Putu Ayu Indrayathi

Child marriage (CM) reflects gender inequality, resulting in adverse health outcomes for adolescent girls in low- and middle-income countries (LMICs). Community participation is vital in preventing CM, but community-led interventions lack sufficient research. This study assessed the effectiveness of community-based interventions in reducing CM in LMICs. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines, we searched PubMed, Scopus, ScienceDirect, and Web of Science for peer-reviewed studies published between 2015 and 2024. Eight studies of high to moderate quality were summarized through a narrative method, guided by three frameworks: the typology of community approaches, the continuum of participation, and the drivers of marriageability. Analysis shows a competing priority between scalability and sustainability. Economic interventions could delay eligibility but were fragile without normative change. Interventions that emphasized desirability, through dialogue or skills training, more effectively changed girls’ perceptions. Community success relied on participation: passive consultation did not change norms, but “shared leadership” created local enforcement. Addressing CM requires targeted solutions. Effective strategies merge economic incentives for immediate poverty relief with community mobilization and vocational training to shift perceptions of girls’ value. Future policies should change from “empowerment-lite” to integrated “structural-plus” approaches, transforming communities from passive recipients to active enforcers and owners of programs.

Background/Objectives: Recent research suggests that international students are particularly susceptible to food insecurity (FI). Yet very few studies have qualitatively examined their experiences with FI and its impacts on their health and well-being. Therefore, our study sought to address this research gap by exploring the psychosocial and academic challenges linked to FI among international students in Hungary. Methods: A qualitative approach using semi-structured, in-depth, one-on-one interviews was carried out from 31 July to 15 November 2024 with 15 international students studying at the University of Debrecen, Hungary. Qualitative data were analyzed using a general inductive approach with the aid of NVivo 11 software. Results: International students discussed five themes regarding the psychosocial implications of FI: stress and anxiety, sadness and depression, anger and frustration, guilt over financial burden, and social isolation. In terms of academic impact, four themes were mentioned: difficulty concentrating, sacrificing studies for work, diminished academic performance, and a loss of motivation and interest in their studies. Conclusions: This study enriches our understanding of the lived experiences of FI among international students. The findings may help shape targeted interventions that align with their needs.

Purpose: Studying abroad represents a significant risk factor for diminished health and well-being due to cultural, environmental, and psychosocial challenges. This study aimed to explore international students’ perceptions of well-being and examine the factors contributing to their well-being while living and studying abroad. Methods: We used an exploratory sequential mixed-methods study design. The first part of the research involved a qualitative study conducted through in-depth interviews and focus group discussions. We analyzed the data using thematic analysis. We used the results from the first stage to develop the quantitative part of the study. Multiple regression was used to analyze the factors contributing to international students’ perceived well-being. Results: The qualitative study identified four main factors: academic life, health, social connectedness, and environmental factors. The quantitative study found that faculty and student status significantly affected well-being. Conclusion: Universities and those managing international student affairs should develop pre-arrival plans for incoming students, considering their diverse backgrounds and perspectives on well-being. Student well-being positively influences academic results by enhancing cognitive function, motivation, social engagement, and resilience while reducing risks of stress, burnout, and dropout rates.

The management of informal sector participants poses the most significant difficulty to universal coverage attempts throughout Indonesia's National Health Insurance era. As a result, in April 2017, BPJS Kesehatan established the JKN Cadre Program. This program intends to expand the number of participants while also improving the collectability of contributions from the informal sector. This study aims to investigate the role of the cadre and explore the supporting, and inhibiting factors of such a program. This study is a qualitative descriptive case study, with data gathered through in-depth interviews. Informants were chosen purposefully. Thematic Analysis was utilized to examine the data, which Source Triangulation subsequently confirmed. The study found that the JKN KIS cadre has five functions, the most important of which is to remind people and collect contributions. Cadre activities included education and outreach, as well as collecting payment arrears receipts. The study also identified three inhibiting and supportive elements for the role of cadre namely individual, environmental, and organisational factors. To reduce unfavourable perceptions of JKN-KIS, it is vital to increase cadre self-actualization, self-esteem, information dissemination, synergy, and quality.

