Media Kesehatan Politeknik Kesehatan Makassar
Media Kesehatan Politeknik Kesehatan Makassar is a scientific journal published by the Research Unit of Poltekkes Kemenkes Makassar. The journal focuses on publishing original and up-to-date research in the field of health sciences, including nursing, midwifery, environmental health, pharmacy, health laboratory technology (also known as medical laboratory sciences), nutrition, physiotherapy, dental health, public health, and other related health disciplines. Media Kesehatan Politeknik Kesehatan Makassar is a peer-reviewed scientific journal designed to promote scientific advancement in the health sector and serve as a credible reference to support evidence-based health practice at both national and international levels. The journal is designed to accommodate high-quality articles that are ready to compete on the global stage and welcomes contributions from both national and international authors. Currently, priority is given to submissions from Indonesian authors, in line with the journal’s commitment to strengthening local research capacity before expanding its publication network to an international level. In addition, the journal serves as an academic forum for health researchers to publish their findings, enrich the scientific literature, and support the improvement of health human resources in Indonesia and internationally. Previously, the Media Kesehatan Journal of Poltekkes Makassar was managed and published via Open Journal Systems (OJS) version 2 at https://dnc.web.id/ojs2/index.php/mediakesehatan . However, due to technical issues—including a malware attack that compromised the system’s security and stability—we were compelled to migrate to OJS version 3. As a result, all manuscript handling and publication processes are now conducted through the new OJS 3-based platform. Readers seeking access to back issues from Volume 11, Issue 2 (2016) through Volume 17, Issue 2 (2022) may still retrieve them via the archived site: https://dnc.web.id/ojs2/index.php/mediakesehatan/issue/archive We sincerely apologize for any inconvenience this transition may have caused and thank you, our readers and authors, for your continued support and understanding.
Direktorat Politeknik Kesehatan Makassar
Concept Analysis of Post-Stroke Cognitive Function in Ischemic Stroke Patients: Implications for Nursing Practice
Ischemic stroke is a major cause of neurological disability, often resulting in cognitive impairment that impacts quality of life, functional status, and caregiver burden. However, there has been no systematic conceptual analysis explaining the attributes, antecedents, and consequences of cognitive function in ischemic stroke patients. Thi study aims to comprehensively analyze the concept of cognitive function in ischemic stroke patients, clarifying its definition, attributes, antecedents, consequences, and empirical references. This concept analysis followed the seven-steps approach by Walker and Avant. Literature search was conducted through PubMed, Scopus, and CINAHL with the following inclusion criteria: publications from 2020 to 2025, in English, focusing on post-stroke cognitive function. A total of 22 articles from various disciplines were analyzed. Empirical references were selected based on their relevance to cognitive attributes. Data were extracted and synthesized according to the attributes, antecedents, and consequences to form a conceptual definition. The six main attributes of cognitive function in ischemic stroke are: memory, executive function, attention, language, orientation, and visuospatial function. Antecedents include biological-structural factors (infarct location/size), sociodemographic factors (age, education), clinical factors (comorbidities, stroke severity), functional factors, and psychological factors. The consequences include a decline in quality of life, functional status, increased caregiver burden, and mortality. Instruments such as MoCA, MMSE, and biological biomarkers were identified as key empirical references. This conceptual analysis provides a strong theoretical foundation for nursing practice, emphasizing the importance of early detection and attribute-based multidisciplinary interventions to prevent further cognitive decline. This study has limitations, as variations in the assessment phase may affect the heterogeneity of cognitive impairment. Further research is recommended to validate this concept with clinical data, test the effectiveness of specifically designed interventions, and conduct longitudinal studies to monitor long-term cognitive function.
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Comparative Study Of Deep Cervical Flexion Exercise With Pressure Biofeedback and Muscle Energy Technique for Neck Pain Reduction in Digital Workers
Mechanical neck pain is a common condition among employees who perform static tasks in non-ergonomic postures while using digital devices, potentially leading to pain, disability, and reduced work productivity. The purpose of this study to prove that deep cervical flexion exercise with pressure biofeedback is more effective than muscle energy technique in reducing neck pain and disability in mechanical neck pain conditions of digital creative employees. This study is a true experiment with pre-test and post-test two group design. The subjects of the study were 24 people who were randomly divided into two groups. Group 1 (n=12) received deep cervical flexion exercise with pressure biofeedback, while group 2 (n=12) received muscle energy technique. Pain intensity was measured using the numeric pain rating scale and neck disability was assessed using the neck disability index. The results of the paired sample t-test showed a significant reduction in pain and disability in both groups (p=0.001; p<0.05). The independent sample t-test confirmed significant differences between the groups (p<0.05), with group 1 showing a greater percentage reduction in both pain (68.40%) and disability (55.48%) compared to group 2 (44% and 30.55%). In conclusion, deep cervical flexion exercise with pressure biofeedback showed greater improvement compared to muscle energy technique in reducing neck pain and disability in mechanical neck pain conditions of digital creative employees. Although limited by age differences between groups as a potential confounding factor, the findings remain applicable to workers with prolonged static and non-ergonomic postures.
