MEDICA (International Medical Scientific Journal)

Maternal Health Seeking Behavior from a Sociocultural Perspective: A Qualitative Ethnographic Study

Arfiah Arfiah, Nurdin Rahman, Andi Mascundra Amir — Tue, 14 Jul 2026 00:00:00 +0000

Maternal healthcare behavior is shaped by biomedical, sociocultural, familial, and traditional factors. However, despite improvements in maternal health programs in Indonesia, limited evidence exists on how sociocultural processes influence maternal healthcare decision-making among indigenous communities. This study aimed to explore the sociocultural influences on maternal healthcare behavior among the Kaili Indigenous community in Loru Village, Central Sulawesi, Indonesia. A qualitative ethnographic study was conducted in Loru Village, Sigi Biromaru District, Central Sulawesi, Indonesia, between January and June 2025, involving seven participants selected through purposive sampling. Data were collected through in-depth semi-structured interviews, participant observation, document review, and triangulation interviews and analyzed using thematic analysis. The findings demonstrated that maternal healthcare behavior was strongly influenced by collective family decision-making, sociocultural values, customary authority, and traditional beliefs. Furthermore, culturally responsive communication by midwives and collaboration with traditional birth attendants increased community acceptance of formal maternal healthcare services while respecting local cultural practices. These findings indicate that maternal healthcare behavior within the Kaili Indigenous community is a socially and culturally embedded process rather than an individual health decision. They further highlight the potential of culturally responsive maternal healthcare strategies that actively engage families, community leaders, and traditional birth attendants to improve maternal healthcare utilization and strengthen culturally appropriate service delivery in indigenous settings. Further research involving multiple indigenous communities, larger participant groups, and comparative ethnographic designs is warranted to confirm the transferability of these findings and broaden understanding of sociocultural influences on maternal healthcare behavior across diverse cultural contexts.

COVID-19 Health Posters: Evaluating Visual Attention and Health Belief Model Components Using Eye-Tracking Technology

Nurbaiti Nurbaiti, Salman Izzuddin, Haikal Djauhari — Thu, 30 Jul 2026 00:00:00 +0000

During the COVID-19 pandemic, health posters became a strategic medium for promoting healthy behavior, especially when direct social interaction was limited. However, the effectiveness of delivering effective messages visually through posters has not been evaluatd objectively through a neurocognitive approach. This study aimed to analyze people's visual attention to two COVID-19 health posters in Indonesia using eye-tracking technology and interpret the findings according to the Health Belief Model (HBM). This study is a descriptive study involved 39 young adult participants (aged 15–55 years) who were purposively selected in Bandung. Research data were collected using the Tobii X120 tool and analyzed based on total fixation time (TFT), fixation count (FC), and heatmap visualization of 22 areas of interest (AOI) on the two posters. The results study shows that the first poster "Semua Pakai Masker" had the highest FC and TFT on the title and main visual icon, reflecting a focused and hierarchical pattern of visual attention. The second poster, “Jaga Diri dan Keluarga Anda dari COVID-19 dengan Germas” showed a scattered distribution of visual attention, with dominance at the top. The second poster had a more comprehensive coverage of the HBM message but was less visually focused. The institutional logo tended to be ignored in both posters. In conclusion, posters with simple designs and strong visual cues are more attractive and more effective in conveying key messages. The integration of eye-tracking technology and HBM theory provides new insights into the development of evidence-based health promotion media that may support behavioral change intentions.

Evaluation of Preconception Health Services and Their Implications for Maternal and Neonatal Health: A Qualitative Study

Silvia Ari Agustina, Liberty Barokah, Nining Tunggal Sri Sunarti — Thu, 30 Jul 2026 00:00:00 +0000

