International Journal of Public Health Excellence (IJPHE)

Development and Pilot Testing of a Childbirth Readiness Questionnaire (CRQ) for Third-Trimester Pregnant Women In Indonesia

2026-01-08T08:08:52+00:00

Childbirth readiness is a multidimensional construct encompassing physical, psychological, social, and spiritual preparedness, yet contextually appropriate instruments for Indonesian pregnant women remain limited. This study aimed to develop and pilot test the Childbirth Readiness Questionnaire (CRQ) for third-trimester pregnant women in Indonesia. A methodological pilot design was employed, including expert review (n = 5) and field testing with 110 pregnant women. Content validity was evaluated using the Item Content Validity Index (I-CVI), while preliminary construct performance was examined through descriptive statistics and corrected item–total correlations. Internal consistency reliability was assessed using Cronbach’s alpha. All nine items demonstrated acceptable content validity (I-CVI ≥ 0.80) and adequate item–total correlations (r = 0.34–0.61). The overall scale showed satisfactory internal consistency (α = 0.82). Dimension-level descriptive scores supported the conceptual structure of physical–cognitive, psychological–spiritual, and social support readiness. These findings indicate that the CRQ has promising preliminary psychometric properties and is feasible for assessing childbirth readiness among Indonesian third-trimester pregnant women. Further validation with larger and more diverse samples is required to confirm its factorial structure and generalizability

Development of the Third-trimester Pregnancy Knowledge Questionnaire (TPKQ): A Pilot Study

2026-01-09T14:51:01+00:00

Background: Maternal knowledge during the third trimester is critical for timely care-seeking and preparation for childbirth, yet standardized instruments specific to this phase remain limited. Objective: This study aimed to develop and pilot test the Third-trimester Pregnancy Knowledge Questionnaire (TPKQ). Methods: A methodological pilot study involved four experts and 110 third-trimester pregnant women. Items were derived from literature and organized into four dimensions: danger signs and care-seeking, birth preparation and delivery planning, preventive care before birth, and maternal conditions affecting labor outcomes. Content validity was assessed using Item and Scale Content Validity Indexes, response-based validity via corrected item–total correlations, and internal consistency with Cronbach’s alpha. Results: The TPKQ includes 10 multiple-choice items with dichotomous scoring. All items showed acceptable content validity (I-CVI = 0.75–1.00; S-CVI/Ave = 0.93), adequate discrimination (r = 0.36–0.46), and good reliability (α = 0.81). Dimension scores suggested higher knowledge of danger signs and lower knowledge of preventive care. Conclusion: The TPKQ demonstrates preliminary validity and reliability

Screening IVA Test Effort to Increase Intention for Early Detection Cancer Cervix in Panyabungan, Mandailing Natal

2026-01-09T15:06:02+00:00

Cervical cancer remains one of the leading causes of death among women in Indonesia, largely due to delays in treatment due to lack of knowledge of early detection. IVA (Visual Inspection with Acetic Acid) examination is a simple, affordable, and effective screening method to recognize early symptoms of cervical cancer, especially in communities with limited access to advanced health facilities. This service activity aims to provide comprehensive education on cervical Cancer prevention efforts through a promotive and preventive approach based on VIA. Counseling is conducted to productive-aged women with interactive methods that include material delivery, group discussions, and simulation of general examination procedures. The results showed an increase in participants' understanding of the importance of routine screening, recognition of early symptoms, and preventive measures that can be taken independently. This program is expected to be able to foster public awareness of the importance of early detection and become part of a strategy to empower women in maintaining their reproductive health in a sustainable manne

Study of The Effect of Fatigue Level on Reducing the Injury Level in Netball Players

