{"id":72018,"date":"2023-03-20T08:37:05","date_gmt":"2023-03-20T00:37:05","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&p=72018"},"modified":"2023-07-04T09:08:38","modified_gmt":"2023-07-04T01:08:38","slug":"increasing-the-value-of-community-based-education-through-interprofessional-education","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/increasing-the-value-of-community-based-education-through-interprofessional-education\/","title":{"rendered":"Increasing the value of Community-Based Education through Interprofessional Education"},"content":{"rendered":"<p>Submitted: 11 February 2022<br \/>\r\nAccepted: 21 July 2022<br \/>\r\nPublished online: 4 April, TAPS 2023, 8(2), 4-13<br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2023-8-2\/OA2755\">https:\/\/doi.org\/10.29060\/TAPS.2023-8-2\/OA2755<\/a><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Tri Nur Kristina<sup>1<\/sup>, Fatikhu Yatuni Asmara<sup>2<\/sup>, Sudaryanto Sudaryanto<sup>1<\/sup>, Nuryanto Nuryanto<sup>3<\/sup> & Saekhol Bakri<sup>1<\/sup><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><span lang=\"EN-GB\">Department of Medicine, Faculty of Medicine, Universitas Diponegoro, Indonesia; <sup>2<\/sup>Department of Nursing, Faculty of Medicine, Universitas Diponegoro, Indonesia; <sup>3<\/sup>Department of Nutrition, Faculty of Medicine, Universitas Diponegoro, Indonesia<\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Introduction:<\/span><\/b><span lang=\"EN-GB\"> <\/span><span lang=\"EN-ID\">This study aimed to examine the usefulness of Community Based-Education (CBE) and Interprofessional Education (IPE) to community health outcomes.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-ID\">Methods:<\/span><\/b><span lang=\"EN-ID\">\u00a0The design was a mixed-method study. Each small group worked together to identify family health problems, implement interventions, and evaluate the results. The Readiness for Interprofessional Learning Scale (RIPLS) questionnaire was applied to compare students’ perceptions before and after the implementation. In addition, qualitative data were acquired from students’ comments on the questionnaire, interviews with community representatives, and FGDs with instructors at the end of the program.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-ID\">Results:<\/span><\/b><span lang=\"EN-ID\">\u00a0Three hundred and sixty-seven out of 465 students returned the completed paired questionnaire (78.9 % response rate). Paired t-test showed that student perception of responsibility slightly increased, whereas teamwork and collaboration, negative and positive professional identity decreased somewhat. However, most pre-post students’ responses already trended to the positive side (scales 4 and 5). Moreover, the Chi-square test showed that pre-post students’ confidence levels significantly increased. Most small groups of students successfully empowered the community to solve health problems. Students, instructors, and representatives of community members appreciated the program. However, several students felt their instructors were not motivated to mentor their tasks, and sometimes they had difficulty conducting home visits together.\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-ID\">Conclusion:<\/span><\/b><span lang=\"EN-ID\">\u00a0This study showed that the combination of CBE-IPE contributes to more favourable community health outcomes. However, it was challenging in several aspects of preparation, including highly motivated instructors. Nevertheless, pre and post-implementation students’ attitudes are still positive.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">Interprofessional Education (IPE), Community Based Education (CBE), Health Profession Students, Readiness<\/span><\/i><\/p>\r\n<div>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">I. <\/span><span lang=\"EN-GB\">INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Community-based education (CBE) programs for medical and other health professionals expose students to community health problems, in which they will work in the future as health professionals. However, the CBE program is usually implemented within a single discipline, whereas community health problems must be solved collaboratively among a health care team (Housley et al., 2018). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Interprofessional Education (IPE) has been identified as a valuable method of learning experiences to increase the collaboration and communication of health professionals in healthcare settings. Several studies have reported positive student perceptions of IPE, including improved patient and community outcomes (Dynes et al., 2013). For example, the Leicester Model of IPE demonstrated that students and healthcare professionals gain valuable insights into the balance task of patient-related issues and offer clarity about the effectiveness of collaborative opportunities in addressing patients’ needs (Lennox & Anderson, 2012). Carr (2015) also reported that after the IPE experience, students perceived strong confidence in communication with other professions, increased knowledge of the importance of teamwork and collaboration, learning professional roles, respecting other professional points of view, and improved communication skills.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The goal of undergraduate education for students in the health professions is mainly to produce graduates who can solve community health problems and increase community health, particularly in primary health care. Moreover, community health problems should be solved collaboratively. Thus, Community Based Education (CBE) combined with IPE is needed to be implemented in health professions schools. Several studies have implemented IPE in the community and positively affected students. For example, a study in the Philippines showed the usefulness of the IPE in the community, such as: learning about collaboration, appreciation of roles, holistic care, service to the community, and unique learning experience (Opina-Tan, 2013). A qualitative study in Australia also concluded that students who were voluntarily involved in an IPE program appreciate the opportunity to have direct practice experience in a community context and see this as a valuable way of engaging in interprofessional learning (Stewart et al., 2015). Furthermore, Wagner et al. (2011) stated that IPE in the community improved teamwork. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">However, the IPE implementation in community-setting in Indonesia is not yet promising. Lestari et al. (2020) reported that communication and mutual support were problems faced by students. Furthermore, Randita et al. (2019) also stated that collaborative patient-centred competence has a moderate effect when IPE is implemented in the community setting. Therefore, IPE in Indonesia needs further exploration, especially when it is implemented in the community setting with a large number of students who are not volunteers but are obliged to be involved in such programs. In addition, it is anticipated that a learning model combining CBE and IPE will have additional benefits in supporting community health. Thus, the research question of this study was, is the combination of CBE-IPE valuable on community health outcomes, and what are the students’ attitudes and perceptions towards the new program?