Women's Health Commons^™

Hubungan Paparan Informasi Anemia Dan Tablet Tambah Darah (Ttd) Melalui Media Digital Dengan Kebiasaan Konsumsi Makanan Ibu Hamil Berdasarkan Food Frequency Questionnaire (Ffq), Muthiah Salsabilah, Bernadette Oktavia Jelita, Thariq Zafar Surapati, Alya Khairunnissa, Primasti Nuryandari Putri, Ratu Ayu Dewi Sartika

Perilaku dan Promosi Kesehatan : Indonesian Journal of Health Promotion and Behavior

Background: Proper nutrition is important for the mother and baby. The media is an important source of information for every pregnant woman, but the information might be inaccurate.

Aim: This study aims to examine the association between exposure to digital media information on anemia and iron-folic acid (IFA) supplementation and the food consumption habits of pregnant women as measured by the Food Frequency Questionnaire (FFQ) at Puskesmas Kecamatan Beji, Depok City in 2024.

Method: This study utilized a cross-sectional design involving secondary data analysis of the 2024 antenatal care (ANC) survey conducted at Beji Primary Health Center, Depok City. Purposive …

Determinants Of Behavioral Intention To Change Sexual And Reproductive Health Practices Among Adolescents: A Hierarchical Multiple Linear Regression Analysis, Md Mizanur Rahman, Gerraint Gillan Ahi, Rafazila Ramli, Rasitasam Safii, Jacey Lynn Minoi, Stephanie Chua Hui Li, Ahmad Sofian Bin Shminan, Lee Jun Choi

Kesmas

Conventional and web-based sexual and reproductive health (SRH) interventions are increasingly used with adolescents, yet their comparative effectiveness and underlying mechanisms remain unclear. This study compared the two formats and examined the Theory of Planned Behavior (TPB) constructs as predictors of changes in intention to adopt health-protective SRH practices (including contraceptive use, service utilization, and parent–child communication) among Malaysian adolescents. A randomized controlled trial allocated adolescents to conventional or web-based SRH education. Intention-to-change behavior towards sexual and reproductive health scores was assessed at baseline, 1 month, and 3 months; change scores were modeled using hierarchical linear regression, including intervention type, …

Prevalence And Determinant Factors Of Depression Among Pregnant Women In Poned Health Center In Tangerang City Area, Dian Geumala Hayati, Sudijanto Kamso, Popy Yuniar, Yuli Puspita Devi

Jurnal Epidemiologi Kesehatan Indonesia

According to World Health Organization (WHO), approximately 10% of pregnant women experience mental disorders, with depression being particularly prevalent. In developing countries, this rate is was even higher, reaching 19.8% after childbirth and 15.6% during pregnancy. Various studies conducted in Indonesia show that the prevalence of depression among pregnant women ranges widely, from 21.4% to 26.2%.This study aimed to determine the prevalence and risk factors associated with depression during pregnancy in pregnant women at the PONED Community Health Center in Tangerang City Area. A facility-based cross-sectional study was conducted with 105 pregnant women attending antenatal check-ups at the 17 PONED …

The Role Of Gynecologic Oncologists In Improving Survival Outcomes Of Epithelial Ovarian Cancer: A Retrospective Cohort Study, Widyorini Lh Hanafy, Bambang Dwipoyono, Asri C. Adisasmita, Yosephine E. Regina, Airine S. Lians, Oktaviani P. Rahayu, Jane G. Auwelia

Kesmas

Epithelial ovarian cancer (EOC) is a leading cause of gynecological cancer mortality and is often diagnosed at an advanced stage, resulting in poor survival outcomes. Access to specialized gynecological oncology services has been associated with improved prognosis; however, data on its impact in Indonesia remain limited. This study aimed to evaluate the association between gynecologic oncologist (GO) services and disease-free survival (DFS) in patients with EOC. This retrospective cohort study included 76 patients with EOC who were treated at a national cancer hospital in Jakarta between 2015 and 2018. Patient data were obtained from medical records and followed for three …

Short-Term Survival And Prognostic Factors In Cervical Cancer Patients Requiring Hemodialysis: A Retrospective Cohort Study, Muhammad Trihatmowijoyo Bundjali, Maruhum Bonar Hasiholan Marbun, Wulyo Rajabto, Ikhwan Rinaldi, Hamzah Shatri, Dwi Lestari Partiningrum, Dadang Makmun, Pringgodigdo Nugroho, Sukamto Koesnoe, Pradana Soewondo