Determinants of the Implementation of the One House One Jumantik Movement for Dengue Vector Control at Kota Ende Health Center
Background: Dengue fever is a public health issue in Ende Regency at Kota Ende Health Center, an endemic area. Since 2015, the One House One Jumantik movement empowers families, but low awareness and resources hinder implementation. Methods: A qualitative case study with a phenomenological approach from January to June 2025 with six purposively selected informants: technical officers, health center leaders, health office officials, three urban village head. Sample size was determined based on information power and theoretical saturation. Data were collected via observation, open interviews, and document review, then analyzed thematically. Triangulation of sources and techniques ensured validity. Ethical approval was obtained from Poltekkes Kemenkes Kupang (LB.02.03/1/0036/2025). Results: Implementers’ positive understanding supports adoption of the One House One Jumantik program. Nonetheless, budget constraints, limited monitoring structures, weak cross-sector communication, and low community engagement reduce effectiveness. Strengthening coordination, providing training, and applying participatory approaches are key to improving sustainability. Conclusion: The implementation of the One House, One Jumantik movement at Kota Ende Health Center remains limited by resource shortages, organizational structure, and cross-sector coordination. Program effectiveness is affected by organizational capacity, communication, and resource distribution. Addressing these challenges requires concrete actions: conducting cadre training and establishing coordination forums at the Health Center level; providing technical guidance, supervision, and budget support at the District Health Office level; integrating formal policies, planning, and performance monitoring at the Regional Government level; and actively involving the community in inspections and mosquito surveillance
The Effectiveness of Hematological Indicator and Iron Biomarkers Evaluation as an Early Detection of Anemia in Adolescent Girls: A Systematic Review
Due to elevated iron requirements during growth and menstruation, anemia in adolescent girls remains a major global health concern. Hemoglobin (Hb) testing alone has low sensitivity in detecting early iron deficiency anemia (IDA). This study aims to evaluate the diagnostic accuracy of hematological indicators (MCV, MCH, MCHC) and iron biomarkers compared to Hb alone. A systematic literature review was conducted in PubMed, Cochrane Library, SAGE Journals, ScienceDirect, Wiley Online Library, Taylor and Francis, and DOAJ, covering publications from 2015 to 2025, following PRISMA guidelines. The Joanna Briggs Institute (JBI) approach was used to assess methodological quality and risk of bias. Analysis of five relevant publications showed that Hb alone often misses subclinical iron deficiency. Sensitivity and specificity improve when combined with ferritin, soluble transferrin receptor (sTfR), and adjustments for inflammatory markers such as alpha-1-acid glycoprotein (AGP) and C-reactive protein (CRP). These findings support a multifaceted approach that integrates hematological indicators, iron biomarkers, and inflammation markers for early and accurate anemia detection in adolescent girls, in line with national and international recommendations to reduce prevalence and long-term complications.
Correlation Between Knowledge and Attitude Toward Treatment Adherence Among Patients with Type 2 Diabetes Mellitus in Makassar, Indonesia
Many patients with diabetes mellitus still exhibit low adherence to long-term treatment. This study aimed to analyze the correlation between knowledge and attitude with treatment adherence among patients with type 2 diabetes mellitus. This research employed an analytical observational design with a cross-sectional approach. The study population consisted of patients receiving outpatient care at Nur Ichsan Clinic, Makassar City, from January to April 2025. A total of 74 respondents were selected using accidental sampling. Research instruments included the Diabetes Knowledge Questionnaire (DKQ-24), Diabetes Self-Management Education (DSME) attitude scale, and the Diabetes Self-Management Questionnaire (DSMQ) for treatment adherence. Each instrument had been validated in Indonesian with Cronbach’s alpha values of 0.82 (DKQ), 0.79 (DSME), and 0.85 (DSMQ), indicating good internal consistency. Knowledge, attitude, and compliance scores were categorized as good, fair, or poor based on mean cut-off points obtained from the total score distribution, as the data were normally distributed according to the Kolmogorov-Smirnov test (p = 0.119). Data were analyzed using Pearson’s correlation test, as the data met the assumptions of normality. The results showed that most patients had good levels of knowledge (75.7%), positive attitudes (75.7%), and high treatment adherence (75.7%). There was a significant positive correlation between knowledge and treatment adherence (r = 0.614, p < 0.001) and between attitude and treatment adherence (r = 0.587, p < 0.001). These findings indicate that patients with higher knowledge and more positive attitudes are more likely to adhere to treatment recommendations. In conclusion, knowledge and attitude are strongly correlated with treatment adherence among patients with type 2 diabetes mellitus. It is recommended that health education programs be strengthened through structured diabetes self-management interventions focusing on knowledge enhancement and attitude change to improve long-term adherence
Competence Of Mothers and Cadres in Early Detection Of Stunting in 3 Provinces in Indonesia
Stunting can affect a child's growth and development, leading to low human resource quality, thus posing a risk to work productivity. The stunting rate has increased significantly over the past 10 years, particularly in Eastern Indonesia, requiring serious attention from various professions, particularly the government, in collaboration with health workers. Research Objectives: 1) To identify the understanding, attitudes, and skills of mothers and health workers regarding the recognition, early detection, and risk factors of stunting, 2) increasing the knowledge of mothers and health cadres about early detection of stunting from the womb to the first 1000 days of life, and 3) To design an effective and practical guidebook that mothers and health workers can use to identify, early detection, and risk factors for stunting in the first 1,000 lives. Methods: This quantitative research study used a descriptive analytical design using a "One Group Pre-Post Test Design" and a pre-experimental method. The sample size was 210 mothers and health workers using a purposive sampling technique in the cities of Makassar, Mataram, and Soe, NTT. The results of the study in Makassar City and Soe City (NTT) showed that the level of knowledge of mothers about early detection of stunting was mostly lacking, namely 136 (93.8%). The level of knowledge of cadres about early detection of stunting was mostly high, namely 13 people (86.7%). Most were lacking, namely 113 (93.42%). While the skills of cadres about early detection of stunting were mostly good, namely 55 people (61.8%). The mother's attitude towards early detection of stunting was mostly lacking, namely 106 (99.1%). Meanwhile, the cadre's attitude towards early detection of stunting was mostly good, namely 62 people (60.2%). The statistical test results obtained p = 0.000, so it can be concluded that there is a difference in the proportion of the level of knowledge, skills and attitudes of mothers and health cadres with the ability to recognize early detection and risk factors stunting. Conclusion: Knowledge, skills and attitudes of mothers and health cadres are very lacking regarding the introduction, early detection and risk factors for stunting, and there is a significant relationship between the level of knowledge, skills and attitudes of mothers and health cadres, with the introduction of early detection and risk factors for stunting.
The Effect of Harvard Step Test on Vital Lung Capacity Among Medical Students at Tadulako University
Background: According to the World Health Organization (WHO), a lack of physical activity contributed to 830,000 deaths annually in 2022. University students are among the populations with low levels of physical activity. Vital capacity is the maximum amount of air that can be expelled from the lungs, influenced by various factors including age, gender, exercise habits, smoking activity, nutritional status, and medical history. This study aims to determine the effect of physical exercise using the Harvard Step Test on vital lung capacity in students at the Faculty of Medicine, Tadulako University. Specifically, this study aims to determine the value of vital lung capacity before and after physical exercise and analyze the effect of physical exercise on changes in vital lung capacity in students at the Faculty of Medicine, Tadulako University.. Methods: This study employed a pre-experimental method with a One Group Pre-Test Post- Test design without a control group, involving 23 participants, both male and female. Sampling was conducted using a non-probability method with purposive sampling technique. The physical exercise intervention consisted of the Harvard step test for four weeks, with a frequency of three times per week for approximately five minutes per session. The results were analyzed using the Paired Sample T-test in SPSS software. Results: The average pre-test vital capacity was 2.64 liters, while the average post-test vital capacity was 3.24 liters, indicating an increase in vital capacity following the intervention. The comparative analysis using the Paired Sample T-test yielded a p- value<0.000 (p<0.05), indicating a significant effect of the Harvard step test on vital capacity. Conclusion: There is an effect of physical exercise using the Harvard step test method on the vital capacity of the lungs in students of the Faculty of Medicine, Tadulako University.
