Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal)
Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal): A Journal of Values, Issues, Experience, and Collaboration has been a leading platform for healthcare thought leaders and innovators since its establishment in 2013. Published in collaboration with DPW PPNI Jawa Barat, the journal is dedicated to advancing nursing and healthcare knowledge through evidence-based research and practice. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) is a peer-reviewed journal published by STIKep PPNI Jawa Barat, quarterly publication released in January, April, July, and October each year. Each issue offers valuable insights into contemporary topics and challenges relevant to nursing professions across diverse practice settings. By fostering collaboration and sharing innovative ideas, the journal serves as a vital resource for nurses, educators, researchers, and policymakers committed to improving nursing outcomes. The dynamic and ever-evolving nature of global healthcare continues to present new challenges and raise critical questions. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) invites researchers, academics, practitioners, managers, and policymakers from diverse countries and backgrounds to submit papers that explore these pressing issues and advance the body of knowledge in nursing and clinical practice. Beginning July 2021, the journal will be published in English. Manuscript submissions can be made online through our website: http://journal.stikep-ppnijabar.ac.id. We look forward to receiving your contributions and fostering meaningful dialogue in the field of nursing and healthcare. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal) has been nationally accredited based on the Decree of Minister of Research, Technology and Higher Education Number : 152/E/KPT/2023 with SINTA Score 4. JKK has p-ISSN: 2354-8428, e-ISSN: 2598-8727, and DOI: https://doi.org/10.33755/jkk Average article statistics (from early 2020 to present) 7 s.d 14 Days to First Editorial Decision 30 Days to Accept 75% Acceptance Rate 25% Rejection Rate
Effectiveness of Ergonomic Training in Reducing Musculoskeletal Disorders Among Farmers: An Agricultural Nursing Program
Background : Musculoskeletal disorders (MSDs) represent a major occupational health concern among agricultural workers in Indonesia. These conditions commonly arise from repetitive workloads, awkward or non-ergonomic body positions, and insufficient understanding of ergonomic practices. As a result, farmers may experience ongoing discomfort, reduced work capacity, and a decline in overall well-being. Objective : The purpose of this study was to assess the effectiveness of an Ergonomics Exercise Program (EEP) in alleviating musculoskeletal complaints among farmers. Methods : This study applied a pre- and post-intervention design involving 85 farmers. Symptoms related to musculoskeletal disorders were evaluated before and after the intervention using the Visual Analog Scale (VAS) and the Nordic Body Map (NBM). The Ergonomics Exercise Program was carried out over a two-week period, with participants performing 10-minute exercise sessions each day prior to starting work. The intervention focused on flexibility training, strengthening of core muscles, and correction of working posture. Changes in MSD symptoms were analyzed statistically to determine the effect of the program. Results : Before the intervention, 54% of participants reported mild pain, while 46% experienced moderate pain levels. The most commonly affected body areas included the calves (62.3%), lower back (45.8%), arms (40%), and shoulders (28.2%). Following the implementation of the Ergonomics Exercise Program, a statistically significant reduction in musculoskeletal complaints was observed (p < 0.05), particularly in the lower back, shoulders, and calves. Conclusion : The findings indicate that the Ergonomics Exercise Program effectively reduced musculoskeletal disorder symptoms among farmers. Incorporating ergonomics-based exercise routines into agricultural nursing and occupational health initiatives may offer a practical and sustainable approach to improving worker health and preventing MSDs in rural farming populations in Indonesia.
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School-Based Peer Group Support as a Psychosocial Strategy to Promote Mental Health in Adolescents: A Quasi-Experimental Approach
Background: Adolescents are vulnerable to psychological distress due to rapid developmental changes and social pressures. School-based psychosocial strategies such as peer group support may enhance early mental-health promotion. Objective: To evaluate the effectiveness of peer group support on mental health indicators among junior high school students. Methods: A quasi-experimental pretest–posttest control group design was conducted among 84 adolescents aged 12–15 years at SMPN 4 Klari, Karawang Regency, Indonesia. The intervention group received 8 peer-support sessions across 8 weeks. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ). Data were analyzed using paired and independent t-tests and ANCOVA. Results: The intervention significantly improved adaptive coping (+42.4%), reduced stress symptoms (−35.8%), and increased health-maintenance behaviors (+43.1%). Between-group post-intervention differences were statistically significant (p < .001). Effect size analysis indicated a large treatment impact (Cohen’s d > 0.8). Conclusion: Peer group support effectively enhances adolescent mental health and coping abilities. Integrating peer-based interventions into school programs is recommended to foster a supportive psychosocial environment.