Preconception health care is an effort to improve maternal and infant health by detecting and managing risk factors before pregnancy. This study aimed to evaluate preconception health services and their implications for maternal and newborn health status. This study used a qualitative evaluative design with the CIPP (Context, Input, Process, Product) approach. The study was conducted from May to December 2025 at five Community Health Centers (Puskesmas), the Office of Religious Affairs (KUA), BKKBN, and the Bantul District Health Office, Yogyakarta, Indonesia. A total of 52 participants were selected using purposive sampling, consisting of 38 premarital couples (who participated in Focus Group Discussions) and 14 key informants including health workers, health program holders, KUA staff, BKKBN officers, and a village head (who participated in in-depth interviews). Data were collected through in-depth interviews and Focus Group Discussions. Based on the CIPP framework, preconception services were found to be supported by cross-sectoral programs and the availability of basic services; however, implementation has not been optimal. Barriers identified included low community awareness, delayed access to services, variation in quality across Puskesmas, inconsistent SOPs, weaknesses in monitoring and evaluation, and poor data integration. Nevertheless, several indicators of maternal and newborn health service coverage from 2022 to 2024 showed improvement. Pregnancy and delivery complications decreased, while postpartum complications increased. The maternal mortality rate decreased, while the infant mortality rate fluctuated. It was concluded that preconception health services have the potential to contribute to increased service coverage and early detection of risk factors, but their impact on maternal and newborn health outcomes remains inconsistent. Strengthening service quality, standardization, cross-sectoral integration, and service continuity are needed to optimize maternal and infant health.

Psychological Coping and Diabetes Distress in Adolescents with Type 1 Diabetes Mellitus: A Systematic Review

Ajeng Gustiani, Siti Yuyun Rahayu Fitri, Taty Hernawati — Thu, 30 Jul 2026 00:00:00 +0000

dolescents with Type 1 Diabetes Mellitus (T1DM) face continuous self-management demands that may contribute to diabetes distress and affect psychological well-being. Evidence on coping strategies in this population remains fragmented. This review aims to synthesize coping strategies, diabetes distress, and psychosocial factors among adolescents with T1DM. This systematic review followed PRISMA 2020 guidelines, with 822 records identified, 353 duplicates removed, 469 records screened, 198 full-text articles assessed, and 11 studies included in the final synthesis. The studies used cross-sectional, cohort, randomized controlled trial, and quasi-experimental designs involving adolescents and young adults with T1DM. Data were synthesized narratively, and study quality was assessed using the Joanna Briggs Institute (JBI) tools. Findings suggest that adaptive coping strategies such as problem solving, emotional regulation, acceptance, and social support may be associated with lower diabetes distress and better psychosocial adjustment. Maladaptive coping such as avoidance and denial may be associated with higher distress and poorer self-management. Psychosocial support from family and peers appears to facilitate adaptive coping, while limited support may increase vulnerability to distress. These findings highlight the importance of integrating coping-focused and psychosocial interventions in supporting psychological adaptation among adolescents with T1DM.

Longitudinal Surveillance of Anopheles Mosquitoes in Kulon Progo, Indonesia

Fardhiasih Dwi Astuti, Ali Sukamto, Shafira Putri Hermayanti — Thu, 30 Jul 2026 00:00:00 +0000

Sustaining malaria elimination requires continued surveillance in receptive areas where ecological and anthropogenic conditions may still support vector persistence. This study assessed monthly Anopheles mosquito density in Kulon Progo Regency, Indonesia, during 2023–2024 as an early warning indicator for malaria re-establishment. A descriptive longitudinal entomological surveillance study was conducted in receptive subdistricts of Kulon Progo. Adult mosquitoes were collected from 18:00 to 06:00 using indoor and outdoor human landing catches and resting collections around houses and livestock shelters. Specimens were identified morphologically, and density was expressed as Man-Hour Density (MHD). Anopheles density varied markedly by subdistrict and year. Nanggulan recorded the highest MHD in both years, increasing from 35.21 in 2023 to 69.46 in 2024. Additional measurable vector activity was detected in Kokap (MHD = 6.53) and Sentolo (MHD = 20.00) in 2024. Species data showed that Anopheles vagus was the dominant morphologically identified taxon, accounting for 84.7% of all specimens, while An. anularis, An. aconitus, An. kochi, An. barbirostris, and several low-frequency taxa were also recorded. Malaria receptivity in Kulon Progo remains heterogeneous and dynamic despite malaria-free status. Routine monthly entomological surveillance can support early detection of increased vector density and guide spatially targeted vector control. The findings should be interpreted as evidence of vector receptivity rather than confirmed transmission because sporozoite infection, vector competence, and blood-meal source were not assessed.