Effectiveness of the Line Probe Assay Compared with Conventional Culture for Detecting Second-Line Anti-Tuberculosis Drug Resistance
Drug-resistant tuberculosis (MDR-TB and rifampicin-resistant TB) is a major challenge in TB control in Indonesia. Rapid detection of second-line anti-TB drug resistance is crucial for timely initiation of therapy. Line Probe Assay (LPA) is a molecular method recommended by WHO as an alternative to conventional culture tests such as Mycobacterium Growth Indicator Tube (MGIT) and Lowenstein Jensen, which have longer detection times. This research aimed to determine the effectiveness of the time and diagnostic efficiency of the Line Probe Assay method compared to conventional cultures (MGIT and Lowenstein Jensen) for identifying second-line anti-TB drug resistance in MDR-TB and rifampicin-resistant TB patients. This study employed an observational analytical design with a cross-sectional approach that incorporated a post-test-only control group framework to compare the performance of the Line Probe Assay (LPA) and conventional culture methods in detecting second-line anti-tuberculosis drug resistanceData were collected from two groups of patients: one group with multidrug-resistant tuberculosis (MDR-TB) and other with rifampicin-resistant TB. All samples were examined using the Line Probe Assay (LPA), Mycobacterium Growth Indicator Tube (MGIT), and Lowenstein-Jensen (LJ) culture methods. A total of 30 collected sputum specimens were analyzed based on the time of the results, ease of interpretation, and readiness for therapy. Findings indicated that the Line Probe Assay (LPA) provided results within 1–2 days, compared to Mycobacterium Growth Indicator Tube (MGIT) (average 17 days) and Lowenstein-Jensen (LJ) culture (average 28–42 days). LPA demonstrated higher efficiency in both laboratory workflow and clinical readiness for early therapeutic decision-making.For the MDR-TB group, LPA successfully detected resistance to fluoroquinolones (gyrA/gyrB mutations) and second-line injectable drugs such as amikacin and kanamycin (rrs/eis mutations), showing full concordance with culture results. Similarly, in the rifampicin-resistant TB group, LPA identified additional resistance patterns consistent with culture findings, confirming its broad applicability for detecting second-line drug resistance. Although the diagnostic accuracy of all three methods was equally high (100% sensitivity and specificity), LPA was clearly superior in terms of turnaround time and overall laboratory efficiency. This study concludes that the Line Probe Assay is more effective and efficient than conventional culture methods for identifying second-line anti-TB resistance in MDR-TB and rifampicin-resistant TB patients, and is strongly suggested for initial screening to accelerate clinical management.
The Effectiveness of Antibiofilm Synergy of Parijoto Leaf Extract (Medinilla speciosa) and Gentamicin on Methicillin-Resistant Staphylococcus aureus (MRSA) from Diabetic Ulcers
Diabetic foot ulcers (DFU) are chronic complications of diabetes that are generally accompanied by bacterial infections. Methicillin-Resistant Staphylococcus aureus (MRSA) is one of the most dominant pathogenic bacteria isolated from DFU wounds. The significant number of MRSA bacteria and the formation of bacterial biofilms result in prolonged wound treatment and high amputation rates. Several medicinal plants in the Muria Mountains have the potential to be alternative antibiofilms supporting gentamicin antibiotic treatment, one of which is the parijoto plant (Medinilla speciosa). This study aims to evaluate the effectiveness of the combination of parijoto leaf extract with gentamicin in inhibiting the growth of MRSA biofilms isolated from DFU. Parijoto leaves were extracted using the UAE (Ultrasound-Assisted Extraction) technique, followed by phytochemical tests and antibiofilm inhibition tests using the microdilution method. The results of phytochemical identification showed that there were saponin, flavonoid, tannin, alkaloid, quinone, and phenol compounds. The combination of gentamicin and parijoto leaf extract with several variations obtained the highest percentage of biofilm inhibition, namely 95%. The IC50 value in the antibiofilm inhibition test of the combination of parijoto leaf extract and gentamicin was 6.90 μg/mL. The chemical bioactive content in parijoto leaf extract can synergize as a supporting treatment with gentamicin to accelerate the treatment of diabetic ulcer wound infections. Further research needs to be carried out to explore and further study to determine the QS (Quorum Sensing) mechanism against MRSA (Methicillin-Resistant Staphylococcus aureus) bacteria by bioactive compounds in parijoto leaf extract and invivo test.
The Relationship between Psychosocial Stress on The Quality of Life and Self-Control in Adolescent Girls
Introduction: High academic pressure affects adolescents’ emotional and social well-being, resulting in a decline in their overall quality of life and impacting their self-control abilities. Objective: This study aimed to analyze the relationship between stress on the quality of life and self-control of adolescents. Methods: This was a cross-sectional study. The sample consists of 225 11th-grade female students, determined using the Lemeshow formula with an α=5% margin of error. Simple random sampling was employed. The instruments used were the Perceived Stress Scale (PSS) questionnaire, WHOQOL-BREF questionnaire, and Self-control Competency Scale questionnaire. Data were analyzed using SPSS version 16 with a chi-square test. Results: Most respondents experienced moderate stress (188 people, 83.6%), most female students had a low quality of life (160 people, 71.1%), and had moderate self-control (188 people, 83.6%). There is a significant correlation between stress and the quality of life of adolescent girls (P=0.000<0.05) and self-control (P=0.000<0.05). Conclusion: High stress is associated with low quality of life and self-control in adolescent girls.