Knowledge and Smoking Behavior Among High School Students : A Cross-Sectional Study
Background: Smoking involves the combustion of tobacco products, producing smoke that is inhaled by the smoker and can also be passively inhaled by individuals in the surrounding environment. Adolescence is a vulnerable period during which smoking behaviors may develop, influenced by knowledge, attitudes, and social factors. Limited awareness of the health risks associated with smoking may contribute to the persistence of smoking behavior among adolescents. Objective: This study aimed to examine the relationship between knowledge and smoking-related behavior among adolescent students at State Senior High School 3 Tambun Selatan in 2025. Methods: A quantitative study with a descriptive correlational design and a cross-sectional approach was conducted. The study population consisted of all male students enrolled at State Senior High School 3 Tambun Selatan (n = 452). A total of 440 respondents participated in the study. Data collection was carried out on January 31, 2025, using structured questionnaires. Statistical analysis was performed using the Chi-square test to assess associations between variables. Results: The analysis revealed a statistically significant relationship between adolescents’ knowledge and smoking behavior (p = 0.005). In addition, a significant association was found between behavioral factors and smoking incidence (p < 0.001), indicating that lower knowledge levels and unfavorable behaviors were associated with higher smoking prevalence. Conclusion: This study demonstrates that adolescents’ knowledge and behavior are significantly associated with smoking habits. Strengthening school-based health education programs focusing on the dangers of smoking is essential to reduce smoking prevalence and promote healthier behaviors among adolescents
Effect of Leaflet-Based Health Education on Spiritual Well-Being and Quality of Life Among Patients Living with HIV/AIDS at Immanuel Hospital, Bandung
Background: Human Immunodeficiency Virus (HIV) is a chronic sexually transmitted infection that progressively weakens the immune system. If untreated, HIV can develop into Acquired Immunodeficiency Syndrome (AIDS), a condition characterized by severe immune suppression and increased vulnerability to life-threatening infections. Beyond physical complications, people living with HIV/AIDS often experience unmet spiritual needs that negatively affect their overall quality of life. Health education interventions using simple and accessible media, such as leaflets, may support spiritual well-being and improve quality of life. Objective: This study aimed to examine the effect of leaflet-based health education on spiritual needs fulfillment and quality of life among patients with HIV/AIDS at Immanuel Hospital, Bandung. Methods: A quasi-experimental study design with a pretest–posttest approach was conducted in August 2022. A total of 63 patients with HIV/AIDS were recruited using purposive sampling. The intervention consisted of structured health education delivered through leaflets focusing on spiritual support and coping strategies. Data were collected through validated questionnaires measuring spiritual needs and quality of life before and after the intervention. Statistical analysis was performed to assess changes following the educational intervention. Results: The findings demonstrated a significant improvement in spiritual needs fulfillment and overall quality of life after the leaflet-based health education intervention. Participants showed increased spiritual well-being and better perceived quality of life following the intervention. Conclusion: Leaflet-based health education is an effective intervention to enhance spiritual needs fulfillment and improve quality of life among patients with HIV/AIDS. Incorporating spiritual-focused educational materials into routine nursing care may contribute to holistic patient management.