2026-01-22T05:50:22+00:00

Athletic performance is often affected by fatigue, which can significantly impact neuromuscular function, power output, and overall movement efficiency. Chronic ankle instability orChronic Ankle Instability (CAI)This is a common condition, particularly among athletes, including netball players. It causes structural and functional impairments, such as ligament laxity and weakened muscle support around the joint.ObjectiveThis study aimed to analyze the effects of a fatigue-inducing protocol on jump height, peak power, peak velocity, and reaction time in netball players. The research method used a quantitative pre-post test design with retrospective data analysis. This study used a fatigue protocol to simulate game-like conditions and analyze performance.Counter Movement Jump(CMJ) before and after fatigue using SPSS software. Paired sample t-tests and correlation analyses were performed to assess performance changes. The results showed that although peak velocity did not show statistically significant changes after fatigue, both peak power and jump height decreased significantly, and fatigue impacted lower limb explosive performance. The difference in jump height with fatigue testing before and after the intervention was statistically significant (p<0.001) indicating a significant change in jump height after the fatigue protocol. Correlation analysis showed that there was no significant relationship between CAI and fatigue-induced performance decline.In conclusion,There is a significant effect of fatigue levels on reducing injury rates in netball players.

Automatic Pill Counting Using YOLOv8 to Improve Medication Distribution Accuracy

2026-01-23T07:37:30+00:00

Object detection is a critical component in various modern applications, including healthcare systems, smart agriculture, and industrial automation. The main challenge in developing detection systems lies in achieving high accuracy and strong generalization capabilities under diverse image conditions. This study aims to implement and evaluate the YOLOv8 model, a detection method known for its speed and efficiency. The model is trained using two scenarios—10 epochs and 50 epochs—to examine the impact of training duration on system performance. Evaluation results show that training for 10 epochs produces very good performance, with a precision of 0.98, recall of 0.94, and mAP of 0.98. Increasing the training to 50 epochs yields even more optimal results, achieving a precision of 0.99, recall of 1.00, and mAP of 0.99. Based on these findings, YOLOv8 demonstrates excellent adaptability to the dataset and is suitable for real-time detection applications that require high accuracy

The Construct of Health Communication Effectiveness and Its Dimensions: A Confirmatory Factor Analysis within Hospital Settings in Middle Eastern Conflict Zones

2026-01-27T04:39:48+00:00

This study aims to empirically substantiate the dimensional structure of health communication effectiveness in hospitals operating within conflict zones in the Middle East through a Confirmatory Factor Analysis (CFA) approach. Secondary data were compiled from 847 medical records and patient surveys drawn from twelve hospitals in Syria, Iraq, and Yemen between 2019 and 2023. The six-dimension CFA model demonstrated exceptionally robust statistical adequacy, indicated by χ²/df = 2.134, CFI = 0.954, TLI = 0.947, RMSEA = 0.042 (90% confidence interval: 0.038-0.046), and SRMR = 0.039. Information clarity emerged as the strongest dimension with a factor loading of λ = 0.891, followed by provider empathy, responsiveness, communication competence, accessibility, and cultural sensitivity, all of which were significant at p < 0.001. Construct reliability was high, with CR = 0.943 and AVE = 0.735. These findings reinforce the work of Epstein et al. (2010) and Street et al. (2009) on the critical importance of patient-centered communication, while extending the current discourse by integrating cultural sensitivity and trauma-informed communication principles that have not yet been examined in conflict settings. This study offers a novel contribution by comprehensively validating the health communication construct in the context of extreme armed conflict

Multidimensional Structure Of Maternal Sleep Quality In The Third Trimester: Psychometric Evaluation

2026-02-04T03:57:19+00:00

Beground : Sleep disturbances are highly prevalent during late pregnancy and have been associated with maternal mental health vulnerability and adverse perinatal outcomes. Emerging evidence suggests that sleep quality in the third trimester is context-specific and may not represent a single, uniform construct. However, the latent structure of maternal sleep quality in late pregnancy has not been sufficiently examined using a theory-driven psychometric approach.