Evaluating the Effectiveness of the Disaster Preparedness Curriculum on the Intention of Midwifery Alumni to Provide Reproductive Health Services in Crisis Situations: A Planned Behavior Theory Approach
The background of the problem in 2024 is that disaster victims in South Sulawesi will reach 795,930 people. According to Law Number 24 of 2007 concerning Disaster Management, vulnerable groups in disaster occurrences include infants, toddlers, children, pregnant mothers, lactating mothers, disabilities, and the elderly. These groups often experience greater impacts due to natural disasters The purpose of the study was to evaluate the effectiveness of the disaster preparedness curriculum that has been passed by D3 Midwifery alumni of the Pelamonia Institute of Health Sciences with a planned behavior theory approach by assessing the differences between the two groups of midwifery alumni. The research method uses quantitative methods with observational approaches and comparative design. to compare two groups of midwifery alumni, namely Group A who received a disaster curriculum during college and Group B who did not get a disaster curriculum. Through the theoretical approach of the Theory of Planned Behavior by measuring the differences between the two groups ranging from knowledge, attitudes, perceptions, subjective norms, and intentions of midwifery alumni in providing services in health crisis situations. The results of the study showed significant differences between the two groups for the knowledge variable of the average difference value of 5.44 with a value of p= 0.00 < 0.05. the attitude variable of the average difference value was 6.46 with a value of p= 0.00 < 0.05, the perception variable of the average difference value was 4.58 with a value of p= 0.00 < 0.05. the variable of subjective norms of the average difference value was 5.65 with a value of p= 0.00 < 0.05. the variable of intention of the average difference value of 16.03 with a value of p= 0.00 < 0.05. In conclusion, there are significant differences in the variables of knowledge, attitudes, perceptions, subjective norms and the intention of midwives to provide services in health crisis situations.
Nurses’ Role in Culturally Sensitive Diabetes Care: A Scoping Review
Culturally sensitive care is essential in diabetes management, as cultural beliefs, language, family roles, and religious practices strongly shape health behaviors and outcomes. Nurses, through their close contact with patients, are uniquely positioned to deliver such care, yet their contributions remain underexplored in previous reviews. This scoping review aimed to map nurse-led culturally sensitive interventions in diabetes care, describe adaptation strategies, synthesize reported outcomes, and identify knowledge gaps. Guided by Arksey and O’Malley’s framework, enhanced by Levac et al., and aligned with PRISMA-ScR and the JBI Manual, a systematic search was conducted across PubMed, Scopus, CINAHL, ScienceDirect, ProQuest, and Google Scholar for English-language studies published between January 2015 and May 2025. Sixteen studies met the inclusion criteria. Nurse-led interventions included Diabetes Self-Management Education (DSME), family-centered programs, faith-based initiatives, mHealth follow-ups, and community-based culturally contextualized care. Strategies applied were language adaptation, religious and spiritual integration, dietary alignment with traditional foods, family and community engagement, and respect for local norms. Reported outcomes were consistently positive across behavioral, clinical, psychosocial, and knowledge domains. However, gaps persist, including underrepresentation of Southeast Asian and Indigenous populations, inconsistent measurement of psychosocial outcomes, minimal reporting on nurse training, and limited system-level integration. This review underscores the central role of nurses as cultural brokers in diabetes care and calls for embedding cultural competence in nursing education, clinical practice, and policy.
The Kacirebonan Gamelan Music Accompaniment in Ergonomic Exercise and Its Impact on Blood Pressure Hypertensive Elderly
Ergonomic exercise has been recommended for older adults with hypertension. However, initially, it was carried out without music. Kacirebonan gamelan music is a traditional music that has characteristics of music therapy. The research objective is to determine the effects of ergonomic exercises accompanied by kacirebonan gamelan music and those not accompanied by kacirebonan gamelan music on systolic and diastolic blood pressure in hypertensive elderly in Cirebon. The research design is a quasi-experimental pretest-posttest intervention with two treatment groups: the first received ergonomic exercise accompanied by kacirebonan gamelan music, and the second received ergonomic exercise only. The intervention was carried out daily for 12 days, with two sessions per day, each lasting about 30 minutes, every 9 hours in the morning. The sample size was formulated by (t-1) (r-1) > 15, so the sample for each group consisted of 16 hypertensive elderly and 32 people for the whole sample, selected by simple random sampling and meeting the inclusion and exclusion criteria. Data analysis was performed using a t-test based on the Shapiro-Wilk normality test, with a p-value> 0.05. The result: there was no significant difference between before and after the intervention in systolic pressure (p=0.787>0,05) and diastolic pressure (p=0.229>0,05) in hypertensive elderly in the treatment group. There was no significant difference between the treatment and control groups in systolic pressure (p = 0.468 > 0.05) or diastolic pressure (p = 0.761 > 0.05) after treatment in hypertensive elderly. Ergonomic exercise without the accompaniment of kacirebonan gamelan music produces a greater effect on systolic (0.036 < 0.05) and diastolic (0.045 < 0.05) blood pressure in hypertensive elderly. The research conclusion is that the accompaniment of kacirebonan gamelan music during ergonomic exercises did not have a significant effect on systolic or diastolic blood pressure in elderly hypertensives. Ergonomic exercise without the accompaniment of kacirebonan gamelan music had a greater impact on reducing systolic and diastolic pressure in hypertensive elderly in Cirebon. Future research should formally operationalise and measure participants' cultural perceptions and expectations of an intervention before implementation.
Digital Education Innovation to Accelerate Stunting Reduction: An Experimental Study of Nutrition Class Mentoring Through SIGINTING
Stunting is a priority problem in Indonesia because it inhibits child growth and development, reduces intelligence, increases the risk of disease, and negatively impacts productivity and the nation's economy. Therefore, stunting prevention is included in the government's Asta Cita program to improve the quality of human resources. However, there is still a gap in the use of technology and monitoring of child growth and development in mothers with stunted children, so that innovative interventions in the SIGINTING application are needed to strengthen the nutritional information system and increase the effectiveness of mentoring and follow-up of stunting cases. The purpose of this study was to improve mothers' knowledge, attitudes, and skills in reducing stunting through nutrition class mentoring with digital educational innovations through the Stunting Response Information System Application (SIGINTING). This type of research is a Quasi-experimental study with a pre-test-post-test control group design, with a sample size of 84 people in each group. The sampling technique used stratified random sampling. Data analysis used the Wilcoxon test. The results showed that the mean value of the level of knowledge before the intervention in the treatment group was 68.7 and after the intervention became 88.79 with a p-value of 0.000. Meanwhile, the mean value of mothers' attitudes before the intervention in the treatment group increased from 64.14 to 74.11 with a p-value of 0.000. The mean maternal skills score before the intervention was 70,64, increasing to 88,79 after the intervention, with a p-value of 0.000. The combination of nutrition class support and the use of the SIGINTING application has proven effective in improving maternal knowledge, attitudes, and skills in reducing stunting rates. Recommendations include implementing regular nutrition classes for mothers of toddlers and utilizing the SIGINTING application as a digital educational medium.