Foot Care Practices as Determinants of Diabetic Foot Ulcer Risk in Rural Populations
Background: Diabetic foot ulcers (DFUs) represent a major chronic complication of diabetes mellitus and are associated with infection, extended hospital stays, and an increased likelihood of lower-limb amputation. Individuals with diabetes remain at lifelong risk of DFUs, with recurrence frequently reported. Consistent and appropriate foot self-care is therefore considered a key preventive measure, particularly in community settings with limited access to specialized care. Objective: This study aimed to examine the relationship between foot self-care behaviour (FSCB) and the risk of developing diabetic foot ulcers among adults with type II diabetes living in rural communities. Methods: A cross-sectional study was conducted involving 100 adult outpatients with type II diabetes attending the Sukawati II Primary Health Care Centre, Gianyar, Bali. Participants were recruited using consecutive sampling. Data were collected through structured questionnaires that included demographic characteristics and foot self-care behaviour assessed using the Nottingham Assessment of Functional Foot Care (NAFF). The risk of diabetic foot ulcers was evaluated using Inlow’s 60-second diabetic foot screening tool, incorporating a 10 g monofilament test. Data analysis employed the Gamma correlation test to determine the association between variables. Results: The findings showed that 62% of participants demonstrated poor foot self-care behaviour. Additionally, 50% of respondents were identified as being at risk of developing DFUs. Statistical analysis revealed a strong and significant inverse relationship between foot self-care behaviour and DFU risk (p = 0.001; r = −0.613). Conclusion: Poor foot self-care behaviour is strongly associated with an increased risk of diabetic foot ulcers among individuals with type II diabetes in rural settings. These findings highlight the importance of strengthening foot care education and preventive interventions at the primary health care level
Factors Associated with Depression in Elderly Patients with Hypertension
Background: Depression in elderly individuals with hypertension is a common but often underdiagnosed mental health issue that affects quality of life and treatment adherence. This study aimed to identify factors associated with depression in elderly patients with hypertension. Design : A descriptive correlational study with a cross-sectional design was conducted. Methods : This study involved 68 community-dwelling elderly patients with hypertension in a village of North Sulawesi selected through total sampling. Data were collected using structured questionnaires covering sociodemographic and clinical characteristics and the Geriatric Depression Scale-15 (GDS-15). Data were analyzed using the Mann-Whitney U test, Kruskal-Wallis H test, and Spearman’s rank correlation. Results : The mean depression score was 9.43 (SD = 1.79), with nearly half of participants experiencing moderate depression (48.5%). Only the duration of hypertension was significantly correlated with depression score (r = 0.275, p = 0.023). Conclusions : These findings highlight the need for routine depression screening among elderly hypertensive patients, particularly those with a longer history of illness. Clinical implications include adopting integrated care models that combine hypertension management with psychosocial support in primary care settings
Development of an AI-Based Clinical Decision Support System for Standardized Nursing Diagnoses in Indonesia
Background: The implementation of the Indonesian Nursing Diagnosis Standards (IDHS) in clinical practice continues to encounter obstacles, including limited time for assessment, documentation burden, and inconsistency in diagnostic interpretation among nurses. Advancements in artificial intelligence (AI) offer opportunities to design clinical decision support systems that may enhance the accuracy, uniformity, and efficiency of nursing diagnoses. Objective: This study aimed to explore nurses’ experiences, challenges, and expectations regarding the use of IDHS and to assess the initial feasibility of developing an AI-based system to support standardized nursing diagnoses. Methods: A descriptive qualitative design was employed using in-depth interviews with five nurses from diverse clinical settings, including emergency, critical care, inpatient, outpatient, and community services. Thematic analysis was conducted to identify perceptions and needs related to IDHS and AI. Content validity of the preliminary system design was evaluated by three expert validators using the Item-Level Content Validity Index (I-CVI) and the Scale-Level Content Validity Index/Average (S-CVI/Ave). Results: Five major themes emerged: (1) varied experiences in formulating nursing diagnoses, (2) inconsistent use of IDHS in practice, (3) challenges related to documentation and diagnostic interpretation, (4) positive attitudes toward AI integration in clinical workflows, and (5) the need for features such as automated diagnostic suggestions, clarification of clinical criteria, and integration with electronic medical records. Content validity testing demonstrated strong agreement among experts, with I-CVI values ranging from 0.80 to 1.00 and an S-CVI/Ave of 0.92. Conclusion: The study indicates that integrating AI into the IDHS-based diagnostic process holds substantial potential to improve diagnostic quality, standardization, and clinical efficiency. The content validity results support further development and prototype testing in subsequent research phases