<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">II. <\/span><span lang=\"EN-GB\">METHODS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">A. <\/span><\/i><i><span lang=\"EN-GB\">The Combination CBE-IPE Model<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Before implementation, we matched the curricula of three health professions study programs (Medicine, Nursing, and Nutrition) at the Faculty of Medicine Universitas Diponegoro (a government medical school in Semarang, Indonesia). Based on the acquired competencies and timing possibility, we agreed that the new CBE-IPE program should be implemented for students in the 6<sup>th<\/sup> semester. In the 6<sup>th<\/sup> semester, all 465 health professions students (212 medical students, 127 nursing students, and 126 nutrition students) participated in this program during one semester.\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Before implementation, we discussed with the head of the district health office and the director of the community health centre (CHC) to receive suggestions related to this program, especially in conjunction with the population health situation. As a result, we agreed that students should be assigned to families with pregnant women to support the local government health program in reducing maternal mortality. Thirty-six cadres (voluntary community members) were requested to participate in the project by the director of the CHC and agreed to help them in the program implementation. All cadres had been trained to conduct simple health promotion by the CHC.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">A total of 465 health professions students were divided into 126 small groups consisting of 1-2 medical and nursing students and one nutrition student. One small group was attached to one family with a pregnant woman. To have experiences with a continuum of care, small groups of students added one other family if the first family had no children or elderly. Students had to work together to measure the health status of all family members, identify health problems, and propose a solution for identified health problems in discussions with their instructors. Based on those discussions, the students worked collaboratively with the cadres to implement collaborative interventions and eventually evaluated the result of their interventions. During this implementation, groups of students presented their work three times in seminars attended by all instructors and coordinators from three departments. The head of CHC received final reports for follow-up.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-ID\">B. <\/span><\/i><i><span lang=\"EN-ID\">Study Design and Subjects<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">The design of this study was a mixed-method study to combine quantitative and qualitative data, in which the qualitative data was used to enrich the quantitative ones. Quantitative data was acquired by asking all students (465 health professions students) to fill out questionnaires before and after implementing the CBE-IPE program. We used the Readiness for Interprofessional Learning Scale (RIPLS) to evaluate students’ perceptions. This questionnaire has been widely used to collect students’ attitudes and perceptions to measure the readiness of healthcare professional students to undertake shared learning activities (Hertweck et al., 2012; Parsell & Bligh, 1999). Negative professional identity items represented negative statements regarding the value of working with other healthcare students. Therefore, this study reversed scored items so that high scores indicated IPE readiness (McFadyen et al., 2006). We used RIPLS in the Indonesian language version, which was developed by Tyastuti et al. (2014). It used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA accounted for 59.9% of the total variance, while the alpha coefficient of CFA was > 0.7. Furthermore, construct validity was acceptable goodness of fit. Thus, the RIPLS in the Indonesian language version is a valid tool to assess students’ attitudes toward IPE.\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">The qualitative data were gained by collecting student comments in the questionnaire by asking: \u201cPlease write your words regarding this new program.\u201d Moreover, TNK conducted interviews one by one with representatives of community members: two housewives and three cadres. At the end of the program, we conducted a workshop, including two times FGD conducted by TNK, FYA, and SB with 16 instructor\u2019s representatives. Verbatim of all qualitative data was completed by TNK. The result of students’ intervention for patients and families was identified from students’ reports.\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-ID\">C. <\/span><\/i><i><span lang=\"EN-ID\">Data Analyses<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">We described the student\u2019s characteristics and the result of student intervention on community outcomes. Paired-sample t-tests were used to compare the pre-post students\u2019 responses to RIPLS. In addition, students\u2019 perceptions related to self-confidence before and after the implementation were compared using chi-square. SPSS v22 was used to analyse the quantitative data. The students\u2019 comments and interviews with community member representatives and instructors were analysed using content analysis according to Braun and Clarke (2006). First, keywords were identified as codes, and we used a matrix consisted three columns, namely keywords<\/span><span lang=\"EN-ID\">, categories, and themes. TNK and FYA conducted qualitative data analysis.\u00a0 Different coding was discussed to reach a consensus.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-ID\">D. <\/span><\/i><i><span lang=\"EN-ID\">Ethical Consideration<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">We verbally explained this study to all participants before collecting the data. Especially for students, we guaranteed that their perceptions would not affect their scores. Then, we asked for participants\u2019 agreement to join this study by signing the informed consent. The author would confidentially keep their identity.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">III. <\/span><span lang=\"EN-GB\">RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Three hundred and sixty-seven out of 465 students returned the completed paired questionnaire (78.9 % response rate). Table 1 shows the subject\u2019s characteristics of this study.<\/span><\/p>\r\n<\/div>\r\n<div>\r\n<div align=\"center\">\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" style=\"border-style: solid; width: 85.7935%;\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.05536%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">No<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 43.5127%;\">\r\n<p><span lang=\"EN-ID\">Subject\u2019s characteristics<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Categories<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">Quantity<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">Percentage<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"6\" valign=\"top\" style=\"width: 6.05536%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">1.<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"4\" valign=\"top\" style=\"width: 135.079%;\">\r\n<p><span lang=\"EN-ID\">Students (n= 367)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"3\" valign=\"top\" style=\"width: 43.5127%;\">\r\n<p><span lang=\"EN-ID\">The study program <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Medicine<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">167<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">45.4<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Nursing<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">100<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">27.3<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Nutrition<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">100<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">27.3<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 43.5127%;\">\r\n<p><span lang=\"EN-ID\">Gender<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Male<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">73<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">20<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Female<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">294<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">80<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"8\" valign=\"top\" style=\"width: 6.05536%;\">\r\n<p><span lang=\"EN-ID\">2.