ABDUCENS PCC EAMSC 2021

ABDUCENS ACADEMIC BUNDLE OF CREATIONS

PCC EAMSC 2021 BY AMSA-UNHAS

PUBLIC POSTER

PCC EAMSC 2021 BY AMSA-UNHAS

DISTRICT WINNER LET’S START FILTER, STOP THE FALSE! Maria Alvenia Chaterina Revita; Yason Nikolaus Liyadi; Wynne Elysia Suriady; Andrea Melynda Panggalo

LET’S START FILTER, STOP THE FALSE! Maria Alvenia Chaterina Revita; Yason Nikolaus Liyadi; Wynne Elysia Suriady; Andrea Melynda Panggalo Hasanuddin University, Makassar, South Sulawesi.

ABSTRACT Background: Health misinformation is health-related claim of fact that is currently false due to a lack of scientific evidence. Health misinformation is on the third place (41.2%) of the most misinformation or hoax that people received in Indonesia following social politics on the first place (91.8%) and “ethnicity, religion, race, and inter-group” topic on the second place (88.6%). Social media is on the first place (92.4%) in the spreading of misinformation in Indonesia, followed by chatting application on the second place (62.8%) and websites on the third place (34.9%). Some characteristics of health misinformation that we can identify such as a provocative headline and evocative content, obscure and untraceable sources, heavily biased, push people to reshare, and meant to distort emotions. The effect of health misinformation on community can make a mass panic, make people to waste time and money, and even worse losing someone’s life due to a misinformation or a false information.

Objective: Through our public poster, we aimed to raise public awareness and reduce the number of health misinformation by filtering the content that people get from any media of the spreading of health misinformation and how to stop the spreading of false medical information in any condition.

Keyword: Health Misinformation, False Claim, Hoax, Provocative Headline References: 1. Chou, W. S., Oh, A., Klein, W. M. P. (2018). Adressing health-related misinformation on social media.

Jama, 320(23), 2417-2418.

2. Sarosa, A. P. (2017). 3 Dominant Characteristics of Internet Hoaxes. Jakarta: Tempo.co.

3. The Indonesian Telematics Society (2019). 2019 National Hoax Outbreak Survey. Jakarta, Indonesia.

4. Thompson Rivers University Library (2019). Characteristics of Fake News & Media Bias. Kamloops, Canada.

STAYING SANE IN THIS PANDEMIC Jeane Kinanti Tandung; Irene Jessica Leonardy; Elvira Horisanto; Ennia Yuniarti Br Bancin

STAYING SANE IN THIS PANDEMIC Jeane Kinanti Tandung; Irene Jessica Leonardy; Elvira Horisanto; Ennia Yuniarti Br Bancin Hasanuddin University, Makassar, South Sulawesi.

ABSTRACT Background: According to WHO on October 5th, 2020, 93% of 130 countries surveyed has disrupted mental health services due to the pandemic, although 89% of the countries reported that mental health is a part of their response plan. Fear of infection , accused for having the disease, racial-related accusations, and losing jobs has resulted to mental health concerns which are worsen by the absence of mental health services due to the pandemic. This is where adequate communication takes place as a personal intervention to maintain self-mental health. Communication is not only done from one party, but a twoway teamwork. One cannot control the media communications but one can choose to block communication to a second party. One can maintain its mental health by minimizing exposure to news about Covid-19 to prevent anxiety, narrowing news consumption to trusted platforms, present to listen and being supportive to one another, and being productively busy to ease one’s mind. Start from a personal communication to the whole population’s mental health.

Objective: Through our public poster we want to convey communication into a personal intervention, we cannot control the media but we can overcome mental health issues by choosing the right communication during pandemic.

Refere rences: 1. WHO. (2020). Coronavirus disease 2019 (COVID-19) Situation Report – 94 (p. 12) 2. Ifdil, I., Fadli, R. P., Suranata, K., Zola, N., & Ardi, Z. (2020). Online mental health services in Indonesia during the COVID-19 outbreak. Asian journal of psychiatry, 51, 102153. https:// doi.org/10.1016/j.ajp.2020.102153 3. Gunawan, J. (2020). Current Mental Health Issues in the Era of Covid-19. Asian Journal Of Psychiatry, 51(102103), 1. Retrieved 13 October 2020.

THE 4 ELEMENT TO ACHIEVE MEDICAL ADHERENCE Maria Dyota Bagus Kusumaningrum; Majesty Patu Buana; Ratu Basyasyah Cianora; Revina Raissa

THE 4 ELEMENT TO ACHIEVE MEDICAL ADHERENCE Maria Dyota Bagus Kusumaningrum; Majesty Patu Buana; Ratu Basyasyah Cianora; Revina Raissa Gunawan AMSA-Hasanuddin University, Makassar, South Sulawesi

ABSTRACT Background: Medication adherence is defined as the extent of patient behavior in obeying the medical direction prescribed by the care provider. It is reported 25% of Americans don’t follow their doctor's advice. As a consequence of non-adherence, many patients have worsened the disease, increase healthcare costs, and even death.

Most of non-adherence is caused by the patient's inability to

understand the medication instructions. Therefore, effective communication is needed when providing health services. The goals of effective communication to achieve the success of diagnosis and medical action for the patient’s recovery.

Objective: the aim of this poster to inform the healthcare provider how to make effective communication with the patient in order to increase the number of medical adherence

Solution: In the application of effective communication, we suggest four important elements to enhance patient adherence and satisfaction, include : 1) Listen and contention.

Let the patients talk and listen to them carefully. Besides, don't limit the time spent on them.

2) Be emphatic and respectful By asking their opinion about the therapy 3) Welcoming attitude Smile, show good gesture, and aware of the patient’s body language 4) Communicate clearly Try to explain the detailed information understandably.

Keyword: effective communication, medical adherence

References: 1. Adherence Section Publication. World Health Organization. (2003), https://www.who.int/chp/knowledge/publications/adherence_Section1.pdf 2. Chisholm-Burns, M. A. and Spivey, C. A. (2012) “The ‘cost’ of medication nonadherence: Consequences we cannot afford to accept,” Journal of the American Pharmacists Association, 52(6), pp. 823–826. doi: 10.1331/JAPhA.2012.11088.

3. Impact of Communication in Healthcare | Institute for Healthcare Communication. (n.d.).

Retrieved October 17, 2020, https://healthcarecomm.org/about-us/impact-ofcommunication-in-healthcare/

Digital Diary of Covid-19 Annisa Ramadhanti Yusuf, Nur Alni Praditha Daenunu, Nurul Khalisah Maisuri

Abstract Digital Dairy of Covid-19 Annisa Ramadhanti Yusuf, Nur Alni Praditha Daenunu, Nurul Khalisah Maisuri Asian Medical Students' Association Hasanuddin University COVID-19 outbreak was declared as pandemic by the WHO on March 11, 2020. As of October 13, 2020, the number of COVID-19 cases in the world has reached 37,601,848 and in Indonesia has reached 298,626 cases. A study has revealed so-called infodemics exacerbate the suffering of COVID19 through spreading rumors and conspiracy theories. Indonesia is one of the 5 countries in the world with the highest spread of hoaxes about COVID-19. Conspiracy and hoaxes raises public distrust of the pandemic, making many people who don’t comply with health protocols properly and end up with COVID-19 cases in Indonesia difficult to decrease.

In this era, smartphones have become part of people's lives, therefore we can use an application to effectively prevent the spread of COVID-19. Digital Diary is an application that allows users to track their own movements and has various self-awareness features such as providing information about where COVID-19 has detected. People can be self-aware and monitoring the development of COVID19 around them. This application also develops Hoax Buster feature that updates about hoaxes that are circulating and inform and educate about the fact. Through this feature, people can confirm whether the news they receive is a hoax or not.

