Jurnal Kesehatan Komunitas Indonesia

Transition Readiness Among Pre-licensure Nursing Students Entering Clinical Practice: A Systematic Review

Sujarwanto, Dodi Wijaya, Anisah Ardiana — Sat, 25 Jul 2026 00:00:00 +0000

The theory-practice gap frequently triggers transition shock among pre-licensure nursing students. This study aims to identify, evaluate, and synthesize recent literature regarding the readiness level of professional nursing students transitioning to clinical practice. This systematic review adhered to the PRISMA protocol and searched PubMed, ScienceDirect, and Google Scholar for studies published over the last five years. Selection followed the PICOS framework, and methodological quality was appraised using the Joanna Briggs Institute (JBI) Checklist. Twelve articles from eight countries were analyzed. Quantitative findings indicate that practice readiness levels range from moderate to high, with mean scores averaging 63.5% to 75.4% of maximum capacity. However, significant variations exist, heavily influenced by healthcare contexts and educational cultures. Results confirm that readiness is multidimensional, integrating clinical skills, intrapersonal factors, teamwork, and professionalism. Limitations include a reliance on self-reported measures and the absence of a singular standardized assessment tool. Ultimately, these findings can directly inform nursing curriculum redesigns and the establishment of robust hospital-university partnership models, highlighting the critical need for structured pre-clinical orientations and integrated nurse residency programs to mitigate transition shock.

The Influence of Work Discipline Systems on Perceived Accident Risk and Unsafe Behaviors in Ship Loading and Unloading Operations

Asteria Narulita Pramana, Muh. Fauji, Sahrul Sahrul — Mon, 27 Jul 2026 00:00:00 +0000

Work discipline plays a vital role in preventing accidents during coal loading and unloading activities on ships. This study aims to analyze the influence of the disciplinary system on the risk of ship-loading and unloading accidents at PT SMD in Semarang. The method used was quantitative research with a cross-sectional survey design. Given that the total population of truck drivers at PT SMD was exactly 55, we employed total population sampling, examining all available workers. Data collection used a Likert scale questionnaire. Statistical tests included validity, reliability, normality (One-Sample Kolmogorov-Smirnov), and simple linear regression. All 10 items of the discipline instrument were declared valid (r > 0.3) with a Cronbach's alpha of 0.927 (very high). Of the 10 items of the loading and unloading instrument, 9 were valid and had a reliability of 0.874 (high). The normality test showed Asymp. Sig. = 0.200 (> 0.05), meeting the assumption of a normal distribution. The ANOVA test results showed Sig. = 0.000 (< 0.05), indicating the regression model is significant. The discipline system significantly influences the risk of ship loading and unloading accidents; the higher the level of worker discipline, the lower the risk of such accidents.

Relationship Between Free Nutritious Meal Program (MBG) Energy Contribution with Daily Energy Requirements and Nutritional Status Among Students of Wawo Junior High Scholl, Bima District

Rhosmiati, Hairunnisah, Dea Zara Avila, Muammar Iksan — Sat, 01 Aug 2026 00:00:00 +0000

Background: The Free Nutritious Meal Program is a school-based nutrition intervention designed to support students’ energy intake and nutritional status. Variations in students’ consumption of the provided meals may influence the program’s contribution to daily energy adequacy and nutritional outcomes. Objective: This study aimed to examine the association between the energy contribution of a Free Nutritious Meal Program, daily energy adequacy, and nutritional status among students of SMP Negeri 2 Wawo (Junior High Scholl), Bima Regency. Methods: A cross-sectional study was conducted among 102 students selected through stratified random sampling. Data were collected using two non-consecutive 24-hour dietary recalls and anthropometric measurements. Data were analyzed using descriptive statistics and Pearson correlation tests. Results: The energy contribution of the Free Nutritious Meal Program was significantly associated with daily energy adequacy (p = 0.003). Daily energy adequacy was significantly associated with students’ nutritional status (p < 0.001). In addition, a significant association was found between the program’s energy contribution and nutritional status (p = 0.010). Conclusion: The energy contribution of the Free Nutritious Meal Program was associated with daily energy adequacy and nutritional status among junior high school students. These findings may support the development of school-based nutrition interventions and community nutrition monitoring programs to improve adolescent nutritional health in rural areas.