Kesmas

Cervical cancer is a common gynecological malignancy, particularly in developing countries, where it coexists with renal impairment in over one-third of patients. This disease typically presents acutely and progresses rapidly. Consequently, kidney replacement therapy, including hemodialysis (HD), is commonly required. To assess survival rates and associated factors, this retrospective cohort study analyzed the medical records of 252 cervical cancer patients who began HD across a three-month follow-up period. Kaplan–Meier analysis indicated a median short-term survival duration of 71.5 days (range: 7–90), with 1-, 2-, and 3-month survival rates of 56%, 51%, and 49%, respectively. Multivariate Cox regression identified post-HD systolic …

Unraveling The Drivers Of Inequality In Maternal Healthcare Utilization In Indonesia: A Decomposition Analysis, Wji Wahyuningsih, Kemal N. Siregar, Syifa Nurhakiki

Jurnal Ekonomi Kesehatan Indonesia

This study assessed socioeconomic inequalities in maternal healthcare utilization in Indonesia and identifies key factors driving these inequalities. We used data from 2013 and 2023 Indonesian Health Surveys, comprised of a total unweighted sample of 15,638 and 9,923 women aged 15-49 in the 2013 and 2023, respectively. Concentration index (CI) measured wealth-based inequality, and decomposition analysis identified primary drivers of inequalities in maternal healthcare access. Overall maternal healthcare service utilization has increased, but significant inequalities persist. Antenatal care showed minimal improvement, with the CI rising from 0.059 to 0.079, indicating a persistent higher socioeconomic distribution. Facility-based deliveries improved, with the …

Exploring The Prevalence And Determinants Of Self-Medication During Pregnancy Among Women From South Punjab, Pakistan, Madiha Madiha, Sehar Jabbar, Imran Masood

Makara Journal of Health Research

Background: For developing countries with high neonatal and maternal mortality rates, any practice that may threaten the maternal-fetal health must be gauged. This study evaluated the prevalence and contributing factors of self-medication during pregnancy among women opting for antenatal or postnatal care in South Punjab, Pakistan.

Methods: A cross-sectional study design was used. Data was collected from 424 women, selected through multi-stage sampling, who visited health care facilities located in six randomly selected cities of South Punjab. Outcomes reported by descriptive and inferential statistics (p < 0.05). Binary logistic regression analysis was performed to determine the association of self-medication with different factors.

Results: Most of the women were involved in self-medication practice (38.9%) …

Workplace Policy And Associated Factors Of Minimum Acceptable Diet Practices: An Online Survey Among Working Mothers In Indonesia, Fadhila Iswi Deandra, Judhiastuty Februhartanty, Muchtaruddin Mansyur

Kesmas

Working mothers in Indonesia may influence complementary feeding practices, particularly their ability to ensure that their infants properly meet the minimum acceptable diet (MAD). In this cross-sectional study, an online survey was distributed through various online platforms where participants were recruited using convenience sampling. The questionnaire covered sociodemographic factors, workplace policies, and infant and young child feeding (IYCF) practices. Descriptive and logistic regression analyses were conducted. A total of 394 working mothers participated, of which over 90% of the respondents reported meeting minimum dietary diversity, minimum milk frequency, minimum milk feeding frequency, and MAD indicators as assessed with a standardized …

Proportion Of Chronic Energy Deficiency In Relation To Macronutrient Intake And Other Determinants Among Pregnant Women In Selected Community Health Center Service Areas In Bogor 2025, Fathimah Afliansa, Ratu Ayu Dewi Sartika, Diah Mulyawati Utari, Suparno Suparno

Indonesian Journal of Public Health Nutrition (IJPHN)

The prevalence of chronic energy deficiency (CED) among pregnant women in Indonesia remains relatively high, ranging from 11.6% to 57.6%. This study aimed to examine the differences in the proportion of CED based on macronutrient intake and related factors. The study used a quantitative cross-sectional design with secondary data involving 124 pregnant women in selected areas served by community health centers in Bogor City and Regency. Data were analyzed using the chi-square test. CED prevalence was 11.3% in the overall areas, with 10.9% in Bogor City and 11.7% in Bogor Regency. Significant differences in the CED proportion were found based …