SCIENTIFIC

PAPER

PCC EAMSC 2021 BY AMSA-UNHAS

Communication in mechanically-ventilated patients: systematic review of current practices Andi Muhammad Zharfan, Arief Abdurrazaq Dharma, Dhiya Muthiah Gaffari, Richard Holman Matanta

Communication in mechanically-ventilated patients: systematic review of current practices Andi Muhammad Zharfan, Arief Abdurrazaq Dharma, Dhiya Muthiah Gaffari, Richard Holman Matanta Medical Student, Faculty of Medicine Universitas Hasanuddin, Makassar, Indonesia Asian Medical Students’ Association Universitas Hasanuddin Introduction: Mechanically ventilated patients often find difficulties with communication. Behaviors such as nodding, gestures, and eye blinking may often not reliable, and can be misinterpreted. There are various kinds of communication aids from low to high technology.

Objective: This review aimed to summarizes the available modes of communication for patients with mechanical ventilation.

Methods: We used five searching tools including PubMed, NIH Clinical Trials, Directory of Open Access Journal, Epistemonikos, and ScienceDirect. We created a flow of study using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement (PRISMA) and assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD).

Results: We reviewed 19 studies, then distinguished several communication intervention types which are: Augmented Alternative Communication (AAC) (n=9), Electrolarynx (n=3), Modified tracheostomy (n=5), and Multiple Intervention (n=2). For the most part, research results have improved communication using alternatives. Studies were considered moderate with QATSDD. Review of current literature returns a wide array of communication strategies to communicate with mechanically ventilated patients. These treatment options will be expected to improve the quality of care for the patients and family, as well as to relieve the communication barriers experienced by healthcare providers. However, more well-controlled and systematic studies are needed before these strategies can be implemented widely.

Conclusion: Numerous communication alternatives for patients undergoing mechanical ventilation are presented in this study. However, further studies assessing the benefits of these treatments are needed in order for these choices to be implemented in respective healthcare facilities.

Keywords: Mechanical ventilation, Communication intervention, Communication tools, Communication method.

Communication in mechanically-ventilated patients: systematic review of current practices

Author: Andi Muhammad Zharfan Arief Abdurrazaq Dharma Dhiya Muthiah Gaffari Richard Holman Matanta

Medical Student, Faculty of Medicine Universitas Hasanuddin Asian Medical Students’ Association Universitas Hasanuddin 2020

Introduction Mechanical ventilation is an artificial ventilation that have goals to provide adequate oxygenation and alveolar ventilation (Hess et al., 2011). Mechanical ventilation is one of the common interventions received by patients to maintain their condition and the necessity of mechanical ventilation will increase proportionally in line with the need of hospitalization in the future(Vincent & Creteur, 2019).

One of the problems that Patient’s with mechanical ventilation has to face is communication barrier. The problem occurs due to the presence of an endotracheal tube or tracheostomy, that compromise the verbal ability of the patients to communicate. Thus, even mechanical ventilator can save a patient’s live, it also creates psychological distress such as frustration in patients (Karlsson et al., 2012; Khalaila et al., 2011).

Different communication methods have been attempted to make it able to communicate such as head nods, spoken word, gesture, even blinking eyes. These strategies itself present significant disadvantages, as it can be interpreted inaccurately, inefficiently, and cause significant misunderstanding for both patients and healthcare providers (Grossbach et al., 2011).

Miscommunication can lead to various negative outcomes: discontinuity of care, patient safety, dissatisfaction in patients and economic consequences (Vermeir et al., 2015).

The use of Augmentative and alternative communication (AAC) could be an alternative to enhance the ability of patients to communicate properly to the healthcare provider. There is a wide range of communication aids from basic to high technology, and the reviewers want to summarize what type of communication that can be used for patients with mechanical ventilation based on their clinical condition.

Methods Four reviewers (A.A, A.M, R.H, dan D.M) conducted systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-analyses statement (PRISMA). The reviewers conducted a search on five onlinedatabase PubMed, NIH Clinical Trials, Directory of Open Access Journal (DOAJ), Epistemonikos, and ScienceDirect using queries as follow: ““communication intervention” OR “communication tools” OR “communication method”” AND “mechanical ventilation” AND “clinical trial”.

Eligibility criteria Studies were considered eligible for systematic review based on the following criteria: 1) all randomized control trials, quasiexperimental studies, observational studies published in English or Indonesian; 2)The population under consideration are all adult patients in the ICU who were using mechanical ventilation; 3)The main focus of the studies had to be the use of communication techniques between healthcare professionals and patients; 4) The studies had to be published from 2010.

Data Collection First, The reviewers screened the studies based on the titles and abstracts to identify eligible studies. Studies that did not meet the criteria were excluded. Studies that met the criteria would be further assessed. We discussed the studies that have incomplete data and exclude if it's not possible based on the agreement of the reviewers.

Data Extraction The following data is extracted from the included studies: first author, publication tear, study design, sample size, intervention type, study population, measures, and found in each of these studies.

Quality assessment The methodological quality and risk of bias of selected studies was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). The QATSDD is a 16-item tool developed for use with varying research designs. The QATSDD shows good reliability and validity for use in the quality assessment of a diversity of studies, which included qualitative and quantitative methods, and clearly-defined scales (Sirriyeh et al., 2012).

Synthesis of result Data that was considered eligible were collected by two reviewers (R.H and D.M) and were adjusted by two other reviewers (A.A and A.M) and inputted to the table. meta-analysis will be conducted if the data collection supports it.

The data will be summarized in a narrative synthesis If the data collection has high heterogeneity.

Results The initial database search yielded 387 articles. Out of those articles, 367 articles were excluded after abstract screening due to 25 articles being published more than 10 Years Ago, 181 articles being focused on mechanically nonventilated population, 23 articles having their communication method non-specified, 73 articles were review article, 8 articles were research protocol, 4 articles having non-communication related intervention, 2 articles were conference reports, and 1 article was written in foreign language. Proceeding to the full-text screening, 1 article was excluded due to irrelevant patient assessment. In total, 19 studies are finally reviewed in our study. This process is summarized in Figure 1.

The included studies were described based on their characteristics in Table 1. Among the included studies. 1 was a controlled clinical trial (El-Soussi et al., 2015), 7 were using quasiexperimental design (Dithole et al., 2017; Garry et al., 2016; Hosseini et al., 2018; Koszalinski et

al., 2015; Otuzoğlu & Karahan, 2014; C. Rodriguez & Rowe, 2010; C. S. Rodriguez et al., 2016), 4 were case-series(16–19) (Kunduk et al., 2010; Leder et al., 2013; Pandian et al., 2014; Pryor et al., 2016), 3 were case reports (Girbes & Elbers, 2014; Mitate et al., 2015; Shimizu et al., 2013), 3 were cohort studies (Maringelli et al., 2013; C. S. Rodriguez et al., 2012; Tuinman et al., 2015), and 1 was a randomized control trial (Pandian et al., 2020). From the studies, we distinguished several communication intervention types which are: Augmented Alternative Communication (AAC) (Eight Studies) (El-Soussi et al., 2015; Garry et al., 2016; Koszalinski et al., 2015; Maringelli et al., 2013; Otuzoğlu & Karahan, 2014; C. Rodriguez & Rowe, 2010; C. S. Rodriguez et al., 2012), Electrolarynx (Three Studies) (Girbes & Elbers, 2014; Shimizu et al., 2013; Tuinman et al., 2015), Modified tracheostomy (Five Studies) (Kunduk et al., 2010; Leder et al., 2013; Pandian et al., 2014, 2020; Pryor et al., 2016), and Multiple Interventions (Three Studies) (Mary Beth Happ et al., 2014; Hosseini et al., 2018; Mitate et al., 2015). The outcome was acquired within a broad spectrum of measures. Mostly, author-devised questionnaires and subjective assessments of improvement in communication were utilized.