Reimagining Nursing Competency Evaluation: Clinical Assessors’ Readiness and Adaptation to Digital Assessment Systems in a Provincial Hospital Setting
Background: Clinical competency assessment is a core component of nursing governance and professional development. In many Indonesian hospitals, competency evaluations remain predominantly paper-based, resulting in administrative inefficiencies and limited data traceability. The implementation of the SICAKEP (Sistem Informasi dan Pencatatan Keperawatan) digital application at RSUD Welas Asih, West Java, represents an important step toward modernizing assessment processes; however, assessors’ experiences during this transition have not been fully explored. Objective: This study aimed to explore the lived experiences of clinical nurse assessors in conducting manual and digital (SICAKEP-based) competency assessments in a provincial teaching hospital in West Java, Indonesia. Methods: A qualitative descriptive phenomenological design grounded in a constructivist paradigm was employed. Four certified clinical nurse assessors with experience in both manual and digital assessments were recruited using purposive and snowball sampling. Data were collected through in-depth semi-structured interviews, brief observations, and document reviews between March and May 2025. Data analysis followed Colaizzi’s seven-step method, supported by reflexive journaling and member checking to enhance credibility. Results: Five themes emerged: adaptation to new assessment roles, multidimensional implementation barriers, constraints related to time and readiness, competency assessment as a driver of professionalism and quality, and transformation from manual to digital systems. Digital assessment improved efficiency and transparency but required stronger digital literacy and infrastructure support. Conclusion: Digital competency assessment represents a meaningful advancement in nursing governance, though sustained institutional support is essential to optimize its implementation
A School-Based Aerobic Exercise Program to Improve Blood Sugar Levels Among Adolescents at Risk of Type 2 Diabetes
Background: The prevalence of type 2 diabetes mellitus (T2DM) continues to increase among adolescents due to sedentary lifestyles and poor health behaviors. Early preventive interventions, particularly physical activity integrated into school settings, are essential to minimize the risk of future metabolic disorders. This study aimed to determine the effect of a school-based aerobic exercise program on blood sugar levels among adolescents at risk of T2DM. Methods: A quasi-experimental pre-test and post-test control group design was conducted among 60 adolescents aged 13–15 years in Bandung City who were identified as having moderate to high diabetes risk using the FRIDEM application. Participants were assigned into an intervention group (n = 30) and control group (n = 30). The intervention group performed structured aerobic exercise for 30 minutes, three times per week over four weeks, while the control group followed their usual school routine. Fasting blood glucose was measured before and after the intervention. Data were analyzed using paired t-test and ANCOVA. Results: There was a significant decrease in fasting blood glucose in the intervention group from 123.00 ± 15.70 mg/dL to 100.97 ± 10.80 mg/dL (p < 0.001). In contrast, the control group showed a slight increase from 110.77 ± 14.12 mg/dL to 115.70 ± 17.55 mg/dL (p = 0.077). ANCOVA indicated a significant difference in post-test blood glucose values between groups after controlling for baseline levels (p < 0.001). Conclusion: A structured school-based aerobic exercise program effectively reduced blood sugar levels among adolescents at risk for type 2 diabetes mellitus. Incorporating regular aerobic exercise into school curricula may serve as an important preventive strategy to improve metabolic health and reduce diabetes risk in youth.
SmartBreastfeed: Effectiveness of a Digital Intervention in Reducing Postpartum Fatigue and Enhancing Breastfeeding Motivation
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
Knowledge of Disease Management and Complication Prevention Among Type 2 Diabetes Mellitus Patients in Tangerang District
Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder with increasing prevalence. Patients' knowledge about T2DM is very important to prevent complications and improve quality of life. Objectives: The aim of this study is to assess the level of knowledge of patients with T2DM at Puskesmas Curug. Methods: The design of the study used a cross-sectional quantitative method with purposive sampling, and included 142 patients with T2DM who visited the Curug Health Center in February-April 2025. Data were collected using the Diabetes Knowledge Questionnaire (DKQ) consists of 24 items on three dimensions: baseline information, glycaemic control, and complications prevention. Results: Results showed that 66.9% of patients had low level of knowledge, with most female respondents (69%). Conclusions: The study concluded that the level of knowledge of patients with T2DM at Puskesmas Curug is still low. Specific educational programs need to be planned and implemented among the population for improvement in knowledge and disease management. Further research is recommended to explore factors influencing patient knowledge in order to make training interventions more effective.