Assessment Of The Dietary Supplements Effects On Maternal Underweight In Nigeria, Chukwuebuka Jude Chiobi, Uzoamaka Angela Chiobi, Ambrose Nnaemeka Omeje, Ikechukwu Andrew Mobosi, Michael Okike Ugwu, Nnamdi Simeon Ugwu

Kesmas

Maternal underweight continues to rise and, if not properly managed, will lead to increased mortality. This contradicts the United Nations Sustainable Development Goal of reducing maternal mortality by 2050. Therefore, this study aimed to determine the probable effect of dietary supplements on maternal underweight in Nigeria. This study employed probit estimation using the maximum likelihood technique in 2022, with the 2018 Nigeria Demographic Health Survey data as the basis for analysis. The results showed a statistically significant effect of dietary supplements on maternal underweight in Nigeria. The likelihood of dietary supplements impacting maternal underweight was approximately 0.4% lower, on average, …

Barriers To Implementing Comprehensive Sexuality Education As A Strategy To Prevent Adolescent Pregnancy In Indramayu District, Indonesia, Een Kurnaesih, Chahya Kharin Herbawani, Nelly Febriani

Kesmas

The implementation of comprehensive sexuality education (CSE) is not optimal. This qualitative study aimed to identify and contextualize barriers to CSE implementation, specifically in Indramayu District, Indonesia. Conventional content analysis procedures were used. Seven participants, consisting of relevant authorities, were interviewed. A purposive sampling technique was employed to select participants. Data were collected through in-depth, semi-structured interviews. All interviews were recorded and transcribed verbatim. Data were analyzed using conventional qualitative content analysis. The barriers to CSE implementation in Indramayu District were identified across five themes: advocacy, technical considerations, coordination and collaboration, integration with other sexual and reproductive health projects, and …

Analyzing High-Risk Fertility Behavior For Sustainable Maternal-Child Health: A 2017 Sociodemographic Study In Urban And Rural Indonesia, Asti Annisa Utami, Fadhaa Aditya Kautsar Murti, Popy Yuniar, Milla Herdayati

Kesmas

Indonesia's goal of achieving Indonesia Emas 2045 hinges on improving Maternal-Child Health (MCH), essential for building a healthy and competitive population. Despite some advancements, the Maternal Mortality Rate (MMR) and Under-five Mortality Rate (U5MR) remain high, particularly because of High-Risk Fertility Behavior (HRFB). The HRFB poses significant risks to MCH, affecting both urban and rural women. This study aimed to identify the factors associated with HRFB in these areas to enhance MCH outcomes and support Indonesia's sustainable health goals. This cross-sectional study used a secondary dataset from the 2017 Indonesian Demographic Health Survey. A total of 20,530 women of reproductive …

Jaminan Kesehatan Nasional Pada Ibu Bersalin: Sebuah Studi Cross Sectional Di Nusa Tenggara Timur, Indonesia, Amanda Firdausya Bahaji, Faris Muhammad, Putri Ayu, Rizani Alia Davina, Vetty Yulianty

Jurnal Ekonomi Kesehatan Indonesia

Maternal Mortality Rate (MMR) in Indonesia remains high, particularly in East Nusa Tenggara (NTT). This study analyzes the relationship between National Health Insurance (JKN) ownership and mothers choosing childbirth facilities in NTT. This study employs a cross-sectional design with a quantitative approach, utilizing secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS), which was conducted from October to November 2024. The study population includes mothers who gave birth in NTT during the 2017 IDHS period, with a sample of 1,236 respondents selected using a stratified two-stage cluster sampling technique. Data analysis was performed using the chi-square test to …

Efektivitas Kartu Permainan Dan Kombinasi Video Animasi -Kartu Permainan Dan Terhadap Kepatuhan Minum Tablet Tambah Darah, Ardi Bastian, Agustin Widyowati, Riza Yuliawati, Kristin Ernawati, Dian Mustikawati

Perilaku dan Promosi Kesehatan : Indonesian Journal of Health Promotion and Behavior

Background: Screening results at the Baron Health Center, Nganjuk Regency showed that the prevalence of anemia in adolescent girls reached 60.89%. Although counseling and provision of iron tablets to increase hemoglobin levels have been carried out, adolescent girls' adherence to iron tablet is still low.

