Public Health and Preventive Medicine Archive

Local Wisdom, Global Impact: Integrating Perarem for Sustainable Tourism in Bali Province, Indonesia

2026-08-05T07:25:27+00:00

The COVID-19 pandemic has accelerated the ongoing global transformation, reshaping tourism, and highlighting the indispensable link between travel and public health ¹. Highly mobile travellers can carry infectious diseases across borders, turning local vulnerabilities into worldwide risks^2,3. Failure to embed robust public health systems into the heart of the tourism sector potentially creates socioeconomic instability rather than sustainable recovery and growth^4.Driven by these heightened risks, modern travellers no longer choose destinations solely for their breathtaking scenery or rich culture—they expect robust health and safety infrastructure as part of the package⁵. Yet, despite growing emphasis on health-conscious travel, a serious disconnect persists on the ground. In destinations like Indonesia, particularly Bali, the public health and tourism sectors continue to operate in silos. This lack of integration creates a critical blind spot for two-way disease transmission. A truly sustainable framework must work both ways: shielding local communities from imported pathogens while simultaneously protecting visiting tourists from endemic health risk.

Understanding COVID-19 preventive behavior among health workers in Bali’s referral hospitals: A socio-ecological approach

2024-08-31T13:28:19+00:00

Background and purpose: Coronavirus Disease (COVID-19) is one of global health problems which affect all aspects of people’s life. Because hospitals are high-risk environments for COVID-19 transmission, healthcare workers' preventive behaviors are critical. These behaviors are shaped by the interaction of personal, interpersonal, and institutional factors. Therefore, this study aimed to explore the COVID-19 preventive behaviors of registration staff at three referral hospitals in Bali, utilizing the Socio-Ecological Model.

Methods: This qualitative study applied a phenomenological approach based on the Socio-Ecological Model of Health Behavior. The study was conducted in March 2021 at three COVID-19 referral hospitals in Bali (Sanglah, Wangaya, and Tabanan Hospitals). We purposely sampled 50 health workers from the registration section. Data were collected via online semi-structured interviews, observations and documentation, then analyzed using phenomenological techniques. Data validity was ensured through source triangulation (comparing insights from staff in outpatient, emergency, and COVID-19 registration posts, as well as the unit heads) and methods triangulation.

Results: The findings demonstrate that preventive behaviors at the personal level interacted dynamically with interpersonal and institutional dimensions. At personal level, workers adhered to standard protocols (masking, handwashing, and physical distancing), utilized hand sanitizer after patient registration, conducted routine disinfection, and wore appropriate personal protective equipment. Individual actions were reinforced through informational support from peers on how to safely interact with patients and their families. At the institutional level, the health facilities supported these personal and interpersonal efforts through official preventive policies and by physically modifying the environment in registration areas.

Conclusion: Preventing the transmission of infectious diseases in healthcare facilities requires a comprehensive approach that encompasses individual behavior, interpersonal support, a safety-oriented work culture, and robust institutional policies. These findings may serve as a reference for developing training programs, establishing standard operating procedures (SOPs), and strengthening a culture of safety among healthcare workers, thereby enhancing their preparedness to respond to future infectious disease outbreaks.

Analysis of food waste behavior among managers, employees, and consumers at Warung Tegal in 2025

2025-07-22T02:59:48+00:00

Background and purpose: In Indonesia, food waste is an urgent problem, especially in the informal food sector, such as Warung Tegal or food stall, which has received insufficient attention in waste-reduction initiatives. Despite its high prevalence, research on food waste behavior in this sector remains limited, creating a gap in understanding of how managers, employees, and consumers influence waste generation. This study aims to explore behavior of managers, employees and consumers of Warung Tegal.

Methods: This study uses a qualitative phenomenological design with thematic analysis, based on in-depth interviews and field observations with 12 informants, including managers, employees, consumers from three Warung Tegal outlets, as well as environmental activists (FoodCycle Indonesia), the South Jakarta Environment Agency, and A Garbage Collector.

Results: The findings suggest that food waste may be influenced by a variety of behavioral factors. It was observed that one in three Warung Tegal had implemented waste sorting, though government support for food waste management was considered inadequate. In addition, awareness programs regarding food waste management have yet to be directed towards Warung Tegal business owners and waste management officers, who play a crucial role in this cycle.

Conclusion: Behavioral analysis of the informants indicates that food waste is influenced by various factors, including community access to waste management facilities and support initiatives tailored to the Warung Tegal sector. These findings highlight that Warung Tegal business operators could benefit significantly from support from the government and environmental organizations to raise awareness about the risks of food waste and mitigate this critical issue.

