the control group was provided drug information according to the pharmacy service standard. Subject compliance was measured by telephone interview using the Morisky Medication Adherence Scale-8 questionnaire within 3-5 days after purchasing the medication. Statistical analysis with the Mann Whitney U Test was performed to determine the difference in mean rank of compliance scores. Logistic regression analysis was conducted to determine the adjusted compliance ratio. Results: The number of subjects analyzed was 98, as five subjects could not be contacted by telephone and one subject was hospitalized. The mean rank of compliance scores in the intervention group (61.05) was significantly higher (p<0.01) than the comparison group (37.95). The proportion of compliance in the intervention group was 65.3% and the control group was 18.4%, with the proportion ratio (PR) of 3.56 (95%CI: 1.90- 6.64). Logistic regression analysis showed that variables which significantly increased compliance with antibiotic use were pharmacist counseling (APR=9.33; 95%CI: 3.24 26.87), frequency of taking medication (APR=6.94; 95%CI: 2.01-23.92) and method of payment (APR=4.30; 95%CI: 1.18-15.66). Conclusion: Pharmaceutical counseling at a pharmacy setting was found to increase compliance of antibiotic use. Compliance of antibiotic use is also influenced by the frequency of taking medication and the method of payment. Pharmacist counseling when accessing medication at a pharmacy is crucial for improving patient compliance of antibiotic use.
Switching of primary health care providers among self-paid health insurance participants in Denpasar, Bali, Indonesia Rai Riska Resty Wasita; Ni Made Sri Nopiyani; Pande Putu Januraga
Public Health and Preventive Medicine Archive Vol. 6 No. 2 (2018)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2018.v6.i2.p12

Abstract

Background and purpose: The number of National Health Insurance (NHI) participants switching their primary healthcare (PHC) providers is increasing and dominated by self-paid participants. This switching could result in unequal distribution of NHI participants and amount of capitation among PHC providers. This study aims to explore the reasons underlying self-paid NHI participants to switch PHC providers. Methods: This is a qualitative study using in-depth interviews with a total of 14 informants recruited purposively, consisted of ten NHI selfpaid participants who had switched and four participants who intend to switch PHC providers. Informants were recruited by approaching NHI participants at BPJS counters and inviting participants through social media. Semi-structured interview guide incorporated the aspects of Consumer Switching Behavior Model. The interviews explored four aspects of participants’ intention to switch providers including inconvenience, service encounter failures, core health service failures, and attraction by competitor. The verbatim transcripts were analyzed thematically. Results: Self-paid NHI participants in this study cited four main reasons for switching PHC providers. The first reason is inconvenience in accessing PHC provider’s services due to long distance, long waiting times, unsuitable opening hours, and poor facilities. Secondly, patients cited the poor interaction between healthcare providers and patients specifically, lack of attentiveness, poor eye contact, poor delivery of health information, lack of consideration of patients’ opinions, and lack of responsiveness to patients’ complaints. The third reason is core healthcare service failures, including hasty examinations, inaccurate diagnoses, and errors in prescribing medication. Finally, informants reported that they wished to switch PHC providers due to the attractiveness of other providers, in terms of facilities availability, professionalism of healthcare providers, additional health programs, and ease of access to referral healthcare facilities. Conclusion: Self-paid NHI participants’ intention to switch PHC providers was mainly attributed to the perceived poor healthcare quality of the provider and superiority of the others. Continuous quality improvement should be undertaken by PHC providers to increase participants’ loyalty.
The roles of case managers and problems encountered in implementing patient centered care in hospitals Ni Kadek Yuliati; Ni Made Sri Nopiyani; Dyah Pradnyaparamita Duarsa
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.p11

Abstract

Background and purpose: Patient centered care in hospitals has yet to be well implemented. The role of case managers is very important in the implementation of patient centered care in hospitals. Research publications on the role of case managers in patient centered care in Indonesia remain limited. This study aims to explore the roles of case managers and problems encountered in the implementation of patient centered care in hospitals. Methods: This study used a qualitative design with a case study approach conducted at Bangli District Hospital in Bali in April 2019. Data was collected through in-depth interviews with seventeen purposively selected informants consisting of ten case managers, one deputy director of medical services, two patient’s family members, two specialist doctors and two implementing nurses at Bangli District Hospital. This study uses the Patient Centered Care Framework from Greene which consists of three dimensions in patient centered care namely interpersonal, clinical and structural dimensions. Data was analyzed thematically using deductive and inductive techniques. Data validation was conducted through triangulation of data based on different sources, member checking and peer debriefing. Results: In this study, five main themes were found regarding the role of case managers in the implementation of patient centered care in hospitals, namely interpersonal, clinical and structural dimensions, support and expectations of case managers. The identified role of the case manager in the interpersonal dimension consisted of listening to patients and families actively, coordination and collaboration in problem solving, providing accurate and easy to understand information about care. Problems encountered included lack of communication between the service provider components and between the service provider with patients and their families. Roles of case manager in the clinical dimension are to hold meetings with a professional team of care givers and continuous monitoring of services to patients, while the issue encountered is the mismatch of time of service provision by specialist doctors. Roles of case managers in the structural dimension is coordination with policy holders, use of information technology and patient reporting. Problems encountered were inappropriate recruitment of case managers, lack of training of case managers, incomplete facilities, inconvenience of services and inadequate incentives. Supports from hospitals for case managers were support of facilities and legality as case managers. Expectations of case managers include case manager training, rewarding and career development opportunities. Conclusion: The roles of case managers in implementing patient centered care in Bangli District Hospital are not optimal. Efforts to address issues in the interpersonal, clinical and structural dimensions need to be carried out by the hospital management to enhance the role of case managers in the implementation of patient centered care.
The Association of Individual Factors and Organization Culture and Approach with Nursing Quality of Care in Ganesha Public Hospital, Gianyar I Gusti A. Ayu Sherlyna Prihandhani; Ni Made Sri Nopiyani; Dyah Pradnyaparamita Duarsa
Public Health and Preventive Medicine Archive Vol. 3 No. 1 (2015)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2015.v3.i1.p09