Aim: This study aims to investigate international students’ perspectives on service quality and analyse factors contributing to the perceived service quality of the university health centre. Background: International students are at increased risk of experiencing poor mental health, isolation from families and cultures, language barriers, financial stress and academic pressures. It is important that universities support international students to enable them to complete their degrees and reach their desired level of achievement and performance. One of the supports required by international students is the availability of healthcare services. Therefore, improving the quality of services to meet international students’ requirements, including healthcare services, is essential. Methods: A three-phase exploratory sequential mixed methods design was used. Phase 1 aims to explore international students’ perceptions of primary healthcare quality by conducting in-depth interviews and focus group discussions. Data were analysed using thematic analysis. Phase 2 is to form questionnaire items based on the results of the qualitative study. The questionnaire is subject to pilot testing to measure validity and reliability. Phase 3 analyses factors influencing international students’ perceived primary healthcare service quality. Multiple regression was used to analyse factors contributing to the perceived service quality of international students. Findings: The qualitative strand revealed five major themes representing the study participants’ thoughts about the quality of services in the university healthcare context. Perceived quality attributes identified in this study were primarily empathy, equity, effectiveness, efficiency and safety. The quantitative strand found that 35.57% of participants consider the perceived quality of the centre as good. The highest and lowest service quality attributes were related to safety and efficiency, with a score of 21.12 ± 3.58 and 19.57 ± 4.34, respectively. The multiple linear regression analyses showed that PhD students from Health Faculty and Scholarship awardees were significantly associated with the perceived quality of healthcare services. Thus, the university management needs to improve service quality considering the diversity of international students’ socio-demographic characteristics.

Purpose: Understanding patient’s preferences is important to delivering good quality services. Patients’ feedback provides healthcare providers with valuable information about the services provided. The increasing number of international students enrolling in Hungarian Universities raises the need to ensure the quality of services meets international students’ requirements, which includes healthcare. This study aimed to assess service quality in the University Health Center (UHC) from the international student’s point of view to be used to improve the quality of services. Methods: This cross-sectional study was conducted at the university health center. We used a mixed methods approach to collect both quantitative and qualitative data. We used the importance-performance analysis (IPA) for quantitative analysis to understand expectations and perceptions in service research. The qualitative analysis was conducted from responses to reflection questions. The qualitative data were then analyzed using thematic analysis. Results: 437 international students participated in the study, but only 402 (91.99%) were analysed. The gaps between the importance and performance of service quality were negative in all dimensions (P-value < 0.001). This suggests that there is an unmet need for student expectations and university health center performance. From the Importance factor, the highest and lowest were related to safety (4.54 ± 0.56) and efficiency (4.31 ± 0.66) dimensions. The Performance factor’s highest and lowest mean scores were also related to safety (4.22 ± 0.72) and efficiency (3.91 ± 0.87), respectively. From qualitative analysis, there are two major themes several secondary themes from the thematic analysis of free-text responses were identified. Conclusion: The importance and performance analysis could provide useful information to university policymakers about university health center service quality. There is a need for improvement and obviating the importance-performance gaps, especially in the efficiency dimension. Decision-makers can use the IPA analysis results to allocate limited resources more effectively, giving special attention to possible organizational weaknesses for further direction.

This study investigated lifestyle factors among Hungarian and international students, utilizing lifestyle medicine principles to enhance overall well-being. Conducted at the University of Debrecen through a cross-sectional survey, we examined selected lifestyle factors, more specifically sleep patterns, weight management, nutrition, physical activity, mental well-being, and alcohol use. Hungarian (N = 122) and international (N = 139) students were compared, revealing significant differences. Hungarian students slept less (p = 0.041), desired weight loss (p = 0.040), ate more fruits and vegetables (p = 0.014), exercised longer (p = 0.002), and reported higher purpose and social support (p = 0.009), with higher alcohol use (p < 0.001). These findings highlight distinct experiences and challenges faced by these student groups including variations in sleep, weight management, diet, exercise, and social support. Targeted interventions and tailored support are essential to address their specific needs. To promote the well-being of both Hungarian and international students, educational programs addressing various facets of a healthy lifestyle are crucial. This study offers valuable insights into lifestyle factors and health outcomes among Hungarian and international students and underscores the importance of addressing the unique needs of each group through tailored interventions.