<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"4\" valign=\"top\" style=\"width: 135.079%;\">\r\n<p><span lang=\"EN-GB\">Instructors (n: 16)<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"3\" valign=\"top\" style=\"width: 43.5127%;\">\r\n<p><span lang=\"EN-ID\">The study program <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Medicine<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">6<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">38<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Nursing<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">5<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">31<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Nutrition<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">5<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">31<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 43.5127%;\">\r\n<p><span lang=\"EN-ID\">Gender<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Male<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">4<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">25<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Female<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">12<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">75<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 43.5127%;\">\r\n<p><span lang=\"EN-ID\">Age<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">31-40<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">6<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">37<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">41-50<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">10<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">63<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"5\" valign=\"top\" style=\"width: 6.05536%;\">\r\n<p><span lang=\"EN-ID\">3<\/span><\/p>\r\n<\/td>\r\n<td colspan=\"4\" valign=\"top\" style=\"width: 135.079%;\">\r\n<p><span lang=\"EN-GB\">Representative of community members<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 43.5127%;\">\r\n<p><span lang=\"EN-ID\">Age<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">30-40<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">3<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">60<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">41-50<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">2<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">40<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" valign=\"top\" style=\"width: 43.5127%;\">\r\n<p><span lang=\"EN-ID\">Gender<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Male<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 19.2882%;\">\r\n<p><span lang=\"EN-ID\">Female <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 16.5491%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">5<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 55.7291%;\">\r\n<p align=\"center\"><span lang=\"EN-ID\">100<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<p align=\"center\"><span lang=\"EN-US\">Table 1. Characteristics of study subjects<\/span><\/p>\r\n<\/div>\r\n<div>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-ID\">A. <\/span><\/i><i><span lang=\"EN-ID\">The Result of Students\u2019 Intervention in the Community Outcomes<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Various health problems were identified and successfully managed by the students in collaboration with cadres (Table 2 and 3). Students also recognised that most families with low social-economic status and little education did not have health insurance. The head of the CHC agreed to follow up on some parts of the identified health problems, such as visiting pregnant women with high risk to ensure that they will deliver in the hospital, giving intervention for malnutrition toddlers, and vitalizing the post-health for the elderly.<\/span>\u00a0<\/p>\r\n<\/div>\r\n<div>\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\" style=\"width: 84.725%;\" class=\"aligncenter\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 7.69231%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">No<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 31.6054%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">Problems identified<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.6087%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">Students\u2019 interventions<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 64.1358%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">Results<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 7.69231%;\">\r\n<p><span lang=\"EN-GB\">1<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 31.6054%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">One pregnant woman with an abortion<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.6087%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Students and cadre provided education and accompanied the mother to the hospital. <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 64.1358%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">a.\u00a0\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-GB\">The mother should be curettage by the doctor in the hospital.<\/span><\/p>\r\n<p><span lang=\"EN-GB\">b.\u00a0\u00a0\u00a0 <\/span><span lang=\"EN-GB\">The mother healthy and agrees to postpone the next pregnancy.<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 7.69231%;\">\r\n<p><span lang=\"EN-GB\">2<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 31.6054%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Only 20% of pregnant women without risk factors who follow gymnastic program in CHC<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.6087%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Motivation to follow gymnastic for pregnant women<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 64.1358%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Moderate-high compliance <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 7.69231%;\">\r\n<p><span lang=\"EN-GB\">3<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 31.6054%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">About 40% of pregnant women have low knowledge about monitoring of pregnancy and low compliance with routine ANC<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.6087%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Direct education and gave motivation<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 64.1358%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Increasing knowledge and compliance for ANC<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 7.69231%;\">\r\n<p><span lang=\"EN-GB\">4<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 31.6054%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">25.4% of pregnant women with risk factors according to the standard of WHO and 0.04% with high risk<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.6087%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Motivation