Prevalence Study of Sexually Transmitted Infections in Pre-Marital Couples Undergoing Pre-Marital Checkups at the Bantimurung Community Health Center
Sexually transmitted infections (STIs) are an important public health issue, especially among adults of reproductive age. Premarital screening plays a strategic role in the early detection of STIs to prevent transmission to partners and offspring. This study aims to determine the prevalence of sexually transmitted infections (STIs) and the characteristics of prospective brides and grooms who undergo premarital examinations at the Bantimurung Community Health Center (UPTD Puskesmas Bantimurung). This study used a descriptive design with a cross-sectional approach. The sample was determined using purposive sampling with a total of 64 respondents, and the sample size was calculated using the Lemeshow formula. This study was conducted from March 3 to June 2, 2025. Data were obtained through laboratory tests, including detection of HIV, syphilis, and hepatitis B using rapid diagnostic tests, as well as structured interviews regarding risk factors. The results showed that most respondents were aged 25–30 years (33 people or 52%), 20–24 years (21 people or 33%), above 30 years (9 people or 14%), and 19 years (1 person or 2%). Based on gender, there were 30 males (47%) and 34 females (53%). Laboratory results showed an STI prevalence of 1.6%, with one reactive syphilis case and 63 (98.4%) non-reactive cases, while all respondents were non-reactive for HIV and hepatitis B. It was concluded that the prevalence of STIs among prospective brides at the Bantimurung Community Health Center was low, with the main risk factors being low knowledge and risky sexual behavior. It is recommended that further research be conducted with a larger sample size and wider coverage area to obtain more representative results, as well as increased education about reproductive health and the importance of premarital checkups in preventing STIs.
Effectiveness of Endorphin Massage for Pain Reduction During the Active Phase of First-Stage Labor: A Quasi-Experimental Pretest–Posttest Study
Pain during the first stage of labor frequently heightens maternal stress and may interfere with the physiological progress of childbirth. This study examined the effectiveness of endorphine massage as a non-pharmacological technique for reducing pain experienced by women in the active phase of first-stage labor. A quasi-experimental one-group pretest–posttest design was conducted with sixteen consecutively recruited participants from a community health center. The intervention consisted of a structured endorphine-massage protocol delivered by trained midwives, involving gentle rhythmic strokes and light pressure applied for approximately 15 minutes to the lower back, shoulders, and pelvic area. Pain intensity was measured before and after the intervention using the validated Numeric Rating Scale (NRS). Normality was confirmed with the Shapiro–Wilk test, permitting the use of a paired t-test. The mean pain score decreased from 7.40 before the intervention to 6.13 afterward, indicating a statistically significant reduction (p = 0.001) with a moderate effect size. These findings suggest that endorphine massage may serve as a supportive option for managing pain during the active phase of labor. However, the small sample size and single-site setting limit generalizability, and larger multi-center studies are recommended to strengthen the evidence base for clinical application
Development of the “SIMANIS” E-booklet as a Family Planning Decision-Making Tool for Women of Reproductive Age (WRA)
The height opportunity Pregnancy in Women of Reproductive Age (WRA) can cause teasing birth if no accompanied by planning a good family, though WRA participation in the family planning program is sufficient high, fulfillment need contraception and enhancement interest still become challenges. The lack of use sheet ABPK return by midwife in family planning counseling also strengthen need will be an interesting and easy educational media accessible in a way independent by WRA. Research this aim for develop sheet back to ABPK become e-booklet and testing its feasibility. Research and Development (R&D) method with the ADDIE model, consisting of five stages: 1) Analysis, 2) Design, 3) Development, 4) Implementation, 5) Evaluation. Subject study covering 22 WRA in the practice area independent midwife “S” Subdistrict Kedungkandang, Malang City, 2 lecturers as expert materials and media, and 1 midwife as expert. Instruments used​ in the form of guide interview, guide FGD (Focus Group Discussion), and questionnaire evaluation product. Data analyzed use approach quantitative and qualitative. Research results produce “SIMANIS” e-booklet (Informasi Metode dan Alat Kontrasepsi Minimalis) designed interesting, using image, language simple, and features voice for make it easier understanding independently by WRA. Validation results show this media is in the "very worthy" category with evaluation expert 93% material, 100% media expert, and trial results group small show that 87% of participants give rating “very worthy”. With Thus, the “SIMANIS” e-booklet is very worthy. used as tool help taking decision family planning in WRA.
Analysis of Risk Factors Associated with Pulmonary Tuberculosis Incidence in the Working Area of Caile Community Health Center, Bulukumba Regency
Pulmonary tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis that attacks the lungs and bronchi. This disease is transmitted through the air. This study aimed to determine the risk factors associated with the incidence of pulmonary TB in the working area of Caile Community Health Center, Bulukumba Regency. This research used an analytical observational design with a case-control approach. The sampling technique was total sampling, with a total of 96 respondents consisting of 48 cases and 48 controls. Data were collected in March 2025. The majority of respondents were aged 50–59 years, and most were male. Data collection techniques included interviews and observations. Data were analyzed using univariate, bivariate (chi-square test), and multivariate (logistic regression) analyses.. The results showed a significant relationship between occupancy density (p = 0.001), ventilation area (p = 0.001), humidity (p = 0.002), and contact history (p = 0.001) with the incidence of pulmonary TB. Although smoking status showed no significant association in the bivariate analysis (p = 0.066), it became statistically significant in the multivariate model after controlling for confounding variables. Multivariate analysis also showed that the most dominant risk factor was contact history, with an OR value of 28.569, indicating that individuals with a history of contact with pulmonary TB patients were 28.5 times more likely to develop the disease..The study concludes that of the five variables analyzed, four were identified as risk factors for pulmonary TB incidence, with contact history being the most dominant. Efforts to prevent and control pulmonary TB should focus on improving housing conditions, enhancing ventilation quality, maintaining appropriate humidity, providing education on the dangers of smoking, and emphasizing the importance of avoiding direct contact with pulmonary TB patients, as well as strengthening contact screening by health workers.
