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Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Published by Universitas Indonesia
ISSN : 19077505     EISSN : 24600601     DOI : https://doi.org/10.7454/kesmas
Core Subject : Health,
Health Professions Public Health
The focus of Kesmas is on public health as discipline and practices related to preventive and promotive measures to enhance the public health through a scientific approach applying a variety of technique. This focus includes areas and scopes such as Biostatistics, Environmental Public Health, Epidemiology, Health Policy, Health Services Research, Nutrition, Occupational Health and Industrial Hygiene, Public Health, Public Health Education and Promotion, Women Health.
Arjuna Subject : Kedokteran - Epidemilogi
Articles 928 Documents
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Social Eating Role in Ultra-Processed Food Consumption Among Urban Young Adults: The 2018 Indonesian Food Barometer Arumsari, Imas; Putri, Nabilla Ayusyah; Lathifah, Siti Nur Lulu; Rosalba, Gita Aisyah Astrid; Khusun, Helda; Februhartanty, Judhiastuty; Aini, Rahmatika Nur
Kesmas Vol. 20, No. 2
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Abstract

This study investigated the differences in ultra-processed food (UPF), fruit, vegetable, and total fat consumption in different aspects of social eating among urban young adults. This cross-sectional study used the 2018 Indonesian Food Barometer dataset with 180 participants aged 18–25 years living in urban areas from 6 provinces in Indonesia. The data on social eating (cooking habits, eating out, and eating alone), UPF, fruits, and vegetables were obtained from an extended 24-hour food recall interview. The Mann-Whitney U test (CI 95%) was employed for data analysis. This study found that groups with less frequent cooking habits tended to have more total energy intake, fat intake, and total energy from UPF (p-value
Direct Medical Costs of Diabetes Mellitus Treatment for Patients with Cardiovascular and Renal Complications Fadila, Rizki; Purnamasari, Ayu Tyas; Citra Dewiyani, A.A. Istri
Kesmas Vol. 20, No. 5
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Abstract

Type 2 Diabetes Mellitus (T2DM) represents a growing global health challenge with significant clinical and economic implications, notably in Indonesia. The burden is intensified by renal and cardiovascular complications, especially among National Health Insurance beneficiaries. This retrospective study evaluated the direct medical costs of hospitalized T2DM patients with such complications at a type B hospital from 2019 to 2022. Costs were analyzed from both healthcare provider and payer perspectives, covering medical services, medical support services, pharmaceuticals, and other support services. Of the 192 patients reviewed, most were male (57.8%), aged 45–64 years (72.4%), with hospital stays of 1–5 days (90,1%) and severity level E-4-10-I (100%). Renal complications incur higher treatment costs than cardiovascular complications, with medical support services dominating renal costs and medical services such as doctor and nursing procedures, examinations, and visits contributing most to cardiovascular costs. These results highlight the urgent need for preventive measures, early diagnosis, and innovative treatments to optimize T2DM management and reduce associated economic burdens.
Analyzing High-Risk Fertility Behavior for Sustainable Maternal-Child Health: A 2017 Sociodemographic Study in Urban and Rural Indonesia Utami, Asti Annisa; Murti, Fadhaa Aditya Kautsar; Yuniar, Popy; Herdayati, Milla
Kesmas Vol. 20, No. 5
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Abstract

Indonesia's goal of achieving Indonesia Emas 2045 hinges on improving Maternal-Child Health (MCH), essential for building a healthy and competitive population. Despite some advancements, the Maternal Mortality Rate (MMR) and Under-five Mortality Rate (U5MR) remain high, particularly because of High-Risk Fertility Behavior (HRFB). The HRFB poses significant risks to MCH, affecting both urban and rural women. This study aimed to identify the factors associated with HRFB in these areas to enhance MCH outcomes and support Indonesia's sustainable health goals. This cross-sectional study used a secondary dataset from the 2017 Indonesian Demographic Health Survey. A total of 20,530 women of reproductive age were included in this analysis. The main dependent variable was the HRFB, and the independent variables were split into three factors: individuals, households, and community factors. The overall prevalence of HRFB was 37.0%, with a slightly higher prevalence in urban areas (37.6%) than in rural areas (36.1%). In rural areas, HRFB was significantly associated with the wealth quintile, while in urban areas, it was linked to women's autonomy and education level. Addressing these factors is critical for improving MCH outcomes and reducing HRFB use.
Cross-Cultural Adaptation and Validation of RANAS-Based Instrument for Measuring Latrine Use Behavior in Indonesia Yulyani, Vera; Dewi, Fatwa Sari Tetra; Iswanto, Iswanto
Kesmas Vol. 20, No. 5
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Abstract

