^1,3,5Poltekkes Kemenkes Bengkulu. Indonesia,

²Poltekkes Kemenkes Jakarta.III. Indonesia

²Poltekkes Kemenkes Jayapura. Indonesia

⁵Puskesmas Curup Timur, Indonesia,

⁶Puskesmas Cibalong.Pamempeuk Garut Kota Jawa Barat. Indonesia

Corresponding author Email: adjieroestamadjie@gmail.com                    

Article Publishing History

INTRODUCTION

Geographically, Indonesia is located between the Asian and Australian continents, the Pacific and Indian Oceans, and is crossed by the equator, giving it a tropical climate. The tropical climate influences factors such as rainfall, temperature, humidity, lighting, and wind, all of which support the development of biota, including disease vectors. In tropical climates, the development of disease vectors tends to increase, making Indonesia an endemic area for a number of infectious diseases. One of the most common diseases in Indonesia is Dengue Hemorrhagic Fever (DHF), which is caused by the bite of the Aedes aegypti mosquito infected with the dengue virus. The disease was first discovered in Surabaya in 1968, with 58 people infected and 24 of them dying. Since then, the disease has spread to various regions, and by 1980, all provinces in Indonesia had DHF [15].

Based on data obtained from the Central Statistics Agency (BPS) of Bengkulu Province, the dengue fever (DHF) case rate in Rejang Lebong Regency has fluctuated in recent years. In 2023, the DHF case rate per 100,000 population was recorded at 102.00. This figure represents a significant increase compared to 2022, which recorded only 36.20 cases per 100,000 population. Previously, in 2021, the DHF case rate in Rejang Lebong reached 127.00, the highest figure in the last three years. Meanwhile, in 2019, the DHF case rate in the area was 114.00. This fluctuation demonstrates the importance of consistent prevention and control efforts to reduce the DHF case rate in Rejang Lebong Regency. Based on the 2020 report from the Rejang Lebong District Health Office, it was recorded that out of 21 Community Health Centers in Rejang Lebong, especially in Curup, there were three Community Health Centers with the highest number of DHF cases. Perumnas Community Health Center (Puskesmas) was the leading source of dengue fever with 23 cases, followed by Curup Community Health Center (Puskesmas) with 21 cases, and Talang Rimbo Community Health Center (Puskesmas) with 21 cases [6].

The increase in dengue fever cases and the expansion of the affected area over time are due to several factors, including advances in transportation, increasing population density, a lack of public awareness of residential and environmental hygiene, and the spread of the Aedes aegypti mosquito, the primary vector of dengue fever, which has spread to almost every corner of the country. Furthermore, the presence of four types of dengue virus circulating throughout the year also contributes to the spread of the disease [8]. “National Population and Immunization (PSN) needs to be increased, especially during the rainy and transitional seasons, because increased rainfall can increase the breeding grounds for dengue- transmitting mosquitoes, thus often leading to outbreaks (KLB), especially during the rainy season.”

“Mosquito Nest Eradication (PSN) is a crucial effort to control dengue fever [1]. Health education is an educational activity aimed at disseminating health messages, strengthening beliefs, and increasing public knowledge, awareness, and understanding so that they are willing and able to make health-related changes. According to Effendy (2012), the goal of health education is to achieve positive behavioral changes in individuals, families, and communities in maintaining healthy behaviors and creating a healthy environment. Furthermore, education also aims to encourage active community participation in efforts to achieve optimal health through the development of healthy behaviors that encompass physical, mental, and social aspects. This is expected to reduce morbidity and mortality [7]

Based on research conducted by [13], the results of counseling and education provided to 66 households in Tunu Village showed that respondents’ knowledge was divided into two categories: good and poor. Data collected before (pre) and after (post) counseling showed an increase in the percentage of respondents with good knowledge (pre=40.2%; post=95.4%), good attitudes (pre=42.5%; post=78.2%), and good behavior (pre=46%; post=52.9%). The results of statistical tests on the knowledge and attitude variables showed a significant difference (p <0.05), while the behavior variable increased from 46% to 60.9%. This indicates that the counseling and education methods have succeeded in increasing knowledge and positive attitudes regarding malaria and mosquito larvae prevention. This increase in positive attitudes is expected to encourage the community to take early preventive measures against mosquito-borne malaria [13]. Based on this, the researcher is interested in determining: “The Influence of the Role of Health Workers and Health Cadres in Health Education on Changes in Student Behavior Regarding Dengue Fever Prevention.”