to routinely ANC and monitoring<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 64.1358%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">High compliance<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 7.69231%;\">\r\n<p><span lang=\"EN-GB\">5<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 31.6054%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">42.1% of pregnant women do not have health insurance <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.6087%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Education to apply government health insurance<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 64.1358%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">25% have insured <\/span><\/p>\r\n<p><span lang=\"EN-GB\">key person agrees to follow up<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 7.69231%;\">\r\n<p><span lang=\"EN-GB\">6<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 31.6054%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Social and cultural problem (do not want to eat fish)<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.6087%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Direct education <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 64.1358%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Moderate-high compliance<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 7.69231%;\">\r\n<p><span lang=\"EN-GB\">7<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 31.6054%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">83.3% of pregnant women not enough nutrition in their daily diet (2 days recall) <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.6087%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Gave leaflet and an example of healthy food<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 64.1358%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Moderate-high compliance<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 7.69231%;\">\r\n<p><span lang=\"EN-GB\">8<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 31.6054%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">20% of pregnant women with anemia)<\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 32.6087%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Gave Fe from CHC or midwives. <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 64.1358%; text-align: left;\">\r\n<p><span lang=\"EN-GB\">Low compliance (reason: not good taste and felt nausea)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 2. Students\u2019 work-related pregnant women in the community<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\" style=\"width: 84.0168%; border-style: solid;\" class=\" aligncenter\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">No<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Problems identified<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">Students\u2019 interventions<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">Results<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"4\" valign=\"top\" style=\"width: 135.423%;\">\r\n<p><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Baby and Toddlers<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">1<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">10% with malnutrition <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Education to mother and giving an example of healthy food<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Head of CHC followed up based on student\u2019s report<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">2<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Acute Respiratory Infection<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Education and Suggested to CHC <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Cured<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">3<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Diarrhoea<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Education and Suggested to CHC <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Cured<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">4<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Motoric low development <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Education and Suggested to CHC <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Still to be followed up<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">5<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Difficult to eat, low knowledge of mother about healthy food<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Education to mother<\/span><\/p>\r\n<p><span lang=\"EN-GB\">and give an example of healthy food<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Increasing knowledge<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">6<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">One child with hydrocephalus<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Motivation to go to the hospital and finding the agency of hydrocephalus<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Has been tackled by the agency of hydrocephalus <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"4\" valign=\"top\" style=\"width: 135.423%;\">\r\n<p><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Puberty<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">1<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Low knowledge about reproductive health<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Direct education<\/span><\/p>\r\n<\/td>\r\n<td rowspan=\"3\" valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Increasing knowledge and Head of CHC agree to follow up <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">2<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Smoking habit & Narcotic consumption<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Direct education<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">3<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Anemia among girl<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Direct education<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"4\" valign=\"top\" style=\"width: 135.423%;\">\r\n<p><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Adult<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">1<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Low knowledge of occupational accident<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Direct education<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Increasing knowledge<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">2<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Low knowledge about family planning<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Direct education<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Increasing knowledge<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td colspan=\"4\" valign=\"top\" style=\"width: 135.423%;\">\r\n<p><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Elderly<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">1<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Hypertension, Knee osteoarthritis, DM type II, Low Back Pain, Stroke, Low quality of life due to osteoarthritis and LBP<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Education and<\/span><\/p>\r\n<p><span lang=\"EN-GB\">Suggestion to routinely to CHC<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Have been followed up by CHC <\/span><\/p>\r\n<p><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 6.02007%;\">\r\n<p><span lang=\"EN-GB\">2<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 29.7659%;\">\r\n<p><span lang=\"EN-GB\">Only 15% routinely come to the integrative post health for elderly<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 37.6254%;\">\r\n<p><span lang=\"EN-GB\">Education and <\/span><\/p>\r\n<p><span lang=\"EN-GB\">Motivation<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 62.0118%;\">\r\n<p><span lang=\"EN-GB\">Low compliance<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 3. Students\u2019 work with other family members<\/span><\/p>\r\n<\/div>\r\n<div>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">B. <\/span><\/i><i><span lang=\"EN-GB\">Pre-post Comparison of Students\u2019 Perceptions<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Students\u2019 perceptions using RIPLS (5-point Likert scale) from all study programs showed a slight decrease in team collaboration, professional identity, and the cumulative sub-scale. Only student perception of responsibility slightly increased (Table 4). However, most pre-post students\u2019 responses to the RIPLS questionnaire already trended to the positive side (scales 4 and 5). Comparison of pre-post students\u2019 self-assessment of their confidence level significantly increased (Table 5).