Objective: The study aims to see the differences in two educational methods to improve adolescent girls' compliance in consuming iron tablet

Method: A total of 201 adolescent girls were divided into 2 different groups. The first group was given education in the form of game cards, while the second group was given combination education cards …

The Impact Of Immigrants On The Number And Type Of Births, Neset Gumusburun, Ergun Mendes

Makara Journal of Health Research

Background: Although cesarean section is a life-saving procedure in certain situations, it may result in complications for maternal and infant health when conducted, especially for nonmedical purposes. The civil war in Syria has significantly modified the demographic and ethnic structure of Turkey, which has affected the number and type of births occurring here. In this study, we aimed to determine the effect of the increasing Syrian refugee patient population on primary cesarean section rates in Kilis/Turkey.

Methods: In this retrospective cohort study, pregnant women who gave birth at the State Hospital in the Kilis province in Turkiye between …

Home Births Among Ethnic Minority Communities In Bokeo Province, Lao People's Democratic Republic, Jukkrit Wungrath, Rungrasami Sriwongphan, Krissana Kapheak, Wanchalerm Ritthimon

Kesmas

Home births among ethnic minorities in developing countries pose significant risks to maternal and neonatal health. In Lao PDR, the government has taken steps to manage home births through training traditional birth attendants, improving transportation, and establishing referral systems. However, high home birth rates in regions like Bokeo remain concerning. This review emphasized the need for more skilled birth attendants and better access to emergency obstetric care in rural, ethnic minority areas. This review used 40 articles published between 2000 and 2023 and highlighted gaps in research regarding healthcare access, cultural practices, socioeconomic barriers, and the role of traditional birth …

Exploration Of Positive Deviance In Prevention Of Underweight In The Under-Five: A Qualitative Study On Low-Income Urban Families, Irwan Budiono, Lukman Fauzi, Dewi Sari Rochmayani

Kesmas

Children under the age of five (the under-five) from low-income families are more vulnerable to experience underweight. This nutritional vulnerability is evident in the preliminary study, where 35.1% of the under-five experience underweight, and 28.48% are low-income families. This study aimed to explore Positive Deviance (PD) behaviors in preventing underweight among the under-five. The study applied a qualitative approach with a case study design. Data collection took place in July-August 2022, focusing on low-income families in the Gunung Brintik area. Data were collected through two focus group discussions, seven in-depth interviews, and five key informant interviews. Coding, subtheme, and theme …

Risk Factors For Cognitive Impairment In Adult Population Of Coastal Area: A Cross-Sectional Study In Maringkik Island, Indonesia, Herpan Syafii Harahap, Arina Windri Rivarti, Nurhidayati Nurhidayati, Fitriannisa Faradina Zubaidi, Dini Suryani, Legis Ocktaviana Saputri, Yanna Indrayana, Athalita Andhera, Muhammad Hilam, Abiyyu Didar Haq

Kesmas

Cognitive impairment is a medical condition commonly found in elderly populations, which can be due to vascular risk factors in patients. There remains limited data on risk factors for cognitive impairment among coastal region populations. This study aimed to investigate risk factors for cognitive impairment in the adult population of Maringkik Island, West Nusa Tenggara Province, Indonesia. Data collected were age, sex, education level, hypertension, antihypertensive treatment, diabetes mellitus, cigarette smoking, and body mass index status. A total of 114 participants were recruited using a consecutive sampling method. The participants’ cognitive function assessment used the Mini-Cog instrument. The cognitive impairment …

Spatial Durbin Model On The Utilization Of Delivery At Health Facilities: A 2017 Indonesian Demographic And Health Survey Analysis, Indah Sri Wahyuni, Ira Gustina, Martya Rahmaniati Makful, Tris Eryando

Kesmas

The utilization of delivery at health facilities is a major intervention in reducing 16 to 33% of deaths. This study aimed to determine the model of utilization of delivery at health facilities in Indonesia in 2017 and its influential factors. This study used secondary data from the 2017 Indonesian Demographic and Health Survey using a Spatial Durbin Model (SDM) approach. The population was mothers aged 15 – 49 years, spread across 34 provinces of Indonesia, and had 15,321 samples. The results showed that the Moran’s I value was positive (0.146) and significant at p-value = 0.007, indicating clustered regions with …