Profile of Self Medication Practices in the Tarramatekkeng Village Luwu District South Sulawesi
Self medication is the practice of treating oneself using over the counter medicines, limited over-the-counter drugs, or prescription medications obtained from pharmacies. This practice requires adequate knowledge to ensure safe and effective use. Self medication is becoming increasingly common due to its affordability, convenience, and easy access to pharmacies and drugstores, as well as the availability of health information through various media. This study aimed to describe self-medication practices in the community of Kasumang Hamlet, Tarramatekkeng Village, especially in terms of illnesses treated, types of medications used, sources of information, places where medicines were obtained and and they purchased medicines either for immediate use or for future stock. A descriptive research design with a cross-sectional quantitative approach was employed. This study was conducted in Dusun Kasumang, Tarramatekkeng Village, Luwu Regency, from May to June 2025. The sample size was determined using the Slovin formula, resulting in a total of 81 participants. Participants were selected using purposive sampling based on predetermined inclusion criteria. Headaches were the most common reason for self-medication (20%), followed by fever (19%). The most commonly purchased drug was Paracetamol (17%), with 53% of participants buying medication at pharmacies. The main source of information was relatives (47%), and 51% of participants were currently using medication. These findings highlight the need for increased public awareness regarding the safe use of medicines, greater access to professional pharmaceutical guidance, and strengthened regulation of prescription drug sales to reduce the risk of inappropriate self-medication and protect community health
Association Between Duration of Antiretroviral Therapy and Virological Suppression Among HIV Patients in South Sulawesi, Indonesia
HIV infection remains a major global health problem requiring lifelong therapy to suppress viral replication. Antiretroviral therapy (ART) has been proven effective in reducing viral load; however, its success may vary depending on treatment duration and patient adherence. This study aimed to analyze the relationship between ART duration and virological status among HIV patients receiving first-line ART in South Sulawesi, Indonesia. This descriptive cross-sectional study used medical record data from patients who underwent viral load testing at the referral laboratory in South Sulawesi. A total of 221 patients who had received ART for at least six months were included. The main variables were ART duration (in months) and virological status, categorized as successful (≤1000 copies/mL) or failed (>1000 copies/mL). Data were analyzed descriptively using frequency and percentage distributions. Most patients in all treatment duration groups achieved virological suppression, with success rates ranging from 90% to 100%. Virological failure was observed in 3.6% of patients, particularly in those with treatment durations of 144–166 months. Overall, 96.4% of patients achieved successful virological suppression, meeting the national target, This study demonstrates high rates of virological suppression among HIV patients in South Sulawesi, supporting the effectiveness of first-line ART programs in the region. Routine viral load monitoring and continuous adherence support are essential to sustain long-term treatment success. Future research should include immunological and adherence parameters to provide a more comprehensive evaluation of treatment outcomes.
Analysis of the Influence of Facility Quality and Health Worker Service Quality on Outpatient Satisfaction at H. Padjonga Daeng Ngalle Regional General Hospital, Takalar
The availability of adequate facilities and the quality of healthcare services are crucial determinants of patient satisfaction, particularly in outpatient care. H. Padjonga Daeng Ngalle Regional General Hospital still faces several infrastructural and service challenges, such as ceiling leaks during the rainy season and limited seating in waiting areas, which may reduce patient comfort. This study aimed to analyze the influence of facility quality and healthcare service quality on outpatient satisfaction at H. Padjonga Daeng Ngalle Regional General Hospital in 2025. A quantitative approach with a cross-sectional design was employed, involving 362 randomly selected respondents. Data were collected through a validated and reliable questionnaire and analyzed using the chi-square test with SPSS software. The results showed a significant relationship between facility quality (p = 0.000; PR = 2.36; 95% CI: 1.78–3.12) and healthcare service quality (p = 0.000; PR = 2.91; 95% CI: 2.04–4.15) with outpatient satisfaction (p < 0.05). These findings indicate that both facility and service quality substantially influence outpatient satisfaction. Therefore, hospital management should prioritize improving physical facilities, service systems, and healthcare personnel competence to enhance patient satisfaction sustainably.
The Effect of Sample Volume Variation on Blood Glucose Measurements Using POCT Devices within the Context of Public Health Services
Blood glucose testing is a crucial step in the detection and monitoring of diabetes mellitus, especially within the context of public health services. The use of Point-of-Care Testing (POCT) devices has become a practical choice due to their speed and ease of use. However, the accuracy of the test results can be influenced by various factors, one of which is the volume of the blood sample utilized. This study aims to evaluate blood glucose measurements using variations in sample volume on a POCT device. The research employed a laboratory experimental design with a within-subject approach. A total of 55 respondents participated in the study. The blood sample volume variations tested were 0.3 µl, 0.5 µl, and 0.7 µl. The measurements were carried out using the Easy Touch POCT device, and the results were compared with a standard laboratory control instrument. The study findings indicate that a blood sample volume of 0.7 µl produced glucose values most consistent with the standard laboratory results, where, based on SPSS analysis, the p-value was > 0.05 (0.137 > 0.05), indicating no significant difference between the POCT measurements and the standard laboratory instrument at this volume. In contrast, sample volumes of 0.3 µl and 0.5 µl showed significant differences compared to the reference values (p < 0.05), which could affect the accuracy of the measurements and potentially impact the accuracy of diagnosis and patient monitoring. Based on these results, it can be concluded that the volume that yields the highest accuracy for glucose testing using the Easy Touch POCT device is 0.7 µl. This study highlights the importance of standardizing blood sample volume in the use of POCT to enhance the accuracy of test results, particularly in primary healthcare settings such as community screening programs or public health centers (puskesmas).