<\/span><\/p>\r\n<\/div>\r\n<div>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"border-style: solid; width: 86.2811%;\" class=\" aligncenter\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 9.40989%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">No<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 35.0877%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Subscale<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Pre<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Mean<\/span><\/b><span lang=\"EN-GB\"> \u00b1<\/span><b><span lang=\"EN-GB\"> SD<\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Post<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-GB\">Mean<\/span><\/b><span lang=\"EN-GB\"> \u00b1<\/span><b><span lang=\"EN-GB\"> SD<i><\/i><\/span><\/b><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 50.7669%;\">\r\n<p align=\"center\"><b><i><span lang=\"EN-GB\">P<\/span><\/i><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 9.40989%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">1<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 35.0877%;\">\r\n<p><span lang=\"EN-GB\">Teamwork & Collaboration<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">38.96 <\/span><span lang=\"EN-GB\">\u00b1 3.2<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">36.93 <\/span><span lang=\"EN-GB\">\u00b1 4.0<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 50.7669%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">< 0.001*<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 9.40989%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">2<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 35.0877%;\">\r\n<p><span lang=\"EN-GB\">Negative professional identity<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">6.01 <\/span><span lang=\"EN-GB\">\u00b1 2.4<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">5.29 <\/span><span lang=\"EN-GB\">\u00b1 1.9<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 50.7669%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">< 0.001*<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 9.40989%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">3<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 35.0877%;\">\r\n<p><span lang=\"EN-GB\">Positive Professional identity<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">20.91 <\/span><span lang=\"EN-GB\">\u00b1 1.9<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">20.23 <\/span><span lang=\"EN-GB\">\u00b1 2.5<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 50.7669%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">< 0.001*<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 9.40989%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">4<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 35.0877%;\">\r\n<p><span lang=\"EN-GB\">Role of responsibility<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">5.38 <\/span><span lang=\"EN-GB\">\u00b1 1.3<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">5.56 <\/span><span lang=\"EN-GB\">\u00b1 1.5<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 50.7669%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">0.07<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 9.40989%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">5<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 35.0877%;\">\r\n<p><span lang=\"EN-GB\">Total subscale<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">70.57 <\/span><span lang=\"EN-GB\">\u00b1 5.0<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.9362%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">68.74 <\/span><span lang=\"EN-GB\">\u00b1 5.9<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 50.7669%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">< 0.001*<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\" style=\"text-align: center;\"><span lang=\"EN-GB\">\u00a0\u00a0\u00a0 Table 4. Comparison of all students\u2019 perception using RIPLS pre and post implementation (n: 367)<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">*Significance (p < 0.05) with paired t test<\/span><\/p>\r\n<p style=\"text-align: center;\"><\/p>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\" style=\"border-style: solid; width: 87.903%;\" class=\" aligncenter\">\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 13.0952%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">No<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 30.102%;\">\r\n<p><span lang=\"EN-GB\">Level of Confidence<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.3878%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">Pre<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 20.5782%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">Post<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 58.4876%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">Sig<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 13.0952%; text-align: center;\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 12pt;\">1<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 30.102%;\">\r\n<p><span lang=\"EN-GB\">Not so confident<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.3878%;\">\r\n<p><span lang=\"EN-GB\">\u00a0 69 (<\/span><span lang=\"EN-GB\">18.8%)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 20.5782%;\">\r\n<p><span lang=\"EN-GB\">\u00a0\u00a0\u00a0 3 (<\/span><span lang=\"EN-GB\">0.8%)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td rowspan=\"3\" valign=\"top\" style=\"width: 58.4876%;\">\r\n<p align=\"center\"><span lang=\"EN-GB\">< 0.00*<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 13.0952%; text-align: center;\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 12pt;\">2<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 30.102%;\">\r\n<p><span lang=\"EN-GB\">Confident<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.3878%;\">\r\n<p><span lang=\"EN-GB\">272 (<\/span><span lang=\"EN-GB\">74.1%)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 20.5782%;\">\r\n<p><span lang=\"EN-GB\">281 (<\/span><span lang=\"EN-GB\">76.6%)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\" style=\"width: 13.0952%; text-align: center;\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 12pt;\">3<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 30.102%;\">\r\n<p><span lang=\"EN-GB\">Very confident<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 19.3878%;\">\r\n<p><span lang=\"EN-GB\">\u00a0 26 (<\/span><span lang=\"EN-GB\">7.1%)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\" style=\"width: 20.5782%;\">\r\n<p><span lang=\"EN-GB\">\u00a0 83 (<\/span><span lang=\"EN-GB\">22.6%)<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 5. Level of students\u2019 Confidence (N: 367)<\/span><\/p>\r\n<p><span lang=\"EN-GB\">*Significance (<i>p<\/i> < 0.05) with chi-square test<\/span><\/p>\r\n<p> <\/p>\r\n<p><i><span lang=\"EN-GB\">C. Students’<\/span><\/i><i><span lang=\"EN-GB\"> <\/span><\/i><i><span lang=\"EN-ID\">Comments<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Only 141\/367 (38%) students wrote their comments in the questionnaire. However, most students (94% of 141 students) appreciated this program and suggested it be continued.