Background and purpose: The prevalence of obesity among adolescents is increasing significantly. One of the predictors of this problem is unhealthy eating pattern due to peer and social media influence. This study aims to explore in depth the experience of college students in watching food content on YouTube.

Methods: This study used a qualitative method with a phenomenological approach. Data were obtained through in-depth interviews with ten informants and one focus group discussion with seven female students aged 18-22 years. The informants were female students who have been watching food content on YouTube for more than one year. Data collection was carried out over April-May 2019. Data were analyzed thematically and presented using a narrative approach.

Results: There were three themes that emerged in this study, namely the reasons for watching food content, the benefits, and the effects of watching food content on adolescent health habits. Food content on YouTube is imagined to be educational and provides new knowledge related to food and culture in various regions of Indonesia and other countries. Watching YouTube has become a routine teen activity where they can spend one to four hours per day and can cause teens to form sedentary lifestyle. YouTube watching habits are influenced by peers and social media. It can increase adolescent appetite, thus, they more often opt for unhealthy foods.

Conclusion: Watching food content on YouTube has a positive and negative impact on adolescent health. One negative impact is that the content or influencers can cause the selection of unhealthy foods. Attractive education method should be applied in order to counteract unhealthy food content and promote healthy eating habits.

Background and purpose: The Birth Insurance Program or called Jaminan Persalinan (Jampersal) aims to reduce maternal and newborn deaths. Bangli is one of the districts in Indonesia with low utilisation of Jampersal program. The study aims to explore factors associated with the low utilization and uptake of Jampersal Program in Bangli District.

Methods: This was a qualitative study conducted between April-May 2019. The study involved 24 informants who were selected purposively. The informants were 18 pregnant women, two community leaders, three health workers and one Bangli Health Office’s staff. Data were collected through in-depth interviews which explore factors associated to utilisation of Jampersal using PRECEDE-PROCEED Framework. Data were analyzed by thematic analysis.

Results: We found that informants who used Jampersal had sufficient knowledge about Jampersal, were exposed to the program informed by health workers and community leaders, and were supported by their families. Whereas, those who yet to utilize Jampersal had a poor understanding on Jampersal service mechanisms, lack of spousal support in preparing Jampersal requirements and private midwives had not signed the Jampersal MoU.

Conclusion: Low utilisation of Jampersal Program in Bangli District partially influenced by low understanding of the program and in-optimal involvement of midwifery networks. The local health office should further expand cooperation with the private midwife network for optimum utilization of Jampersal, elucidation of the Jampersal technical guidelines to health workers, as well as technical support for participants in completing required documents.

Background and purpose: The Government of Indonesia established the National Health Insurance or in Indonesia called Jaminan Kesehatan Nasional (JKN) in 2014 with the target of achieving universal health coverage (UHC) by 2019. However, many have not become JKN participants and still use the fee for service financing system. The purpose of this study was to determine patient’s perceptions of the quality of health services under the JKN and fee for service payment methods.

Methods: A cross-sectional study was conducted at West Denpasar II Public Health Centre (PHC) with 133 outpatient respondents who were selected sequentially. Data collection was carried out in June 2019 through interviews. Patients' perceptions of service quality were measured according to the six domains of health service quality established by the Institute of Medicine (IOM) which include effectiveness, efficiency, timeliness, patient-centered approach, safety and equity. Bivariate analysis was conducted with Mann Whitney test and multivariate analysis with Ancova.

Results: Patients' perceptions of the quality of services in the JKN and fee for service payment methods were found to be quite good with an average of 3.08 and 3.17 of the maximum value of 4.0. Bivariate analysis showed a significant difference with a mean rank of 54.28 for JKN and 79.16 for fee for service (p<0.01). Patients' perceptions of service quality also differed significantly based on the dimensions of efficiency (p=0.001), effectiveness (p=0.005), timeliness (p=0.007) and patient-centered approach (p=0.032). Multivariate analysis showed that the variable that was significantly related to patient perceptions of service quality was the payment methods (p<0.001).

Conclusion: Patients with a fee for service payment methods have a better perception of service quality than patients who use JKN. Advocacy to policy makers and service providers should be conducted in order to ensure the equal quality of service for all patients.

Background and purpose: Air quality is an important determinant of a healthy life. One indicator of air pollutants in the room is fungi, which in hospital setting may cause nosocomial infection. This research aims to find out a correlation between physical characteristics of the indoor environment  toward the concentration of fungi in the inpatient rooms of dr. Soebandi Regional Hospital Jember, East Java.