Menstrual Personal Hygiene Behavior Among Adolescents With Physical And Intellectual Disabilities, Nur Khotimah Elfiyani, Agustin Kusumayati, Caroline Endah Wuryaningsih, Kemal Nazaruddin Siregar

Kesmas

Reproductive health for adolescents with disabilities is often disregarded, and education on personal hygiene is insufficient because some people perceive menstruation as a sensitive topic and have a false belief that adolescents with disabilities have no sexual desire. This study aimed to determine the overview of personal hygiene behavior among adolescents with physical and intellectual disabilities when facing menstruation. The method used was qualitative, with case studies, in-depth interviews, and observations for data collection. The informants comprised four adolescents aged 19-21 years, two mothers, and two therapists for special needs children. This study was conducted at two growth and development …

Age, Body Mass Index, Physical Activity And Quality Of Life In Turkish Pregnant Woman With And Without A Diagnosis Of Gestational Diabetes Mellitus: A Comparative Study, Yaren Nur Tayyar, Hatice Kahyaoglu Sut

Makara Journal of Health Research

Background: This study aimed to examine and compare the age, body mass index (BMI), physical activity (PA), and quality of life (QOL) of third-trimester Turkish pregnant women with and without a diagnosis of gestational diabetes mellitus (GDM).

Methods: A comparative study was conducted in the obstetrics clinic of a university hospital in Turkey, and it included 210 women (GDM women = 105 and non-GDM women = 105). Personal Information Form, International Physical Activity Questionnaire-Short Form (IPAQ), and World Health Organization Quality of Life-Short Form-Turkish (WHOQOL-Bref-TR) were used.

Results: The age and BMI of GDM women were higher …

Editorial: The Public Health Scholars As The Health Leaders, Al Asyary, Meita Veruswati, Putri Bungsu Machmud, Indri Hapsari Susilowati

Kesmas

1. Achmadi UF. Kesehatan Masyarakat: Teori dan Aplikasi. Jakarta: Rajawali Pers; 2014.

2. Asyary A. Editorial. Kesmas. 2023; 18 (Special Issue 1): 1-3. DOI: 10.21109/kesmas.v18isp1.7201

3. Badan Kebijakan Pembangunan Kesehatan. Pembangunan Kesehatan di Indonesia melalui Kesinambungan Finansial Jaminan Kesehatan serta Meningkatkan Kualitas Layanan dengan Integrasi Data. Jakarta: Kementerian Kesehatan Republik Indonesia; 2023.

Role Of Partner And Health Workers On Modern Contraceptive Use Among Married/In-Union Women In Uzbekistan, Supriatin Supriatin, Mohamed Rifky, Muhammad Uzair Khan, Lili Amaliah, Marlynda Happy Nurmalita Sari, Eko Budi Santoso, Indra Ruswandi, Maretalinia Maretalinia, Linda Suwarni

Kesmas

Many factors contribute to the declining total fertility rate, including family planning programs. The successful implementation of the family planning method might be influenced by how the decision to choose a contraceptive method was made. This study aimed to examine the correlation between family planning decision-makers and modern contraceptive use among married/in-union women of reproductive age in Uzbekistan. The 2021-2022 Multiple Indicator Cluster Survey was used by selecting only married/in-union women of reproductive age of 15 to 49 years, totaling 2,794 eligible samples. The modern family planning use variables were divided into not using, using Long-Acting Contraceptives (LAC), and Short-Acting …

Knowledge, Awareness, And Perceived Barriers Regarding Cervical Cancer Screening Among Bangladeshi Women Suffering From Cervical Cancer: A Cross-Sectional Study, Muhammed Mohibul Islam, Farhana Sultana, Md Hasan Shahriar Rahman, Nandita Islam Pia, Md. Al Hasibuzzaman, Arman Ahmed, Mohammed Shamim Hasan, Md Kayes Mahmud, Rabeya Akter, Md. Saqline Mostaq, Mohammad Nurul Amin

Makara Journal of Health Research

Background: This study aimed to evaluate the knowledge, awareness, and perceived barriers regarding cervical cancer screening among women in Bangladesh.

Methods: A hospital-based survey was conducted from January to April 2021 among 200 female participants. Statistical analysis of this study was performed by using Stata 13 (StataCorp LP, 4905 Lakeway Drive, College Station, TX 77845, USA), where Chi-square test was used for the determination of the correlation among different variables.