Association of Physical Activity and Fruit-Vegetable Consumption with Nutritional Status among Adolescent Girls
Nutritional status represents an individual’s overall physical condition, which is influenced by dietary intake and the body’s ability to utilize nutrients efficiently. Among the various determinants, physical activity and fruit–vegetable consumption play essential roles. According to the 2018 Basic Health Research data in Makassar City, the prevalence of nutritional status among adolescents aged 13–15 years was 2.69% severely thin, 7.01% thin, 63.21% normal, 17.67% overweight, and 9.42% obese. This study aimed to analyze the association between physical activity, fruit–vegetable consumption, and nutritional status among 65 female adolescents at SMPN 40 Makassar. Data were collected from November 2024 to February 2025 using a validated Food Frequency Questionnaire (FFQ) for dietary assessment and the International Physical Activity Questionnaire (IPAQ) for activity measurement. Nutritional status was classified based on the Body Mass Index-for-Age (BMI/A) criteria from the World Health Organization (WHO, 2007). Statistical analysis employed the Chi-Square test. The results showed no significant association between physical activity and nutritional status (p = 0.210) nor between fruit–vegetable consumption and nutritional status (p = 0.243). These null findings suggest that other dietary or lifestyle factors, such as total energy intake, meal frequency, or sedentary behavior, may play a more dominant role in determining adolescent nutritional status in urban settings. Future studies are recommended to expand the scope by including multiple determinants of adolescent health and nutrition behaviors
Birth Companionship as a Non-Pharmacological Strategy to Reduce Maternal Anxiety and Enhance Perceived Support and Safety During Childbirth
Birth companionship is globally recognized as an effective non-pharmacological approach to improving maternal psychological well-being during labor, yet evidence from Indonesian urban settings remains limited. This study evaluated mothers’ perceptions of birth companions and examined changes in anxiety levels before and after an intervention consisting of antenatal education and continuous companionship during labor. A quasi-experimental one-group pretest–posttest design was conducted involving 30 primigravida mothers in Balikpapan, Indonesia. Data were collected using closed-ended nominal questionnaires and analyzed with the McNemar test. Significant improvements were observed in several maternal perception indicators, including feeling calmer (p = 0.000), emotionally supported (p = 0.004), physically assisted (p = 0.016), helped in communicating with health workers (p = 0.008), and safe and comfortable during labor (p = 0.031). Maternal anxiety levels also decreased significantly across key indicators, including fear of childbirth (p = 0.016), negative thoughts (p = 0.016), restlessness while waiting for labor (p = 0.001), and feelings of helplessness (p = 0.016). These findings indicate that antenatal education combined with continuous birth companionship is effective in enhancing perceived support and safety while reducing pre-delivery anxiety. However, because this study used a one-group pretest–posttest design without a comparison group, the generalizability and causal interpretation of the findings remain limited. Further research employing controlled or randomized designs is recommended to strengthen causal inference and expand applicability.
Periosteal Pecking versus Piston Dry Needling Techniques: A Comparative Study on Pain Reduction in Tennis Elbow
Lateral epicondylitis is a musculoskeletal disorder caused by overuse of the extensor carpi radialis brevis (ECRB) tendon, characterized by pain and decreased muscle function. This study aimed to compare the effectiveness of piston dry needling and periosteal pecking techniques in reducing pain and improving handgrip strength in patients with lateral epicondylitis. This research employed a quasi-experimental pretest–posttest two-group design involving 20 respondents who were divided into two groups: the piston dry needling group (n = 10) and the periosteal pecking group (n = 10). Both groups received dry needling intervention once per week for four consecutive weeks, for a total of four treatment sessions. The instruments used included the Visual Analog Scale (VAS) to measure pain and a Hand Dynamometer to measure handgrip strength. Data were analyzed using paired t-tests for within-group differences and independent t-tests for between- group comparisons. The results showed that both dry needling techniques were effective in significantly reducing pain and increasing handgrip strength (p<0.001). In the piston dry needling group, the mean VAS decreased from 6.78 ± 0.66 to 2.55 ± 1.27 (Δ 4.23 ± 1.01), and handgrip strength increased from 23.20 ± 3.82 to 28.30 ± 4.12 (Δ 5.10 ± 2.60). In the periosteal pecking group, the mean VAS decreased from 7.25 ± 0.54 to 1.55 ± 0.35 (Δ 5.20 ± 0.70), and handgrip strength increased from 22.60 ± 3.20 to 25.90 ± 3.85 (Δ 3.30 ± 1.60). The independent t-test revealed significant differences in pain reduction (p=0.020) and handgrip improvement (p=0.050). In conclusion Periosteal pecking demonstrated greater effectiveness in reducing pain, while piston dry needling showed a stronger tendency to increase handgrip strength, although the between-group difference for handgrip strength was marginal. Future studies with larger samples or longer follow-up periods are recommended.
Fatigue as the Dominant Predictor of Impaired Quality of Life Among Post-Tuberculosis Patients in Yogyakarta, Indonesia
Background: Tuberculosis (TB) remains a significant global health problem. Although bacteriological cure can be achieved, many post-tuberculosis patients experience persistent residual symptoms and a decline in quality of life. Objective: This study aimed to identify factors associated with quality of life among post-tuberculosis patients. A cross-sectional study was conducted among 54 post-tuberculosis patients in Yogyakarta, Indonesia. Quality of life was assessed using the St. George's Respiratory Questionnaire (SGRQ). Bivariate and multivariate analyses (linear regression) were performed to identify factors associated with quality of life. Results: The median SGRQ score was 42.8 (IQR: 12.5–68.3). Fatigue was reported in 20.4% of participants. Multivariate analysis showed that fatigue was the dominant independent predictor (B=28.5, β=0.412, p=0.008), explaining 38.0% of the variance in SGRQ scores.. Conclusion: Fatigue is the dominant independent predictor of impaired quality of life in post-tuberculosis patients. Comprehensive care programs that include fatigue assessment and management are needed to improve the quality of life of TB survivors.
Analysis of Risk Factors Affecting the Incidence of ARI in Toddlers in Benteng City, Selayar Islands Regency
especially in the respiratory system. Toddlers are one of the risk populations for ARI. This study aims to analyze the risk factors that influence the incidence of ARI in toddlers in Benteng Town, Selayar Islands Regency. The type of research used is analytic with a case control approach. The sampling method used was purposive sampling technique. The total number of samples was 74 samples. The results of data analysis were tested using the Chi Square test and the Logistic Regression test. The results showed that ventilation factors (p = <0.001 <0.05), occupancy density (p = 0.020 <0.05), and smoking habits of family members (p = 0.006 <0.05) were risk factors for the incidence of ARI in toddlers. The use of mosquito coils (p = 0.100 > 0.05), immunization history (p = 1.000 > 0.05), nutritional status (p = 0.563 > 0.05), and family income (p = 0.053 > 0.05) were not risk factors for ARI among children under five. The conclusion of this research is that of the seven variables studied, there are three variables that are risk factors for the incidence of ARI in toddlers, with ventilation being the most influential risk factor for the incidence of ARI in toddlers. Suggestions in this research are to maintain the cleanliness of the environment around the house and behave cleanly and healthily to prevent toddlers and families from ARI disease transmission.
