International Journal of Health, Education & Social (IJHES)

Factors Affecting the Implementation of the GERMAS Program: Analysis of Social Support and Community Empowerment in Langkat Regency

Maria Tiarma Carolina Saragih, R. Kintoko Rochadi, Nurmaini — Sat, 28 Feb 2026 00:00:00 +0000

Indonesia still faces the double burden of both noncommunicable and communicable diseases. The government has launched a movement for a healthy living program (Gerakan Masyarakat Hidup Sehat, or GERMAS) to reduce morbidity, mortality, and healthcare costs caused by these two types of diseases, but its implementation remains challenging. This could be due to various factors, both internal and external. The aim of this study is to analyze the effect of social support and community empowerment on the implementation of GERMAS. This cross-sectional study was conducted in Langkat Regency, one of the regencies in North Sumatra Province, Indonesia, where the burden of noncommunicable diseases has increased. The sample size was 96 respondents, selected using cluster random sampling from seven community health centers located in seven subdistricts in Langkat Regency. Data were collected using questionnaires and analyzed using multiple logistic regression. The findings showed that social support (Exp (B): 5.585 (2.080-14.997); p=<0.001) and community empowerment (Exp (B): 6.276 (2.342-16.819); p=<0.001) had an effect on the implementation of GERMAS. The most important factor affecting GERMAS implementation in Langkat Regency was community empowerment, in which poor community empowerment increased the tendency of the community to not properly implement GERMAS by 6.276 times. Local governments are expected to focus on strengthening community empowerment through health cadre training, continuous socialization, and the provision of health infrastructure support. Families must also actively support healthy living behaviors through strengthened communication and practicing healthy living together.

Development, validation and implementation of an online educational module on sensory processing disorders for special educators

Pranjal Grover, Ajit Dabholkar — Sat, 28 Feb 2026 00:00:00 +0000

Purpose: Sensory Processing Disorder (SPD) is a dysfunction in children where the processing and use of sensory information for regulating motor function is affected. Even though special educators are important stakeholders in identification and management of SPD’s, this topic is not included in their formal curriculum in India.

Methods: An online module on SPD’s was developed based on a Knowledge, Attitudes and Practices survey of special educators and literature review. It included eight lectures, each with a 30-minute presentation and 15-minute case scenario. Experts validated content using a 5-point Likert scale, calculating CVR and I-CVI. Participants’ knowledge was assessed via pre- and post-tests, and feedback was collected to evaluate learning outcomes and content quality.

Results: The values of I-CVI (0.839) and CVR (0.84) values depict good content validity. The pre and post-test scores showed a statistically significant difference. The feedback proved that the online module was thorough, well designed and suited to the needs of the special educators.

Conclusion: The online educational module on SPDs is a useful tool in providing knowledge about SPD’s to special educators.

Key words: Online educational module, Sensory Processing Disorders, special educators, validation.

ASSESSING SCHOOL ATTENDANCE ON THE FIRST WEEK AND ACADEMIC PERFORMANCE IN EBONYI STATE BASIC EDUCATION

Sat, 28 Feb 2026 00:00:00 +0000

The first week of the term is critical as it sets the tone of academic activities. Unfortunately, most staff and pupils do not resume schooling in this period. This diminishes school outputs and jeopardizes the attainment of its objectives. This motivated the researchers to conduct this study to determine the school attendance rates of pupils and teachers of Ebonyi State Basic Education on the first week of the term; and to discover whether differences exist in the rate of school attendance among the sample LGAs. The researchers relied on official data kept in the State Ministry of Education Headquarters. The Ministry’s officials collected the data using an instrument developed and validated by the Federal Ministry of Education. Six research questions and four hypotheses tested at a significance level of .05 guided the study. The researchers on permission extracted the data of interest from the instrument. MannWhitney and Kruskal Wallis tests were used to analyze the extracted data. The results showed that pupils’ attendance to school within the period was low, with male (25.28%), females (29.7%) and total (27.49%). The teachers’ attendance was commendable, with males 898(87%), females 2,249(86%) and total 3,147(89%). Furthermore, no statistical significance differences existed between male and female pupils and teachers and among the sample LGAs school attendance rates. Based on the findings, the researchers recommended that Ebonyi State Ministry of Education should domesticate and implement the national framework on school enrolment drive campaign; intensify the conduct of and implement recommendations on the report of effective school reopening supervision; and, engage frequently with parents and guardians to sensitize them on the benefits of pupils starting school on the first week of school resumption.

A Confirmatory Factor Analysis of Environmental Welfare and Maternal Health Performance: Macro-Regional Evidence from North Sumatra, Indonesia

Erna Mutiara, Maya Fitria — Mon, 02 Mar 2026 05:17:45 +0000

Regional development strategies increasingly prioritize the integration of physical infrastructure and public health outcomes. However, structural evidence linking environmental welfare to maternal health performance at the macro-regional level remains scarce, particularly in diverse archipelagic provinces. This study aims to validate the structural relationship between environmental welfare—comprising housing quality, sanitation, and water access—and maternal health intervention performance across the 33 municipalities of North Sumatra, Indonesia.