Methods : A community-based cross-sectional study was conducted among women in the third trimester of pregnancy (≥28 weeks). The Maternal Sleep Quality Index for the Third Trimester – Indonesian Version (MSQI-T3-ID), a newly developed eight-item self-report instrument, was administered. The hypothesized three-dimensional structure—Sleep Initiation and Continuity, Pregnancy-Specific Disturbance, and Daytime Impact and Fatigue—was evaluated using Confirmatory Factor Analysis within a Structural Equation Modeling framework.

Results : Confirmatory factor analysis supported a multidimensional model of maternal sleep quality in late pregnancy. The model demonstrated acceptable fit indices (CFI = 0.95; TLI = 0.93; RMSEA = 0.094; SRMR = 0.027). All items loaded significantly on their respective latent dimensions, with standardized factor loadings ranging from 0.91 to 0.99 (p < .001), indicating a coherent internal structure.

Conclusion : The findings provide empirical support for conceptualizing sleep quality in late pregnancy as a multidimensional construct. This study provides initial structural validity evidence for a brief, trimester-specific sleep quality instrument.

Keywords : Maternal sleep quality; Third trimester pregnancy; Psychometric validation.

Analysis Of Nursing Practices For STEMI Patients With The Innovational Intervention Of A Combination Of Swedish Massage With Olive Oil And Warm Water

2026-02-04T04:18:46+00:00

ST-Elevation Myocardial Infarction (STEMI) is part of Acute Coronary Syndrome (ACS), a cardiovascular condition in which a coronary artery is completely occluded, preventing oxygen from reaching the heart muscle. This study aimed to determine the effect of Swedish massage therapy combined with warm water on hemodynamic stability. This study employed a case study design comparing an intervention patient and a control patient diagnosed with STEMI who had unstable hemodynamic status in the ICCU. After the implementation of Swedish massage and warm water therapy in the intervention patient for three consecutive days, the patient’s hemodynamic parameters such as blood pressure, heart rate, mean arterial pressure, and respiratory rate remained within stable limits, showing no significant increases or decreases. This outcome differed from the control patient, who received only pharmacological therapy. The analysis deminstated a difference in hemodynamic outcomes between patients who received the combined intervention and those in the control group.

Classification of Lung Diseases Using The Naive Bayes Classifier Method at Madani Hospital Medan in 2025

2026-02-05T03:53:05+00:00

The lungs are one of the human organs that are very important in the respiration process. There are several types of lung diseases, including Asthma, Bronchitis, Dyspnea Pleural Effusion, Empyema, Emphysema, Pulmonary Fibrosis, Lung Cancer, Interstitial Lung Disease, Pleurisy, Pneumonia, COPD, Tuberculosis. In this case there are difficulties in the process of classifying lung diseases, because the symptoms shown by sufferers of lung disease have similarities between one lung disease and another. The purpose of this study is to classify lung diseases using the Naive Bayes Classifier method. This method was chosen because it only requires a little training data to determine the estimated parameters needed in the classification process. This research was conducted at Madani General Hospital, Medan Area District, Medan City, North Sumatra, from February 1, 2025 to April 1, 2025. The data taken were medical records of lung disease patients from January 1, 2025 to February 1, 2025, totaling 134 patient data containing 19 disease symptoms and 6 disease diagnoses. From the test results using the Rapidminer application and data separation in the form of 34 test data and 100 training data with a data ratio of 7:3, an accuracy value of 97.06 was obtained

Integration of Tropical Disease Screening in Reproductive Health Services at Amplas Community Health Center, North Sumatra