Methods: This research uses a cross-sectional method with a total of four inpatient rooms. We measured physical room characteristics including room temperature, humidity, light intensity, and room density. The concentration of fungi was measured by collecting air sample using passive air sampling method with a potato dextrose agar as the media to optimize the fungal growth. The data was processed with Saphiro-Wilk and Pearson correlation analysis using SPSS 25.0.

Results: The ranges of room temperature and humidity were 29.6-32.2°C and 41-59%, respectively; while the light intensity and room density were 10-30 and 1.88-2.38 person/10 m². The bivariate analysis showed a correlation between two components of physical characteristic of the indoor environment, room temperature and room density, with the concentration  of fungi.

Conclusion: There is a correlation between room temperature and room density with the concentration of fungi in the inpatient rooms of dr. Soebandi Regional Hospital Jember. The management of hospitals should take measures to improve the air quality within inpatient rooms.

Background and purpose: Development of e-Puskesmas information system is one of the government’s efforts to improve efficiency and effectiveness of primary healthcare services. A comprehensive evaluation of e-Puskesmas implementation has not been conducted. This study aims to explore the implementation of e-Puskesmas system in Badung District from health providers’
perspectives.

Methods: This study was an explorative qualitative study conducted in Badung District from July to August 2019. Data collection was carried out through in-depth interviews with 14 informants who were selected purposively, consisted of managers and operators of e-Puskesmas in Badung District, Health Office and Public Health Centre (puskesmas). Semi-structured interview guidelines were developed based on the Health Metrics Network (HMN) Framework. Data were analyzed by thematic analysis. Data validation was carried out through source triangulation, member checking and peer debriefing.

Results: The input of e-Puskesmas is generally sufficient in terms of policies, financing and infrastructure, but it is necessary to improve the quality and quantity of human resources, the internet network, and availability of standard operating procedure. The e-Puskesmas indicators have not accommodated the overall minimum health service standards of puskesmas, data on promotive and preventive programs, and data from private health care facilities. Data management is non optimal due to poor data completeness, breach of confidentiality and also the existence of other disease specific information system that is not integrated into the e-Puskesmas system. The quality of information produced from the system should be improved since there is lack of validity and unable to provide comprehensive information regarding health status of the community. The use and dissemination of information is limited to reporting to the health office while dissemination to the public has not been optimal.

Conclusion: The implementation of e-Puskesmas in Badung District has not been optimal. Concerted efforts should be undertaken to overcome the barriers in the implementation and to develop a more effective, efficient and integrated health information system.

Background and purpose: The introduction of an online referral system aims to improve the quality and costs control of the National Health Insurance (NHI) or Jaminan Kesehatan Nasional. This study aims to determine the impact of the NHI online referral system implementation on access and quality of health services in Gianyar District.

Methods: This is an explorative qualitative study conducted in Gianyar, Bali, Indonesia. Data was collected through semi-structured in-depth interviews to a total of 26 informants recruited purposively. They were including policy makers in the health office and the NHI implementing organization (BPJS), heads of public health centres (puskesmas), private health facilities and referral healthcare facilities; and 13 NHI participants. Data collection was undertaken from May to August 2019. The interview results were thematically analysed based on the Health Care Reform Control Knobs Framework.

Results: The study identifies several positive impacts of the online referral system, which include: the closer distance of patients accessing services, the easier it is to obtain information on services at referral health facilities, and the easier the hospital to promote its service products, the higher assurance of patients being accepted by the referral hospitals, patients with special conditions are better accommodated, the easier the administrative procedure, improved time, cost and working procedure efficiencies, increased punctuality of the services, and guaranteed data security that reduces the risk of lost or damaged referral documents. On the other hand, the online referral system has also resulted in negative impacts, some of them were system inconsistencies, information and communication technology (ICT) constraints, service discontinuity, service injustices and loss of patients’ loyalty.  

Conclusion: NHI online referral system generally have positive impacts on access and quality of health services, however, it is necessary to improve several aspects of the online referral system to better accommodate user needs and to optimize service.

The COVID-19 pandemic is still unfolding. At least, 214 countries have reported confirmed cases, and 185 countries have confirmed local transmission, including Indonesia (WHO 2020, Ministry of Health of Indonesia 2020). The pandemic has transformed the way people interact, including in healthcare settings. Patients are under lockdown; human movements are restricted, and health workers are at risk of infection. There is no certainty regarding how long this pandemic will endure.