Journal of Health Innovation and Environmental Education

Redefining Early Childhood Growth and Development Surveillance: A Sustainable, Technology-Integrated Primary Care Ecosystem Linking Maternal Health Literacy, Digital Monitoring, and Predictive Analytics

2026-03-13T06:35:08+07:00

Purpose of the study: This study aimed to analyze the relationships between maternal health literacy, digital monitoring utilization, growth and development surveillance behavior, and early developmental risk detection among mothers of toddlers.

Methodology: A mixed-methods sequential explanatory design was employed at Arosbaya Public Health Center, Bangkalan, Indonesia. The quantitative phase involved a cross-sectional survey of 210 mothers with children under five years old. Data were analyzed using structural equation modeling–partial least squares (SEM-PLS) to examine relationships among variables. The qualitative phase consisted of in-depth interviews with mothers, healthcare workers, and community health volunteers to provide contextual explanations for the quantitative findings. Thematic analysis was used to interpret qualitative data.

Main Findings: Maternal health literacy significantly influenced digital monitoring utilization (β = 0.54, p < 0.001) and surveillance behavior (β = 0.32, p = 0.002). Digital monitoring utilization significantly affected surveillance practices (β = 0.41, p < 0.001) and early developmental risk detection (β = 0.29, p = 0.004). Growth and development surveillance behavior demonstrated the strongest association with early risk detection (β = 0.46, p < 0.001). Qualitative findings revealed mothers who possessed higher health literacy were more capable of interpreting child development information and were more likely to utilize digital tools for monitoring their children’s growth.

Novelty/Originality of this study: This study integrates maternal health literacy, digital monitoring utilization, and child growth surveillance behavior within a mixed-methods framework, providing a multidimensional understanding of early developmental risk detection in primary healthcare settings.

Household Sanitation Access, Maternal Personal Hygiene, and Child Snacking Practices as Predictors of Diarrheal Morbidity in Under-Five Children Living Along the Citarum River Basin

2026-03-09T19:02:07+07:00

Purpose of the study: This study aimed to examine household sanitation access, maternal personal hygiene, and child snacking practices as predictors of diarrheal morbidity among under-five children living along the Citarum River Basin, Indonesia.

Methodology: A community-based case–control study was conducted in Kelurahan Andir, Baleendah Subdistrict. A total of 122 participants (61 cases and 61 controls) were selected using simple random sampling. Data were collected through structured questionnaires, non-participant observation, and environmental assessment of sanitation facilities. Variables included clean water access, latrine condition, wastewater disposal, solid waste management, maternal hygiene practices, and child snacking behaviors. Data were analyzed using descriptive and bivariate statistical approaches to assess associations between exposures and diarrheal morbidity.

Main Findings: Although 75.8% of households had access to clean water meeting health standards, substantial deficiencies were observed in latrine adequacy (54.1% not meeting standards), wastewater disposal systems (59.0% inadequate), and solid waste management (67.6% inadequate). These sanitation gaps, combined with suboptimal hygiene practices and unsafe snacking behaviors, indicate multiple environmental and behavioral exposure pathways contributing to diarrheal morbidity in the study area.

Novelty/Originality of this study: ffective prevention strategies should adopt an integrated environmental–behavioral approach that simultaneously strengthens sanitation infrastructure and promotes hygiene behavior change in high-risk settlements.

Examining the Relationship between Environmental Health Conditions and the Incidence of Acute Respiratory Tract Infections (ARI) Among Students at San Roque Elementary School

2026-03-09T19:21:19+07:00

Purpose of the study: This study aimed to examine the relationship between environmental health conditions and the incidence of ARI among elementary school students.

Methodology: An analytic observational study with a cross-sectional design was conducted among 80 students at San Roque Elementary School. Environmental health conditions were assessed using a structured observational checklist covering ventilation, sanitation, classroom density, waste management, and water availability. ARI incidence was determined through school health records and parental confirmation. Data were analyzed using Chi-square tests and multivariate logistic regression at a 95% confidence level.