\u00a0<\/span><\/p>\r\n<p><i><span lang=\"EN-ID\">“The program is good; it can help community member to solve their health problem”<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F23Nurs<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p><i><span lang=\"EN-ID\">“I agree if the program will be continued” <\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F50Nurs<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p><span lang=\"EN-ID\">Positive aspects raised by the students were:<\/span><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-ID\"><\/span><span lang=\"EN-ID\">Opportunity to have direct communication with the community member (68%),<\/span><\/li>\r\n<\/ul>\r\n<p><i><span lang=\"EN-ID\">“I have the opportunity to communicate directly with patients and family, which is difficult to do when I’m only studying in the class”<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">M13Med<\/span><\/i><i><span lang=\"EN-ID\">\u00a0<\/span><\/i><\/p>\r\n<ul>\r\n\t<li><span lang=\"EN-ID\"><\/span><span lang=\"EN-ID\">Understanding each other when exploring and sharing knowledge to solve the identified health problems (32%),<\/span><\/li>\r\n<\/ul>\r\n<p><i><span lang=\"EN-ID\">“I feel amazed that each of us has our roles in solving health problems” <\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F67Med<\/span><\/i><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<ul>\r\n\t<li><span lang=\"EN-ID\"><\/span><span lang=\"EN-ID\">Learning about health team collaboration in the actual situation (40%),\u00a0<\/span><\/li>\r\n<\/ul>\r\n<p><i><span lang=\"EN-ID\">“I learn a lot about how to collaborate with other health students in the real situation”<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F90Nut<\/span><\/i><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<ul>\r\n\t<li><span lang=\"EN-ID\"><\/span><span lang=\"EN-ID\">Feeling proud that they had the opportunity to contribute to managing community health problems (69%).<\/span><\/li>\r\n<\/ul>\r\n<p><i><span lang=\"EN-ID\">“This program gives me an opportunity to collaborate with other professions to solve community health problems”<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F44Nurs<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p><span lang=\"EN-ID\">The student’s complaints were as follows:<\/span><\/p>\r\n<ul>\r\n\t<li><span lang=\"EN-ID\"><\/span><span lang=\"EN-ID\">Their task of working with a continuum of care was too heavy and exhausting.\u00a0<\/span><\/li>\r\n<\/ul>\r\n<p><i><span lang=\"EN-ID\">“Focus on one family problem for one small team would be more useful.”<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F57Med<\/span><\/i><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<ul>\r\n\t<li><span lang=\"EN-ID\"><\/span><span lang=\"EN-ID\">Several students (13%) also felt that their instructors were not motivated to mentor their tasks.<\/span><\/li>\r\n<\/ul>\r\n<p><i><span lang=\"EN-ID\">“It is difficult to make an appointment with the instructors, so we don’t have enough time to get feedback from him” <\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F21Med<\/span><\/i><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<ul>\r\n\t<li><span lang=\"EN-ID\"><\/span><span lang=\"EN-ID\">They had difficulty conducting home visits together (73%).<\/span><\/li>\r\n<\/ul>\r\n<p><i><span lang=\"EN-ID\">“Our biggest problem is matching the schedule to do a home visit.” <\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">M98Nut<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p align=\"right\"><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-ID\"><\/span><\/i><i><span lang=\"EN-GB\">D. Interviews<\/span><\/i><i><span lang=\"EN-ID\"> with Representatives of Community Members (two housewives, three cadres)<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Both housewives and cadres appreciated the students’ work. They believed the students already had enough competencies to help their health problems. Cadres were still committed to participating in the following program and working with the students to implement, monitor, and evaluate the intervention.<\/span><\/p>\r\n<p><i><span lang=\"EN-ID\">“We are so happy that students help us a lot to identify and to solve our health problems”<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F01HW<\/span><\/i><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<p><i><span lang=\"EN-ID\">“Yes, of course, we will help students to communicate with the family as well as report the result of students’ intervention to Community Health Centre” <\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F03C<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Community members thought they were not receiving enough information about the students’ purpose for visiting their house. They suggested that the cadre should have explained to them this program. However, they welcomed the students and told them to make an appointment before the home visit.<\/span><\/p>\r\n<p><i><span lang=\"EN-ID\">“There was no information from cadres of CHC that students will come to our house, but we still welcoming the students because it gives many benefits for us”<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">FHW02<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p><i><span lang=\"EN-ID\"><\/span><\/i><i><span lang=\"EN-ID\">E. FGD with Instructors at the End of the Program<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Most instructors (94,5%) appreciated the value of this program. However, they needed more detailed information about the program, especially assessing students. They also thought it was too hard for students to add one family after already concentrating on one family’s health problem. They agreed that a tiny group should only be attached to one family with a pregnant woman. To strengthen collaboration competencies, all groups of students should implement a “collaborative intervention” that involves all disciplines.\u00a0<\/span><\/p>\r\n<p><i><span lang=\"EN-ID\">“Sometimes students implemented their intervention within a single discipline that they thought more appropriate to solve the specified health problem.”<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">F05Inst<\/span><\/i><span lang=\"EN-ID\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">The instructors suggested that the assessment include peer assessment to increase students’ attitudes toward valuing each other. It was finally agreed that in the next implementation, various types of assessment would be implemented, namely students’ activities, presentation and discussion, peer assessment, and students’ assessment by the family members.