Higher Risk of Airway Obstruction in Male Garment Workers Associated with Smoking and Occupational Exposure

Ni Wayan Rusni, Tanjung Subrata; Luh Gede Sri Yenny — Thu, 30 Jul 2026 00:00:00 +0000

Respiratory disorders remain an important occupational health concern among garment workers due to workplace conditions and individual behavioral and health-related factors. However, evidence regarding factors associated with airway obstruction in this occupational group remains limited. This study aimed to identify factors associated with airway obstruction among garment workers in Badung Regency, Bali. An analytical observational study with a cross-sectional design was conducted among 52 garment workers selected using simple random sampling. Primary data were collected through structured interviews and spirometry examinations. Independent variables included demographic characteristics, clinical factors, occupational characteristics (including working duration), and behavioral factors. Data were analyzed using descriptive statistics, Chi-square tests, and Odds Ratio (OR) analysis with a significance level of p < 0.05. Airway obstruction was identified in 34.6% of respondents. Significant associations were observed between airway obstruction and gender, body mass index (BMI), blood pressure, heart rate, working duration, health history, and smoking habits (p < 0.05). Higher odds of airway obstruction were observed among male workers (OR = 26.40), workers with poor health history (OR = 12.92), hypertension (OR = 8.00), and smoking habits (OR = 6.00). Age and personal protective equipment (PPE) use were not significantly associated with airway obstruction. These findings should be interpreted cautiously because of the relatively small sample size. Airway obstruction among garment workers was associated with multiple demographic, clinical, occupational, and behavioral factors, particularly smoking habits and longer working duration. Since workplace dust exposure was not directly measured, the observed occupational associations should be interpreted as indirect indicators rather than direct measures of exposure. Further studies with larger sample sizes and objective environmental exposure assessments are recommended.

Exploring Needs for Integrated Website-Based E-Learning Platform Strengthening School Disaster Preparedness in Tsunami-Prone Schools

Lale Wisnu Andrayani, Eka Rudy Purwana, Hamdan Hariawan — Thu, 30 Jul 2026 00:00:00 +0000

Schools play a critical role in disaster risk reduction; however, disaster preparedness education remains inadequately implemented in many disaster-prone regions, particularly due to limited learning media and weak preparedness systems. This study aimed to explore the needs and key components required for developing a website-based e-learning platform to support school disaster preparedness. A qualitative exploratory design was employed. Data were collected through four Focus Group Discussions involving 30 participants, including students, teachers, school administrators, community representatives, village officials, and members of the Village Disaster Preparedness Team. The study was conducted in tsunami-prone schools located in Kuta Village, Central Lombok, Indonesia. The data were analyzed using thematic analysis. Five major themes emerged: limited procedural knowledge of disaster preparedness, low internalization of preparedness attitudes, inadequate resources and evacuation capacity, weak organizational systems and standard operating procedures, and the need for a website-based e-learning platform. Participants emphasized that a digital platform could provide accessible preparedness information, standardized learning materials, and integration with early warning systems. These qualitative findings suggest that an integrated website-based e-learning platform may serve as a practical strategy to support school disaster preparedness through accessible learning resources, standardized preparedness procedures, and strengthened coordination among stakeholders.

Effect of a Warm Ginger Lemongrass Herbal Compress on Back Pain Intensity in Postpartum Women

Kristina Maharani, Qomariyah Qomariyah, Ellyzabeth Sukmawati, Achmad Solechan — Thu, 30 Jul 2026 00:00:00 +0000