The Role of Nurses to Optimizing the Mechanical Ventilation for Acute Respiratory Failure in the Intensive Care Unit (ICU) of Hospital
Background: The largest component at every health care facility center is the Nurse. In hospitals, nurses are placed in various health care units or sections, one of which is the Intensive Care Unit (ICU). Generally, Nurses at ICU have greater duties, roles, and responsibilities than nurses in other service units. Every day, these nurses must deal with critical patients, especially patients with acute respiratory failure on ventilators whose lives are threatened and have a high risk of death. Therefore, ICU nurses are increasingly required to play an integrated and comprehensive role to optimize mechanical ventilation management so that critical patients (acute respiratory failure) can be saved. Objective: To examine the nurse’s role of ICU and any supporting and inhibiting factors them to optimizing mechanical ventilation in patients with acute respiratory failure at the ICU. Method: A qualitative descriptive as type of this study, and use analytical, exploratory, phenomenological, and evaluative design. This research has been conducted in the ICU Room of Dr. Wahidin Sudirohusodo General Hospital of Makassar, Makassar City, South Sulawesi Province, Indonesia. The subjects are 21 nurses at ICU’s room. The informants include: the doctor in charge of the ICU, the Head of the Nursing Section, nurses, patients and families. Observation, interviews, and documentation as methods are used to collecting any data need to analyses problem and objective this study. A qualitative used as analyses approach.Results: All nurses at ICU room of hospital have an urgent, important and strategic role to optimizing mechanical ventilation against patients with acute respiratory failure. The specifically roles that must be played them by stages, integrated and holistic include: observation (observer), monitoring (monitor), evaluation of monitoring results and data analysis, airway management, examination and assessment of patient conditions, nursing care and actions, communication and coordination, preparedness and collaboration, as well as prevention and management of complications. The supporting factors of the role of nurses at ICU include: the human resources (HR) competence of nurses, the increasing number of acute respiratory failure patients requiring care, policy support and mechanisms as guidelines, support from hospital management, infrastructure and facilities and equipment, communication relationships and lines of coordination and collaboration, and the support of the patient's family. While the inhibiting factors include: patient factors, nurse negligence factors (in monitoring and managing ventilators, evaluating and analyzing data, managing patient breathing), quantity and quality of nurse HR factors, high nurse workload factors, limited time management factors in assessments, limited infrastructure and facilities and equipment factors. ineffective communication factors, conflict of interest factors, and poor role conflict management factors
Gender-Specific Determinants of High Cholesterol: A Cross-Sectional Study Among Health Institution Employees in Makassar, Indonesia
High cholesterol or dyslipidemia is one of the main risk factors for cardiovascular disease (CVD), including coronary heart disease, stroke, and peripheral artery disease. The World Health Organization (WHO) estimates that more than 39% of adults worldwide have total cholesterol levels above safe limits, with more than 4.4 million deaths each year directly related to increased LDL cholesterol levels and decreased HDL. Global trends show a significant increase in the prevalence of dyslipidemia in low- and middle-income countries, particularly in Southeast Asia, driven by changes in diet, urbanization, and decreased physical activity. At the national level, Basic Health Research (Riskesdas) and the Indonesian Nutrition Status Study (SSGI) report show that the prevalence of high cholesterol in Indonesia has continued to increase over the past decade. This study analyzed factors affecting high cholesterol using logistic regression in groups of women and men. The variables tested included blood pressure, body weight, and fasting blood sugar. Using data from 276 employees of a public health polytechnic in Makassar (January–June 2025), separate logistic regression models for women and men revealed that blood pressure was a significant predictor in both groups (ORwomen = 6.48, ORmen = 7.04), while fasting blood sugar was significant only in women (OR = 5.26). The results show that blood pressure is a significant predictor in both groups, while fasting blood sugar is significant only in women. The model explained 50.7% of variance in women versus 39.0% in men. The prediction model shows higher accuracy in women. These findings have important implications for gender-based dyslipidemia prevention efforts.
Randomized Controlled Trial of Mindfulness-Based Therapy on Psychological Distress and Clinical Outcomes in Preeclampsia
Preeclampsia is one of the leading causes of maternal morbidity and mortality worldwide, often associated with psychological distress that worsens clinical outcomes. This study aimed to examine the effectiveness of Mindfulness-Based Therapy (MBT) on psychological distress and clinical outcomes in women with preeclampsia. A randomized controlled trial was conducted among 60 pregnant women diagnosed with preeclampsia who were randomly assigned into two groups: intervention (MBT + standard care) and control (standard care only). MBT was delivered in six sessions over three weeks, focusing on mindfulness breathing, body scanning, and acceptance strategies. Psychological distress was measured using the Depression Anxiety Stress Scale (DASS-21), while clinical parameters included systolic and diastolic blood pressure, and proteinuria level. The results showed a significant reduction in stress, anxiety, and depression scores (p < 0.05) in the intervention group compared to the control group. Clinically, the intervention group demonstrated better blood pressure control and reduced proteinuria. Mindfulness-Based Therapy effectively reduces psychological distress and improves clinical outcomes in preeclampsia. Integrating mindfulness interventions into antenatal care could enhance maternal well-being and pregnancy outcomes.
Bibliometric Mapping of WhatsApp-Based Health Research (2015–2025): Global Trends, Leading Countries, and Emerging Themes
The use of WhatsApp (WA) in the health sector is increasingly widespread for communication, education, and intervention. Yet, systematic and updated bibliometric analyses of global trends remain limited, particularly those covering post-2023 developments and comparing contributions between high-income and developing countries. This study aims to systematically map and analyze the international landscape of WA-based health research published between 2015 and 2025. We employed a bibliometric research design with data sourced from the Scopus database, using the keywords "WhatsApp" AND "health". A total of 50 relevant articles were analyzed using descriptive statistics and VOSviewer software to visualize networks. The findings indicate that the use of WA as a health communication tool is firmly established. Publication trends indicate growth, with the COVID-19 pandemic serving as a significant catalyst that has driven the exploration of WA for remote healthcare services. The five most productive countries are India, Saudi Arabia (with five articles each), Brazil, Malaysia, and Indonesia (with four articles each). The most influential themes centered on the benefits of WA in clinical practice and the enhancement of supervision for community health workers. In conclusion, WA is proven to be a vital health communication tool, and the future direction of research is expected to increasingly focus on establishing its effectiveness, testing service models, and its broader, more systematic integration into the digital health ecosystem.