<\/span><\/p>\r\n<p><i><span lang=\"EN-ID\">“Various assessment methods are preferable to capture students’ performance from the different side”<\/span><\/i><\/p>\r\n<p align=\"right\"><i><span lang=\"EN-ID\">M09Inst<\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">This study aimed to examine the impact of implementing the CBE-IPE model on the outcomes of student intervention in the community and students’ attitudes and perceptions towards the new program. Within the CBE-IPE program, the health professions students successfully worked together to empower the community to solve most community health problems. The CBE-IPE program aims to give health profession students direct experiences in working as a health team in dealing with community health problems that might correlate with the social and economic backgrounds of community members. In this study, students identified several health problems in the family with low financial status, low education, and did not have any health insurance. Hence, the health profession students within this program also had an opportunity to learn several principles, including the level of education and economic aspects when implementing their interventions. It is in line with the study by Ngo et al. (2021), who reported that hypertension and cardiovascular risk could be identified by conducting CBE-IPE in homeless adults.\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">We implemented the CBE-IPE program without any serious obstacles due to the support from the local health government and the director of CHC. Cadres and representatives of community members also commented that the students’ presence and work were beneficial. They stated that they would be involved in the program and work with students to implement, monitor, and evaluate the result. It is important to involve cadres in this program because they will handle the follow-up under the supervision of CHC. Some studies also involved non-health workers in IPE implementation, such as Akter et al. (2016), who involved lay health workers, and Dynes et al. (2013), that involved health extension workers and community health promoters in improving maternal and neonatal health outcomes.\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-ID\"><\/span><\/i><i><span lang=\"EN-ID\">A. Students’ Attitudes and Perceptions Toward the CBE-IPE Program<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">This study showed that students’ attitudes and perceptions toward this program have improved, especially regarding the role of responsibility and confidence level. In this study, students have tasks to implement health intervention after discussing health problems identified with their instructor, which might increase their commitment and confidence. Tan et al. (2021) also demonstrated the importance of feedback and discussion, in which IPE participants noted that the debriefing process improves their compliance and teamwork.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Students’ perceptions as assessed by the RIPLS in aspects of team collaboration and interprofessional identity were slightly lower, although statistically significant. These statistically significant differences might result from the large sample size of this study. Several studies have shown that one-time IPE implementation is unlikely to change attitudes, whereas multiple or longitudinal IPE experiences elicit attitudinal change with a more positive response (Hammick et al., 2007; Pollard et al., 2006). Hind et al. (2003) reported little to no change in the health professions students’ perception of the RIPLS between pre-and post-implementation. Schreiber et al. (2014) also reported a slight increase and no statistically significant differences in the pre-post response to the RIPLS because the students already had positive attitudes toward IPE. Torsvik et al. (2021) reported that RIPLS tends to have a ceiling effect. Therefore, RIPLS no longer seems suitable for measuring and evaluating the impact of interprofessional learning. In this study, “most pre-post students’ responses to the RIPLS questionnaire already trended to the positive side.” Thus, the RIPLS also possibly has a ceiling effect in this study.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-ID\"><\/span><\/i><i><span lang=\"EN-ID\">B. Wrapped up CBE-IPE Program Evaluation<\/span><\/i><b><span lang=\"EN-ID\"><\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Evaluation of this initial program demonstrates that students felt favourable toward the CBE-IPE program and felt more confident when dealing with community health problems. In line with Wong et al. (2018) study, the final students of six health programs have a positive attitude towards working together in an interprofessional health care team. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Nevertheless, students also complained that their tasks in working within a continuum of care were too heavy. As a result, they felt exhausted and less motivated to identify other health problems in another family. This complaint was in line with the instructors’ opinion. It concurred that students could learn from each other when they presented and discussed their work in the seminar. The recommendations included an adjustment in the tasks, scheduling, and improvements in the communication and quality of supervision. Therefore, the students’ tasks must be adjusted to accommodate these suggestions in the following implementation. Sunguya et al. (2014) reported that curriculum is an essential challenge in implementing IPE, which is in line with the study conducted by Thistlethwaite (2012) and Herath et al. (2017), which states that teaching methods and learning activities can be problems faced when implementing IPE. Furthermore, scheduling is one of the problems faced by faculty who implement the IPE program (Ngabonzima et al., 2020)<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">The instructors mentioned that the students’ interventions were not always “collaborative disciplines” since sometimes only a single discipline intervention for some health problems, and very little content was contributed by the other students in the specified group. Therefore, these circumstances might influence the lower perception of negative professional identity after the program implementation (Hind et al., 2003). Milot et al. (2015) also reported that it could sometimes be challenging to combine heterogeneous student teams during the learning together phase, where every discipline should be represented. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Understanding the attitudes of health professional students and the factors that influence their perceptions, including the situation they face during implementation, may help implement the program in several stages. There are four levels for the students to join the interprofessional collaborative practice. These include level 1: intra-professional education: the foundation of group skills, level 2: introduction to interprofessional education and collaboration: exposure to the healthcare team, level 3: interprofessional collaboration, and level 4: becoming an influential member of the healthcare team (Salfi et al., 2012).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-ID\">\u00a0C. <\/span><\/i><span lang=\"EN-ID\"><\/span><i><span lang=\"EN-ID\"><\/span><\/i><i><span lang=\"EN-ID\">Limitations\u00a0<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">This study’s limitation lies in the type of data collection that only uses a closed-ended questionnaire and asks the students to write their comments on the program. Although the students raised several positive attributes, this study did not obtain sufficient information about what happened during the implementation and what was behind the students’ rated aspects. Therefore, FGDs with students are still needed to understand program implementation in-depth. Further, direct participation in program implementation might identify obstacles regarding when students should collaborate in their intervention program. Additionally, limitations in this study are acknowledged as data were collected from less than 80% of students participating in the program. Finally, no formal feedback was collected from the community members, although verbal input in the interview was positive. A collection of more detailed data would have provided a deeper understanding of the program’s impact on community perceptions.