Postpartum lower back pain is a common musculoskeletal condition that can negatively affect maternal comfort, mobility, breastfeeding, infant care, and overall quality of life. This study evaluated the effect of warm herbal compress therapy on lower back pain intensity among postpartum women. A quasi-experimental study with a pretest–posttest control group design was conducted in the Demak area, Indonesia, from August 2025 to January 2026. A total of 102 postpartum mothers on days 2–7 after normal vaginal delivery were recruited using purposive sampling and allocated to an intervention group (n = 51) and a control group (n = 51). Pain intensity was assessed using the Numeric Rating Scale and analyzed using the Mann–Whitney U test and effect size. The findings suggest that the mean pain score in the intervention group decreased from 5.6 on postpartum day 2 to 1.9 on day 7, whereas the control group showed a reduction from 5.7 to 2.2. Significant differences between groups were observed from postpartum day 3 onward (p < 0.05), with large effect sizes on days 4 and 5, indicating a clinically meaningful reduction in pain among mothers receiving warm herbal compress therapy. These findings suggest that warm herbal compress therapy may serve as a safe, simple, and supportive non-pharmacological intervention for alleviating postpartum lower back pain and improving maternal recovery during the early puerperium. Further randomized controlled trials with larger samples and longer follow-up are warranted to confirm its clinical effectiveness.

Parenting Style and Early Childhood Development among Toddlers in Coastal Communities of Semarang, Indonesia

Fri, 31 Jul 2026 00:00:00 +0000

Early childhood development remains a major public health concern in Indonesian coastal communities, where socioeconomic vulnerability and suboptimal parenting practices may adversely affect developmental outcomes. This study examined the association between parenting styles and early childhood development among toddlers in coastal communities of Semarang, Indonesia, using a convergent mixed-methods design. A total of 371 mothers with children aged 12–59 months were selected through stratified random sampling from nine coastal villages within the Bandarharjo Primary Health Center catchment area. Quantitative data were collected using the Parenting Styles and Dimensions Questionnaire and the Indonesian Pre-Screening Developmental Questionnaire, while qualitative data were obtained through in-depth interviews with mothers, health cadres, midwives, and community leaders. Quantitative data were analyzed using descriptive statistics, Chi-square tests, and logistic regression, whereas qualitative data were analyzed thematically. Democratic parenting was the predominant parenting style (57.7%), and 72.0% of toddlers demonstrated age-appropriate development. Parenting style was significantly associated with child development (p < 0.001; Cramer's V = 0.27). Logistic regression showed that democratic parenting was associated with better developmental outcomes (OR = 2.94; 95% CI: 1.61–5.37; p < 0.001). Qualitative findings revealed that fragmented caregiving, parental workload, limited developmental literacy, and reliance on digital devices as caregiving substitutes influenced parenting practices and child development. These findings highlight the importance of promoting democratic parenting while addressing socioeconomic and contextual barriers to improve developmental outcomes among children in vulnerable coastal communities.

Factors Associated with Syphilis Infection Among Pregnant Women Attending Antenatal Care Facilities: A Cross-Sectional Study

Dolfinus Yufu Bouway, Fatimah Rahma Nurul Jannai, Inriyanti Assa — Thu, 30 Jul 2026 00:00:00 +0000

Syphilis remains a major public health concern among pregnant women because of its serious maternal and neonatal consequences. However, factors associated with syphilis infection among pregnant women in Jayapura City, Indonesia, remain insufficiently understood. This study aimed to identify factors associated with syphilis infection among pregnant women in Jayapura City. An observational analytic study with a cross-sectional design was conducted at seven public health centers between July and August 2025 involving 161 pregnant women selected through purposive sampling. Data were collected using structured questionnaires and laboratory screening records and analyzed with Chi-square tests, Fisher’s Exact tests, and multiple logistic regression. The findings demonstrated that 27.2% of respondents were diagnosed with syphilis. Bivariate analysis showed significant associations between syphilis infection and ethnicity (p = 0.029), occupation (p = 0.009), family income (p = 0.015), knowledge level (p = 0.005), history of sexually transmitted infections (p = 0.013), and risky sexual behavior (p = 0.008). Multivariable analysis identified ethnicity (AOR = 2.846; 95% CI: 1.243–6.514), occupation (AOR = 23.883; 95% CI: 2.356–242.064), and knowledge level (AOR = 2.637; 95% CI: 1.116–6.229) as independent factors associated with syphilis infection. These findings highlight the importance of socioeconomic and knowledge-related determinants in syphilis prevention and support culturally appropriate reproductive health education and community-based interventions. Given the cross-sectional design and purposive sampling, the findings should be interpreted as associations rather than causal relationships.

