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All Journal Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) Jurnal Keperawatan PPNI Jawa Barat
Astri Mutiar
STIKep PPNI Jawa Barat
Education Health Professions Medicine & Pharmacology Nursing Physics Public Health Other

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Longitudinal Mixed-Methods Study: Impact of Social Determinants on Maternal Health Access among Women with Disabilities (Urban vs. Rural) Elfira Elfira; Achmad Fauzi; Astri Mutiar; Linlin Lindayani
Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) Vol. 11 No. 4 (2025): JURNAL KEPERAWATAN KOMPREHENSIF (COMPREHENSIVE NURSING JOURNAL)
Publisher : STIKep PPNI Jawa Barat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33755/jkk.v11i4.922

Abstract

Background: Women with disabilities face persistent inequities in accessing maternal health services, despite legal guarantees of inclusive care. Evidence suggests amplified barriers in rural settings; however, longitudinal data capturing temporal changes and women’s lived experiences remain limited. This study investigated how social determinants shape maternal health access among women with disabilities in urban versus rural settings in Indonesia. Methods: A longitudinal mixed-methods design was applied across two sites in West Java: Bekasi City (urban) and Garut District (rural). A total of 300 women with physical, sensory, or mild intellectual disabilities were followed from early pregnancy to six weeks postpartum. Quantitative data were collected at three time points and analyzed using Generalized Estimating Equations and multilevel logistic regression. Concurrently, 35 participants were purposively recruited for in-depth interviews and focus group discussions, analyzed thematically with NVivo. Data were integrated through triangulation and convergence to explain disparities across the maternal healthcare continuum. Results: Significant urban–rural inequities were found. Urban participants demonstrated higher utilization of ≥4 ANC visits (from 62% to 84%), facility-based deliveries (91%), and postnatal care (77%) than rural participants (ANC from 39% to 56%; delivery 68%; postnatal 52%) (p < 0.05). Key determinants of access included maternal education (AOR = 1.46; 95% CI 1.18–1.81), health insurance (AOR = 1.50; 95% CI 1.20–1.87), family support, economic status, and transportation accessibility. Six qualitative themes revealed reinforcing relational and emotional dynamics: structural barriers, stigma and discrimination, family role, digital divide, coping strategies, and emotional experiences. Conclusion: Women with disabilities experience compounded inequities in maternal healthcare access, particularly in rural areas, driven by intersecting structural, socioeconomic, and relational determinants. Improving accessibility, enhancing disability-sensitive and stigma-free care, and strengthening digital and community support systems are essential to achieve equitable maternal services. Findings inform a new integrative framework for inclusive maternal health, guiding targeted policy and health system interventions in Indonesia and similar low-resource contexts.
SmartBreastfeed: Effectiveness of a Digital Intervention in Reducing Postpartum Fatigue and Enhancing Breastfeeding Motivation Lia Idealistiana; Achmad Fauzi; Astri Mutiar; Linlin Lindayani; Irma Darmawati
Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) Vol. 11 No. 4 (2025): JURNAL KEPERAWATAN KOMPREHENSIF (COMPREHENSIVE NURSING JOURNAL)
Publisher : STIKep PPNI Jawa Barat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33755/jkk.v11i4.923

Abstract

Background: Postpartum fatigue is a highly prevalent condition affecting up to 88% of mothers in the early postpartum period, negatively influencing maternal well-being and breastfeeding outcomes. In Indonesia, fatigue contributes to low exclusive breastfeeding rates, which remain below national and WHO targets. Digital health solutions offer promising opportunities to provide continuous breastfeeding support; however, existing applications are predominantly infant-focused and rarely address maternal psychosocial needs such as fatigue and motivation. Objective: To evaluate the effectiveness of the SmartBreastfeed mobile application in reducing postpartum fatigue and enhancing breastfeeding motivation among mothers during the first six weeks after childbirth. Methods: A quasi-experimental pretest–posttest control group design was employed among 64 postpartum mothers recruited from two urban health facilities. Participants were assigned to either the intervention group using SmartBreastfeed for four weeks or the control group receiving standard education through leaflets. Postpartum fatigue and breastfeeding motivation were assessed using validated Indonesian versions of the Postpartum Fatigue Scale (PFS) and Breastfeeding Motivation Scale (BFMS). Data were analyzed using paired t-tests and ANCOVA with significance set at p < 0.05. Results: Mothers using SmartBreastfeed experienced a significantly greater reduction in fatigue scores compared with controls (Δ = -13.5 ± 5.2 vs. -4.1 ± 3.8; p < 0.001). The intervention group also demonstrated significant improvements in breastfeeding motivation—including increased intrinsic (p < 0.001) and extrinsic motivation (p = 0.02), and reduced amotivation (p = 0.01). ANCOVA showed the intervention as the strongest predictor for improved outcomes, with medium-to-large effects (partial η² = 0.09–0.27). Conclusion: SmartBreastfeed effectively reduced postpartum fatigue and enhanced breastfeeding motivation through personalized digital support integrating self-monitoring, educational modules, reminders, and motivational messaging. This user-centered innovation shows potential to complement community maternal health programs and improve breastfeeding success in Indonesia
FACTORS ASSOCIATED WITH FEAR OF CHILDBIRTH AMONG PREGNANT WOMEN Dewi Marfuah; Shindy Kartika Sari; Astri Mutiar; Dewi Srinatania
Jurnal Keperawatan PPNI Jawa Barat Vol 3 No 2 (2025): JURNAL KEPERAWATAN PPNI JAWA BARAT
Publisher : DPW PPNI Provinsi Jawa Barat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70332/jkp.v3i2.40

Abstract

Background: Fear of Childbirth (FoC) is a common psychological concern during pregnancy and may negatively affect maternal health and birth outcomes, including increased blood pressure, prolonged labor, and postpartum depression. FoC is influenced by various demographic, obstetric, and psychosocial factors. Objective: This study aimed to identify factors associated with FoC among pregnant women. Methods: A quantitative cross-sectional study was conducted involving 113 pregnant women across the first to third trimesters. FoC was assessed using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), while perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Data were analyzed using Pearson correlation, Spearman correlation, and multiple linear regression analyses. Results: Bivariate analysis demonstrated that maternal age, household income, and parity status were significantly associated with FoC (p < 0.05). In contrast, education level, occupation, gestational age, and perceived social support showed no significant associations (p > 0.05). Multivariate analysis revealed that parity status was the most influential factor affecting FoC among pregnant women. Conclusion: Younger women and those with lower parity are more likely to experience FoC, primarily due to limited childbirth experience and uncertainty about labor and infant care. Higher household income was also associated with greater FoC, possibly related to increased exposure to childbirth-related information. Strengthening antenatal education and psychological support is essential to enhance maternal preparedness for childbirth.
Co-Authors Achmad Fauzi Dewi Marfuah Dewi Srinatania Elfira Elfira Lia Idealistiana Linlin Lindayani Shindy Kartika Sari