Holistic Nursing Plus

Development and Validity-Reliability Testing of a Questionnaire on Public Knowledge, Attitudes, and Practices Regarding the Risks of Consuming Illegal Herbal Medicines Sold through E-Commerce in Indonesia

ani syafriati — 2026-10-31

Background: The widespread circulation of illegal herbal medicines through e-commerce platforms has become a significant public health concern in Indonesia. Many consumers remain unaware of the potential risks posed by unregistered or counterfeit herbal products, which may contain harmful substances and lead to adverse health effects. To address this issue, a valid and reliable instrument is needed to assess public knowledge, attitudes, and practices (KAP) related to the consumption of such products.

Purpose: This study aimed to develop and test the validity and reliability of a KAP questionnaire assessing public awareness and behavior regarding the risks of consuming illegal herbal medicines sold through e-commerce in Indonesia.

Methods: The study was conducted at RSUD Siti Fatimah, South Sumatra Province, Indonesia. The questionnaire was developed through literature review, expert consultation, and item validation processes. Data were collected from 50 respondents selected using purposive sampling. Validity testing was performed using the Pearson product–moment correlation, while reliability was assessed using Cronbach’s Alpha. An item was considered valid if the correlation coefficient (r-calculated) exceeded the r-table value (0.279) at p < 0.05, and reliable if Cronbach’s Alpha > 0.60.

Results: The knowledge questionnaire (15 items) demonstrated validity with r-calculated values ranging from 0.325 to 0.582 and a Cronbach’s Alpha of 0.794. The attitude questionnaire (10 items) showed valid item correlations between 0.333 and 0.634, with a Cronbach’s Alpha of 0.711. The practice questionnaire (12 items) also met validity criteria (r-calculated = 0.291–0.609) and achieved a Cronbach’s Alpha of 0.724. All instruments fulfilled the required thresholds for validity and reliability.

Conclusions: The developed KAP questionnaire was proven valid and reliable for assessing public knowledge, attitudes, and practices regarding the consumption of illegal herbal medicines sold through e-commerce in Indonesia. Conducted at RSUD Siti Fatimah, this study provides a useful instrument for future research and public health programs aimed at reducing the risks of illegal herbal product use.

Effectiveness of Prenatal Yoga in Reducing Back Pain Among Third-Trimester Pregnant Women: A Literature Review

Armiyati Somantri — 2026-10-31

Background: Back pain is one of the common discomforts experienced by pregnant women, particularly during the third trimester, due to changes in body posture, increased body weight, and hormonal changes during pregnancy. Prenatal yoga is a non-pharmacological intervention that may help reduce back pain during pregnancy.

Purpose: This literature review aimed to analyze the effectiveness of prenatal yoga in reducing back pain among third-trimester pregnant women.

Methods: This literature review identified, examined, and analyzed original research articles on prenatal yoga and back pain among third-trimester pregnant women. The literature search was conducted through Google Scholar and PubMed using the keywords “Prenatal Yoga,” “Back Pain,” “Third-Trimester Pregnant Women,” and “Pregnancy.” Articles published between 2021 and 2026, available in full text, written in Indonesian or English, and addressing the effect of prenatal yoga on back pain among third-trimester pregnant women were included. The selection process referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Nine articles met the inclusion criteria and were reviewed. The included studies used experimental and quasi-experimental designs and involved pregnant women, particularly those in the third trimester. The reviewed studies consistently reported reductions in back pain following prenatal yoga, with statistically significant findings. The findings were observed across different sample sizes, study designs, and pain assessment methods.

Conclusions: Prenatal yoga may be used as a non-pharmacological intervention to help reduce back pain and improve comfort among third-trimester pregnant women.

The Effect Of Audiovisual Educational Media On Improving Nutrition Knowledge Of Pregnant Women In Maternity Clinic At Palembang, Indonesia

aminah maya — 2026-10-31

Abstract

Background: The high Maternal Mortality Rate (MMR) is closely related to the quality of nutrition during pregnancy. Besides anemia, malnutrition during pregnancy also increases the risk of babies being born with low birth weight and stunted growth at an early age. More interactive, contextual, and easily accessible education is really needed so that nutrition messages are not just delivered but also understood and practiced by pregnant women. Audio-visual media approaches, like educational videos, are seen as effective in improving literacy and promoting strategy in primary care.

Purpose: This study aimed to assess the effect of video-based nutrition education on improving pregnant women’s knowledge in maternity clinic at Palembang in 2026

Methods: A quasi-experimental study with a two-group pre-test and post-test design was conducted. The sample consisted of 34 third-trimester pregnant women divided into an intervention group (Education with Audio visual educational media, n=17) and a control group (Education with Mother Child Health Book, n=17) using purposive sampling. Data were analyzed with the Wilcoxon and Mann-Whitney tests due to non-normal distribution

Results: The intervention group showed a significant improvement, with pre-test scores ranging from 25%–68.8% and reaching 100% in the high category at post-test. The control group demonstrated lower and more varied improvement (68.8%–100%). Final analysis revealed a higher Mean Rank in the intervention group (24.74) compared to the control group (10.26). The Mann-Whitney test yielded Z = -4.312 and p-value = 0.000 (p < 0.05). Conclusions: Audio visual educational media was proved significantly more effective than the independent use of the MCH Book in improving pregnant women’s nutritional knowledge in Maternity Clinic at Palembang.