A Scoping Review of Nursing Approaches to Spiritual Care in Cardiovascular Disease: Clinical Practice and Patient Outcomes

Thu, 30 Jul 2026 00:00:00 +0000

Cardiovascular disease (CVD) remains a leading cause of global morbidity and mortality. Beyond physical symptoms, patients frequently experience psychological distress, existential concerns, and spiritual needs that may influence coping, treatment adherence, and overall well-being. Although spiritual care is increasingly recognized as a component of holistic cardiovascular nursing, evidence regarding nurse-led spiritual care remains heterogeneous in terms of intervention models, implementation strategies, cultural adaptation, and reported outcomes. This scoping review aimed to systematically map nursing approaches to spiritual care for adults with CVD and summarize their implementation across clinical settings. The review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches were conducted in PubMed, Scopus, Web of Science, CINAHL, and ScienceDirect for studies published between 2015 and 2025. Quantitative, qualitative, and mixed-methods studies involving nurse-led or nurse-integrated spiritual care interventions were included. Eighteen studies met the eligibility criteria. Thematic synthesis identified four categories of nursing approaches: spiritually supportive communication, faith-based spiritual interventions, mindfulness- and meaning-centered approaches, and holistic spiritually integrated nursing care. These interventions were implemented across acute care, coronary care, cardiac rehabilitation, outpatient, palliative, and community settings. Reported outcomes encompassed psychosocial, spiritual, patient-centered, and selected physiological domains, with anxiety reduction, emotional comfort, coping, spiritual well-being, quality of life, and patient satisfaction being the most frequently described outcomes. This review provides a comprehensive overview of contemporary nursing approaches to spiritual care in cardiovascular practice, highlights important variations in intervention characteristics and outcome assessment, and identifies priorities for developing standardized, culturally responsive, and theory-informed spiritual care frameworks and future cardiovascular nursing research.

App-Based Cardiovascular Risk Monitoring among Adults with Hepatitis B and C in Primary Care: A Pre-Experimental Study

Resa Nirmala Jona, Arlies Zenitha Victoria, Danny Putri Sulistyaningrum — Fri, 31 Jul 2026 00:00:00 +0000

Chronic hepatitis B and C infections are increasingly understood as systemic diseases with metabolic and cardiovascular implications. Community-based digital monitoring may support early detection and self-management of cardiovascular risk, but empirical evidence among adults with viral hepatitis remains limited. This study evaluated the preliminary effectiveness of an app-based monitoring and evaluation strategy for reducing cardiovascular risk among adult patients with hepatitis B and C in a primary care setting in Semarang, Indonesia. A pre-experimental one-group pre-test-post-test study was conducted from August to November 2025 among 30 adults aged 20-60 years with hepatitis B or C in the Tlogosari Wetan Community Health Center area. Participants used a heart health monitoring application for one month. The application enabled routine recording of blood pressure, resting heart rate, oxygen saturation, random blood glucose, medication reminders, and health education. Outcomes were systolic and diastolic blood pressure, resting heart rate, and cardiovascular risk category. Paired comparisons were analyzed using Wilcoxon signed-rank tests. Most participants were aged 41-60 years (63.3%), female (53.3%), diagnosed with hepatitis B (96.7%), and had a history of high cholesterol (63.3%) or diabetes mellitus (53.3%). Mean systolic blood pressure decreased from 147.9 to 135.1 mmHg (p=0.002), mean diastolic blood pressure from 93.1 to 85.6 mmHg (p=0.003), and mean resting heart rate from 85.7 to 79.2 beats/minute (p=0.004). Median cardiovascular risk score decreased from 2.0 to 1.0 (Z=-3.08; p=0.002). App-based cardiovascular monitoring was associated with significant short-term improvements in blood pressure, resting heart rate, and cardiovascular risk among adults with hepatitis B and C. Controlled studies with longer follow-up are warranted.