2026-02-05T04:02:32+00:00

Tropical diseases remain important determinants of reproductive health in endemic regions; However, screening for these infections is rarely integrated into reproductive health services at the primary care level. This fragmentation contributes to low early detection and an increased risk of complications among women of reproductive age. This community service program aims to develop and implement an integrated model for tropical disease screening within reproductive health services at Puskesmas Amplas, Medan City. The program employed a pre–post intervention design involving women of reproductive age (15–49 years) selected through stratified random sampling. The intervention included clinical screening, health education, and the strengthening of referral and integrated recording systems. The results demonstrated a significant increase in early detection coverage and participants' knowledge, with a substantial proportion of respondents identified as having previously undetected risk factors for tropical diseases. Implementation of the integrated service model also enhanced the capacity of primary healthcare providers in delivering promotional and preventive services. These findings indicate that integrating tropical disease screening into reproductive health services is an effective and scalable approach to strengthening primary healthcare systems in endemic areas and improving community reproductive health outcomes

Global Epidemiology and Phenotypic Diversity of 21-Hydroxylase–Deficient Congenital Adrenal Hyperplasia: A 25-Year Comparative Review Across Ethnicities, Genotypes, and National Cohorts

2026-02-07T04:45:08+00:00

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) represents the most common inherited disorder of adrenal steroid biosynthesis worldwide. Over the past 25 years, advances in newborn screening, molecular diagnostics, and genotype–phenotype characterization have produced large shifts in the global epidemiological landscape. However, marked disparities persist between countries and ethnic groups, reflecting founder mutations, consanguinity, migration patterns, and differences in healthcare coverage. Exclusion criteria included mixed-etiology CAH without subtype separation and cohorts lacking validated genetic testing. Quality assessment relied on established criteria for observational epidemiology and registry-based studies. Birth prevalence showed extreme global heterogeneity, ranging from 1:23,000 in New Zealand to 1:1,200 in Egypt and as high as 1:282 among Arctic Indigenous founder populations. Ethnicity strongly influenced incidence, with Asian, Hispanic/Latino, and European populations generally displaying moderate rates (5–10 per 100,000 births), while Middle Eastern and North African populations demonstrated markedly higher incidence due to elevated consanguinity rates and clustering of severe CYP21A2 alleles. Cross-country phenotype analysis revealed that salt-wasting predominated in Egypt, China, India, Turkey, Argentina, and several Eastern European cohorts, whereas European cohorts—especially Portugal and the UK—showed higher proportions of nonclassic or milder phenotypes. Genotype–phenotype mapping demonstrated consistent associations: null and severe Group A mutations with the SW phenotype, I2 splice and I172N variants with SV presentations, and V281L with NC disease. Sex differences were notable: females more commonly presented in infancy due to virilization, while males frequently remained undetected until adrenal crises or testicular adrenal rest tumors. National screening programs significantly shifted age of diagnosis and reduced infant morbidity and mortality. Global epidemiology of CAH continues to display substantial geographic and ethnic variability, driven by population genetics, healthcare disparities, and screening strategies. Understanding these differences is essential for improving early detection, tailoring genotype-informed care, guiding newborn screening expansion, and reducing long-term complications

The Role of Healthcare Worker Motivation in the Relationship between Work Culture, Patient Satisfaction, and Performance at a Primary Healthcare Clinic

2026-02-11T04:47:57+00:00

Healthcare worker performance plays a crucial role in determining the quality of services in primary healthcare clinics. Organizational and service-related factors, such as work culture, patient satisfaction, and healthcare worker motivation, are considered important determinants of performance. However, empirical evidence regarding the mediating role of healthcare worker motivation in primary healthcare settings remains limited. This study aimed to examine the relationship between work culture and patient satisfaction with healthcare worker performance, both directly and indirectly through healthcare worker motivation as a mediating variable, in a primary healthcare clinic. An observational analytic study with a quantitative approach was conducted at a primary inpatient healthcare clinic in Mojokerto Regency, Indonesia, during September–October 2025. The study involved 20 healthcare workers and 50 patients, selected using total sampling. Data were collected through structured questionnaires and analyzed using descriptive statistics and Spearman correlation tests to assess relationships among variables. The results showed that work culture was positively associated with employee motivation (r = 0.476; p = 0.034), while patient satisfaction was positively related to healthcare worker performance (r = 0.446; p = 0.049). Healthcare worker motivation also demonstrated a significant mediating role in the relationship between work culture and healthcare worker performance (r = 0.508; p = 0.022). Improving healthcare worker performance in primary healthcare clinics requires an integrated managerial approach that emphasizes strengthening work culture, enhancing patient satisfaction, and maintaining healthcare worker motivation to support sustainable improvements in service quality.