Results: Among the participants, 86.5% were rural residents, 96% were married, 87.5% were housewives, 47% were uneducated, and 93.5% lived on a husband’s income. Moreover, 84.5% hadn’t …

Evaluation Of Self-Confidence In Women With Chronic Disease, Sebahat Atalıkoğlu Başkan, Sevinç Kose Tuncer, Demet Güneş

Makara Journal of Health Research

Background: Self-confidence, which is an important emotional need in women, affects women's quality of life. This research was conducted to evaluate the self-confidence of women with chronic diseases.

Methods: This study was conducted at the internal medicine clinic of Erzincan Mengücek Gazi Training and Research Hospital in Turkey between August 2019 and June 2020. The sample consisted of 339 female patients with chronic diseases who agreed to participate in this study. Data were collected through face-to-face interviews using information form and the Women’s Self-Confidence Scale.

Results: The mean total score of the participants was 136.40 ± 24.92. …

A Qualitative Exploration Of Exclusive Breastfeeding Practices Among Karen Ethnicity Mothers In Northern Thailand Remote Rural Areas, Wanchalerm Ritthimon, Aksara Thongprachum, Jukkrit Wungrath

Kesmas

Low exclusive breastfeeding rates among the Karen ethnic group in Northern Thailand's remote rural areas underscore the need to understand knowledge, attitudes, and social support to develop targeted interventions. This qualitative study examined exclusive breastfeeding practices and the factors influencing breastfeeding behavior among 14 Karen Ethnicity Mothers (KEMs) in Northern Thailand. A structured interview was used to collect the data, a triangular method to determine the data's validity, and a content analysis method to examine the data revealed seven themes and 14 subthemes. This study identified three key factors for successful breastfeeding: self-motivation, social support, and effective problem management, which …

Maternal Factors Influencing Postpartum Depression In Indonesia, Nurhalina Sari, Nova Muhani, Friska Novira Maya Dewi

Kesmas

The estimated prevalence of postpartum depression differs in developed and developing countries. Due to the increasing number of cases in developing countries like Indonesia, postpartum depression has become a serious issue. This study aimed to identify factors influencing postpartum depression in Bandar Lampung, Indonesia, in 2023 using the Edinburgh Postnatal Depression Scale instrument. This study employed a cross-sectional design with a sample size of 251 respondents, selected based on inclusion and exclusion criteria using a purposive sampling technique. The multiple logistic regression results indicated that women with abortion records had a three times higher risk (95% CI = 1.394–7.648; p-value …

Kangaroo Mother Care In Improving Thermoregulation Of Premature Babies During The Covid-19 Pandemic: A Case Report, Ari Damayanti Wahyuningrum, Yuni Sufyanti Arief, Rizki Fitriyasari Pk, Chui Ping Lei, Rinik Eko Kapti

Kesmas

Premature babies lose four times more heat than those with sufficient birth weight. Moreover, their body temperature regulation center does not function properly. This study aimed to investigate Kangaroo Mother Care's effect in increasing premature babies' thermoregulation during the COVID-19 pandemic at Hospital A in Malang City, Indonesia. This study was a case report with data from follow-up checks on premature babies discharged from the hospital. The Kangaroo Mother Care method, carried out by the mother, increased the thermoregulation of premature babies' temperature by 0.2ᴼC compared to the father. It was because women have a slightly higher body temperature than …

Editorial, Al Asyary

Kesmas

No abstract provided.

Effects Of Using An Application For Postpartum Contraceptive Use In Family Planning Counseling During Pregnancy, Lia Nurcahyani, Dyah Widiyastuti, Arief Tarmansyah Iman, Yanti Cahyati, Yeni Fitrianingsih

Kesmas

A decision-making tool for family planning flipchart is used for contraceptive counseling, but the use of this flipchart is suboptimal. In this study, primary study resulted in innovative decision-making tools for family planning applications. “Si KB Pintar” was also developed, a tool that women can use to discuss contraceptives with their husbands after family planning counseling. This study analyzed the effectiveness of family planning counseling during pregnancy by applying postpartum contraceptive use. Analytical quantitative quasi-experimental methods were used with a control group design. The sampling method was two-stage sampling. In the first stage, from 22 primary health care (PHC) in …