Quality Assessment Using the QATSDD appraisal outline, the overall methodological varied from poor to moderate; score 9–40 out of 42 and 48, median 25 (Table 2). Overall, the studies were considered moderate, and considered poor on case series and case report (Girbes & Elbers, 2014; Kunduk et al., 2010; Mitate et al., 2015; Pandian et al., 2014; Shimizu et al., 2013). Only six studies that reporting an evidence of sample size considered in term of analysis (Mary Beth Happ et al., 2014; Hosseini et al., 2018; Otuzoğlu & Karahan, 2014; Pandian et al., 2020; C. Rodriguez & Rowe, 2010; C. S. Rodriguez et al., 2016). There’s no study in quantitative study that assessed the reliability of

analytical processes (Koszalinski et al., 2015; Kunduk et al., 2010; Mitate et al., 2015; Pandian

et al., 2014; Pryor et al., 2016; C. Rodriguez & Rowe, 2010).

Figure 1. Flow diagram of study selection procedure.

Table 1. Characteristics of the included studies (n=19)

Table 2. Critical Appraisal (QATSDD)

Criteria were scored on a scale from 0 to 3 (0 = not at all, 1 = very slightly, 2 = moderately, 3 = complete, # = no quantitative methods used, X = no qualitative methods used).

List of Item Reviewed: 1. Explicit theoretical framework 2. Statement of aims/objectives in main body of report 3. Clear description of research setting 4. Clear description of research setting 5. Representative sample of target group of reasonable size 6. Description of procedure for data collection 7. Rationale for choice of data collection tool(s) 8. Detailed recruitment data 9. Statistical assessment of reliability and validity of measurement tools (Quantitative only) 10. Fit between stated research question and method of data collection (Quantitative only) 11. Fit between stated research question and format and content of data collection tool e.g. interview schedule (Qualitative only) 12. Fit between research question and method of analysis 13. Good justification for analytical method selected 14. Assessment of reliability of analytical process (Qualitative only) 15. Evidence of user involvement in design 16. Strengths and limitations critically discussed

Modified Tracheostomy Modified Tracheostomy Tube is a tracheostomy tube that underwent several methods of modification to produce audible phonation (Pandian et al., 2014). The Blom Tracheostomy Tube was reported to be used in each of these 3 studies in 2010, 2012, and 2016 which in total includes 36 case reports (Kunduk et al., 2010; Leder et al., 2013; Pryor et al., 2016). In 2010, reported by Pryor et al, the tube was successfully implanted in 2 out of 3 patients and they maintain audible phonation and high level of comfort(Pryor et al., 2016). In 2012, reported by Leder et al, all patients (n=23) were able to maintain audible voicing with significantly greater voice intensity than room noise by >10 dB SPL (p = .003) and also speech intelligibility scores improved from 80% to 85% (p = 0.03)(Leder et al., 2013). In 2016. Kunduk et al reported that, 9 out 10 patients were able to maintain audible phonation (Kunduk et al., 2010).

The second type, The BLUSA Tracheostomy Tube was reported to be used in conducting two studies respectively in 2010 and 2019 (Pandian et al., 2014, 2020). In 2010, reported by Pandian et al, all patients (n=4) who were treated with this tube were able to proficiently speak under mechanical ventilation, though they cannot handle cuff deflation (Pandian et al., 2014). In 2019, Pandian et al conducted a randomized controlled trial which accounted 25 patients, which shows that the change of Quality of Life is significantly better in patients (n=25) treated with these tubes (Pandian et al., 2020).

Electrolarynx Electrolarynx is a device powered by battery that helps user to produce speech through generating vibration to the oropharyngeal cavity (Shimizu et al., 2013). We included 3 studies that involve the usage of EL, which 2 were case reports and 1 was a cohort study. Both Shimizu et al and Girbes et al reported success through their case reports that with the usage of EL, patients

could communicate clearly after being unable to speak (Girbes & Elbers, 2014; Shimizu et al., 2013). Tuinman et al, through conducting a cohort study measuring the effectivity of electrolarynx using Electrolarynx Effectivity Score (EES) found that 6 /15 patients scored 4 and 5 in EES and 2/15 patients scored 3 in EES. Which indicates improvements among 8/15 of the patients (53,33%) (Tuinman et al., 2015).

Augmented Alternative Communication (AAC) Augmented Alternative Communication (AAC) is a system that helps people with difficulties in communicating. This system consists of Unaided and Aided systems. Unaided systems utilize only the skill (lip reading, mouthing) owned by individuals and it is unnecessary to use additional equipment. In other hand, Aided systems utilize additional equipment to help people encompass their difficulties in communicating, distinguished into two groups which are High-tech AAC (speech generating device, eye-tracker) and Low-tech AAC (communication board) (Mary Beth Happ et al., 2014).

Our search showed three distinct types of AAC systems, unaided system, low-tech AAC, and high-tech AAC. In our review, we included two studies that utilized Low-tech AAC and six studies that utilized high-tech AAC. El-soussi et al conducted a controlled clinical trial using modified communication board and paper/pen and reported that level of satisfaction differs significantly (40% are Satisfied, compared to 6.66% in control group (p<0.001); 10% were Very Dissatisfied compared to 53,33% in control group) and there were no significant differences in mortality between the two groups (El-Soussi et al., 2015). Otuzoglu et al reported that using authordeveloped illustration in managing the difficulties in communication undergone by post open-heart surgery patient, there were significant differences between groups (Intervention group 2.2% vs.

35,6% Control group, p < 0.000) (Otuzoğlu & Karahan, 2014).

Among the studies that utilize High-tech AAC, there were Maringelli et al. who demonstrates a gaze-controlled system that managed to mediate and improve the communication between mechanically ventilated patient and healthcare workers in ICU and there was a significant decrease in negative feeling and thoughts among all groups (p < 0.001) (Maringelli et al., 2013). Rodriguez et al. who conducted 3 researches in 2010, 2012, and 2016 with completely different characteristics but reported a similarity in outcomes (C. Rodriguez & Rowe, 2010; C. S. Rodriguez et al., 2012, 2016).

Rodriguez et al. conduct a research with quasiexperimental design using The Springboard Programmable speech-generating device and reported that there were significant improvements in communication quality, mean satisfaction score was 4.18/5 indicating 'quite satisfied', importance level score was 4,5/5 indicating 'quite important', only that patients reported issues associated with accessibility of the device (C. Rodriguez & Rowe, 2010). In 2012, another study by Rodriguez et al using speech generating software in a tablet computer and reported that Intervention given to participant was considered high importance (a Kappa = 0,421, 95% CI (-0,243,1.00)), easy to use (a Kappa = 0,388, 95% CI (-0,011, 0,789)) and qualitatively high satisfaction among the participant (C. S. Rodriguez et al., 2012). In 2016, another quasi-experimental design study conducted by Rodriguez et al reported the use of Software incorporated within a touch-screen tablet (include pictorial hot-buttons with spoken message, handwriting using finger or stylus, typewriting) which demonstrate a significantly lower mean frustration level (-2.68; 95% CI -3.02 to -2.34, p=<0.001), and higher satisfaction level ((0.59, 95% CI 0.27 to 0.91; p<0.0001)) within the intervention group compared to the control groups (C. S. Rodriguez et al., 2016). Koszalinski et al. also conducted a study with quasi-experimental

design using Speak for Myself Computer Pad Software Application and stated that all patients (n = 20) prefer to use the Speak for Myself software, only one patient had difficulty to operate the computer tablet (Koszalinski et al., 2015). Garry et al. using The Tobli C12 eye-tracking computer enable patient to communicate basic needs to nursing staff and family with a positive mean overall impact score (PIADS = 1.30; n = 12, p = 0.004), and in mean scores for each PIADS domain: competence = 1.26, adaptability = 1.60, and self-esteem = 1.02 (all n = 12, p < 0.01) (Garry et al., 2016).