Effectiveness of Health Education on Iron Supplement Adherence Among Adolescent Girls: A Scoping Review

Sun, 02 Aug 2026 00:00:00 +0000

Anemia in adolescent girls affects cognitive performance, physical and mental health, social development, and increases the risk of anemia during pregnancy. Health education programs have been implemented to improve adherence with iron supplementation, yet evidence comparing the effectiveness of different approaches remains limited. This study aimed to map and synthesize evidence on the effectiveness of health education interventions in improving adherence to iron supplementation among adolescent girls. A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute (JBI) scoping review framework with PCC criteria: adolescent girls (Population); health education (Concept); adherence with iron supplementation (Context). Articles with no date restriction were retrieved from Scopus, PubMed, and EBSCO using predefined keywords. Data extraction included country, design, findings, and study limitations. Seven articles were included following title, abstract, and full-text screening. Thematic analysis was applied, and results were presented in tables and narrative form. Studies were conducted in India (n=4) and Indonesia (n=3), published between 2008 and 2025, involving samples ranging from 70 to 150,700 adolescent girls. All included studies reported a positive association between health education and improved adherence to iron supplementation, with adherence rates ranging from 26.5% in WhatsApp-based reminder interventions to 97.1% in teacher-supervised, directly observed treatment. Health education combined with direct supervision, family support, and digital reminders can effectively improve adolescent girls' adherence to iron supplementation. Subsequent studies should use standardized adherence indicators and longer follow-up periods to enhance comparability and generalizability.

The Effect of Sleep Quality, Hot Work Climate, and Age on Work Fatigue Through Work Duration as an Intervening Variable on Charcoal Workers in Batam City

Sun, 02 Aug 2026 00:00:00 +0000

Workers in the informal charcoal industry face the risk of physical exposure and high workloads. This study aims to analyze the effects of sleep quality, hot work climate, and age on work fatigue, with work duration as an intervening variable, among charcoal workers in Batam City. This study used a quantitative, observational-analytical design. The population was charcoal workers; a sample of 99 workers was selected using a total sampling technique. Data were collected using a questionnaire and analyzed using Smart-PLS SEM. The results showed that sleep quality had a significant direct effect on work duration (coefficient = 0.591, p = 0.000) and work fatigue (coefficient = 0.618, p = 0.000). A hot work climate has a significant effect on work duration (coefficient = 0.264, p = 0.002). However, it does not have a significant direct effect on work fatigue (coefficient = 0.027, p = 0.354). Age has a significant direct effect on work duration (coefficient = 0.0395, p = 0.003) and work fatigue (coefficient = 0.431, p = 0.000). Work duration is significantly associated with work fatigue (coefficient = 0.431, p = 0.000) and fully mediates the relationship between hot work climate and work fatigue. The value indicates that the combination of variables in the model explains 96.5% of the variation in work fatigue. Sleep quality and work duration are the main determinants of work fatigue among charcoal workers. Hot work climates do not directly cause fatigue, but rather must first lead to an increase in workers' work duration. It is recommended that charcoal business owners arrange adequate rest periods between burnings and that workers maintain sleep quality to reduce the risk of chronic work fatigue. While previous studies examined these factors separately, the mediating role of work duration among informal charcoal workers remains under-investigated, which constitutes the research gap addressed here. Ethical approval was obtained prior to data collection, and informed consent was secured from all respondents.

Developing an Integrated Process Safety Management Framework for Nickel Smelter Operations: Alignment of PP 50/2012, CCPS-RBPS, and OSHA 29 CFR 1910.119

