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Public Health and Preventive Medicine Archive
Published by Universitas Udayana
ISSN : 23031816     EISSN : 25032356     DOI : https://doi.org/10.53638/
Core Subject : Health,
Public Health
ublic Health and Preventive Medicine Archive (PHPMA) is an open access, peer reviewed journal published by Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University. Issues covered in the journal are as the following: Environmental and occupational health Field and Clinical Epidemiology Global health Health policy analysis Health promotion Health systems and health care management Maternal and child health Program monitoring and evaluation Public health nutrition Reproductive health, sexually transmitted infections and HIV related issues Travel health and health tourism Population and family planning Disaster management
Arjuna Subject : Kedokteran - Kesehatan Masyarakat, Kesehatan Lingkungan dan Pekerjaan
Articles 310 Documents
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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.
Utilization of the smoking cessation clinic at Public Health Centre 1 North Denpasar: A qualitative study Sri Idayani; Putu Ayu Indrayathi; Dyah Pradnyaparamita Duarsa; Dinar Lubis
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.p13

Abstract

Background and purpose: The incidence of morbidity and mortality due to tobacco use is very high. There are several strategies to help smokers quit, one of which is counseling to stop smoking in a clinic setting. The purpose of this study was to explore in depth the utilization of smoking cessation clinics at a Public Health Centre (PHC). Methods: A qualitative study through in-depth interviews was conducted with 14 informants who had been provided with a counseling at a smoking cessation clinic, consisting of five informants who had quit smoking and nine informants who were still smoking. Triangulation of data was carried out by conducting in-depth interviews with the head of PHC and one counselor on duty at the smoking cessation clinic. The information collected includes the utilization of the clinic, strategy of PHC in recruiting patients, knowledge about smoking cessation and the benefits of attending counseling. Data collection was carried out at the home of each informant during March-April 2018. The results of the interviews were analyzed thematically after a verbatim transcription being conducted. The data presented in a narrative to provide an in-depth description of the utilization of smoking cessation clinics in a PHC. Results: The results of interviews with PHC staff showed that in order to increase the utilization of the smoking cessation clinic, the services are integrated into the general polyclinic. Interviews with informants who have not stopped smoking indicate that to improve the utilization of the clinic, promotion and service variations are needed and not only focus on counseling. Interviews with informants who have stopped smoking show that counseling at the clinic can increase their willingness to stop smoking. Conclusion: To improve the utilization of smoking cessation clinics, in addition to integrating services into the general polyclinic, promotion and variations in services are also required.
Incidence of dispensing errors before and after root cause analysis at Sanglah General Hospital, Denpasar Ni Kadek Erna Erawati; I Made Ady Wirawan; Cokorda Bagus Jaya Lesmana
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.p06

Abstract

Background and purpose: Drug dispensing errors have a major impact on the incidence of medication errors, and can be very dangerous to patients and affect the quality of care. Root cause analysis (RCA) is an approach to prevent dispensing errors by identifying the root of the problem, make efforts to improve comprehensively across departments so that incidence of dispensing errors are not repeated. The purpose of this study is to determine the differences in the incidence of dispensing errors before and after the RCA. Methods: This is a descriptive study by calculating the incidence of dispensing errors before and after the RCA, conducted in four inpatient wards at Sanglah Hospital Denpasar. Dispensing errors were categorized into ten types namely errors in drug’s identity, name, dosage, number of drugs, absence of high alert labels, incorrect drug preparations, incorrect strength, expired drugs, incorrect place of delivery and incorrect instructions. In February and April 2018 there were 80 and 40 dispensing errors which met the study criteria, respectively. Results: Crude incidence of dispensing errors before and after RCA were 2.54 per 1000 (95%CI: 1.98-3.10) and 1.26 per 1000 (95%CI: 0.87-1.65), respectively. The decrease in dispensing error after RCA was 50.39%. The ratio of dispensing error incidence rates after and before the RCA is 0.49. Significant decrease in the incidence of dispensing errors was only found in drug identity errors of 1.27 per 1000 (95%CI: 0.88-1.66) before an RCA and 0.06 per 1000 (95%CI: -0.03-0.15) after RCA, or decreased by 95.27% and there was no significant decrease in other dispensing errors. Conclusion: The decrease of dispensing errors after the RCA was only found in the medication identity error and not found in the other dispensing errors. Direct observation and intensive supervision are needed in order to accurately calculate and reduce the incidence of dispensing errors.
Pilot project on Global Youth Reproductive Health Program: Implementation in Denpasar City I Gusti Ayu Agung Putri Krismayanthi; Pande Putu Januraga; Desak Putu Yuli Kurniati
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.p07