Multiple Interventions Our search also returns 3 studies which implemented mixed communication strategies to the patients (Mary Beth Happ et al., 2014; Hosseini et al., 2018; Mitate et al., 2015). Mitate et al. reported findings on the usage of VocalAid tracheostomy tube in pairing with Modified mouthstick stylus for tablet and communication board (High-tech AAC) which indicated that speaking tracheostomy tube was found insufficient for the patient to communicate and mouthstick stylus left him fatigued by the constant biting.

Until modification was made to the mouthstick stylus then the patient can communicate with his surroundings (Mitate et al., 2015).

Hosseini et. al conducted a quasiexperimental design study using only routine nursing practices on control group and adding communication board (low-tech AAC) to the intervention group and stated that there was a significant difference in ease of communication scores between the two groups (z = −4.69; p = 0.001)(Hosseini et al., 2018).

Happ et al. through their three phase cohort-study stated that communication frequency and positive nurse communication behavior increased significantly in one cohort, successful communication rate is significantly better when being compared with control groups and patient

with AAC and SLP has a lower difficulty in communication (Mary Beth Happ et al., 2014).

Discussion Communication is an essential part of human life, and also a huge part determining the quality of care provided by the healthcare providers, and determines the treatment outcome by patients(M B Happ, 2001; Patak et al., 2004).

Our search reveals numerous studies which have proven to positively impact the outcome of care provided to the patients (Koszalinski et al., 2015).

A number of studies described the patient’s feeling when they cannot communicate with the healthcare workers, or their family(Koszalinski et al., 2015; Mazor et al., 2012). Repeatedly, the feeling of “loneliness”,“helplessness” or “trapped in their own head” are being described by these patients (Koszalinski et al., 2015). Due to this problem, assessments which may need subjective reports from the patient, such as pain intensity or the location of pain, may often be impossible to be done. This problem may affect how they perceive the treatment they went through, and will also determine their quality of life (Pandian et al., 2020; Patak et al., 2004). Similar to this, the healthcare providers are also having troubles in communicating with the patients, which will significantly hinder the assessments and alter the treatments provided (Patak et al., 2004). Our review may gives insights about the available technologies and alternatives to help overcome these situations.

The emergence of new technology such as the Electrolarynx, the Modified Tracheostomy Tube, eye tracking devies or computer softwares (such as the Speak for Myself) may provide useful solutions for patients undergoing mechanical ventilation. New technologies such as eyetracking devices and novel softwares may help provide a mode of communication which is easy to use, and may cut unnecessary cost related to the need to purchase additional devices. With these technologies arises, the patients may regain their

voices, and may help the healthcare providers to help choose the best strategies for the patients (Ten Hoorn et al., 2016).

A similar study was conducted by Ten Hoorn et al., which shows a wide array of communication methods available in the literature for patients undergoing mechanical ventilation.

Hoorn et.al attempted to create an algorithm in order to help healthcare providers in choosing the best communication strategies for these patients(Ten Hoorn et al., 2016). However, with the limited data in proving the efficacy of these options, the strategies may be difficult to be implemented.

In order to choose the best communication strategies for the patient, the assessment of cognition and functional status is an essential part to be done (Ten Hoorn et al., 2016). Patients who can maintain their vocalization and undergo mechanical ventilation may be benefitted by the modified tracheostomy tube.

Modified tracheostomy tubes (such as the Blom tracheostomy tube or the BLUSA tracheostomy tube) may provide a good alternative to allow patients to vocalize their words. Similarly, the Electrolarynx, which works by augmenting the vibration from the patient’s oral or pharyngeal mucosa may provide a good phonation for the patients. However, for those who cannot maintain vocalization, other communication strategies may be more suitable. For such patients, communication may still be possible to be conducted with tools such as the Speak for Myself software, which translate the need of the patients into audible voice. Some attempt to provide alternative tools for patients to interact with the given technologies have been developed. Eyetracker devices may be useful to help the patients who cannot or are difficult to move, especially paraplegic patients. New modified stylus developed by Mitate et.al may also be useful for these patients. However, due to the energy exertion which may be caused by these devices,

more research is needed before these strategies are implemented.

Apart from the technologies, the role of well-trained health providers is also an important issue. Healthcare providers trained for the communications may perform better in communicating with the patient, resulting in a better quality of care (Nilsen et al., 2014).

Oftentimes, patients with mechanical ventilation are unable to convey messages other than simple syllables or behavior. With this in mind, the importance of proper consultation to the welltrained nurses or Speech Language Pathologist are crucial.

The main limitation in providing the best communication method for the patient is the lack of recommendation and research in the field.

Despite the importance of communication strategies in order to improve patients' treatment outcome, this matter is often under-appreciated.

Our study shows that only one randomizedcontrolled trial is available in assessing the importance and effect of the available communication method. We suggest that proper trials which assess clear outcomes for the patients are needed in order for the new technologies to be implemented by the patients.

Conclusion Numerous communication alternatives, such as Electrolarynx, the Modified Tracheostomy Tube, eye-tracking devices or computer software (such as the Speak for Myself), for patients undergoing mechanical ventilation are presented in this study.

However, further studies assessing the benefits of these treatments are needed in order for these choices to be implemented in respective healthcare facilities.

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O’Connor, S. N., & Chapman, M. J. (2016).

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Speech, Language and Hearing, 19(4), 227– 237. https://doi.org/10.1080/2050571X.2016.1196 035 Rodriguez, C., & Rowe, M. (2010). Use of a speech-generating device for hospitalized postoperative patients with head and neck cancer experiencing speechlessness.

Oncology Nursing Forum, 37(2), 199–205. https://doi.org/10.1188/10.ONF.199-205 Rodriguez, C. S., Rowe, M., Koeppel, B., Thomas, L., Troche, M. S., & Paguio, G. (2012). Development of a communication intervention to assist hospitalized suddenly speechless patients. Technology and Health Care : Official Journal of the European Society for Engineering and Medicine, 20(6), 489–500. https://doi.org/10.3233/THC-2012-0695 Rodriguez, C. S., Rowe, M., Thomas, L., Shuster, J., Koeppel, B., & Cairns, P. (2016).

Enhancing the Communication of Suddenly Speechless Critical Care Patients. American Journal of Critical Care : An Official Publication, American Association of Critical-Care Nurses, 25(3), e40-7. https://doi.org/10.4037/ajcc2016217 Shimizu, K., Ogura, H., Irisawa, T., Nakagawa, Y., Kuwagata, Y., & Shimazu, T. (2013).

Communicating by electrolarynx with a blind tetraplegic spinal cord injury patient on mechanical ventilation in the ICU. Spinal Cord, 51(4), 341–342. https://doi.org/10.1038/sc.2012.170 Sirriyeh, R., Lawton, R., Gardner, P., & Armitage, G. (2012). Reviewing studies with diverse designs: the development and evaluation of a new tool. Journal of Evaluation in Clinical Practice, 18(4), 746–752. https://doi.org/10.1111/j.13652753.2011.01662.x Ten Hoorn, S., Elbers, P. W., Girbes, A. R., & Tuinman, P. R. (2016). Communicating with conscious and mechanically ventilated critically ill patients: a systematic review.