METHOD

This study used a pre-experimental design with a One Group Pretest and Posttest Design, which aimed to measure changes in the experimental group after treatment. The sample used in this study was 90 people selected purposively. The treatment provided was an integration of the 3M Plus movement, which consisted of draining bathtubs, covering water reservoirs, burying used items, and sprinkling abate powder in water reservoirs. Before the treatment was administered, an initial measurement (pretest) was conducted to determine the participants’ initial level of behavior regarding preventing vector-borne diseases such as mosquitoes. After the treatment was administered, a final measurement (posttest) was conducted to assess the behavioral changes that occurred in the study participants. The results of the pretest and posttest will be analyzed to determine the effectiveness of implementing the 3M Plus movement in increasing awareness and changing disease prevention behavior.

RESULTS

Before the health education program, a pretest was conducted to assess participants’ initial knowledge. This was followed by a presentation of material covering the definition of dengue fever, symptoms, treatment methods, and preventative measures. Following the presentation, a posttest was administered to assess changes in participants’ knowledge. The results of this community service activity are presented in the form of an Influence Index, which compares the average community knowledge score before and after the health education program regarding dengue prevention.

Table 1. Influence of dengue prevention efforts before and after health education.

	Pretest		Posttest
Prevention of dengue	n	%	n	%	P-Value
Good	14	15,6	82	91,1
Poorly	76	84,4	8	8,9	0,000
Total	90	100	90	100

Based on the data presented in the table, changes in dengue fever prevention behavior can be seen before and after the counseling. In the pre-test, only 15.6% of participants demonstrated good dengue fever prevention efforts, while 84.4% demonstrated poor prevention efforts. However, after the health counseling (post-test), a significant change occurred, with the number of participants demonstrating good dengue fever prevention efforts increasing sharply to 91.1%, while those demonstrating poor prevention efforts decreased to only 8.9%.

This change demonstrates the effectiveness of health counseling in increasing public knowledge and awareness of the importance of dengue fever prevention, particularly in implementing the 3M Plus movement. The statistical test results showed a p-value of 0.000, indicating a significant difference between the pre- and post-conference conditions. Since the p-value is less than 0.05, it can be concluded that health counseling had a significant impact on improving dengue fever prevention efforts in the community According to [1].

Health education is an integrated activity within every health effort, aimed at changing individual behavior for healthy living through communication, information, and education. This aligns with research, which states that health education provided to respondents can provide additional information and increase respondents’ confidence to behave better in maintaining their health, as also found in research by [11]. The results showed that respondents’ knowledge increased after receiving health education provided by the researcher, proving that health education can influence a person’s knowledge. This indicates a congruence between existing facts and theory.

DISCUSSION

Based on the results presented in Table 1, before receiving health education (pre-test), 14 people (15.6%) demonstrated good dengue fever prevention efforts. Factors influencing this included respondents’ education level and information received from various sources, such as social media, the internet, and family. Meanwhile, 76 people (84.4%) demonstrated poor dengue fever prevention efforts. This was due to respondents’ lack of knowledge about dengue fever prevention methods, due to never having received health education, and laziness, which hindered the adoption of healthy lifestyle behaviors.

After the health education (post-test), the results showed a significant improvement, with 82 (91.1%) respondents now demonstrating good dengue fever prevention efforts, compared to only 14 (15.6%) before the education. This improvement can be explained by respondents’ greater understanding of the material presented during the education and increased awareness of healthy living. Furthermore, easy- to-understand counseling materials and the use of appropriate methods also contributed to this change. However, 8 people (8.9%) still. Those whose dengue fever prevention efforts have been inadequate, due to a lack of understanding during counseling, limited understanding, and deeply ingrained beliefs and habits that make it difficult to change behavior. Poor residential conditions were also a limiting factor.

In the pre-test phase, data processing showed that not all respondents were able to answer questions about dengue fever prevention efforts correctly. This is understandable, as respondents had not received sufficient information about dengue fever prevention efforts prior to counseling. However, some respondents were still able to provide good answers, as evidenced by the relatively adequate average response rate. This indicates that respondents had received basic information about dengue fever prevention prior to counseling, both through social media and other sources. These analysis results align with research by [1].