Determinants of Leprosy Incidence in West Bekasi, Indonesia: A Cross-Sectional Study
Background : Leprosy remains a chronic infectious disease that can lead to long-term disability when diagnosis and treatment are delayed. Caused by Mycobacterium leprae, the disease primarily affects the skin and peripheral nerves and continues to pose public health challenges in several endemic regions, including parts of Indonesia. Understanding the factors associated with leprosy incidence is essential for developing effective prevention and control strategies. Objective : This study aimed to identify factors associated with the incidence of leprosy at the Danau Indah Cikarang Barat Community Health Center, Bekasi Regency. Methods : A quantitative study with a cross-sectional design was conducted involving 90 respondents selected through purposive sampling. The independent variables examined included age, sex, socioeconomic status, educational level, knowledge, history of contact with leprosy patients, personal hygiene practices, environmental conditions, and access to health information media. Data were collected using structured questionnaires and analyzed using the Chi-square test with a significance level set at 0.05. Results : The analysis revealed statistically significant associations between leprosy incidence and contact history, socioeconomic status, personal hygiene, and environmental conditions (p < 0.05). In contrast, age, sex, educational level, and access to information media were not significantly associated with leprosy incidence. Conclusion : The findings indicate that leprosy incidence is strongly influenced by social, behavioral, and environmental factors. Strengthening health education, improving environmental sanitation, and enhancing early detection and treatment programs are essential to reduce leprosy transmission in endemic areas. These results may serve as valuable input for healthcare providers and policymakers in developing targeted leprosy prevention and control initiatives.
Effectiveness of the EM 2R3SW Digital Application on Parental Outcomes for Childhood Leukemia Prevention: A Quasi- Experimental Study in Depok, Indonesia
Background: Childhood acute lymphoblastic leukemia (ALL) is a leading cause of cancer-related morbidity and mortality in low- and middle-income countries, including Indonesia. Parental gaps in knowledge, attitudes, preventive behaviors, and healthy lifestyle practices contribute to delayed detection and poor outcomes. Digital health platforms offer scalable strategies to strengthen preventive health literacy in families. Objective: To evaluate the effectiveness of EM-2R3SW, a web-based digital education application, on parental knowledge, attitudes, preventive behaviors, and healthy lifestyle practices related to childhood leukemia prevention. Methods: A quasi-experimental pretest–posttest study was conducted among mothers of children aged 0–18 years in Sukmajaya District, Depok, Indonesia (N = 112). Participants accessed leukemia-prevention multimedia content within EM-2R3SW over two weeks. Validated questionnaires measured outcomes at baseline and post-intervention. Data were analyzed using Wilcoxon signed-rank tests due to non-normal distribution (Kolmogorov–Smirnov p < 0.05). Results: Significant improvements were observed across all outcomes. Knowledge scores increased from 16.48 to 27.65, attitudes from 68.15 to 85.95, preventive behaviors from 72.39 to 112.20, and healthy lifestyle practices from 68.39 to 109.27 (all p < 0.001). Category transitions demonstrated marked progression from inadequate to good–very good levels, particularly in preventive practices. Conclusion: The EM-2R3SW digital intervention effectively improved parental literacy and behavioral determinants for childhood leukemia prevention. This approach is feasible, low-cost, and scalable for community-based cancer prevention efforts in resource-limited settings. Larger randomized studies with long-term follow-up are recommended
Comparative Effectiveness of Pamphlet and Video Media in Enhancing Breast Self-Examination Knowledge Among High School Students
Background: Adolescence represents a critical developmental stage during which health-related knowledge and preventive behaviours begin to form. Limited awareness of breast health and breast self-examination (BSE) among adolescent girls may reduce opportunities for early detection of breast abnormalities. Educational interventions delivered through accessible media may play an important role in improving adolescents’ understanding of BSE. Objective: This study aimed to evaluate the effectiveness of health education delivered through pamphlets and video media on the level of knowledge regarding breast self-examination among female adolescents. Methods: A quantitative study with a quasi-experimental design using a two-group pretest–posttest approach was conducted at SMAN 3 Tambun Selatan. The study population comprised 598 female students, of whom 592 participated using a total sampling technique. Knowledge of breast self-examination was assessed using a structured questionnaire administered before and after the educational intervention. Data were analysed using the Wilcoxon nonparametric test. Results: The findings demonstrated a statistically significant improvement in adolescents’ knowledge of breast self-examination following education delivered through pamphlets and video media (p < 0.001). Prior to the intervention, most participants showed limited concern for breast health. Post-intervention results indicated increased awareness and understanding of the importance of regular breast self-examination. Conclusion: Health education using pamphlets and video media is effective in enhancing adolescents’ knowledge of breast self-examination. Integrating structured and media-based educational strategies within school health programmes may strengthen preventive health behaviours and promote early breast health awareness among adolescents.