Assessment of Cognitive Function in Elderly Patients Undergoing Hemodialysis

Fri, 31 Jul 2026 00:00:00 +0000

Cognitive impairment is often not properly managed, which may lead to complications such as Alzheimer’s disease, sleep disorders, depression, increased risk of falls, difficulty in decision making, decreased quality of life, and increased mortality risk. This study aimed to identify cognitive impairment among elderly patients undergoing hemodialysis. This study used a descriptive quantitative design. A total of 101 respondents were selected using a total sampling technique. The inclusion criteria were patients who routinely underwent hemodialysis twice a week, were aged ≥55 years, were conscious and oriented, and were able to read and write. Cognitive function was assessed using an electronic-based Mini-Mental State Examination (MMSE). Data were analyzed using univariate analysis and Spearman’s rank correlation test. Spearman’s correlation was selected because the numerical variables were not normally distributed. The mean age of the respondents was 62.11 years, and the mean duration of hemodialysis was 4,252 hours. Most respondents were male (55.4%), had undergone hemodialysis for more than 24 months (49.5%), and had hypertension as the most common underlying disease (55.4%). Most respondents had normal cognitive function (76.2%). Spearman’s rank correlation analysis showed a significant negative correlation between age and MMSE score (rₛ = −0.241, p = 0.015) and between hemodialysis session duration and MMSE score (rₛ = −0.198, p = 0.047). In contrast, the length of undergoing hemodialysis was not significantly correlated with MMSE score (rₛ = 0.123, p = 0.222). Age and hemodialysis session duration were significantly associated with cognitive function, whereas the length of undergoing hemodialysis was not significantly associated with MMSE scores. Periodic cognitive ass essment should therefore be considered, particularly among older patients and those undergoing longer hemodialysis sessions.

Effectiveness of the “My Body Belongs to Me” Pop-Up Book on Preschool Children’s Understanding of Body Safety

Fri, 31 Jul 2026 00:00:00 +0000

Child sexual violence is a major public health concern, emphasizing the need for developmentally appropriate body safety education during early childhood. This study aimed to evaluate the effectiveness of the My Body Belongs to Me Pop-Up Book in improving preschool children's understanding of body safety. A quasi-experimental pretest-posttest control-group study was conducted among 60 preschool children at Al Huda Kindergarten, Semarang, Indonesia. Participants were assigned to an intervention group receiving body safety education through the My Body Belongs to Me Pop-Up Book or a control group receiving conventional leaflet-based education. Children's understanding was assessed using a 10-item picture-based Situational Judgment Test. Data were analyzed using independent-samples and paired-samples t-tests, with Cohen's d used to estimate effect size. Baseline understanding did not differ significantly between groups (p = 0.076). After the intervention, the intervention group achieved significantly higher posttest scores than the control group (8.37 ± 1.40 vs. 5.73 ± 1.11; p < 0.001), with a very large effect size (Cohen's d = 2.08). Significant improvement was observed only in the intervention group (p < 0.001). The My Body Belongs to Me Pop-Up Book was more effective than leaflet-based education in improving preschool children's understanding of body safety, supporting its use as an interactive and developmentally appropriate educational tool for early child sexual violence prevention.

Relationship Between Socioeconomic Status and Diet Quality in Obese Adolescents

Fri, 31 Jul 2026 00:00:00 +0000

The increasing prevalence of adolescent obesity and poor diet quality remains a significant public health issue, with socioeconomic factors playing an important role in shaping dietary behaviors. This study aimed to analyze the relationship between socioeconomic status and diet quality among obese adolescents in Tomohon City using a cross-sectional design. A total of 316 obese adolescents aged 17–19 years were recruited through purposive sampling, a non-probability sampling technique in which participants were selected based on predetermined inclusion criteria. Diet quality was measured using the Healthy Eating Index 2015 (HEI-2015), while socioeconomic status was assessed through a parental questionnaire covering income, education, occupation, and household expenditure. Data were collected via Google Forms and analyzed using the Chi-square test and simple logistic regression at a significance level of p ≤ 0.05. The results showed that most respondents had medium socioeconomic status (61.4%) and diet quality categorized as “needs improvement” (75.0%), with a significant association between socioeconomic status and diet quality (p < 0.001; OR = 13.168; 95% CI: 6.975–24.859). In conclusion, socioeconomic status is significantly associated with diet quality among obese adolescents in Tomohon City. These findings underscore the need for targeted nutrition interventions to improve dietary quality among socioeconomically disadvantaged adolescents.