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547–548). https://doi.org/10.1007/s00134014-3591-2 Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., Hallaert, G., Van Daele, S., Buylaert, W., & Vogelaers, D. (2015). Communication in healthcare: a narrative review of the literature and practical recommendations. International Journal of Clinical Practice, 69(11), 1257– 1267. https://doi.org/10.1111/ijcp.12686 Vincent, J.-L., & Creteur, J. (2019). Critical care medicine in 2050: less invasive, more connected, and personalized. In Journal of thoracic disease (Vol. 11, Issue 1, pp. 335– 338). https://doi.org/10.21037/jtd.2018.11.66

KNOWLEDGE, ATTITUDE, AND PRACTICES TOWARD COVID-19:HOAX AMONG HIGH SCHOOL STUDENTS IN INDONESIA Teguh Islamy Putra, Aminah Karima Aridya, Stevens Wijaya

KNOWLEDGE, ATTITUDE, AND PRACTICES TOWARD COVID-19 : HOAX AMONG HIGH SCHOOL STUDENTS IN INDONESIA Author : Teguh Islamy Putra Aminah Karima Aridya, Stevens Wijaya ABSTRACT

COVID-19 is a disease caused by infection of SARS-COV2 virus which was first discovered in Wuhan, China at the end of December 2019, Declared a pandemic by WHO on Wednesday, 11 March 2020 until now. From then on, the government adopted a response that used elements of what other countries had successfully tried (including a sensible socio- economic relief package), but rejected a coherent, strictly enforced stay-at- home regime advocated by medical professionals. The result is that there are still many people who do not comply with health protocols such as not using masks when leaving the house, not using hand sanitizers and still gathering in crowded places which can actually increase the risk of rapidly spreading Covid-19. This raises questions about knowledge, attitudes, and practices (KAP) towards Covid19 in social media users, especially high school teenagers who like to use social media. This KAP crosssectional study aims to provide basic information about Covid-19 in order to avoid misunderstandings in the face of the Covid-19 Virus outbreak. A quantitative approach was used to achieve the objective of this descriptive study. The study instrument used in this study is an adaptation of the measures developed in a study of Chinese residents’ Knowledge, Attitude, and Practice (KAP) towards COVID-19 in China. The study results in good practice yet poor knowledge and attitudes.

Keywords : COVID-19, Knowledge, Attitudes, and Practices, Senior High Schoolers of Indonesia

Knowledge,Attitude, and Practices Toward COVID-19: Hoax AmongHigh School Studentsin Indonesia

Scientific Paper

TeguhIslamy Putra AminahKarima Aridya StevensWijaya

Faculty ofMedicine Universitas Hasanuddin

Introduction Covid - 19 is a disease caused by infection with the Sars - CoV - 2 virus which was first discovered in Wuhan, China at the end of December 2019. Declared a pandemic by WHO on Wednesday, 11 March 2020 Until now (October 2020), 39,801 have been obtained, 612 Confirmed cases included 1,110,908 patients who died worldwide ( WHO, 2020 ).

The first case in Indonesia itself was reported on 2 March 2020 at the RS. Sulianti Saroso, involving 2 positive confirmation patients for Covid - 19. The number of cases continues to increase to date (19 October 2020) in Indonesia 365,240 confirmed cases have been recorded with 12,617 patients dying. One of the efforts made by the Indonesian Government to prevent the transmission of the Corona virus is Semi-Lockdown. In principle, the implementation of the Semi-Lockdown limits nonessential activities outside the home and is implemented in various regions throughout Indonesia. Residents are only allowed to leave the house for very important things, such as shopping for basic necessities or health needs, factories and industries are also asked to close or lay off their employees. In addition, the Indonesian government also enforces the application of Health Protocols when outside the home, such as wearing a mask, using a hand sanitizer, maintaining distance and not gathering in crowded places.

From then on, the government adopted a response that used elements of what other countries had successfully tried (including a sensible socio- economic relief package), but rejected a coherent, strictly enforced stay- at- home regime advocated by medical professionals ( Meitzner et al, 2020 ). Without recourse to expert advice and recommendations, Indonesia and their government downplayed the emergence of COVID-19 in their territory there by hesitating the adoption of initial preventive measures which would have saved costs while protecting the citizenry from undue exposure to the virus ( Reuben et al, 2020 ). Especially for people who do not understand the medical world, especially about Covid-19 .

The result is that there are still many people who do not comply with health protocols such as not using masks when leaving the house, not using hand sanitizers and still gathering in crowded places which can actually increase the risk of rapidly spreading Covid-19, coupled with the spread of misinformation (Hoax) regarding Covid - 19 which was distributed to social media became a communication breakdown between the health system and the public. This raises questions about knowledge, attitudes, and practices (KAP) towards Covid-19 in social media users, especially high school teenagers who like to use social media.

This KAP study aims to provide basic information about Covid-19 in order to avoid misunderstandings in the face of the Covid-19 Virus outbreak ( Azlan et al, 2020 ). Assessing KAP related to COVID-19 among social media users will help provide better insights to overcome poor knowledge about the Covid-19 disease and increase efforts to prevent disease transmission and overcome

the spread of Hoax on social media as a form of Communication Breakdown between Systems Health and Society.

Methods Study Design A quantitative approach was used to achieve the objective of this study, and the type of study used was a descriptive study. In this study, a cross-sectional survey was utilised to gather the information regarding COVID-19 as it can be easily utilized in a large population (Jones et al, 2013). Data collection was performed using the Google Form platform, comprising a serial of questionnaires about the hoax and facts regarding the COVID-19.

Recruitment Procedure The cross-sectional survey was conducted between 17th to 19th October 2020, with the target sample size 100 respondents. Senior High School Students in Indonesia were eligible to participate in the survey. The social media platforms used in disseminating this survey are Whatsapp and Line.

Study Instrument The study instrument used in this study is an adaptation of the measures developed in a study of Chinese residents’ Knowledge, Attitude, and Practice (KAP) towards COVID-19 in China (Zhong et al, 2020). The questionnaire consisted of 4 main themes : 1) demographics, which surveyed participant’s socio-demographic information, 2) Knowledge about COVID-19, 3) Attitudes toward COVID-19, and 4) Practices relevant to COVID-19, with a total of 21 items.

To measure knowledge about COVID-19, 8 items included the participant trivial knowledge regarding the COVID-19 disease. Participants were given “True” or “False” response options to each of these items. To measure attitudes toward COVID-19, 4 items included the participants’ certainty or uncertainty that the pandemic would be successfully controlled. To measure practices, 5 items included whether the participants comply to the COVID-19 safety protocol or not (Azlan et al, 2020). Each of participants’

result reaching 80% of the proper answers would be considered Good, whereas each of participants’ result not reaching 80% of the proper answers would be considered Poor.

Result A total of 111 respondents completed this online survey. Majority of the study population were female (69.37%) and all of them were high school student. Among the respondents 77 (69.37%) chose social media, 30 (27.03%) chose television, 1 (0.9%) chose school, 1 (0.9%) chose medical journal, and 2 (1.8%) chose health authority as source of information regarding COVID-19. These students chose Twitter 27.02% (30), Facebook 29.73% (33), WhatsApp 72.07% (80), Line 16.22% (18), Instagram 76.58% (85), YouTube 49.55% (55), and TikTok 1.8% (2) as the social media platforms they use the most.