The aim of the present study was two-fold: Firstly, to estimate the prevalence of psychological distress among international students at a Hungarian university two years after the COVID-19 outbreak; and secondly, to identify its demographic and socioeconomic factors, with special regard to the students’ food-security status. A cross-sectional study using a self-administered questionnaire was carried out from 27 March to 3 July 2022 among international students at the University of Debrecen. The questionnaire included information on demographic and socioeconomic characteristics, food-security status (six-item United States Department of Agriculture Food Security Survey Module (USDA-FSSM)), and psychological distress (Depression, Anxiety and Stress Scale (DASS-21)). Bivariate analysis was conducted to examine the potential associations between demographic/socioeconomic factors and psychological distress. Additionally, multiple logistic regression was employed to further analyze these associations. Of 398 participants, 42.2%, 48.7%, and 29.4% reported mild to extremely severe depression, anxiety, and stress, respectively. The ages 18–24 (AOR = 2.619; 95% CI: 1.206–5.689) and 25–29 (AOR = 2.663; 95% CI: 1.159–6.119), reporting a low perception of health status (AOR = 1.726; 95% CI: 1.081–2.755), and being food insecure (AOR = 1.984; 95% CI: 1.274–3.090) were significantly associated with depressive symptoms. Being female (AOR = 1.674; 95% CI: 1.090–2.571), reporting a low perception of health status (AOR = 1.736; 95% CI: 1.098–2.744), and being food insecure (AOR = 2.047; 95% CI: 1.327–3.157) were significantly associated with anxiety symptoms. Furthermore, being female (AOR = 1.702; 95% CI: 1.026–2.824)), living with roommates (AOR = 1.977; 95% CI: 1.075–3.635), reporting a low perception of health status (AOR = 2.840; 95% CI: 1.678–4.807), and being food insecure (AOR = 2.295; 95% CI:1.398–3.767) were significantly associated with symptoms of stress. Psychosocial programs combined with strategies to alleviate food insecurity are required to enhance international students’ mental health and well-being.

The coronavirus disease 2019 (COVID-19) is the first pandemic in history where technologies and social media are used on a large scale to make people safe, informed, productive, and connected. At the same time, these technologies enabled the rise of the infodemic, which endangered pandemic control. This study aimed to assess COVID-19 information exposure in the community, the efforts to find related information in online media, and COVID-19 preventive behavior. A cross-sectional study was conducted with 909 participants in Indonesia using the consecutive sampling technique. Data were collected using a questionnaire distributed through social media (WhatsApp, Instagram, and Facebook) and analyzed using univariate analysis, bivariate analysis (Chi-square test), and multivariate analysis (multiple logistic regression). The results showed that about 838 (92.2%) participants said they often or always obtain information about COVID-19 online, 662 (72.8%) participants stated that information from online sources increased their knowledge of the disease, and 728 (80.1%) said that online information enabled them to make preventive efforts. Marital status (AOR: 1.81, p-value = 0.002) and perceived susceptibility (AOR: 1.42, p-value= 0.011) were the most influential factors for COVID-19 preventive behaviors. Information sources and channels frequently accessed by the community must be professionally managed by the government as valuable tools for mitigating an epidemic or pandemic.

Background and purpose: Due to COVID-19 pandemic, demand for technology in daily interaction has rapidly grown to ease communication while maintaining physical distance. This study examines the determinants of the intention to use telemedicine using the Unified Theory of Acceptance and Use of Technology (UTAUT) Model. Methods: This cross-sectional study was an online survey using Google Form application conducted from March 11 to May 3, 2021. The inclusion criteria of samples were aged 18 years or older, residing in Bali during the data collection period and knowing telemedicine health services. Variables collected include intention to use telemedicine, demographic characteristics of respondents and UTAUT variables, namely performance expectancy, business expectancy, social influences, and facilitation conditions. The statistical test used is simple and multiple logistic regression analysis. Results: Of 458 survey respondents, 287 were included for analysis due to incomplete data. Almost half of the respondents (48.8%) was aged Conclusion: Telemedicine is relatively popular in Bali, Indonesia. Performance expectancy, effort expectancy, and social influence are the predominant factors influencing the intention to use telemedicine. It shows the potential to employ telemedicine service to cover the inadequate distribution of health professionals and healthcare in Indonesia.