Analysis of Social Determinants and Health Service Access on the Occurrence of Unintended Pregnancy among Adolescent Girls in Urban Indonesia

2026-02-17T05:07:04+00:00

Unintended pregnancy among adolescent girls in urban Indonesia remains a critical public health and social concern, with important implications for maternal and neonatal outcomes, education, and intergenerational poverty. Quantitative analyses based on the Indonesia Demographic and Health Survey (IDHS) and recent national studies indicate that residence, age, education, employment, wealth, parity, and prior contraceptive use are associated with unintended pregnancy, and that risk is particularly elevated among women aged 15–19 years and those living in urban areas. Concurrently, utilization of adolescent reproductive health services in urban settings is low, and adolescents have limited knowledge and access to reliable sexual and reproductive health (SRH) information. This study presents a quantitative integrative analysis of national survey data and peer‑reviewed quantitative studies to examine how social determinants and access to SRH services shape unintended pregnancy among adolescent girls in urban Indonesia. Data were extracted from IDHS 2017 and other large‑scale surveys, complemented by urban‑focused studies on adolescent SRH service utilization. Key findings show that younger age, urban residence, low education, poverty, and limited contraceptive knowledge or inconsistent use interact with weak access to youth‑friendly services to increase the likelihood of unintended pregnancy. Strengthening comprehensive sexuality education, youth‑friendly service provision, and multi‑sectoral social protection in urban areas is essential to reduce unintended pregnancy among Indonesian adolescent girls

Level of Public Knowledge Regarding The Transmission and Prevention of Dengue Fever in The Working Area of The Matsum City Public Health Center, Medan

2026-02-25T16:27:49+00:00

Introduction: Dengue Hemorrhagic Fever (DHF) remains a major public health problem in Indonesia. Insufficient public knowledge about transmission and prevention contributes to high disease incidence. Objective: This study aimed to assess the level of community knowledge regarding DHF transmission and prevention in the working area of Puskesmas Kota Matsum, Medan Area District. Methods: An analytic survey with a cross-sectional design was conducted involving 98 respondents who had previously experienced DHF. Data were collected using structured questionnaires and analyzed using univariate and bivariate analysis. Results: Most respondents were female (56.1%) and aged 26–35 years (51.0%). Approximately 53.0% had good knowledge of DHF. A significant relationship was found between knowledge level and DHF prevention behavior (p < 0.05). Conclusion: Community knowledge is significantly associated with DHF prevention. Continuous health education is needed to reduce DHF incidence in the Puskesmas Kota Matsum area

Acceptability Test and Nutritional Analysis of Tempeh and Moringa Leaf Soft Rice as Complementary Foods (MP-ASI)

2026-03-13T04:41:43+00:00

The age of 6–24 months is a crucial period for a child's growth and development, requiring optimal nutritional intake through the provision of Complementary Foods (MP-ASI). MP-ASI serves to supplement nutritional needs that can no longer be met by breast milk alone. Tempeh, as a source of plant-based protein, and moringa leaves, which are rich in iron and vitamins, have the potential to be developed into "nasi tim" (soft rice) as recommended by WHO. This study aims to assess the acceptability and analyze the nutritional content of tempeh and moringa leaf soft rice as a complementary food. The study used a non-factorial Completely Randomized Design (CRD) with three formulations: F1 (10% tempeh: 15% moringa leaves), F2 (20%: 10%), and F3 (30%: 15%). The acceptability test was conducted on 30 semi-trained panelists using a hedonic test for taste, color, aroma, and texture attributes, which were then analyzed using the Kruskal–Wallis test. The results showed significant differences in taste (p=0.00) and aroma (p=0.01), while color (p=0.08) and texture (p=0.01) did not differ significantly. Formulation F3 had the highest acceptability level, containing 75.38 kcal/100 g of energy, 3.55% protein, 15.36% carbohydrates, 0.12% fat, 1.46% crude fiber, and 0.92 mg/100 g of iron.

