Factors associated with pasung (physical restraint and confinement) of schizophrenia patients in Bogor regency, West Java Province, Indonesia 2017.

BACKGROUND: Schizophrenia is a chronic mental disorder affecting more than 21 million worldwide. In Indonesia, 14.3% of households have a patient with a mental disorder, and the majority of these are in rural areas. Family members in Indonesia use repressive social measures like pasung (physical restraint and confinement) for these patients. A study was conducted with the objective to determine the factors associated with pasung among patients with schizophrenia in Bogor Regency, West Java Province, Indonesia 2017. METHODS: A case-control study was conducted in Bogor Regency from May-June 2017. A case subject was defined as a patient with schizophrenia who was ever subjected to pasung and a control subject was defined as a patient with schizophrenia residing in the same geographical area and never subjected to pasung. Multi-stage sampling was used to select case and control subjects from the registered reports of the Health Service of Bogor Regency (2012-16) in 34 sub districts and 59 health centers. Multivariate logistic regression was used to identify the factors associated with pasung. Attributable and population attributable risks (AR, PAR) for pasung were calculated. RESULTS: A total of 114 case and 136 control subjects were studied. Patient's aggressive or violent behavior (AdjOR: 4.49, 95%CI: 2.52-8.0), unemployment (AdjOR: 2.74, 95%CI: 1.09-6.9) and informal employment (AdjOR: 2.5, 95%CI: 1.1-5.84) in the family and negative attitude of the family towards the patient (AdjOR: 2.52, 95%CI: 1.43-4.43) were associated with pasung. Patient's aggressive or violent behavior (PAR = 44.3%) and unemployment in the family (PAR = 49.3%) were the predominant factors of pasung. CONCLUSIONS: Patient's aggressive or violent behavior, negative attitude of the family towards the patient and unemployment in the family were associated with pasung. We recommend health education and encouraging family members to shift patients with schizophrenia exhibiting aggressive or violent behavior to a mental health facility. Strengthening of basic mental health services and involving family members while treating patients with schizophrenia to develop positive attitudes could be considered. Creating employment opportunities and a social support system for treated patients with schizophrenia and family members could further avert pasung.

Perceptions about pasung (physical restraint and confinement) of schizophrenia patients: a qualitative study among family members and other key stakeholders in Bogor Regency, West Java Province, Indonesia 2017.

BACKGROUND: The UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung. OBJECTIVE: To explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017. METHODS: This qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation. RESULTS: Family members and society in general perceived that pasung is necessary for security reasons due to the patient's aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient's request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community. CONCLUSION: Concurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.

Arbi Care: an innovative educational game to increase healthy behavior in diarrhea prevention among preschoolers

Innovation is needed to improve healthy behaviors of children in order to prevent diarrhea. Education through games is widely recommended as a way to change behavior in children. This study describes the process of developing an educational game to increase healthy behaviors of preschool children. This study used research and development design techniques with four stages, including: define, design, develop, and disseminate. Observation sheets were used to assess the effectiveness of the game in educating children. The process of developing this educational game included several phases: 1) exploration of the characteristics of games favored by children; 2) design of the intervention based on games preferred by children; 3) validation of the game prototype by experts and testing of the game by preschool children, and 4) revision of the game in order to obtain a game focused on diarrhea prevention that can be used as a behavioral health intervention. Results showed that in testing of the game by ten preschool were able to play and understand the message of the game 92% of the time. The results showed that the Arbi Care game can be used as a learning device to increase healthy behavior in preschool children

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Developing a health education game for preschoolers: What should we consider?

Objective: To provide a comprehensive picture of what preschoolers prefer in computer game so that such game may be developed as a medium in health education. This is an important step to attract the children's attention so that the learning objectives from the educational game can be achieved. Method: This study used descriptive qualitative approach and involved seven children aged from three to six years. Purposive sampling was used to choose participants in accordance with the inclusion criteria. Participants were also chosen on the basis of whether they had good communication skills based on evaluation by their teachers. Data were collected through interviews and observation of types and models preferred by preschoolers followed by the analysis process using the Colaizzi method. Results: Research showed there were three characteristic features of games preferred by preschoolers: 1) main character was preferred to be a moving creature, contain elements of fantasy, and have an attractive appearance; 2) game model was favored when it involved activities and rewards, and 3) the use of bright colors, particularly primary and secondary colors. Conclusions: To develop an appealing game for preschoolers, features such as the main character, activities in the games, and bright colors should be considered

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Arbi Care application increases preschool children's hand-washing self-efficacy among preschool children

Objective: This research aimed to examine the effectiveness of an Android mobile game application called Arbi Care as a means to prevent diarrhea and build self-efficacy in hand washing among preschool children. Method: This research used a pre- and post-test control group and time series design approach. Respondents were chosen randomly from a group of four to six years children. The intervention group (n = 60) received Arbi Care intervention for 25 minutes, twice a week, for five weeks while the control group (n = 60) received standard education. Self-efficacy was measured by using questionnaire and observation. Measurement was carried out three times in the sixth, eight, and tenth week post-intervention. The data was analyzed using the GLMRM test. Results: There was a significant increase in the average score of self-efficacy in hand washing for the intervention group versus the control group. Moreover, there were significant differences in the results of average scores in which the intervention group showed much better self-efficacy improvement over the control group during the first, second, and final post-test after the intervention was given (p < 0.001). Conclusions: An Android-based educational game can be an effective medium to improve hand washing self-efficacy among preschool children, thus helping to prevent diarrhea

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