Main Findings: Of the observed classrooms, 40.0% were classified as having inadequate environmental health conditions. ARI prevalence among students was 36.3%. A significant association was identified between environmental health status and ARI incidence (p = 0.001). Students exposed to inadequate environmental conditions had 4.12 times higher odds of developing ARI (AOR = 4.12; 95% CI: 1.68–10.09; p = 0.002).

Novelty/Originality of this study: This study advances prior research by operationalizing environmental health as a multidimensional composite construct within a real-world public elementary school setting, thereby generating context-specific empirical evidence linking structural environmental exposure to respiratory morbidity.

Effectiveness of Health Education and Short Message Service Reminders Reminders on Iron Supplement Adherence among Pregnant Women

2026-03-13T10:29:53+07:00

Purpose of the study: This study aimed to evaluate effectiveness structured health professional led education embedded within routine antenatal care in enhancing iron supplement adherence among pregnant women.

Methodology: A quasi-experimental pretest–posttest control group design conducted among 120 pregnant women at Masis Maternity Hospital. Participants allocated to intervention group^. receiving structured professional-led education with reinforcement or a control group receiving routine care. Primary outcome was iron supplement adherence (≥80% consumption), while secondary outcomes included knowledge score and hemoglobin level changes over 8 weeks. Data analyzed using chi-square tests, independent and paired t-tests, and logistic regression.

Main Findings: After 8 weeks, adherence significantly increased to 81.0% in ^.intervention group comparedwith 51.7% in control group (p < 0.001). The intervention group was nearly five times more likely to achieve adequate adherence (AOR = 4.83; 95% CI: 2.01–11.61). Knowledge scores improved by +5.27 points in the intervention group versus +1.78 in controls (p < 0.001). Hemoglobin levels increased by 0.86 g/dL in intervention group ⁱcompared to 0.32 g/dL control group (p < 0.001).

Novelty/Originality of this study: This study advances maternal health practice by reframing health education as a structured, professionally embedded care model rather than a single counseling encounter, demonstrating measurable behavioral and clinical impact within routine antenatal services.

Continuity of Open Umbilical Cord Care and Risk of Neonatal Infection in a Primary Obstetric Setting: A Retrospective Cohort Study

2026-03-13T10:27:05+07:00

Purpose of the study: This study aimed evaluate association between open umbilical cord care and neonatal infection within 28 days postpartum in primary midwifery facilities in Iseyin, Oyo State, Nigeria, and to identify independent biological and environmental predictors of infection risk.

Methodology: A retrospective cohort design was applied to 980 term neonates delivered between January 2022 and December 2024 in six registered primary obstetric centers in Iseyin, Oyo State, Nigeria. Data were extracted from maternity registers and follow-up records. Multivariable log-binomial regression and 1:1 propensity score matching were performed using STATA version 17 to estimate adjusted relative risks (RR) with 95% confidence intervals.

Main Findings: Neonatal infection occurred in 8.7% of the open cord care group and 6.5% of antiseptic group. After multivariable adjustment and propensity score matching, open cord care was not significantly associated with increased infection risk (aRR 1.15; 95% CI 0.76–1.73; p = 0.49). Low birth weight, prolonged rupture of membranes, and limited household sanitation were independent predictors, while early breastfeeding initiation was protective.

Novelty/Originality of this study: This study provides context-specific effectiveness evidence on open umbilical cord care within real-world primary midwifery services in semi-urban West Africa. By integrating propensity score matching with routine service data, it bridges the gap between controlled antiseptic trials and implementation-level nursing practice, supporting risk-stratified and system-oriented neonatal infection prevention strategies.