A. Yani Esbe, Irfan Bahiuddin — Sun, 02 Aug 2026 00:00:00 +0000

The rapid expansion of Indonesia’s mineral processing and refining industry, particularly nickel smelters, has heightened the need for a systematic, risk-based Process Safety Management (PSM) program. Existing Occupational Health and Safety Management Systems under Government Regulation No. 50/2012 are considered insufficient to address the complex process hazards associated with smelter operations comprehensively. This study aimed to develop an integrated Process Safety Management (PSM) framework for PT Ceria Nugraha Indotama (PT CNI) that aligns with Government Regulation No. 50/2012, the Center for Chemical Process Safety Risk-Based Process Safety (CCPS-RBPS) framework, and OSHA 29 CFR 1910.119 requirements. A mixed-methods approach was employed. Qualitative data were collected through document reviews, field observations, focus group discussions, and in-depth interviews with operational personnel and management to identify implementation barriers and enabling factors. Quantitative data were collected from 101 purposively selected respondents, comprising internal personnel and external professionals from high-risk industries. An initial set of 22 PSM elements identified through cross-comparison analysis was consolidated into 12 integrated components through expert validation and focus group discussions. Data analysis included Pearson correlation validity testing, Cronbach’s Alpha reliability testing, Shapiro-Wilk normality testing, and One-Sample Wilcoxon Signed-Rank testing using Jamovi software. The Wilcoxon Signed-Rank Test showed significant positive responses across all twelve integrated components (W = 5151, p < 0.001), showing strong stakeholder acceptance of the proposed framework. Major implementation challenges included a limited understanding of trade secret management, mechanical integrity, and pre-startup safety review. In contrast, training systems, incident investigation practices, and work permit systems were identified as supporting factors. The integrated PSM framework developed in this study provides a practical reference for enhancing process safety performance in nickel smelters and other high-risk industries in Indonesia through a sustainable and risk-based management approach.

The Effect of The Free Nutritious Meal Program (MBG) on The Nutritional Status of Pregnant Women in The Service Area of The Paruga Community Health Center

Nurul Hamiah, Muammar Iksan, Darmin, Dea Zara Avila — Sun, 02 Aug 2026 00:00:00 +0000

Background: Indonesia continues to face high rates of stunting and maternal malnutrition, necessitating innovative interventions. The Free Nutritious Meals Program (MBG), launched in 2024, aims to improve nutritional status among vulnerable populations, including pregnant women. Objective: To evaluate the effect of the MBG program on the nutritional status of pregnant women in the Paruga Community Health Center service area. Methods: A quasi-experimental study with 1:1 matching was conducted from April to May 2026, involving 108 pregnant women (54 intervention, 54 control) selected through proportional random sampling. Nutritional status was assessed using mid-upper arm circumference (MUAC) measurements before and after the intervention. Data were analyzed using paired and independent t-tests. Results: Within the MBG group, nutritional status improved significantly post-intervention (p<0.001), with 87% (47/54) of participants showing improvement. Although between-group comparison did not reach statistical significance (p=0.102), the MBG group demonstrated clinically meaningful improvements: normal nutritional status prevalence was higher (32.4% vs. 15.7%) and undernutrition lower (13.0% vs. 27.8%) compared to controls. Program acceptance was high, though challenges included uneven distribution across Posyandu centers and food-sharing practices. Conclusion: The MBG program shows promise in improving pregnant women's nutritional status. Strengthening distribution equity and nutrition education is recommended to maximize program impact.

Analysis of Safety Leadership Styles Based on the Leadership Style Approach and Their Effect on Worker Participation in Mining Safety Implementation

Muhammad Osaegi Restu Amrulloh, Mila Tejamaya — Mon, 03 Aug 2026 00:00:00 +0000

Worker participation is a critical factor in the successful implementation of the Mining Safety Management System. The level of worker participation is influenced by various factors, including the safety leadership demonstrated by supervisors and managers. This study aimed to analyze the influence of safety leadership styles on worker participation in implementing mining safety at a Private Limited Company. An explanatory sequential mixed-methods design was employed. The quantitative phase used a cross-sectional approach involving 715 respondents selected through proportionate stratified random sampling. Data were analyzed using Spearman correlation and multiple linear regression. The qualitative phase was conducted through in-depth interviews, observations, and focus group discussions to explain and enrich the quantitative findings. The results showed that all dimensions of safety leadership were positively and significantly associated with worker participation, with the strongest relationship observed in task-centered leadership (r = 0.688; p < 0.001). Multivariate analysis revealed that task-centered leadership was the most influential dimension affecting worker participation (β = 0.295; p < 0.001), followed by democratic leadership (β = 0.292; p < 0.001) and relationship-centered leadership (β = 0.200; p = 0.001), while authoritarian leadership was not significantly associated with worker participation (p = 0.372). The regression model explained 49.4% of the variance in worker participation (Adjusted R² = 0.491). Qualitative findings indicated that clear work instructions, consistent safety supervision, two-way communication, worker involvement in decision-making, and follow-up on worker feedback were key factors supporting increased worker participation. This study concludes that safety leadership plays an important role in enhancing worker participation in mining safety initiatives, with task-centered leadership as the most dominant dimension influencing it.