The purpose of this study was to determine the effectiveness of marigold plant powder aroma as a mosquito repellent. The study was conducted in a room containing a mosquito net box with 140 mosquitoes. The results of the Chi-square analysis are as follows: P-value = 0.043 <α 0.05, indicating a statistically significant effectiveness between soaking marigold plant root powder in mosquito repellent, with an odds ratio of 4.12 times. P-value = 0.043 <α 0.05, indicating a statistica ly significant effectiveness between soaking marigold plant bark powder in mosquito repellent, with an odds ratio of 4.08 times. P-value = 0.043 <α 0.05, indicating a statistica ly significant effectiveness between soaking marigold flower powder in mosquito repellent, with an odds ratio of 4.06 times.

Students are advised to familiarize themselves with this method by placing soaked powdered roots, bark, and flowers indoors to repel mosquitoes. The results of this analysis align with [9] study, “The Effect of Counseling on Community Knowledge Levels and Aedes aegypti Mosquito Density in Bayah District, Banten Province.” The study showed an increase in community knowledge about Mosquito Nest Eradication (PSN) after the counseling session. However, this increase in knowledge was not accompanied by a decrease in the density and distribution of Aedes aegypti mosquitoes. This finding suggests that despite increased public knowledge, the application of this knowledge in practice has not been fully effective in reducing the spread of disease.

This aligns with Notoatmojo’s opinion, which states that the influence of knowledge on practice or role can be direct or through attitudes. Knowledge acquired by an individual is not always directly translated into concrete actions. To transform attitudes into concrete actions or practices, supporting factors or enabling conditions are needed, such as environmental support, resources, and stronger individual motivation. Therefore, although counseling can increase knowledge, other factors also need to be considered so that changes in attitudes can be translated into real behavioral changes in disease prevention practices.

The results of this study differ from the findings obtained in the study of Dwi Sutakresna and Made Marwati (2020) entitled “General Overview of the Level of Knowledge and Behavior of Heads of Households Regarding the Eradication of Dengue Fever Mosquito Nests (PSN DBD) in the Working Area of the South Kuta Community Health Center.” The results showed that 82 respondents (85.42%) had good behavior in preventing dengue fever by implementing 3M Plus. This finding is in line with the research of Tri Nurul [4] entitled “Factors Related to PSN Behavior (3M Plus) as an Effort to Prevent Dengue Fever in the Sendangmulyo Village Community.” The results revealed that 51 respondents (56.7%) had good behavior in preventing dengue fever. This difference in results is likely influenced by differences in research methodology, respondent characteristics, or differences in geographical and cultural contexts between research locations. Nevertheless, these two studies have similarities in the implementation of the 3M Plus movement as a dengue fever prevention strategy that has a positive impact on changing community behavior towards health.

One factor that can support increased public knowledge is the availability of effective health education. Health education is delivered through various methods, such as counseling, training, and providing technical assistance as needed by the community. Furthermore, the availability of adequate health facilities for individuals, families, and communities is also a crucial factor in supporting increased health knowledge.

Adequate facilities can facilitate public access to the necessary health information and services. Furthermore, the attitudes and behaviors of community leaders and health workers play a crucial role in increasing public knowledge. Health education focused on religious leaders, community leaders, and health workers will be more effective because they are seen as role models in the community. The positive attitudes and behaviors demonstrated by community leaders and health workers can serve as a guide for the community to adopt healthy behaviors in their daily lives. With good examples from community leaders and health workers, the community is more motivated to change their attitudes and behaviors towards a healthy lifestyle.

The researchers’ assumptions indicate that the majority of the community has demonstrated good behavior in implementing dengue fever prevention through the 3M Plus in their daily lives. This This is in accordance with the Stimulus-Organism (SOR) theory, which states that behavioral changes are influenced by the quality of the stimulus interacting with the organism. To reduce the incidence of dengue fever, active community participation is needed to support the implementation of government programs, as stipulated in Circular Letter Number PM.01.11/Menkes/591/2016 concerning the Implementation of Mosquito Nest Eradication (PSN) 3M Plus with the One House One Mosquito Larvae Movement.

Monitoring mosquito larvae and implementing the PSN 3M Plus should be carried out routinely by every family, at least once a week. Unmonitored standing water can become a breeding ground for Aedes aegypti mosquitoes, which can lay eggs and spread disease. Therefore, the participation of the entire community in the PSN DHF program is crucial to reducing the risk of transmission of this disease. With active community involvement in prevention efforts, the spread of dengue fever can be significantly minimized, which in turn will contribute to a decrease in the incidence of the disease.