Utilizing a census-based macro-dataset, this research employs a Confirmatory Factor Analysis (CFA) within a Structural Equation Modeling (SEM) framework. The model’s structural integrity was rigorously tested using goodness-of-fit indices to evaluate the latent constructs of environmental welfare and health service delivery.

The CFA validated a robust two-factor model with excellent fit indices (chi² = 21.937, df = 15, p = 0.109; CFI = 0.972; TLI = 0.948; SRMR = 0.066). The findings reveal that environmental welfare is most dominantly indicated by access to clean water (l = -0.916) and decent housing (l = -0.909). Concurrently, the performance of maternal health services is most significantly represented by the coverage of Iron-Folic Acid (IFA) supplementation (l = 1.000), which outperformed clinical visit frequency as a structural indicator. The study confirms a significant structural linkage between macro-environmental conditions and maternal health outcomes in North Sumatra. The results suggest that achieving maternal health targets requires a synchronized policy that integrates basic infrastructure development with community-based nutritional interventions. This research provides a parsimonious validated framework for regional governments to monitor development progress through high-impact macro-indicators.

USING THE INQUIRY METHOD TO IMPROVE LEARNING OUTCOMES OF GRADE VI STUDENTS AT SDN GIRIMEKAR 1 CILENGKRANG ON ENVIRONMENTAL CARE MATERIAL IN ISLAMIC RELIGIOUS EDUCATION (PAI) SUBJECT

USEP SUHENDAR — Mon, 02 Mar 2026 05:18:12 +0000

This classroom action research (CAR) aims to improve the learning outcomes of sixth-grade elementary school students on the topic of environmental care in Islamic Religious Education (PAI) through the application of the inquiry method. The research was conducted in three cycles, with each cycle consisting of planning, implementation, observation, and reflection. The subjects of the study were 31 sixth-grade students at SDN Girimekar 1 Cilengkrang. Data was collected through learning outcome tests, observation of student activities, and field documentation.

The results showed that the inquiry method can improve student learning outcomes, with the classical mastery percentage increasing from 29% in the pre-cycle to 39% in cycle 1, then 52% in cycle 2, and further rising to 72% in cycle 3. Additionally, students became more active and enthusiastic in the learning process.

The conclusion of this research is that the inquiry method is effective for use in the learning process to improve student learning outcomes on the topic of environmental care in PAI subjects

The IMPACT OF HEALTHCARE ACCESSIBILITY ON THE REFERRAL SERVICE SELECTION DECISIONS OF JKN PBI BENEFICIARIES IN MEDAN, NORTH SUMATRA

Devi Nur Harvita, Destanul Aulia, Deli Theo — Mon, 02 Mar 2026 05:18:45 +0000

Decision-making among National Health Insurance–Contribution Assistance (JKN-PBI) beneficiaries in selecting referral health services remains substantially influenced by accessibility constraints. Accessibility continues to be a major barrier, particularly for JKN-PBI beneficiaries living in areas with high poverty levels and unequal distribution of healthcare facilities. Although the referral system has been updated to enhance service accessibility, many JKN-PBI beneficiaries still face obstacles such as long distances to referral facilities, limited availability of public transportation, and unaffordable travel costs, all of which affect their decisions when choosing referral services. This study aims to analyze the influence of accessibility on the decision-making of JKN-PBI beneficiaries in selecting referral health services in Medan City. A quantitative cross-sectional design was employed and conducted from August to September 2025. The study population consisted of 7,464 JKN-PBI beneficiaries from six districts selected through cluster sampling. A total sample of 90 respondents was determined using the Slovin formula and selected through simple random sampling. Data were collected using a structured questionnaire that had undergone validity and reliability testing. Data analysis utilized chi-square tests and multivariate logistic regression. The findings indicate that three accessibility variables had significant effects on referral service decision-making: distance (p-value=0.002; ExpB=0.183), ease and availability of public transportation (p-value=0.001; ExpB=0.143), and affordability of transportation costs (p-value=0.002; ExpB=0.186), while time required to healthcare services showed no significant effect (p-value=0.132). It is recommended that the government expand transportation access, provide subsidies or financial support for health-related travel costs, and strengthen the referral system based on geographic proximity to improve equitable access to healthcare services.

Beyond Phishing: Detecting MFA Fatigue and Adversary-in-the-Middle at Scale

Kimberly Green — Mon, 02 Mar 2026 05:19:01 +0000

This study proposes a defender-centric strategy to detect and contain two fast-rising attack patterns—MFA fatigue and Adversary-in-the-Middle (AiTM)—without relying on expensive tooling. We introduce a lightweight pipeline that fuses identity telemetry (push frequency anomalies, impossible travel), web gateway indicators (suspicious reverse-proxy domains), and endpoint signals (token theft heuristics) into actionable detections. Evaluated across 15 small-to-medium organizations, the approach reduced median time-to-detect by 63% and cut successful account takeovers by 41% over eight weeks. We document failure modes (e.g., noisy travel baselines), provide hardening tips (phishing-resistant MFA, conditional access, token binding), and publish query patterns that can be adapted to common SIEM/XDR platforms. The results indicate that defenders can meaningfully blunt modern phishing and session-hijacking campaigns with modest engineering effort and targeted telemetry enrichment.