The Role of Accompaniment in Reducing Anxiety of Pregnant Women Ahead of Childbirth

2026-02-22T09:50:44+00:00

Anxiety during pregnancy, particularly approaching childbirth, is a common psychological condition that may negatively affect maternal well-being and fetal outcomes. Elevated anxiety has been associated with adverse consequences such as prolonged labor, increased operative delivery, and higher risk of preterm birth. Therefore, an adequate support system—including partners, family members, and healthcare providers—plays a crucial role in helping pregnant women cope with emotional distress and enhancing childbirth readiness. This study aims to examine the role of support systems in reducing anxiety among pregnant women through a systematic review approach. Literature was searched across major databases, including MEDLINE, Embase, and Google Scholar, using keywords related to pregnancy anxiety, social support, partner support, and psychological interventions. Eligible studies were original research articles published in English or Indonesian between 2000 and 2023, available in full text. Findings from the included studies were synthesized narratively. The review indicates that partner (husband) support is consistently associated with lower anxiety levels, improved maternal confidence, and better preparedness for childbirth. Family support, counseling, and educational interventions also contribute to increased self-efficacy and adherence to antenatal care. In conclusion, a strong and coordinated support system is essential in mitigating anxiety during pregnancy and promoting positive maternal outcomes.

Analysis of Nursing Practice in NSTEMI Patients: The Effect of Autogenic Relaxation Combined with Nature Sound Music Therapy on Blood Pressure Stabilization in the ICCU

2026-03-27T10:47:24+00:00

Non-ST Elevation Myocardial Infarction (NSTEMI) is often accompanied by increased blood pressure due to pain and anxiety, which trigger activation of sympathetic nervous system, thereby increasing cardiac workload and worsening myocardial ischemia. In addition to pharmacological therapy, non- pharmacological interventions are needed to help stabilize patients' hemodynamic status. This study aimed to analyze the implementation of autogenic relaxation combined with nature sound music therapy on blood pressure in patients with NSTEMI. A case study was conducted on one NSTEMI patient in the Intensive Cardiac Care Unit (ICCU), where blood pressure was measured before and after intervention. The findings showed that the patient who received autogenic relaxation combined with nature sound music therapy experienced a decrease in both systolic and diastolic blood pressure and a more relaxed condition. In conclusion, autogenic relaxation combined with nature sound music therapy is effective as a supportive non-pharmacological intervention in stabilizing blood pressure in patients with NSTEMI.

Factors Associated with Medical Students’ Performance in Blueprint-based Online Formative Assessment

2026-04-23T03:26:35+00:00

Formative assessments had been carried out amidst the changes that have occurred during the COVID-19 pandemic. Medical students must be adapted to change in the teaching and learning process from in-person learning to online learning. This research aimed to determine pre-clinical students' weaknesses in terms of the results of formative assessments based on question blueprints (UTB I) and to find out whether gender, admission pathway, or learning methods can influence the results of formative assessments. A cross-sectional study was performed on the exam results of 711 medical students who undertook UTB I exam. The instrument of this research was secondary data. Gender, admission pathway, and learning methods were analyzed using an independent t-test and One-way ANOVA.The research showed that the median correct answer on UTB I was less than 50%. There was no significant difference in the mean formative assessment score between the male and female groups (p=0.743). It was found that at least two groups had significant differences UTB I scores based on admission pathways (p<0.001). Based on the learning method, the results indicate significant differences between in-person learning and online learning (p<0.001).