Gender Male Female Sourceof Information Social media Television Radio School Medical journal Newspaper Health authority

Most UsedSocial Media Twitter Facebook WhatsApp Line Instagram YouTube TikTok

34 77 n

total 77 30 0 1 1 0 2

30 33 80 18 85 55 2

111 30,63063 111 69,36937 % 111 69,36937 111 27,02703 111 0 111 0,900901 111 0,900901 111 0 111 1,801802

111 111 111 111 111 111 111

27,02703 29,72973 72,07207 16,21622 76,57658 49,54955 1,801802

Aspect

Question

TRUE

FALSE Total

%

COVID-19wasfirst identified in Wuhan, China, in December 2019,andis nowa pandemicaffectingmany countries globally, includingIndonesia.

Knowledge

Attitude

Practice

Inhalingsteamprevents COVID-19.

Neemleaves cure COVID-19.

COVID-19doesnotinfect patients with mental disorder.

Thermo gundamagesbrain cells.

Ginger and black pepper cure COVID-19.

Wearingmask causespleurisy.

Wearingmaskdecreases inhaled oxygenlevel upto 60%.

I often forward social mediamessages/postswithoutreadingthrough the whole article.

I often try to find references to the social mediamessages/posts.

I tend to trust every messages/postsfromthe social media.

Are you confident that Indonesia will be able to overcome COVID-19?

Doyou wear maskeverytime you leave house?

Doyou avoid crowded places?

Doyou openyour windowsor keepa healthy air circulationin yourhousefrequently?

Doyou washyour handswith soap andwater or with handsanitizer regularly?

Doyou often clean surfacesyou regularly touch(such asphone, doorhandles, etc)?

107 71 93 96 88 78 95 68 14 77 94 99 106 87 96 92 64

4 40 18 15 23 33 16 43 97 34 17 12 5 24 15 19 47

Good Poor Knowledge 50 61 Attitude 47 64 Practice 99 12 The current foundings showed that majority of the respondents stated social media as their source of knowledge (69,37%), followed by television (27.03%). Although 96.4% (107) agreed on COVID-19 status as a pandemic, 3.64% (4) did not have the correct knowledge. 13.51% (15) believed COVID-19 does not infect a person with mental disorder. Majority of respondents showed knowledge of samples of false information regarding of herbal remedies as cure and/or prevention against COVID-19, 16.22% for neem leaves and 29.73% for ginger and black pepper. 85.59% agreed wearing mask does not cause pleurisy. However, only 61.26% agreed on mask causing a decrease in inhaled oxygen level. This concludes 50 respondents have good knowledge regarding COVID-19 and 61 poor.

87.39% respondents showed a tendency to forward messages/posts before reading throughly, 69.36% finds references of them, and 84.68% trusts every of them. Over all, 89.19% believes that Indonesia can overcome the pandemic. This concludes 47 respondents have good attitude regarding COVID-19 and 64 poor. The survey also shows respondents willingness to wear mask 95.5%, avoid crowded places 78.38%, keep healthy air circulation 86.49%, keep hands hygiene 82.88%, and clean surfaces regularly touched 57.66%. This concludes 99 respondents had applied good practice regarding COVID-19 and 12 poor.

Discussion

111 111 111 111 111 111 111 111 111 111 111 111 111 111 111 111 111

96,3964 63,96396 83,78378 86,48649 79,27928 70,27027 85,58559 61,26126 12,61261 69,36937 84,68468 89,18919 95,4955 78,37838 86,48649 82,88288 57,65766

This study is the first epidemiological survey aimed at assessing the KAP (Knowledge, Attitude, and Practice) of individuals within Indonesia towards the COVID-19 Pandemic. With the novelty of COVID-19 with its pathological and epidemiological uncertainties, the study of the population levels of KAP becomes critical for efficient health planning, implementation and management of the public.

(Reuben et al, 2020) This survey was dominated by female (69,37%) respondents, Social medias (69,36%) and Televisions (27,02%) constitute the major sources of informations about COVID-19, and the most frequently used social medias were Instagram (76,57&) and Whatsapp (72,07%).

In the Knowledge aspect, most of the participants (96,39%) answered correctly on statement “COVID-19 was first identified in Wuhan, China in December 2019, and is now a pandemic affecting many countries globally, including Indonesia.”, while 61,2% of the participants answered wrong on statement “Wearing masks decreases inhaled Oxygen level up to 60%.”. In the Attitude aspect, most of the participants (89,19%) answered the question “Are you confident that Indonesia will be able to overcome COVID-19?” with the correct attitudes, while 30,63% of the participants answered the statement “I often try to find references to the social media messages/posts.” With the poor attitude. In the Practice aspect, most of the participants (95,49%) answered the question “Do you wear mask everytime you leave the house?” with good practices, whereas 42,34% of participants answered the question “Do you often clean surfaces you regularly touch (such as phone, door handles, etc)?” with poor practices.

While 57,65% of the participants display poor attitudes towards COVID-19 and 54,95% display poor knowledge about COVID-19, 89,18% of the survey participants display good practices relevant to COVID-19. Despite the poor knowledge and attitudes towards COVID-19, most of Senior High Schoolers of Indonesia seem to display high compliance to their school rules regarding the correct practices relevant to COVID-19.

Conclusion This study provides assessment of the KAP of high school student in Indonesia towards COVID19. The findings concludes a situation of concerning susceptibility of high school students in Indonesia of false information spreading through the social media, as well as their attitude regrading COVID-19.

Although the number of students who had good practice regarding COVID-19 were relatively high (89.19%), the number of student who had poor practice might be an alarming sign of false information effect on public health.

References : WHO. (2020, October 20). WHO Coronavirus Disease (COVID-19) Dashboard. Retrieved October 20, 2020, from https://covid19.who.int/ Azlan, A. A., Hamzah, M. R., Sern, T. J., Ayub, S. H., & Mohamad, E. (2020). Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PloS one, 15(5), e0233668. https://doi.org/10.1371/journal.pone.0233668 Reuben, R. C., Danladi, M., Saleh, D. A., & Ejembi, P. E. (2020). Knowledge, Attitudes and Practices Towards COVID-19: An Epidemiological Survey in North-Central Nigeria. Journal of community health, 1–14. Advance online publication. https://doi.org/10.1007/s10900-020-00881-1 Mietzner, M. (2020). Populist Anti-Scientism, Religious Polarisation, and Institutionalised Corruption: How Indonesia’s Democratic Decline Shaped Its COVID-19 Response. Journal of Current Southeast Asian Affairs, 39(2), 227–249. https://doi.org/10.1177/1868103420935561 Jones, T. L., Baxter, M. A., & Khanduja, V. (2013). A quick guide to survey research. Annals of the

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https://doi.org/10.1308/003588413X13511609956372 Zhong, B. L., Luo, W., Li, H. M., Zhang, Q. Q., Liu, X. G., Li, W. T., & Li, Y. (2020).

Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. International journal of biological sciences, 16(10), 1745–1752. https://doi.org/10.7150/ijbs.45221

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The Power of Celebrities’ Social Media Posts Nurul Izza Sanusi, Akhmad Zani Tasir, Alya Fatimah Darmawan, Karen Kurnia

The Power of Celebrities’ Social Media Posts Nurul Izza Sanusi, Akhmad Zani Tasir, Alya Fatimah Darmawan, Karen Kurnia Faculty of Medicine, Univeritas Hasanuddin Background Influencers or celebrities are seen as role-model by their fans and it is seen often that these fans would follow their behaviors. Neuroscience research has shown that celebrity endorsements activate brain regions involved in making positive associations, building trust and encoding memories. When the advices congruent with the fans’ self-conception, they will follow them. If not, the fans would go through cognitive dissonance that the fans would follow advices from the celebrities to decrease a psychological discomfort caused by different opinions (1). The reason for celebrities’ tendency to share unverified information is caused by self-promotion and entertainment (2). With the increasing number of social media activity during this pandemic (3), the fans would get more exposed to unverified information, including the behaviors of celebrities that might impact the people’s actions towards the health protocol of COVID-19.