The Effect of Health Education on Childhood Diarrhea on Knowledge and Anxiety Levels of Parents with Toddlers at Abdul Wahab Syahranie Regional Hospital, Samarinda

2026-03-10T22:16:59+07:00

Purpose of the study: This study aimed to assess the effect of health education on childhood diarrhea on parents’ knowledge and anxiety levels regarding their toddlers, focusing on improving both informational and emotional outcomes in a hospital setting.

Methodology: A quasi-experimental design with pretest-posttest was employed involving 50 parents of toddlers admitted to the Melati ward at Abdul Wahab Syahranie Regional Hospital, Samarinda. Data were collected using structured questionnaires for knowledge and a validated anxiety scale. Paired t-tests analyzed pre- and post-intervention scores using SPSS version 25. Ethical approval and informed consent were obtained.

Main Findings: The results showed a significant increase in parental knowledge scores from 55.2 ± 8.3 to 82.5 ± 6.2 (p < 0.001). Anxiety levels decreased significantly from 52.4 ± 10.1 to 38.7 ± 7.5 (p < 0.001). Health education effectively enhanced parents’ competence in managing diarrhea and reduced psychological stress, confirming the dual impact of the intervention.

Novelty/Originality of this study: This study uniquely integrates both cognitive and emotional outcomes, demonstrating that structured health education simultaneously improves knowledge and reduces anxiety. Unlike previous research focusing only on information, this study highlights the psychosocial dimension of parental support, providing practical insights for hospital-based educational programs and contributing to holistic pediatric care strategies

Enhancing Schoolchildren’s Enterobiasis Prevention Through Booklet-Based Health Educatioan

2026-03-11T00:05:44+07:00

Purpose of the study: This study aims to examine the effect of booklet-based health education on fifth-grade students’ knowledge and preventive behaviors regarding Enterobius vermicularis at Primary School Ye Twin Kaung, Ye Twin Kaung Village, Sagaing. The study focuses on assessing whether visual and verbal educational materials can improve hygiene practices to prevent pinworm infection.

Methodology: A pre-experimental one-group pretest–posttest design was applied. Participants were 11 fifth-grade students selected by purposive sampling. Data were collected using structured knowledge questionnaires and observation checklists. The intervention consisted of a 30-minute booklet-based health education session with visual illustrations and verbal explanations. Data were analyzed using the Wilcoxon Signed-Rank Test.

Main Findings: Booklet-based health education significantly improved students’ knowledge and preventive behaviors against Enterobius vermicularis. Knowledge levels increased from 9.1% to 90.9% for good knowledge, while good preventive behaviors rose from 18.2% to 81.8%. The intervention effectively translated understanding into observable hygiene practices, such as handwashing and avoiding soil contact, within three days post-intervention.

Novelty/Originality of this study: This study introduces a visually engaging, age-appropriate booklet combined with facilitator-led discussion to improve both knowledge and practical preventive behaviors in elementary school children. Unlike prior research relying on static or passive educational materials, this intervention links cognitive understanding directly to action, offering a novel, sustainable approach for school-based enterobiasis prevention programs.

Assessing the Resilience of Primary Health Care Services: Evidence from Public Health Centers in Depok City

2026-03-11T01:18:13+07:00

Purpose of the study: This study aims to quantitatively assess the resilience level of primary health care services at Public Health Centers (Puskesmas) in an urban setting by measuring multiple resilience dimensions under routine service conditions in Depok City, Indonesia.

Methodology: This quantitative descriptive cross-sectional study used a structured questionnaire based on the WHO Primary Health Care Measurement Framework and the Oktari–Kurniawan resilience model. Data were collected via Google Forms from 100 purposively selected Puskesmas staff and analyzed using descriptive statistics with univariate analysis.

Main Findings: The findings show that primary health care services demonstrated high resilience across all assessed dimensions. Good resilience was reported for physical conditions (83%), institutional roles (88%), staff capacity (83%), external relationships (84%), and environmental exposure (81%), indicating strong organizational readiness and service continuity at the primary care level.