Abstract

Background and purpose: Premarital sexual relations in adolescents and early marriage tends to increase in Indonesia. One of the programs implemented in Indonesia to reduce these problems is the reproductive health program for adolescents in schools. The Youth World Spirit Module or called SEmangaT duniA RemajA (SETARA) is used as a tool for teaching and learning activities in pilot projects in several cities in Indonesia, including Denpasar. This study aims to determine the implementation of the program in Denpasar. Methods: This study employed a qualitative approach conducted at junior high schools in Denpasar City. Data collection was carried out with six focus group discussions (FGDs) consisting of three FGDs with 20 students aged 13-15 years and three FGDs with 15 teachers who were appointed as a facilitator of the program. In addition, indepth interviews were also conducted with three junior high school principals. FGDs and in-depth interviews were recorded, transcribed and analysed thematically using the Miles and Huberman Technique. Results: The study showed that the provision of the SETARA module was able to change the impression of taboo and broaden adolescent insights on reproductive health material. The implementation of this module is slightly different between schools due to differences in time allocation, number of activities in schools and the absence of standardised implementation guidelines. However, teachers and schools continue to support the implementation of this module. Conclusion: This module is quite effective in providing information so as to eliminate the taboo impression from reproductive health material.
Risks factors for diarrhea among travellers visiting Bali Ni Wayan Mega Sri Wahyuni; I Made Ady Wirawan; Made Agus Hendrayana
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.p08

Abstract

Background and purpose: The number of foreign travellers visiting Bali continues to increase and diarrhea often occur among them. The purpose of this study is to determine the risk factors for the incidence of diarrhea in foreign travellers. Methods: A case-control study was conducted in foreign travellers visiting the international clinic at the Port Health Office at Ngurah Rai International Airport in Denpasar during the period from May to October 2018. Cases were foreign travellers visiting the clinic with diarrhea symptoms. Controls were non-diarrhea foreign travellers visiting the clinic for other purposes. The number of cases and controls was 87 people each and were matched by gender and citizenship. Data collected were age, travel plans, type of food and beverage consumption, hand washing habits and type of food providers (roadside food sellers, restaurants, hotel restaurants and food stalls). Multivariat analysis was performed using logistic regression to determine the adjusted odds ratio (AOR) of each risk factor. Results: Characteristics of cases and controls do not differ in terms of gender and citizenship. Multivariate analysis shows that significant risk factors associated with diarrhea in foreign travellers are a history of consuming street food with AOR=3.94 (95%CI: 1.19-12.97) and a history of traditional barbequed pork consumption (called babi guling) with AOR=6.24 (95%CI: 2.09-18.64). Other risk factors, namely consumptions of Indonesian food, traditional mixed chopped meat and vegetables (called lawar), mixed rice and drinks with ice cubes, are not found to be associated with the incidence of diarrhea in foreign travellers. Conclusion: Consumptions of street food and traditional barbequed pork were found to be associated with the incidence of diarrhea in foreign travellers during a visit to Bali. Street food hygiene, education for food vendors and information provision to foreign travellers on choosing food types need to be improved
Exclusive breastfeeding: The role of midwives at pregnancy, childbirth and postpartum Ni Kadek Neza Dwiyanti; Komang Ayu Kartika Sari; Dyah Pradnyaparamitha 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.p09

Abstract

Background and purpose: The coverage of exclusive breastfeeding is reported to be low. The aim of this study was to explore the extent of the roles of midwives during pregnancy, childbirth and postpartum to increase exclusive breastfeeding. Methods: This study applied a qualitative approach by in-depth interviews based on interview guidelines to explore the role of midwives in increasing exclusive breastfeeding during pregnancy, childbirth and postpartum. This study was conducted in the area of Kuta I Public Health Center (PHC), Badung District, Bali Province from October 2017 to July 2018. Interviews were conducted with 12 informants chosen purposively, namely three PHC midwives, two private practice midwives, one nutrition program manager, four mothers who managed to provide exclusive breastfeeding and two who did not. Data were analyzed with a thematic approach. Results: This study shows that the roles of midwives are not optimal. The role that has been carried out during pregnancy is to provide information about breast care but not to practice breast care. During labor, the midwife facilitated the initiation of early breastfeeding except for mothers who experienced childbirth complications. During the postpartum period the midwife provides information about breastfeeding to working mothers and monitors exclusive breastfeeding at the integrated health services centers or in Indonesia called pos pelayanan terpadu (posyandu) until the infant reach the age of six months. Midwives provide information about breast care and how to overcome problems in breastfeeding, but do not facilitate the practice of both. All midwives do not conduct home visits for several reasons, such as distance to residents’ homes, high burden of tasks and lack of human resources. Midwives also provide counselling at posyandu on maternal and child nutrition but do not focus on exclusive breastfeeding. Conclusion: The roles of midwives in facilitating exclusive breastfeeding during pregnancy, childbirth and postpartum are still superficial and not in accordance with the guidelines for obstetric care. The roles of midwives need to be enhanced to increase exclusive breastfeeding.
Smoking as a health problem: A priority-setting study in a tobacco industry dependent village Nuzulul Kusuma Putri; Riris Diana Rachmayanti
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.p10