ASSESSING THE EFFECTS OF LOW ACADEMIC PERFORMANCE FROM SECONDARY EDUCATION ON THE PROFESSIONAL ABILITY AT THE TERTIARY HEALTH EDUCATION; CORRELATIONAL CASE STUDY AT MANYARA REGION

Mon, 02 Mar 2026 05:19:17 +0000

In various health training institutions in Tanzania, the failure to achieve a required level of pass among middle health programs is about 18% in continuous assessment tests (CATs) and end of semester examinations. This situation raises question to many academicians that “Do grades of academic performance from secondary education matter towards professional ability at tertiary health education?

Objectives: This study aimed to assess the effects of low academic performance from secondary education on the professional ability at the tertiary health education

Method: A cross-sectional explorative design was employed whereby secondary data from both secondary and tertiary academic performance were retrospectively collected from three (3) health-training institutes at Manyara region. The sample size of 274 was drawn from an estimated total population of 1000 students

The results: Of all enrolled students to the study, (46%) were those with D grades in science subjects from secondary education. Those with poor academic performance from secondary education have higher twice proportion of lower academic performance at tertiary education in all semesters and NTA levels. Similarly, those with good academic performance from secondary education had double higher proportion of good academic performance at tertiary education (66.4% Vs 33.6% p-value<0.001).

On the impacts of low academic performance, those with poor academic performance from secondary education have higher twice percentages of supplementary, repeat modules and discontinued for both semesters of all NTA levels compare to their fellow counterparts of good academic performance.

Conclusion: Students with D grades in science subjects from secondary education have high rate of failure in tertiary education. Those with good academic performance have double higher proportion of good academic performance at tertiary education. The authors recommend to the responsible selection authorities (NACTVET and MoH training sector) including other stakeholders to review and uplift the minimal admission requirement grades from D; the currently operating one to C so as to improve academic performance among health training institutes

Key word: Low Academic Performance, Secondary Education, Professional Ability

CHARACTERIZATION AND EFFECT OF FLOOD WATER YIELD IN AKPOHA, EBONYI AND INYABA RIVERS,IN THE ECONOMY OF EBONYI STATE, NIGERIA

Mon, 02 Mar 2026 05:19:45 +0000

This work characterized flood water yield of Akpoha, Ebonyi and Inyaba rivers. It adopted flood metrics of the three rivers to determine the behaviour of the affected rivers. This assessment tried to characterize the water yield and how it affects the economic activities within the affected floodplains in Ebonyi State. This proffered solution to the problems of annual flooding in the affected floodplains. Akpoha, Ebonyi and Inyaba Rivers were sampled at different points. Questionnaire used to ascertain effect of flood water and 5x4 factorial design adopted to determine the relationship between sample points and parameters for 2014, 2015 and 2016 using analysis of variance for Completely Randomized Design. Mean values evaluated for significant differences using Fisher’s Least Significant Differences at P < 0.01.T-test was used for confirmation. The rivers sampled at four points, a1, a2, a3, a4 Akpoha. b1,b2, b3, b4. Ebonyi and c1, c2, c3,c4 Inyaba. The main factors determined were discharge, flow velocity, flow rate, width and depth.150 questionnaires drawn in 2014, 2015 and 2016 to determine the effect of flood on the economy. Results showed that the factors were highly statistically significant at 1% level and the confirmatory test via FLSD also agreed to that. Results of the questionnaire showed that the highest income of one million seven hundred and ninety seven thousand Naira was recorded by fish farmers in Akpoha in 2016 and the least sum of one million two hundred and eighty five thousand Naira was recorded in Ebonyi in 2014. The Table also indicated that the highest sum of two million fifty four thousand Naira was observed in Inyaba in 2015 and the least sum of one million two hundred and fifty thousand five hundred Naira was recorded in Inyaba in 2014 by the crop farmers. The maximum loss of one million nine hundred and eighty two thousand Naira was observed in Akpoha in 2016 while the least loss of six hundred and eighty four thousand five hundred Naira was recorded in Ebonyi in 2015. The test of hypothesis for the aggregate economic indexes and losses showed that in the year 2014 the variation at Akpoha, Ebonyi and Inyaba were low at 0 -20 percent. Akpoha, Ebonyi and Inyaba were moderate at 20 -50 percent in 2015. The result also showed that Akpoha, Ebonyi and Inyaba were very low at 0 – 20 percent in 2016. The results were recommended to save the economy and individuals living in floodplains and also exploit benefits from the areas.