The Relationship Between Maternal Work Duration, Caregiver Involvement, and Picky Eating Behavior Among Toddlers Aged 1-3 Years in Bekasi City

Aulia Rahmawati, Agung Nugroho, Siti Fadhilahtun Nasriyah — Mon, 03 Aug 2026 00:00:00 +0000

Picky eating behavior is a common nutritional challenge among toddlers, characterized by a strong preference for specific foods and the rejection of novel items. This study aimed to examine the relationship between maternal work duration and caregiver involvement with picky eating behavior among toddlers aged 1–3 years in Bekasi City. Employing a quantitative cross-sectional design, data were collected via online questionnaires from 174 mothers selected through convenience sampling. Data were analyzed using the Chi-square test with a 95% confidence level (α = 0.05). The results indicated a high prevalence of picky eating (71.8%), with slightly higher proportions observed among children of mothers who worked long hours and across all caregiver involvement categories. However, statistical analysis revealed no significant relationship between maternal work duration (p=0.255) or caregiver involvement (p=0.179) and picky eating behavior. These findings suggest that picky eating is a complex, multifactorial issue not solely dictated by maternal employment hours or basic caregiver involvement metrics. In conclusion, fostering healthy eating habits requires comprehensive strategies involving both parents and caregivers. Community health practitioners must prioritize promoting responsive feeding practices and positive mealtime environments rather than merely focusing on maternal work schedules.

Evaluating Corrective Action Effectiveness Against Incident Recurrence in Mining Operations: A Hierarchy of Controls Approach (2023–2025)

Zinedina Salsabila Mustain, Doni Hikmat Ramdhan — Mon, 03 Aug 2026 00:00:00 +0000

Incident recurrence indicates that organizational learning has not fully succeeded in breaking the chain of failure. This study aims to analyze the relationship between the quality of corrective actions, as measured by the Hierarchy of Controls, and incident recurrence, while accounting for incident characteristics as control variables, at PT XYZ (mining contractor) during 2023–2025. This quantitative study with a retrospective correlational design analyzed 124 incident investigation reports. Critical factors are classified using two schemes presented side by side, namely the company's internal taxonomy and the Human Factors Analysis and Classification System (HFACS). Analyses were conducted at univariate, bivariate (Fisher's Exact Test and Pearson Chi-Square), and multivariate (multiple logistic regression) levels. The reliability of corrective action scoring was validated through inter-rater agreement (weighted Kappa = 0.722; substantial). Results show a high recurrence rate under both schemes (65.3% under HFACS; 72.6% under the internal scheme). Critical Factor was the most dominant predictor (OR = 7.02; p < 0.001), followed by Incident Classification (OR = 8.91; p = 0.003), while Corrective Action Quality was not significant (p = 0.556), consistently across both schemes. Applying the HFACS taxonomy refined the dominant Human Error category (80.6%) into Violation (38.7%) and Error (41.1%), revealing a diversity of failure types useful for improving investigation. The study concludes that the effectiveness of recurrence prevention is determined more by the accuracy of root-cause diagnosis during investigation than by the technical level of corrective actions alone.