Development and Validation of a 3D Hologram-Based Learning Media for Emergency Preparedness in Islamic Boarding Schools
Background: Islamic boarding schools (pesantren) have distinctive educational settings, yet emergency preparedness education remains limited by conventional learning methods. Objective: This study aimed to develop and validate a three-dimensional (3D) hologram-based learning media on school safety zones and first aid for students in Islamic boarding schools. Methods: This research employed a Research and Development (R&D) approach using the 4D model, consisting of the Define, Design, and Develop stages. Validation was conducted by two material experts and two media experts using standardized assessment instruments covering aspects of content accuracy, visual quality, and practicality. Data were analyzed descriptively to determine the feasibility level of the developed media. Results: Validation by material experts yielded an average score of 93.33%, while media experts obtained 92.94%, both categorized as very feasible. These findings indicate that the 3D hologram-based learning media meets both substance and technical standards required for preparedness and first-aid education. Conclusion: The developed 3D hologram-based learning media was declared very feasible based on expert validation, making it a valid and appropriate educational tool for future implementation in nursing and health education programs.
The Relationship Between Self-Efficacy and Diet Compliance in Hypertensive Patients with Comorbidities
Background: Hypertension is referred to as “the silent killer” because it often does not show any symptoms, so people are unaware that they have it. This condition can increase the risk of various serious diseases such as aneurysms, heart failure, metabolic syndrome which can trigger diabetes mellitus, heart disease, stroke, dementia, and an increased risk of end-stage kidney disease. Dietary compliance is very important to avoid complications of hypertension, where self-efficacy is one of the main determinants of success in maintaining dietary compliance. Objective: This study focuses on determining the relationship between self-efficacy and diet compliance in patients with hypertension and comorbidities. Methods: This study is a quantitative study with a cross-sectional design. The sampling technique used was purposive sampling, where 120 respondents with hypertension and comorbidities at Dr. Moewardi General Hospital, Surakarta, were selected. The research instruments used were a self-efficacy questionnaire and a dietary compliance questionnaire. Results: Statistical test results using SPSS and Chi-Square analysis showed a significant relationship between self-efficacy levels and diet compliance in hypertensive patients with comorbidities (P-value <0.001). Most respondents had high self-efficacy and adhered to their diet, namely 59 respondents (93.7%), while 55 respondents (96.5%) of those with low self-efficacy were non-adherent. Conclusion: This study indicates that the higher a person's self-efficacy, the higher their confidence in adhering to a diet. Therefore, interventions aimed at increasing self-efficacy can be an effective strategy for improving diet compliance
Effectiveness of Lemongrass Essential Oil Therapy Combined with Foot Marble Exercises on Foot Sensory Function in Patients with Type 2 Diabetes
Background: Peripheral neuropathy is one of the most common chronic complications of Type 2 Diabetes Mellitus (T2DM), characterized by decreased sensory nerve function, numbness, and high risk of foot ulceration. Non-pharmacological foot care interventions, including foot exercises and essential oils, are increasingly recognized as complementary treatments for improving peripheral nerve sensitivity. Objective: This study aims to evaluate the effectiveness of combining Lemongrass Essential Oil (ESSOL) massage and marble-based foot exercises in improving foot sensitivity among patients with T2DM. Methods: A quasi-experimental pretest–posttest design with a control group was employed, involving 40 respondents selected through inclusion and exclusion criteria. Participants were divided into intervention (n = 20) and control (n = 20) groups. Foot sensitivity was assessed using the 10 g Semmes-Weinstein monofilament test before and after the intervention. Data were analyzed using appropriate statistical tests with α < 0.05. Results: There was a significant improvement in foot sensitivity in the intervention group compared to the control group (p < 0.05). The findings indicate that the combined intervention effectively enhances peripheral sensory response in individuals with T2DM. Conclusion: The combination of ESSOL massage and marble foot exercises is an effective non-pharmacological strategy to improve foot sensitivity among patients with T2DM and has the potential to prevent diabetic foot complications.