Using toilets is a simple way to prevent diarrhea, yet no validated tool exists to measure this habit. This study aimed to develop and validate instruments for measuring latrine use consistency. This questionnaire was adapted from the risk, attitude, norm, ability, and self-regulation (RANAS) framework developed in India and modified for Indonesia. It was evaluated by three experts using the content validity index (CVI). The face validity index (FVI) was pilot-tested on 40 community respondents. Variables measured included behavior, habits, intentions to use toilets, knowledge, attitudes, norms, abilities, and self-regulation. Question items with relevance and clarity scores of item CVI above 0.80 were considered valid and appropriate. Item scoring 0.70–0.79 required revisions, while scores below 0.70 led to deletion. The relevance and clarity assessment results for behavioral, intention, knowledge, norm, and attitude to use toilet questions yielded a scale CVI of more than 0.80, indicating that all items were valid and reliable. However, the habits, abilities, and self-regulation variables had varying I-CVI scores, indicating a need to revise or remove certain items. A culturally adapted and validated RANAS-based instrument is reliable for measuring latrine use behavior in Indonesia.
Contribution of National Health Insurance Patient Revenue to Financial Performance of Private-Profit Hospitals from 2017 to 2022 Imansyah, Fadlul; Sjaaf, Amal Chalik; Nadjib, Mardiati; Hartini, Rina
Kesmas Vol. 20, No. 5
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Abstract

This study investigated the relationship between National Health Insurance (NHI) patient revenue and profit-private hospital financial performance in Indonesia. As the NHI provider, Badan Penyelenggara Jaminan Sosial (BPJS) Healthcare Security’s influence on hospital revenues has raised concerns about its impact on financial sustainability. This study used financial performance indicators to develop a financial performance index—Return on Assets (ROA), Return on Equity (ROE), Earnings Before Interest, Taxes, Depreciation, and Amortization (EBITDA) Margin, Current Ratio, and Net Profit Margin (NPM)—to assess the financial impact of BPJS Healthcare Security revenue. A partial model approach of multiple linear regression was employed using secondary data from seven private-profit hospitals listed on the Indonesian Stock Exchange from 2017 to 2022. The findings indicated a negative correlation between BPJS Healthcare Security patient revenue and the hospital financial performance index. Specifically, higher patient revenue correlated with lower performance across key financial indicators, including ROA, ROE, EBITDA Margin, Current Ratio, and NPM. It was essential for hospitals but not necessarily to improve their financial health performance. Hospitals need to optimize their revenue mix and explore alternative financial strategies to enhance performance.
Associated Factors in Willingness to Shift Tobacco Expenditure Into National Health Insurance Premium Among Subsidized Members Wahidin, Mugi; Mikrajab, Muhammad Agus; Agustiya, Rozana Ika; Azteria, Veza
Kesmas Vol. 20, No. 5
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In Indonesia, subsidized members are the largest group in the National Health Insurance program. Hence, it is essential to understand their ability to pay (ATP) based on tobacco expenditure. This study aimed to determine the ATP of subsidized members based on tobacco expenditure and factors associated with their willingness to pay (WTP). This cross-sectional study used secondary data from the National Institute of Health Research and Development. The population included all subsidized members; 19,918 were sampled for ATP, and 14,560 were WTP. The independent t-test, ANOVA, and logistic regression were performed. Results showed that ATP from tobacco expenditure ranged from USD 4 to 4.8, higher than the minimum monthly payment, and WTP ranged from USD 0.1 to 1.2. About 73.6% of respondents preferred to pay less than USD 0.3 as an additional payment, while 3.5% were willing to pay more than USD 1. The ATP was higher than the monthly payment and WTP, but only a few were willing to be non-subsidized members. Factors associated with WTP were sex, age, education level, family member, occupation, expenditure, and history of health facility utilization, implying the subsidized members should be reviewed, especially among smokers.
The Effectiveness of Remote Patient Monitoring in Reducing the Risk of Rehospitalizations in COVID-19 Patients: A Meta-Analysis Riadi, Dela; Trihandini, Indang; Sari, Dewi Nirmala; Wijaya, Fikri
Kesmas Vol. 20, No. 5
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Abstract