The Relationship between the History of Exclusive Breastfeeding and Complementary Feeding (MP-ASI) with Stunting among Children Under Five in the Working Area of Penana'e Public Health Center, Bima City: A Cross-Sectional Study

Agnis Setiawati, M. Noris, Darmin, Juraidin — Wed, 05 Aug 2026 00:00:00 +0000

Background: Stunting is a chronic nutritional problem that remains a public health challenge in Indonesia, including in the working area of the Penana'e Health Center in Bima City. Inappropriate practices of exclusive breastfeeding and complementary feeding can affect toddler growth and increase the risk of stunting. Objective: This study aims to determine the prevalence of stunting and to analyze the relationship between the history of exclusive breastfeeding and complementary feeding and stunting in the working area of the Penana'e Health Center in Bima City. Methods: A cross-sectional study was conducted in the working area of Penana'e Primary Health Center, Bima City, Indonesia. A total of 80 mothers with children aged 6–59 months were included. The sample size was determined using the Slovin formula, and participants were selected using purposive sampling based on predetermined inclusion and exclusion criteria. Data were collected through structured interviews using a validated questionnaire. Data were analyzed using descriptive statistics and Pearson's Chi-square test. Effect sizes were expressed as Odds Ratios (ORs) with 95% Confidence Intervals (95% CIs). Results: Exclusive breastfeeding was significantly associated with stunting (p<0.001). Children who were not exclusively breastfed had 4.96 times higher odds of being stunted than those who received exclusive breastfeeding (OR=4.96; 95% CI=1.86–13.23). In addition, the timing of complementary feeding was significantly associated with stunting (p<0.001). Children who received complementary feeding either before or after six months of age had 5.32 times higher odds of stunting than those who received complementary feeding at six months (OR=5.32; 95% CI=1.97–14.32). Conclusion: The history of exclusive breastfeeding and MP-ASI is related to the incidence of stunting in toddlers in the working area of the Penana'e Health Center, Bima City, so it is necessary to increase education to mothers about the importance of providing exclusive breastfeeding and appropriate MP-ASI to prevent stunting.

Systemic Breakdowns in Safety Defenses: An HFACS Analysis of Fatigue-Related Accidents and Organizational Failures in Coal Mining (2020–2024)

Sari Febryanti Wibisono, Robiana Modjo — Wed, 05 Aug 2026 00:00:00 +0000

Background: Coal mining is among the industries with the highest risk of occupational accidents due to the complex interactions among humans, machines, and the environment. Objective: This study aims to analyze the causal factors of occupational accidents in the coal mining sector by reviewing 25 incident investigation reports from 2020 to 2024. Methods: A descriptive analysis using the Swiss Cheese Model and the Human Factors Analysis and Classification System (HFACS) was employed to identify systemic patterns and contributing factors. Results: The results indicate an increasing trend in incidents, rising from 5 cases (2020) to 10 cases (2024), with total material losses exceeding Rp 1.2 billion. Severity classification: Near Miss 2 cases (8%), Property Damage 16 cases (64%), First Aid Injury 5 cases (20%), and Lost Time Injury 2 cases (8%). The HFACS analysis identified failures at four levels: organizational influences (production pressure, inconsistent policies), inadequate supervision, unsafe conditions, and unsafe operator actions. Fatigue was identified as a consistent contributing factor in 100% of cases, manifesting as microsleep, insufficient sleep duration, and dishonesty in reporting physical condition. The gap analysis indicates that the simultaneous failure of multiple barriers is not due to random factors but rather systemic failures rooted in an organizational culture that prioritizes production. Conclusion: The occupational accidents that occurred were not caused by random factors, but rather a series of systemic failures culminating in operator fatigue. This study recommends an integrated approach to prevent incidents, which includes system strengthening (such as the utilization of monitoring technology and roster optimization), cultural transformation (from a blame culture to a learning culture), and consistent policy implementation with clear accountability across all organizational levels.

Micronutrient Deficiency and Autophagy Dysregulation in Pulmonary Tuberculosis Pathogenesis: A Systematic Review