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">We realize that implementing the CBE-IPE program in the community, which involves many students, was challenging and needed more careful preparation. Moreover, the lecturers’ motivation might be increased by encouraging and facilitating them to include field epidemiology research in the same area, with research funding from the faculty. Several changes should be made based on this evaluation, including more detailed guidance for the students and instructors.<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study revealed that the combination of CBE-IPE for 6th-semester health profession students had been perceived as a valuable learning experience to build community health. Nevertheless, it was challenging for many students in several aspects of the preparation. Moreover, highly motivated lecturers are required, which might be increased by encouraging and facilitating field epidemiology research in the same area. Finally, further research is needed to explore students\u2019 experiences during implementation, primarily how they work as a team and their belief in professional identity. It is also important to identify the result of a combination of CBE-IPE implementation in terms of the satisfaction of students, instructors, and family members.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Tri Nur Kristina conceptualised and designed the research, participated in the analysis and intepretation of data, drafted and revised the manuscript, and giving final approval of the version to be published.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Fatikhu Yatuni Asmara conceptualised of the program implementation, participated in the data collection, and revised the manuscript.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Sudaryanto c<\/span><span lang=\"EN-GB\">onceptualised<\/span><span lang=\"EN-US\"> of the program implementation.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Nuryanto c<\/span><span lang=\"EN-GB\">onceptualised<\/span><span lang=\"EN-US\"> of the program implementation and <\/span><span lang=\"EN-GB\">participated in the<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-US\">data collection.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Saekhol Bakri conception of the program implementation and <\/span><span lang=\"EN-GB\">participated in the<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-US\">data collection.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The Medical and Health Research Ethics Committee (MHREC), Faculty of Medicine Diponegoro University-Dr. Kariadi General Hospital had approved this study (<\/span><span lang=\"EN-US\">No. 519\/EC\/FK\/2020).<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Author could not share the data of this study widely because of its privacy. It also contains qualitative data.<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"IN\">The authors would like to thank the <\/span><span lang=\"EN-GB\">Faculty of Medicine Universitas Diponegoro<\/span><span lang=\"IN\"> for providing the funding for this study.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This work supported by Faculty of Medicine Universitas Diponegoro (Grant number: 233-71\/UN7.6.1\/PP\/2020).<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center;\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Akter, T., Sibbritt, D., & Dawson, A. (2016). Workforce interventions to deliver postnatal care to improve neonatal outcomes in low- and lower-middle-income countries: A narrative synthesis. <i>Asia-Pacific Journal of Public Health<\/i>, <i>28<\/i>(8), 659\u2013681. <\/span><a href=\"https:\/\/doi.org\/10.1177\/1010539516656435\"><span lang=\"EN-US\">https:\/\/doi.org\/10.1177\/1010539516656435<\/span><\/a><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Braun, V., & Clarke, V. (2006). Qualitative research in psychology using thematic analysis in psychology. <i>Qualitative Research in Psychology<\/i>, <i>3<\/i>(2), 77\u2013101. <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Carr, S. 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Has \u201cthe ceiling\u201d rendered the readiness for interprofessional learning scale (RIPLS) outdated? <i>Journal of Multidisciplinary Healthcare<\/i>, <i>14,<\/i> 523\u2013531. <\/span><a href=\"https:\/\/doi.org\/10.2147\/JMDH.S296418\"><span><span lang=\"EN-US\">https:\/\/doi.org\/<\/span><\/span><span lang=\"EN-US\">10.2147\/JMDH.S296418<\/span><\/a><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Tyastuti, D., Onishi, H., Ekayanti, F., & Kitamura, K. (2014). Psychometric item analysis and validation of the Indonesian version of the Readiness for Interprofessional Learning Scale (RIPLS). <i>Journal of Interprofessional Care, 28<\/i>(5), 426-432. <\/span><a href=\"https:\/\/doi.org\/10.3109\/13561820.2014.907778\"><span lang=\"EN-US\">https:\/\/doi.org\/10.3109\/13561820.2014.907778<\/span><\/a><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-GB\">Wagner, J., Liston, B., & Miller, J. (2011). Developing interprofessional communication skills. <i>Teaching and Learning in Nursing<\/i>, <i>6<\/i>(3), 97-101. <\/span><a href=\"https:\/\/doi.org\/10.1016\/j.teln.2010.12.003\"><span lang=\"EN-US\">https:\/\/doi.org\/10.1016\/j.teln.2010.12.003<\/span><\/a><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Wong, <\/span><span lang=\"EN-US\">P. S., Hasan, S. S., Ooi, J., Lim, L. S. H., & Nadarajah, V. D. (2018). Assessment of attitude for interprofessional team working and knowledge of health professions competencies for final year health professional students. <i>The Asia Pacific Scholar, 3<\/i>(1), 27-37. <\/span><a href=\"https:\/\/doi.org\/10.29060\/TAPS.2018-3-1\/OA1064\"><span lang=\"EN-US\">https:\/\/doi.org\/10.29060\/TAPS.2018-3-1\/OA1064<\/span><\/a><span lang=\"EN-GB\"><\/span><\/p>\r\n<p>*Fatikhu Yatuni Asmara<br \/>\r\nDepartment of Nursing, Faculty Medicine, <br \/>\r\nUniversitas Diponegoro<br \/>\r\nJl. Prof Soedarto, SH, Tembalang, <br \/>\r\nSemarang, Indonesia<br \/>\r\n+6281229495962<br \/>\r\nEmail: f.y.asmara@fk.undip.ac.id<\/p>\r\n<\/div>","protected":false},"featured_media":0,"parent":0,"menu_order":2,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61876],"class_list":["post-72018","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-8-number-2-april-2023"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Increasing the value of Community-Based Education through Interprofessional Education - The Asia Pacific Scholar<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/increasing-the-value-of-community-based-education-through-interprofessional-education\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Increasing the value of Community-Based Education through Interprofessional Education - The Asia Pacific Scholar\" \/>\n<meta property=\"og:description\" content=\"Submitted: 11 February 2022 Accepted: 21 July 2022 Published online: 4 April, TAPS 2023, 8(2), 4-13 https:\/\/doi.org\/10.29060\/TAPS.2023-8-2\/OA2755 Tri Nur Kristina1, Fatikhu Yatuni Asmara2, Sudaryanto Sudaryanto1, Nuryanto Nuryanto3 & Saekhol Bakri1 1Department of Medicine, Faculty of Medicine, Universitas Diponegoro, Indonesia; 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