Novelty/Originality of this study: This study provides novel quantitative evidence on primary health care resilience during routine, post-crisis operational conditions rather than emergency phases. It integrates five resilience dimensions within a single empirical framework at the Puskesmas level, contributing localized urban evidence to strengthen primary health care resilience assessment and policy development.

Development and Validation of an Integrated Electronic Patient Progress Note-Based Healthcare Evaluation Instrument for Diabetes Management

2026-03-13T10:23:51+07:00

Purpose of the study: This research sought to design and rigorously evaluate an Integrated Electronic Progress Note instrument intended to support frailty risk monitoring and strengthen care coordination among older adults.

Methodology: A methodological research approach was undertaken, beginning with conceptual framework development and item generation, followed by expert review for content adequacy and empirical validation. Data were obtained from 210 healthcare professionals alongside 320 de-identified electronic progress notes collected at Uzsoki Street Hospital. Psychometric evaluation included content validity indexing, internal consistency assessment, and construct validation using Partial Least Squares Structural Equation Modeling with bootstrapping procedures to test structural relationships.

Main Findings: The developed instrument demonstrated high content agreement among experts (S-CVI = 0.93) and strong reliability indicators, with composite reliability values exceeding 0.90. Convergent validity met recommended thresholds (AVE > 0.50), while discriminant validity was confirmed through HTMT ratios below 0.90. The structural analysis indicated that the model accounted for 68% of the variance in documentation quality (R² = 0.68) and showed meaningful predictive capability (Q² = 0.49). Among the examined constructs, Care Coordination exerted the most substantial positive influence on documentation quality (β = 0.41, p < 0.001). Furthermore, improved documentation performance was significantly linked to a lower likelihood of 30-day readmission (β = –0.32, p < 0.01).

Novelty/Originality of this study: This study presents a validated multidimensional measurement tool that connects frailty risk assessment elements with the quality evaluation of electronic clinical documentation, thereby advancing the integration of geriatric clinical assessment and digital health governance frameworks.

Clinical Skills Development and Competency Assessment Needs among Nursing Assistant Students: A Design and Development Study

2026-03-13T06:35:04+07:00

Purpose of the study: This study aimed to develop and validate a competency-based clinical skills development model for nursing assistant students and evaluate its effectiveness in improving clinical performance, procedural competence, and self-efficacy.

Methodology: A Design and Development Research (DDR) approach with a sequential exploratory mixed-methods design was employed. Phase 1 involved qualitative needs assessment with 24 students and 6 clinical instructors to identify competency gaps. A competency-based learning model integrating structured simulation, standardized rubrics, DOPS-based formative feedback, and OSCE assessment was subsequently constructed and validated by seven experts (S-CVI = 0.92). Effectiveness was evaluated using a quasi-experimental pre-test–post-test control group design with 64. Outcomes included OSCE performance, DOPS ratings, and clinical self-efficacy. Data were analyzed using ANCOVA and effect size calculations.

Main Findings: The intervention group demonstrated significantly higher post-test OSCE scores (82.6 ± 5.9 vs. 69.4 ± 6.7; p < 0.001; d = 1.95), improved DOPS ratings (4.3 ± 0.4 vs. 3.5 ± 0.5; p < 0.001), and increased self-efficacy (81.1 ± 7.5 vs. 64.3 ± 8.1; p < 0.001; d = 2.09) compared to controls. Skill retention at four weeks remained significantly higher in the intervention group (p < 0.001).

Novelty/Originality of this study: Findings support structured operationalization of competency-based education in assistant-level nursing training and provide an empirically grounded framework for curriculum reform.

Meaning of Childbirth Experiences Handled by Traditional Midwives for Mothers in Parung District, Bogor: A Phenomenological Approach in Public Health Studies

2026-03-13T11:06:48+07:00

Purpose of the study: This study aimed to explore the meaning of childbirth experiences among mothers who delivered with the assistance of traditional birth attendants in Parung District, Bogor.]