Keywords: Audiovisual Educational Media, MCH Book, Knowledge, Pregnancy Nutrition

Factors Associated the Physical Activity of the Elderly at Care Home in D.I Yogyakarta

Rahma Fauziya Azzahra — 2026-08-31

Background: Institutionalized elderly often exhibit lower functional mobility than community dwellers. However, how demographic factors, clinical profiles, and exercise habits interact to influence overall physical activity in long-term care facilities remains insufficiently understood.

Purpose: To examine the associations between age, gender, comorbidities, exercise regularity, and physical activity levels among care home residents

Methods: A cross-sectional study was conducted among 65 elderly ( aged > 60 years, ambulatory, capable of verbal communication, and had no history of dementia, stroke, depression, or severe physical injuries) at the Abiyoso care Home D.I. Yogyakarta. The sample size was calculated using Slovin’s formula (5% error margin) and simple random sampling. Data were collected using structured demographic sheets, 1-week direct observation for exercise regularity and PASE. Data were analyzed using Chi-square tests (p < 0.05)

Results: Most respondents were aged 60–70 years (47.7%), female (67.7%), without comorbidities (50.8%), regularly exercised (83.1%), and exhibited low overall physical activity (75.4%). Age was significantly associated with physical activity (p = 0.020). Gender (p = 0.917), comorbidities (p = 0.614), and exercise regularity (p = 0.053) showed no statistically significant associations.

Conclusions: Advancing age is associated with lower physical activity, whereas brief formal exercise alone fails to offset daily sedentary habits. Care facilities should embed continuous, age-tailored daily mobility strategies rather than relying solely on periodic exercise programs.

Implementation of a Nola J. Pender-Based Health Promotion E-Module to Improve Knowledge and Treatment Adherence Among Patients with Pulmonary Tuberculosis

Khaireza Rindang Kamudi — 2026-10-31

Background: Pulmonary tuberculosis (TB) remains a major public health concern, requiring effective educational strategies to improve patient knowledge and treatment adherence.

Purpose: This study evaluated the effectiveness of a Nola J. Pender’s Health Promotion Model-based educational e-module in improving knowledge and treatment adherence among patients with pulmonary TB.

Methods: A quasi-experimental pretest–posttest control group study was conducted at RSUP Surakarta, Central Java, Indonesia. Fifty participants were included, comprising 26 in the intervention group and 24 in the control group. The intervention group received e-module-based education, while the control group received routine education. Data were analyzed using the Wilcoxon signed-rank and Mann–Whitney U tests.

Results: Knowledge improved significantly in the intervention group (Z = −4.309, p < 0.001), with 24 participants improving. Treatment adherence also improved significantly (Z = −3.651, p < 0.001), with 21 participants improving. Between-group differences were significant for knowledge (U = 172.000, p = 0.006) and treatment adherence (U = 156.000, p = 0.002), with higher mean ranks in the intervention group.

Conclusions: The Health Promotion Model-based e-module may improve knowledge and treatment adherence among patients with pulmonary TB. Further studies with larger samples and longer follow-up are recommended.

Psychological Impact and Quality of Life in Patients with Transfusion-Dependent Thalassemia and Their Families: A Systematic Review

Nanang Saprudin — 2026-10-31

Background: Transfusion-dependent thalassemia is a chronic blood disorder that can affect psychological well-being and quality of life among patients and their families.

Purpose: This systematic review examined the psychological challenges and quality-of-life concerns experienced by patients with transfusion-dependent thalassemia and their families.

Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Scopus, ProQuest, ScienceDirect, and Taylor & Francis were searched for relevant studies published from 2022 through December 2024. Eligible studies used standardized, validated instruments to assess psychological health or quality of life in patients with transfusion-dependent thalassemia and their families and employed a cross-sectional design.

Results: Eleven studies met the inclusion criteria. Patients experienced psychological difficulties, including anxiety, depression, panic symptoms, social phobia, and problems with self-concept. Children also exhibited behavioral difficulties, attention-related problems, and challenges in peer relationships. Quality-of-life concerns included impaired school functioning, emotional well-being, social participation, physical health, pain, fatigue, and work limitations. Families and caregivers experienced emotional distress, financial strain, and challenges associated with regular blood transfusions. Caregivers also reported feelings of discouragement and powerlessness, underscoring the demands of long-term care.

Conclusions: Transfusion-dependent thalassemia is associated with psychological challenges and reduced quality of life among patients and their families. Comprehensive, family-centered support may help address these multidimensional needs. Further research should evaluate interventions that support psychological well-being and quality of life in both patients and caregivers.