An integrated analysis of various Remote Patient Monitoring (RPM) studies is needed to evaluate the reduction rate of the risk of rehospitalization in COVID-19 patients. This meta-analysis aimed to provide an overview of the effectiveness of RPM. A literature search through online databases (PubMed, Science Direct, Scopus, ProQuest, and Embase) was conducted from 2019 to 2022. After using the Cochrane Collaboration's risk of bias tool, five studies on COVID-19 were selected. Based on the data collected from 2,685 participants (intervention = 1,060, control = 1,625), the use of RPM was found to reduce rehospitalization by 0.56 times compared to not using RPM (I2 = 9%; n = 2,685; OR 0.56 [95% CI 0.39-0.82]; p-value = 0.003). According to the characteristics analysis, sex, comorbidity of hypertension, heart failure, obesity, chronic lung, and chronic kidney disease had no significant effect on the risk being studied. It was only the comorbidity of diabetes that showed a significant impact. Both RPM intervention duration and long-term monitoring effectively reduced rehospitalization (>14 days). In brief, RPM may reduce hospitalizations in response to an impending epidemic. Future research should look into using RPM to treat chronic post-hospitalization conditions.
Supporting and Hindering Factors Associated with COVID-19 Health Protocol Adherence Among Online Motorcycle Taxi Riders in Samarinda City, Indonesia Setyowati, Dina Lusiana; Asrianti, Tanti; Kamba, Ismail; Agustini, Rina Tri
Kesmas Vol. 20, No. 5
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Abstract

The COVID-19 pandemic has underscored the importance of preventive health protocols, especially for high-contact occupations, such as online motorcycle taxi riders. However, adherence among these riders is inconsistent, particularly in economically constrained regions, such as Samarinda, a buffer zone for Indonesia's new capital. This study examined the influence of supporting and hindering factors on COVID-19 protocol compliance. A cross-sectional design was employed with 87 riders selected through quota sampling. Data were collected using structured questionnaires and analyzed using Spearman's rank correlation to assess the relationships between influencing factors and compliance levels. Economic barriers, especially high personal protective equipment (PPE) costs (46%), hindered protocol adherence, whereas supporting factors such as leadership and workplace-provided PPE showed no statistically impact on compliance. This finding suggested that financial constraints were the primary barrier, outweighing institutional support. Therefore, targeted financial assistance and strengthened public health policies are recommended to improve compliance. Enhancing community-level awareness and providing PPE subsidies could reinforce adherence and reduce transmission risk in high-contact occupations.
Sustaining Digital Health Interventions for Long-Term Cardiovascular Disease Prevention in the Energy Industry Isnadi, Yul; Kurniawidjaja, L. Meily; Ramdhan, Doni Hikmat
Kesmas Vol. 20, No. 5
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Cardiovascular disease (CVD) is a major health concern for energy industry workers due to occupational risks. Digital health interventions (DHIs) offer innovative strategies for CVD prevention in this high-risk group. This study aimed to explore the effectiveness and sustainability of DHI by incorporating behavior change theories, behavior change techniques, and principles of persuasive system design. A literature review was performed using PubMed, Scopus, Web of Science, and CINAHL databases to collect relevant information on interventions for CVD prevention among energy sector workers. The results indicated that while DHI could improve physical activity, dietary habits, and medication adherence in the short term, sustaining these changes remained challenging due to intervention fatigue, lack of ongoing support, and changing user engagement. To maintain long-term effectiveness, strategies including adaptive interventions, gamification, social support, and iterative refinement based on user feedback are essential. Furthermore, employing a user-centered design approach and integrating DHIs with existing health programs can further enhance sustained behavior change. In conclusion, DHI holds significant potential for CVD prevention in the energy industry. However, its long-term success requires structured approaches, personalized strategies, and ongoing evaluation tailored to this unique occupational setting.
Health Economics Perspective on Indonesian Telemedicine Platform Practices: A Qualitative Study Wibowo, Yossico Ria; Pasaribu, Rina Djunita
Kesmas Vol. 20, No. 5
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Telemedicine in Indonesia has experienced significant growth since its introduction in 2014. The financing system is regulated independently by each platform, leading to disparities in teleconsultation fees and medical incentives. This qualitative study, which involved a literature review and interviews with 33 participants, offered a health economics perspective on the implementation of telemedicine. The recommended teleconsultation fee ranges from USD 0.05 to USD 2.54, with medical incentives set at USD 1,59-3.18 for general practitioners and USD 4.77-6.36 for specialists, using telephone or video calls as the preferred means of teleconsultation. Although most patients and Indonesian Medical Association administrators generally agreed with these recommendations, platform managers expressed reservations, particularly regarding the fees for specialists. Video calls were widely accepted as the preferred medium for teleconsultations. This study concludes that the maximum recommended teleconsultation fee is USD 2.54, with minimum medical incentives of USD 1.59 for general practitioners and USD 4.77 for specialists, and that the teleconsultation medium for making a diagnosis on the telemedicine platform is chat, with a mandatory feature allowing optional use of video calls, which can be used according to the mutual agreement and adjustment of teleconsultation fees.

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