Abstract

Background and purpose: Indonesia is one of the most cigarettefriendly countries. The tobacco industry has gained economic dependence both nationally and domestically. Baureno Village in Indonesia has more than half of its population relied their life on the tobacco industry for long time. This study analysed how this high tobacco dependent community considered the smoking behaviour as one of prioritized health problems. Methods: This priority-setting study was conducted in quantitative and qualitative phases sequently. The quantitative data on smoking behaviour were collected on 251 households as the samples. This study captured the twelve healthy family indicators issued by The Indonesia Ministry of Health. Further, this data were brought into two different focus group discussions with community leaders and primary healthcare workers to understand how this community considered smoking as a health problem. Their prespective on prioritized health problem was revealed by performing a prioritysetting analysis. Results: Smoking behaviour in cigarette producing areas is the impact of the economic dependence created by the tobacco industry. Ease of access and weak supervision of cigarette distribution in producing cigarette region caused smoking behaviour to be common place in this community group. Community considered smoking as a bottom priority of health problems, while health workers considered smoking as the second priority out of four identified health problems. Conclusion: Community and health workers have a different prioritized health problems. Education to community should be enhanced to increase their awareness on the health impacts of tobacco smoking.
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.
Association between husband support and compliance with post-cryotherapy requirements among mothers in Tabanan District, Bali Gede Ngurah Upadana; Anak Agung Sagung Sawitri; I Nyoman Mangku Karmaya
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.p12

Abstract

Background and purpose: Cervical cancer is a major global health problem for women, with most of cases occurring in developing countries. Visual inspection with acetic acid (VIA) is one method for screening precancerous cervical lesions which can then be followed up with cryotherapy. The success of cryotherapy is influenced by many factors including maternal compliance to meet the clinical requirements after cryotherapy. This study aims to determine the association between husband’s support and mother’s compliance with post-cryotherapy requirements. Methods: A cross-sectional study was conducted on 142 mothers with positive VIA test results and had received cryotherapy in six Tabanan public health centers (PHCs) consisting of four PHCs in urban areas and two PHCs in rural areas. All mothers who underwent cryotherapy during 2017 were selected as samples. Data were collected through face-to-face interviews in each respondent’s home using a questionnaire. The information collected was four post-cryotherapy requirements consisting of sexual abstinence, on schedule follow-up examinations, compliance to the recommended antibiotic use, not using topical vaginal medication and husband’s support. Husband’s support measured by 11 questions consisted of psychological, social and environmental support. Bivariate analysis was performed with chi-square and multivariate analysis with logistic regression. Results: This study shows that only 39.4% of respondents were compliant to meet the four post cryotherapy requirements. As many as 32.4% of mothers had sex within 4 weeks after cryotherapy and 40.1% did not have the follow up examinations on schedule. Husband’s support was significantly associated with maternal compliance in the form of asking about respondent’s health condition with AOR=6.658 (95%CI: 1.794-24.702) and not asking for sex with AOR=4.151 (95%CI: 1.491-11.556). Conclusion: Mother’s compliance with the four requirements after cryotherapy remains low and the husband’s support has a role in increasing maternal compliance. Education on post cryotherapy requirements needs to be improved particularly in regards to the role of the husband.
Synergizing early detection and comprehensive mandatory notification to improve Tuberculosis case finding through public private mix Artawan Eka Putra, I Wayan Gede
Public Health and Preventive Medicine Archive Vol. 10 No. 1 (2022)
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53638/phpma.2022.v10.i1.p01

Abstract

Tuberculosis (TB) is a priority health problem in Indonesia. Incidence rate estimation for TB in 2020 was 301 per 100,000 population or 824,000 new cases per year which is the third highest worldwide. The Corona Virus Disease (COVID-19) Pandemic has caused decreasing performance of TB control program globally, including Indonesia. The treatment coverage was declined from 67% in 2019 to 48% in 2020 and 54% in 2021, far behind the 80% target. This fact signifies that around a half of people with TB in Indonesia are overlooked, which is estimated to be accounted for over 400,000 cases. Another TB Program’s main indicator, treatment success rate at 86%, remains below the target of 90%. Low achievement of the two main indicators may result in the increasing of TB transmission, morbidity and mortality in population. Besides, Indonesia also faces the triple burden of TB, high prevalence of drug resistance TB and coinfection of TB and HIV

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