Child, Parental, and Family-Related Characteristics Associated with Caregiver Burden Among Parents of Children With β-Thalassemia: A Cross-Sectional Study

Nanang Saprudin — 2026-10-31

Background: Parents of children with transfusion-dependent β-thalassemia experience continuing treatment-related, emotional, and practical caregiving demands.

Purpose: To examine associations between child-, parental-, and family-related characteristics and parent-reported caregiver burden among parents of children with β-thalassemia receiving routine transfusion therapy.

Methods: This cross-sectional study included 104 parents consecutively recruited at a tertiary referral hospital in Indonesia from August 2025 to February 2026. Caregiver burden was assessed using an 8-item instrument adapted from the Caregiver Strain Index. Variables meeting a prespecified bivariate screening criterion of p < .25 were entered simultaneously into multiple linear regression. Bootstrap estimation used 2,000 resamples. Sensitivity analysis excluded the observation with the highest centered leverage (.501).

Results: Mean caregiver burden was 20.10 (SD = 4.94). The original model was significant, F (8, 95) = 3.569, p = .001, explaining 23.1% of the variance (adjusted R² = .166). Compared with homemaker/unemployed mothers, burden was lower among self-employed (B = −4.498, p = .009) and civil-servant mothers (B = −8.020, p = .001). After sensitivity analysis, the overall model remained significant, F (7, 94) = 3.111, p = .005, whereas the self-employment association was no longer significant (B = −4.461, p = .187).

Conclusions: The overall multivariable model was associated with caregiver burden, but individual associations were not consistently robust. Maternal employment warrants cautious interpretation because of very small subgroup sizes. Family-centered nursing assessment should consider employment within the broader caregiving and family context.

Association Between Perceived Stress and Academic Adjustment Among First-Year Health Sciences Students: A Cross-Sectional Study

Eltanina Ulfameytalia Dewi — 2026-08-31

Abstract

Background: The transition to higher education requires students to adapt to new academic demands, social environments, and responsibilities. These changes may increase stress and potentially affect students' ability to adapt academically.

Purpose: This study aimed to determine the association between stress level and academic adaptability among students at STIKES Guna Bangsa Yogyakarta.

Methods: This study employed a quantitative research design with a cross-sectional approach. The population consisted of 340 first-year students at STIKES Guna Bangsa Yogyakarta aged 18–21 years. A total of 93 respondents were selected using random sampling. Data were collected using questionnaires and analyzed using the Pearson Product-Moment correlation test.

Results: The findings showed that 53 respondents (56.99%) experienced severe stress, 33 respondents (35.48%) experienced moderate stress, and 7 respondents (7.53%) experienced mild stress. Regarding academic adaptability, 60 respondents (64.52%) demonstrated high adaptability, while 33 respondents (35.48%) demonstrated moderate adaptability. The Pearson Product-Moment analysis showed a statistically significant negative association between stress level and academic adaptability (p = 0.002; r = −0.315).

Conclusions: There was a statistically significant negative association between stress level and academic adaptability among students at STIKES Guna Bangsa Yogyakarta. The low-strength negative correlation indicates that students with higher stress levels tended to have lower academic adaptability.

Family-Involved and Telenursing-Supported Self-Management for Older Adults with Hypertension in Low- and Middle-Income Countries: A Rapid Scoping

Sulkifli Nurdin — 2026-10-31

Background: Hypertension is common and poorly controlled among older adults in low- and middle-income countries (LMICs), where families provide much of the daily care and digital health services are expanding. Family-involved and telenursing-supported self-management have each been studied, but their evidence has not been mapped together for older adults in LMICs.

Purpose: To map family-involved and telenursing or digital self-management interventions for older adults with hypertension in LMICs, including intervention components, outcomes, populations, and evidence gaps.

Methods: We conducted a rapid scoping review guided by the Joanna Briggs Institute approach and reported according to PRISMA-ScR. Consensus, a semantic search engine for academic literature, was searched with four queries on 30 October 2026 and supplemented by web searches. One reviewer screened 38 unique records on title and abstract. Study characteristics, intervention components, and outcomes were charted from abstracts and available source pages.

Results: Ten studies published between 2015 and 2026 were included: seven family-involved interventions and three telenursing or digital interventions, conducted in Indonesia, Iran, Thailand, and Jordan. Four studies were randomized and six were quasi-experimental. Blood pressure was the most frequent outcome (eight studies), followed by self-management or self-care (five) and quality of life (three). No study combined family involvement with a telenursing or digital component. Caregiver-level outcomes were not reported in the retrieved abstracts, and follow-up did not exceed three months where it was reported.

Conclusions: The evidence is small, limited to short follow-up, and methodologically uneven. Family-involved and digital approaches have developed in parallel. Trials that integrate family roles with telenursing, measure caregiver and implementation outcomes, and follow participants for longer are needed, and a full multi-database review should confirm these findings.