Family Support vs. Family Strain: Determining Aggression Pathways in Adolescents from Bandung
Background: Aggressive behavior remains a significant concern during adolescence, a developmental period marked by emotional instability and social adjustment. Family functioning is known to shape adolescents’ emotional regulation and behavioral outcomes. However, evidence regarding how family function relates to aggressive tendencies among Indonesian adolescents remains limited. Objective: This study aimed to analyze the relationship between family function and aggressive behavior in adolescents. Methods: A cross-sectional correlational design was used involving 140 students recruited using convenience sampling at SMK Bina Warga Bandung. Data were collected using two validated instruments: the Family Assessment Device (FAD) to assess family functioning and the Buss-Perry Aggression Questionnaire (BPAQ) to measure aggressive behavior. Data analysis was performed using the Pearson correlation test. Results: The mean score for family function was 141.06 ± 9.73, indicating generally good family functioning. Meanwhile, the mean score for aggressive behavior was 77.32 ± 4.51, with hostility as the highest-scoring domain. Pearson correlation analysis revealed a significant negative relationship between family function and aggressive behavior (r = –0.287, p < 0.001), indicating that adolescents who perceive their family functioning as better tend to exhibit lower levels of aggression. Conclusion: Family function plays a crucial protective role in reducing aggressive behavior among adolescents. Interventions that enhance family communication, emotional support, and collaborative problem-solving may effectively prevent aggression and promote healthy adolescent development. Further research incorporating longitudinal designs and broader socio-cultural variables is recommended.
Effectiveness and User Satisfaction of an ePRO-Based mHealth Application for Near Miss Reporting and Patient Safety Culture in the ICU
Background: Near miss reporting and patient safety culture are critical to quality improvement in intensive care units (ICUs), yet conventional reporting systems are often constrained by underreporting, delayed submission, and limited feedback. Mobile health (mHealth) applications integrated with electronic patient-reported outcomes (ePRO) offer a promising approach to facilitate real-time reporting and strengthen safety culture in high-risk clinical environments. Objective: This study evaluated the effectiveness and user satisfaction of an ePRO-based mHealth application in improving near miss reporting and patient safety culture in ICU settings. Methods: A mixed-methods study was conducted in the ICU of a level B hospital in Karawang, Indonesia, involving 250 healthcare workers, primarily nurses. The intervention was implemented over six months using a user-centered design approach. Outcomes included near miss reporting rates, reporting timeliness, and Hospital Survey on Patient Safety Culture (HSOPSC) scores. Quantitative data were analyzed using paired t-tests and multiple linear regression, while user satisfaction and implementation experiences were explored using the System Usability Scale (SUS) and focus group discussions. Results: Near miss reporting increased 2.3-fold after implementation, and timely reporting within one hour rose from 21.4% to 68% (p < 0.001). Significant improvements were observed in patient safety culture domains, particularly non-punitive response to error and communication openness. User satisfaction was high, with a mean SUS score of 82.3. Technical challenges and initial staff resistance were identified as key barriers. Conclusion: The ePRO-based mHealth application significantly improved near miss reporting, enhanced patient safety culture, and demonstrated high usability in ICU settings. Despite technical and cultural challenges, the intervention aligns with the WHO Global Patient Safety Action Plan 2021–2030 and underscores the importance of integrating digital innovation with safety culture initiatives in resource-limited healthcare systems
Longitudinal Mixed-Methods Study: Impact of Social Determinants on Maternal Health Access among Women with Disabilities (Urban vs. Rural)
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.