Objectives We aim to educate people the importance of seeking the right information from a credible source to avoid wrong actions influenced by celebrities. Therefore we can stop the chain reaction of COVID-19 and reduce the mortality rate due to this disease.

Reference : 1.

Hoffman SJ, Tan C. Biological, psychological and social processes that explain celebrities’ influence on patients’ health-related behaviors. Arch Public Heal [Internet]. 2015 Jan 19 [cited 2020

Oct

19];73(1):1–11.

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https://link.springer.com/articles/10.1186/2049-3258-73-3 2.

Islam AKMN, Laato S, Talukder S, Sutinen E. Misinformation sharing and social media fatigue during COVID-19: An affordance and cognitive load perspective. Technol Forecast Soc Change [Internet].

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Keeping Our Services Stable and Reliable During the COVID-19 Outbreak - About Facebook [Internet].

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PRESCRIPTION IN COMMUNICATION Richard Pinarto, Trixie NathaniaZelig, Da’watul Khair, Alma Sutyono

PRESCRIPTION IN COMMUNICATION Richard Pinarto, Trixie Nathania Zelig, Da’watul Khair, Alma Sutyono Medical Faculty, Hasanuddin Univeristy ABSTRACT Introduction : Communication is an important aspect in society, spesifically in health services. Through effective communication, the good quality of healthcare will also be established. The problems in Indonesia are essentially caused by the distribution of health workers that are centralized on a certain region and also the lack number of health workers compared to the population, where the ratio of doctors and population in Indonesia in 2019 is 1:3.925 (BPS, 2020). The number is considered very low compared to WHO recommendation regarding the ideal ratio of doctors to patients in a country, which is 1:1000. These problems have made healthcare communication limited and ineffective. In facing the current COVID-19 pandemic, Indonesia’s government have already given full support in online doctor consultation as a novel innovation to healthcare communication (Kemenkes RI, 2020). The use of online doctor consultation services has helped health services to be more evenly distributed and made communication between doctor and patients more adequate. We believe this application will be more effective with E-medical record to provide additional information about patient’s disease history and treatment to the doctor and improves health services.

Objective : The aim is to introduce online health consultation with the adding of new feature in order to solve the problem of communication in health services as it may leads to the miscommunication between doctors and patients.

Keywords : Healthcare Communication, Online Consultation, E-Medical Record REFERENCES Badan Pusat Statistik (2020). Persebaran Dokter di Indonesia 2019. Jakarta, Indonesia: BPS. Kementrian Kesehatan Republik Indonesia (2020, April 21). Strategi Telemedicine Hadapi COVID-19.

Mora Claramita, A. U. (2011). Doctor–patient communication in a Southeast Asian setting: the conflict between ideal and reality. Advances in Health Sciences and Education, 69-80.

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COMMUNICATION IN HEALTH THROUGH MULTIDISCIPLINARY ASPECTS OF LIFE WITH HEALTHME! APPLICATION TO RAISE HEALTHY LIFE AWARENESS IN INDONESIA

Megan Janice Nawing, Tiara Resky Anugrah Mahmud, Venna Regita Cahyani, Vinson Evan Thenardy

COMMUNICATION IN HEALTH THROUGH MULTIDISCIPLINARY ASPECTS OF LIFE WITH HEALTHME! APPLICATION TO RAISE HEALTHY LIFE AWARENESS IN INDONESIA

Megan Janice Nawing, Tiara Resky Anugrah Mahmud, Venna Regita Cahyani, Vinson Evan Thenardy Faculty of Medicine, Hasanuddin University

Abstract. Surfing in cyberspace is something very often done for most people nowadays. However, it cannot be denied that a lot of hoaxes are circulating today, especially regarding health sector. People tend to assume the information should be immediately spread because it is useful for others and this makes hoax spreading faster. Even worse, people who have been attached by hoaxes will be very difficult to provide education about the real facts. It can be happened due to the low level of public knowledge about the health sector. This is why health literacy is an important component of effective health communication. In fact, the level of literacy of Indonesian people is still very low compared to other countries. Due to these problems we come up with a solution to invent a mobile application named HealthMe!. By providing innovations in the form of easy access to health information that has high validity and accuracy, this application has various features that package various health information into something interesting to learn, such as movies, songs, comics, podcasts, etc. All features are accessible by all users and we can also share the contents to the other social media too. Even though it seems fun, it will not eliminate the essence of the health information since all contents are checked and approved by the doctors. We hope this application can help the society to understand the real information related to the health sector.

Key Findings: Health Literacy, Health Communication, Mobile Application, Health Information

COMMUNICATION IN HEALTH THROUGH MULTIDISCIPLINARY ASPECTS OF LIFE WITH HEALTHME! APPLICATION TO RAISE HEALTHY LIFE AWARENESS IN INDONESIA

By: Megan Janice Nawing Tiara Resky Anugrah Mahmud Venna Regita Cahyani Vinson Evan Thenardy

AMSA UNIVERSITAS HASANUDDIN

INTRODUCTION Health communication is a multidisciplinary approach to inform and influence people to improve health outcomes by reaching different audiences and sharing health-related information whether by verbal or written communication approach (CDC, 2011; Schiavo, 2007). Health communication is focused on numerous disciplines including global health patterns, health education, health promotion, disease prevention efforts, quality of life, strategic marketing, also mass and speech communication skills (Leshner & Gardner, 2011; Rider, 2019; Schiavo, 2007).

Health communication is used in the health care industry to market to and educate the public by developing activities and interventions to improve health (RHIhub, 2018). Health communication is important to the health care system for copious reasons, including the following (Rimal & Lapinski, 2009; ODPHP, 2020): ●

Improves the health literacy of a population

●

Improves the quality of materials about health and wellness available to the public

●

Improves the quality of life especially the aspect of health and well-being

●

Increases the number of prevention to prevent illness and increase life expectancy

●

Changes social norms to be more health-focused

●

Increases the availability of hospitals and medical services

●

Empowers positive change or health improvement for individuals and groups

According to European Centre for Disease Prevention and Control (ECDC, 2017) there are six main areas modeling knowledge, developing practice, and ongoing international debate that contributes to more effective implementation of health communication, these are as followed: 1. Health Literacy, 2. Health Education, 3. Social Marketing, 4. Risk Communication, 5. Crisis Communication, and 6. Health Advocacy.

Health Literacy itself has been defined as the use of a wide range of skills such as cognitive and social skills which determine the motivation and ability of individuals to gain access to, obtain, process, understand, and effectively use health-related information in ways to make “well-informed” health decisions and which promote also maintain good health (ECDC, 2017; Institute of Medicine Committee on Health Literacy, 2004; NLM, 2016). Health Literacy aims to influence not only health education and individual behavior-oriented communication but it also addresses factors that determine health such as environment, political, and social factors. Many studies showed that health education and health literacy

correlates in a positive way, which leads to personal and social benefit (Auld et al., 2020; RHIhub, 2018; WHO, 2010; WHO, 2013).

The Shanghai Declaration of 2016 recognizes health literacy as one of the key health promotion pillars for achieving the Sustainable Development Goal (SDG) targets (WHO, 2016). A study by ChahardahCherik et al. (2018) showed that there was a significant role in health literacy toward health-promoting behaviors in diabetic patients.

According to the Joint Commission, there are three approaches to address effective communication in the health care setting, which are (Schyve, 2007): 1. Patient Health Literacy, 2. Cultural Understanding, and 3. Language Barriers.