CONCLUSION

Based on the research results, it can be concluded that health education plays a significant role in improving public understanding and behavior regarding dengue fever (DHF) prevention in remote areas. Before the education, only 15.6% of respondents reported good dengue fever prevention practices, while after the education, this figure increased dramatically to 91.1%. Statistical tests showed a significant difference between before and after counseling, with a p-value of 0.000, indicating the effectiveness of the intervention. Health education, particularly through the 3M Plus program,

(drain, cover, recycle, and sprinkle abate) approach, has been shown to increase public awareness of dengue prevention measures. However, challenges remain in translating increased knowledge into long-term behavioral changes, requiring ongoing environmental and policy support. Therefore, collaboration between the community, health workers, and policymakers is needed to strengthen the overall dengue prevention strategy.

REFERENCES

1. Aji Rustam Rochmat, et al. (2024): “Effectiveness of the Aroma of Marigold Plant Parts on the Power of Mosquito Repellency.” Power System Technology Journal. Scopus Q.1. SJR 0.98. Year 2023. ISSN 1000-3673. Paper ID: PST-0993. Vol. 48, Issue 2, Pages: 1-12. Published: July 1, http://repository.poltekkesbengkulu.ac.id/id/eprint/3218.
2. Aji Rustam Rochmat, et al. (2024): “The Role of Health Workers and the Community in the Effectiveness of Marigold Plants Against Mosquito Repellency (Preventive Collaboration in Handling Dengue Fever).” ISBN: 978-623-125-519-8. Publisher: Get Press Indonesia, IKAPI Member No. 033/SBA/2022, Air Pacah, Koto Tangah District, Padang, West
3. Arikuntono (2010): “Nursing ” Jakarta. Azizah, T. N., Shaluhiyah, Z., & Syamsulhuda, B. M. (2017): “Several Factors Related to PSN Behavior (3M Plus) as an Effort to Prevent DHF in the Community of Sendangmulyo Village, ” Journal of Public Health (Undip), 5(3), 645-652.
4. Dinkes Province Bengkulu (2019): “Health Profile of Bengkulu Provincial Health Office.” Bengkulu
5. Dinkes Rejang Lebong (2020): “Report on Data from Rejang Lebong Health “
6. Fabiana, F. (2019): “Scoring of the poses was improved by post-processing with physics- based implicit solvent MM-GBSA calculations.” Pages 8–31.
7. Genis, G. (2016): “What Your Doctor Does Not Tell You About Dengue Fever.” Jakarta: Mizan Publika.
8. Kurniawan et al. (2010): “The Effect of Counseling on the Level of Community Knowledge and Aedes Aegypti Density in Bayah District, Banten Province.” Makara, Health, Vol 14, No 2, P 81-85.
9. Notoatmodjo, (2010): “Health Behavior Science.” Jakarta: Rineka Cipta.
10. Reni Ranteallo et al. (2021): “The Effect of Health Counseling on Efforts to Prevent Dengue Hemorrhagic Fever (DHF) in Dusun Tengah Lembang Sa’Dan Andulan District Sa’Dan North Toraja Regency in ” Scientific Journal of Promotive Health, 6(1), 25– https://doi.org/10.56437/jikp.v6i1.54.
11. Sutakresna et al. (2020): “Description of Knowledge and Behavior of Family Heads About Eradication of Mosquito Nests in the Working Area of Kuta Selatan Health Center.” Journal of Environmental Health (JKL), 10(1).
12. Takaeb & Sabat (2023): “Community Counseling Related to Malaria and Education on Types of Mosquito Larvae Found in Residential Areas in Tunua Village, North Mollo District.” SABAJAYA Journal of Community  Service, 1(2), 11–14. https://doi.org/10.59561/sabajaya.v1i2.12.
13. Yosvara & Atzmardina (2020): “Description of Knowledge and Attitudes Towards Dengue Fever Prevention Behaviors in Cikole Community in 2019.” Tarumanagara Medical Journal, 2(1), 90–97. https://doi.org/10.24912/tmj.v2i2.7843.
14. Yuningsih, R. (2019): “Policies for Addressing Outbreaks of Dengue Hemorrhagic Fever in Tangerang ”   Aspirasi:   Journal  of  Social  Issues,  9(2), 260–273. https://doi.org/10.46807/aspirasi.v9i2.1104.