Salma Winda Aufa, Delmi Sulastri — Wed, 05 Aug 2026 00:00:00 +0000

Pulmonary tuberculosis remains a critical global health burden, with Indonesia ranking second in the world for the highest TB burden. Autophagy is an essential innate immune mechanism for eliminating intracellular Mycobacterium tuberculosis (Mtb) in macrophages, but it is susceptible to dysregulation by micronutrient deficiencies, which are highly prevalent in populations with active TB. This systematic review aims to synthesize scientific evidence on the effects of deficiencies in vitamin D, vitamin A, zinc, and selenium on the dysregulation of the autophagy pathway and its implications for the pathogenesis of pulmonary tuberculosis. Literature searches were performed in PubMed and ScienceDirect for studies published from 2006 to 2025, using a combination of MeSH terms and free-text keywords. A total of 11 studies were included in the final synthesis. The results of the synthesis indicate that vitamin D deficiency inhibits the transcription of autophagy genes (LC3, Beclin-1, ATG5) by disrupting VDR signaling. Combined zinc and vitamin D deficiency reduces autophagy capacity by up to 85% and correlates with worse clinical outcomes of TB. Specifically, zinc and vitamin D deficiencies act synergistically to inhibit autophagy, representing the most significant interaction. Micronutrient deficiencies were shown to dysregulate autophagy through distinct yet synergistic molecular pathways, facilitating Mtb persistence and exacerbating the pathogenesis of pulmonary TB. Micronutrient supplementation holds potential as an adjuvant host-directed therapy strategy in the management of pulmonary tuberculosis.

Predicting E-Cigarette Adoption Among University Students: A Theory of Planned Behavior Approach in a Collectivist Context

Thu, 06 Aug 2026 00:00:00 +0000

E-cigarette use has become an increasingly prevalent trend among university students, accompanied by ongoing debates regarding its long-term health effects. This trend is linked to the perception that e-cigarettes contain lower levels of nicotine and otherharmful substances compared to conventional tobacco cigarettes. This study aimed to examine the factors influencing students' adoption of e-cigarettes by applying the Theory of Planned Behavior(TPB). The research was conducted among students at UIN Sunan KalijagaYogyakarta. Data were collected via an online survey distributed through the university's academic system, with respondents recruited through accidental and snowball sampling. A total of 105 students completed the questionnaire and were included in the analysis. The results showed that the TPB model explained only 12.1% of the variance in students' intention to adopt e-cigarettes, a notably low value indicating the influence of factors beyond the standard TPB constructs. Attitude toward behavior (β= 0.251) and perceived behavioral control (β= 0.169) were positively associated with intention, whereas subjective norm was negatively associated. This finding indicates that social referents tended to discourage rather than promote the adoption of e-cigarettes. The attitude toward behaviorconstruct was primarily driven by items reflecting social acceptance rather than health-risk perceptions. These findings suggest that students' adoption of e-cigarettes as an alternative to conventional tobacco cigarettes is influenced more by social factors than by perceptions of reduced health risks

Kingella denitrificans as a Mimicker of Neisseria meningitidis in Carriage Surveillance

Wed, 05 Aug 2026 00:00:00 +0000

Background: Meningitis caused by Neisseria meningitidis remains a significant public health concern. A carriage study is crucial for understanding the distribution of Neisseria meningitidis serogroups in the community. The presence of Kingella denitrificans may lead to misidentification as N. meningitidis due to phenotypic similarity on blood agar. However, the prevalence of K. denitrificans in nasopharynx and oropharynx remains unclear. Objective: This study aimed to determine the prevalence of K. denitrificans as a mimicker of N. meningitidis in a carriage surveillance setting and to evaluate the role of MALDI-TOF MS in ensuring accurate bacterial identification. Methods: A cross-sectional study was conducted from September to December 2025 among unvaccinated adults in Jakarta with meningococcal disease. Oropharyngeal and nasopharyngeal swabs were collected and cultured on VCNT-supplemented blood agar. Preliminary identification was performed using colony morphology, Gram staining, and oxidase and catalase tests. Definitive identification was carried out using MALDI-TOF MS. Results: Among 228 participants, 11 (4.8%) carried Kingella spp. in the nasopharynx and/or oropharynx. All carriers were females aged 19–33 years (median age: 25 years). The isolates exhibited colony morphology similar to N. meningitidis, potentially leading to misidentification. However, they could be differentiated by their Gram staining morphology and catalase test results. MALDI-TOF MS identified 5 of 11 isolates (45.5%) as K. denitrificans with high-confidence log scores. Conclusion: K. denitrificans phenotypically might mimicked N. meningitidis in carriage surveillance but can be distinguished with Gram staining. The integration of MALDI-TOF MS is essential to improve diagnostic accuracy and prevent false-positive results. Further studies are needed to assess the feasibility of implementing this technology in resource-limited settings.