Abstract

Background and purpose: Satisfaction survey among patients of the inpatient unit at Ganesha Public Hospital indicated lack of caring behavior among nurses. This study aims to reveal level of quality of care and the factors associated with related behavior among inpatient ward at Ganesha Public Hospital. Methods: The study used cross-sectional survey design. Data were collected through self-administered questionnaires among 48 inpatient nurses during November-December 2014. Multivariate logistic regression was applied to determine factors associated with caring behavior of nurses. Results: The study found that 56.3% believed they provided a relatively high quality of care and 54,2% of nurses indicated a positive perception of the organization culture. Result of multivariate analysis indicated that only rewards system is independently associated with caring behavior of nurses (adjusted OR=23,39; 95%CI: 1.53-356.94; p=0,023). Conclusion: It was evident that nurses’ practice toward caring behavior is related to their attitude toward the rewards system of nurses’ performance.
Co-Authors ., Ni Putu Ayu Laksmini A.A. Ketut Agung Cahyawan W Anak Agung Istri Ratna Maadnyani Dewi Ariani, Ni Nyoman Astuti, Maria Magdalena Zulian Puji Ayu Ratih Cempakasari Cempakasari, Ayu Ratih D. YULIANTI Desak Putu Yulita Kurniati DEWA ALIT Dewa Ayu Putu Gek Mega Suryasih Putri Dyah Pradnyaparmita Duarsa I Gusti A. Ayu Sherlyna Prihandhani I Gusti Ayu Dinda Sarmista Dewi I Kadek Candra Dwi Astawa Alit Putra I Ketut Indra Wiguna Cakera I Made Ady Wirawan I Made Santiana I Made Subrata I MADE SUTARGA I Nyoman Mangku Karmaya I Nyoman Sutarsa, I Nyoman I Putu Ganda Wijaya I Putu Sakamekya Wicaksana Sujaya I Putu Yoga Kusuma Widnyana I Wayan Gede Artawan Eka Putra I Wayan Weta Ida Ayu Agung Dewi Sawitri Ida Ayu Indira Sarasija Indra Wiguna Cakera, I Ketut Kadek Suranugraha Ketut Espana Giri Ketut Espana Giri Ketut Suarjana Ketut Tuti Parwati Merati Komang Ayu Kartika Sari Luh Putu Lila Wulandari Luh Putu Sinthya Ulandari Luh Yulia Adiningsih Luh Yulia Adiningsih Made Karma Maha Wirajaya Made Pasek Kardiwinata Maria Magdalena Zulian Puji Astuti Merati, Tuti Parwati N. P. O. M. Prasari Ni Kadek Fiora Rena Pertiwi Ni Kadek Yuliati Ni Komang Ekawati Ni Luh Putu Suariyani Ni Made Widiastuti Ni Nyoman Ariani Ni Wayan Arya Utami, Ni Wayan Arya Ni Wayan Meni Ni Wayan Purnama Dewi Ni Wayan Septarini P. Muliawan P. Muliawan Pande Putu Januraga Partha Muliawan Partha Muliawan, Partha Prihandhani, I Gusti A. Ayu Sherlyna Putra, I Kadek Candra Dwi Astawa Alit Putu Ayu Indrayathi Putu Ayu Risnia Jayanti Putri Putu Ratna Kusumadewi Giri Rai Riska Resty Wasita Rina Listryowati Rina Listyowati Rina Listyowati Rina Listyowati, Rina S.G. Purnama Samuel Pramadisa Santiana, I Made Sari, Komang Ayu Kartika Sawitri, Ida Ayu Agung Dewi Steffano Aditya Handoko Steffano Aditya Handoko Steffano Aditya Handoko Suranugraha, Kadek Widiastuti, Ni Made Widowati, I Gusti Ayu Rai - Wijaya, I Putu Ganda Yuliati, Ni Kadek