Methodology: A qualitative study with a descriptive phenomenological approach was conducted. Participants were selected using purposive sampling, consisting of eight mothers who had experienced childbirth assisted by traditional birth attendants. Data were collected through in-depth semi-structured interviews and analyzed using phenomenological thematic analysis to identify significant statements, meaning units, and emerging themes.]

Main Findings: The findings identified four major themes shaping mothers’ childbirth experiences: emotional comfort and trust in traditional birth attendants, accessibility barriers to formal health services, influence of family and cultural traditions, and perceptions of safety during childbirth. Although traditional birth attendants provided emotional support and cultural familiarity, concerns regarding medical safety and emergency management were also reported by several participants.

Novelty/Originality of this study: This study provides a phenomenological perspective on the lived experiences of mothers delivering with traditional birth attendants in a community where formal maternal health services are available. The research highlights the sociocultural and experiential factors that sustain traditional childbirth practices and offers insights for developing culturally responsive maternal health interventions.]

Integration of Health Education Technology to Improve Mothers' Understanding of Toddler Nutrition in the Ciputat Timur Community Health Center Area, South Tangerang

2026-03-13T11:11:43+07:00

Purpose of the study: This study aimed to analyze the effectiveness of integrating health education media in improving maternal knowledge regarding toddler nutrition in the working area of the Ciputat Timur Community Health Center, South Tangerang.

Methodology: A quantitative study with a quasi-experimental design using a non-equivalent control group approach was conducted. The study involved 36 mothers of toddlers, consisting of 9 mothers of underweight toddlers (intervention group) and 27 mothers of well-nourished toddlers (control group). Data were collected using a structured questionnaire measuring maternal knowledge before and after the educational intervention. The intervention included health education using flipchart media and video-based educational materials, while the control group received education using flipchart media only.

Main Findings: The results showed a significant improvement in maternal knowledge after the educational intervention. In the underweight toddler group, the median knowledge score increased from 65.00 to 80.00 (p = 0.007). In the well-nourished toddler group, the median knowledge score increased from 70.00 to 80.00 (p < 0.001). Furthermore, the proportion of mothers with knowledge scores above 70 increased from 0% to 66.7% in the underweight group and from 48.1% to 85.2% in the well-nourished group.

Novelty/Originality of this study: The novelty of this study lies in the integration of multiple health education media, including flipcharts and video-based learning, within a community-based nutrition education intervention at the primary health care level, providing a more interactive and effective approach to improving maternal nutrition literacy.

Development of a Web-Based Patient Service Management Information System to Improve Administrative Efficiency at Su'adah Clinic, Palembang

2026-03-13T11:14:08+07:00

Purpose of the study: This study aimed to develop and evaluate a web-based patient service management information system to improve administrative efficiency at Su’adah Clinic in Palembang.

Methodology: This research employed a research and development approach using the Waterfall system development model. Problem identification was conducted using the PIECES framework (Performance, Information, Economy, Control, Efficiency, and Service). Data were collected through observation, interviews, and documentation analysis at the clinic. The developed system integrates patient registration, administrative data management, payment processing, and automated reporting into a single web-based platform.

Main Findings: The implementation of the developed system significantly improved administrative performance at the clinic. The average patient registration time decreased from approximately 10 minutes to 3 minutes, while average patient waiting time was reduced from 25 minutes to 10 minutes. The time required to retrieve patient records decreased from 5–7 minutes to less than 1 minute, and the preparation of monthly administrative reports was reduced from 2–3 hours to approximately 15 minutes. In addition, daily paper usage decreased from about 120 sheets to around 30 sheets after system implementation. User evaluation results indicated high acceptance of the system, with an overall satisfaction score of 4.5 out of 5.

Novelty/Originality of this study: The novelty of this study lies in the development of an integrated web-based patient service management system specifically designed for small-scale healthcare clinics, combining online patient registration, administrative management, payment documentation, and automated reporting within a single accessible platform.