Patient health literacy becomes one of the important points in establishing good communication between health workers and patients themselves. This relates to the tendency of patients to accept explanations from health workers. People who have been attached by hoaxes will be very difficult to provide education about the real facts and prefer to believe in hoaxes that have been neatly packaged so that they sound more reasonable (Bronstein et al., 2019). Although currently there are many media that facilitate access to literacy sources, in fact there are still many layers of society that have low literacy, especially those related to health aspects. According to Health Resources and Services Administration (HRSA, 2019) low health literacy is more prevalent among: ●

Older Adults,

●

Minority Populations,

●

People with low socioeconomic status, and

●

Medically underserved people.

On the other hand, according to a new study conducted by Central Connecticut State University in 2016, Indonesia is the second-least literate nation in the world in a list of 61 measurable countries, only higher than Botswana. This study actually looked at literacy and literate behavior characteristics in 200 countries, but only 61 countries made the list because the rest lacked relevant statistics. Although, it cannot be denied that Indonesia is in the second-lowest position and this indicates that our country is in a state of literacy emergency (Miller & McKenna, 2016).

In addition, according to a survey conducted by the Research Center for Education and Culture Policy, a research institute under the Ministry of Education and Culture of Indonesia (Kemendikbud), the Alibaca Index (reading literacy activity index) in South Sulawesi is relatively low, with a score of 38.82

from a perfect score of 100 (Solihin et al., 2019). Whereas, according to that survey done by a Indonesian Journalists Association (PWI), which was published on World Press Freedom Day 2017 held by UNESCO (1/5/2017), the most hoaxes in Indonesia are information about health. The hoax is propagated by people accidentally. They assume the information should be immediately spread because it is useful for other people. Also, the dynamics of new knowledge can catalyze the formulation of effective strategies in protecting society from the threat of hoax spread (Talwar et al., 2019). No wonder hoaxes in health sector are more easily spread nowadays and this also has a direct impact on the hindrance of effective communication in health care settings (Hopf et al., 2019).

OUTLINE PROBLEMS Low literacy rates are associated with poor health and high mortality rates. We can examine the relationship by looking at the reality of the condition of society where people who have a low level of literacy will be very at risk of experiencing obstacles in their prevention or treatment procedures. This is because the public will lack an understanding of the procedure, which can lead to ineffective communication between doctors and patients. Low health literacy will also make it difficult for people to face health problems because of insufficient skills and abilities related to the problems and complexity required (Kemendikbud, 2018).

The European Health Literacy Survey demonstrates a correlation between health literacy and personal health where limited health literacy also impacts on limited involvement in health promotion, early detection, activities that pose a risk to health, occupational accidents, management of chronic diseases, increasing numbers of patients with hospitalization, and increased morbidity and premature mortality (WHO, 2013).

Some health problems that also can arise due to low literacy levels, such as inadequate health services, inappropriate drug use, poor management and slow response to chronic conditions, low self-esteem and self-confidence, depletion of individual and community finances, and discrimination socially. This makes health literacy also one of the spearheads of health development in Indonesia (Hadisiwi & Suminar, 2016).

Related to efforts to increase health literacy, it is very dependent on all components of society, health officials or institutions, as well as the government through information dissemination tools and policies issued. Based on the study, one of the determinants of health literacy is information technology as a means of disseminating health information so that access to information technology greatly influences a person's health literacy (Putri, 2016).

Nutbeam (2000) argues that increasing people's access to health information and their capacity to use it effectively is very crucial in the problem of health literacy. Easy access to information and information media that is packaged in an attractive manner and in language that is easily understood by the layman, and comes from sources who are experts in their fields can also increase health literacy in the community.

As the conclusion, the level of literacy in Indonesia is still below average where literacy can affect the quality of individual health. By providing easy access to information, it is hoped that the level of literacy will increase so that the quality of Indonesian health will increase.

SOLUTION As we all know, there are four elements involved in basic communication: messages, senders, channels, and audiences (NCI, 2011). We come up with HealthMe!, a solution that combines visual and auditory channels to deliver this health information. Houts et al. (2006) through their studies concludes that using pictures linked to written or spoken text can gain more attention than the text by itself. This is in line with CDC (2019) statement that visuals might be a promising solution to communicate health information. People can understand the information easier, while visuals can be used to confirm the written and spoken health information.

All is combined through one mobile application: HealthMe! (coming from: Help Me, to help people).

HealthMe! is a multidisciplinary application that invites all health care workers, designers, animators, singers, dubbers, and medical students to contribute together. HealthMe! will provide a simple and fun way to understand many aspects of healthy life. Its features are wide-coverage, but can be simplified as D-SPACE. -

Detective: to detect any false information or misinformation spread out in the public. Detective will allow the users to directly type any keywords they want to find out, and this feature will show up the right information with a little bit of simple explanation and catchy look. This feature will be run by doctors, collaborating with medical students and designers.

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Songs: to meet the needs of music lovers who are curious about health information. The essence of Songs is to enrich the users health knowledge through meaningful and “eargasm” songs.

This feature will be run by singers, collaborating with doctors and medical students.

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Podcasts: to spread healthy lifestyles from the health care workers, therefore educate the users.

In Podcasts, the users can listen to the doctors’ and medical students’ experiences. This feature will be run by doctors, collaborating with dubbers and medical students.

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Animation Movies: to provide health information through an interactive story, served in a short movie. This feature brings up a superb way to figure out many aspects of health. Animation

Movies will speak up many sides about healthy life. This feature will be run by designers, animators, dubbers, collaborating with doctors and medical students.

-

Comics: to pack up many health aspects through serial stories. It is mainly made for kids and teens in plain language, without diminishing its medical significance. Its colorful story combined with valid health information made Comics are officially fun and highly recommended to read. This feature will be run by designers, collaborating with doctors and medical students.

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Extras: to offer many life hacks, DIY (Do It Yourself) things at home, and fun mnemonics about healthy life. This feature will be run by doctors and medical students, collaborating with designers.

Figure 1. The features of HealthMe!

All features are accessible by all users. The users can download Animation Movies to enjoy them in the offline mode. The users are suggested to sign up their information, such as email and username, so we may share our newest developments and latest contents. Also, our team allows the users to share the contents to the other social media, so other people who have not downloaded our application might feel the benefits too. All teams are certified by their organization. All contents are checked and approved by the doctors.

Due to its multidisciplinary workers, we need a wide-scale publication to promote this application to the public. Prior to achieving our goal in raising people's awareness of health literacy by HealthMe!, we highly require massive support from governments and health care workers to introduce this new application to everyone.

CONCLUSION Health literacy is an important component in the implementation of effective health communication. In fact, the level of literacy of Indonesian people is still very low compared to other countries where access to information using information technology is an important factor affecting the level of health literacy.

By providing innovations in the form of easy access to health information that has high validity and accuracy, this application has various features that package various health information into something interesting to learn, such as movies, songs, comics, podcasts. The different concepts of the presentation will not eliminate the essence of the health information provided as can be obtained from health journals, etc. This new solution can help in increasing Indonesian health literacy. Still, to ensure this solution runs well, it requires good collaboration from the government, application developers, doctors, and citizens.

RECOMMENDATION We believe that the government and especially every health institutions could be allocating more on Health Literacy by support the funding of the research of this application and create new policy, which requires fresh graduated doctors, public health graduates to sign up as volunteers and giving socialization of this application to the public society. Other than that, we also hope illustrator, producer, and every media workers especially health care workers in every clinical phase medical students, nurse, doctors, and specialist to contribute as volunteer in developing and carrying out this application. We concern that all hospitals in Indonesia to participate and cooperate on the development of this application. Not forgetting the public society as the user to actively use this application and giving advice on the feature available. At last, we hope all stakeholders that are involved can socialize this application to be well known in the society.

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