The association of PM 2.5 and sun exposure with depression in Jakarta, Indonesia

2025-07-22T03:33:26+00:00

Background and purpose: Depression is a mental disorder with a high prevalence among young adults in Indonesia. Environmental factors such as sunlight and PM2.5 potentially influencing risk of depression. This study aimed to determine the levels of sunlight and PM2.5 exposure and their association with depression among young adults in urban Jakarta.

Methods: This study used a cross-sectional design conducted in Penjaringan, North Jakarta during December 2023 to November 2024. Sample was 90 young adults recruited using consecutive sampling methods. Data were collected using structured questionnaire to assess sun exposure and the Patient Health Questionnaire-9 (PHQ-9) to assess depression. The PM2.5 air-quality monitoring data was obtained from the World Air Quality Index (AQICN) platform. Data were analyzed descriptively and analytically using frequency distributions and the Chi-square test.

Results: The mean age of respondent were 21.92 years old, 62.2% were male and 75.6% were working. Overall, 45.6% had high PM2.5 exposure, while 53.3% had low sun exposure and 45.6% had depression. PM2.5 exposure was significantly associated with depression (OR=2.66; 95%CI: 1.13–6.25), whereas sun exposure was not (OR=1.47; 95%CI: 0.64–3.39).

Conclusion: The study identified substantial PM2.5 exposure and depressive symptoms among young adults, with higher PM2.5 exposure significantly associated with depression. Public health interventions should prioritize reducing air pollution and promoting healthier urban environments alongside mental health programs

Exposure to Transtheoretical Model-based exercise associated with higher physical activity levels among type 2 diabetes mellitus patients at Dr. Oen Hospital, Surakarta

2025-01-08T09:08:04+00:00

Background and purpose: Many people with type 2 diabetes mellitus (T2DM) do not do physical activity and those who have started doing physical activity often stop within 3-6 months. The main difficulty faced by individuals with T2DM is psychological, primarily due to low self-confidence to engage in regular physical activity. It is necessary to provide IEC or physical activity recommendations using behavior change strategies to encourage compliance of individuals with T2DM in carrying out physical activity, one of which is using the transtheoretical model (TTM). This research aims to find the association between giving physical activity recommendations based on TTM and the level of physical activity in individuals suffering from T2DM.

Methods: This research is a cross sectional analytic carried out at Dr. Oen Kandang Sapi Hospital Surakarta in February 2024. This research involved 91 respondents selected through consecutive sampling. Data collection was carried out using questionnaires. The available data was analyzed by univariate analysis and bivariate analysis using the Chi-square test.

Results: Most of the physical activity levels of T2DM patients were low (58.2%) and the majority of physical activity behavior change stages were in the preparation stage (51.6%). Meanwhile, 67% of T2DM patients did not carry out physical activity according to recommendations and as many as 71.4% did not receive physical activity recommendations based on TTM. The results of the Chi-square test between physical activity recommendations based on TTM and physical activity levels obtained p value= 0.015.

Conclusion: There is a significant relationship between the provision of physical activity recommendations based on TTM and the physical activity level of T2DM patients at Dr. Oen Kandang Sapi Hospital Surakarta.

Development and usability assessment of an integrated digital surveillance system for dengue control in Bali, Indonesia

2025-08-12T12:43:30+00:00

Background and purpose: Dengue infection remains a major public health issue in Bali, Indonesia, where high mobility and tourism increase the risk of transmission. Existing manual surveillance systems are often slow, fragmented, and resource-intensive. A digital, integrated approach is needed to improve early detection, reporting, and community participation in dengue control. This study aimed to design, develop, and assess the usability of an integrated digital surveillance system for dengue control in Bali, Indonesia.

Methods: The application, named SILIRA, was developed using the Rapid Application Development (RAD) approach and validated by experts in health information systems, vector control, and health promotion media. Usability was assessed through the Post-Study System Usability Questionnaire (PSSUQ), administered to 120 respondents (100 community users and 20 health workers). The evaluation focused on system usefulness, information quality, interface quality, and overall satisfaction

Results: SILIRA integrates hospital-based and community-based reporting, epidemiological investigation, entomological surveillance, and digital education. Usability testing showed favourable mean scores among community vs. health workers were 3.83 vs. 4.14 (system usefulness), 3.74 vs. 4.01 (information quality), and 4.18 vs. 4.25 (interface quality), with overall satisfaction of 4.08 vs. 4.30. System usage data showed that the education menu was the most frequently accessed feature (88%), followed by the dengue control (82%) and dengue information (75%) menus. A preliminary feasibility assessment suggested that SILIRA was compatible with existing reporting procedures and could be implemented within the existing health system.

Conclusion: The SILIRA prototype demonstrates strong usability and feasibility as an integrated digital surveillance system for dengue control. By combining rapid case reporting, larva density monitoring, and digital education. SILIRA has the potential to support dengue surveillance and control by facilitating integrated reporting, spatial monitoring, and community engagement.