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The Effect of Health Community Behavior (PHBS), Health Service Quality to

Diare’s Disease in Sub-Division Karang Jaya Palembang Sub-District

Article · March 2018

DOI: 10.22135/sje.2018.3.1.19-26

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Sriwijaya Journal of Environment
P-ISSN: 2527-4961 E-ISSN: 2527-3809

The Effect of Health Community Behavior (PHBS), Health Service Quality to

Diare’s Disease in Sub-Division Karang Jaya Palembang Sub-District

Iman Suwono1, M.T. Kamaluddin2, Sriati3, Dwi Putro Priadi4

1
Doctoral Program of Environmental Science, Sriwijaya University, Indonesia
2
Faculty of Medicine, Sriwijaya University, Indonesia
3
Faculty of Agriculture, Sriwijaya University, Indonesia
4
Faculty of Agriculture, Sriwijaya University, Indonesia

Abstract
The aims of this study were to analyze the Effect of Healthy Living Community Behavior (PHBS), Quality of Health Service against
Overcoming Diarrhea Disease in Sub-division Karang Jaya Palembang. The type of research used in this study was analytical research.
This research was conducted in Palembang City selected area of Karang
​​ Jaya Sub-district Gandus District. The study was conducted in
May 2016 to June 2017. The samples of research were people affected by diarrhea in 2017 as many as 95 people. Method’s of data analysis
using logistic regression. Result showed that the PHBS coefficient with odds ratio-0.760 (1.561-0.370) with significance of 0.045 less than
the 0.05 significance level (α). This means that hypothesis one (H1) was accepted if the variable quality of health service, constant then
every increase PHBS effect on the occurrence of diarrhea. The better PHBS will decrease the incidences of diarrhea. Coefficient of health
service quality with odds ratio 1.598 (3.217-0.74) with significant equal to 0.009 less than level of significant (α) 0.05. This means that
hypothesis two (H2) is accepted if the variable PHBS, constant then the quality of health services affect the occurrence of diarrhea. The
better quality of health care will reduce the incidence of diarrhea

Keywords: PHBS, quality of service, health, diarrhea

1. Introduction to increase public access to quality health services with the main
objectives of each village in the availability of competent human
Health is a human right and one of the elements of welfare that must resources (HR) and health services in every Hospital, Center for
be realized in accordance with the ideals of the Indonesian nation Public Health, and its network meet the quality standard (Fahriadi,
as intended in the Preamble of the Constitution of the Republic of 2006). The community is entitled to health services with the best
Indonesia Year 1945. Improvement of optimal health status for the performance of health promotion staff and other health workers.
community is conducted through health efforts with maintenance However, affordable and quality health services are still difficult to
approach, health (promotive), prevention of disease (preventive), implement. Not infrequently heard about the poor practice of health
curative disease (curative) and health recovery (rehabilitative) is care services provided to the community both in hospitals, health
done thoroughly, integrated and sustainable. Implementation of centers, as well as health care clinics.
health service efforts is implemented by health personnel who have The facts in Indonesia, including the service of Center for Public
the authority and minimum qualifications. Health and hospitals, indicate that there are still many complaints
Indonesia's health development aims to encourage people and dissatisfaction with the quality of service of the government
to live healthy lives. Healthy living behaviors can be enhanced apparatus in spelling out its public service duties, especially when
through various extension and health education activities to be- it is associated with the obligation to observe the principles of good
come part of the community's living and cultural norms. One of the governance. Not infrequently, the low quality of public services is
Department of Health's main strategies is to mobilize and empower the cause of cases that can be categorized as mal-administration,
people to live healthy lives (Hapsara, 2004). The health rating in such as protracted service, unfair treatment, demand for compensa-
Indonesia for the past three decades has increased significantly, but tion, and abuse of authority (Riyadi, 2005: 23).
when compared to neighboring countries, the increase is still low. In general the above conditions stems from the poor three as-
The main problem faced is the low quality of public health seen pects of the pattern of implementation (management), human
in MOH strategy plan. (2005), Maternal Mortality Rate (MMR): resources and public service institutions in Indonesia covering
262/100,000 live births and Life expectancy (UHH): 69 years (Syukri, 2007):
(Ministry of Health RI, 2005). 1. The pattern of organizing is less responsive, less informative,
The strategy to achieve the vision of Healthy Indonesia 2010 is less accessible, less coordinated, too bureaucratic, unwilling to
listen, and inefficient;
2. Human resources are less professional, competent, empathy,
Article History: and ethical;
Received: 12 November 2017 3. Institutions tend to be hierarchical and not designed to be able
Accepteed: 20 February 2018 to provide services to the community efficiently and optimally.
DOI: 10.22135/sje.2018.3.1.19-26 Some Health Center and hospitals have a number of patient vis-
its and the number of different employees. In improving the qual-
*Corresponding Author: [email protected] ity of public services, the government makes a policy by applying
quality management of international standard services in the hope
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 Suwono et al. | Sriwijaya Journal of Environemnt, 3(1) 2018

of improving the quality of public services, especially in the health integrated environmental health. PHBS is all health behavior that is
sector. Because Center for Public Health is a government-owned done on the awareness so that family members or family can help
agency that serves the community and its presence is close to the themselves in the field of health and play an active role in activi-
middle and lower class society. ties in the community (MOH, 2007: 2). The purpose of this study
This is important as a reference in improving services in or- was to analyze the Effect of Healthy Living Community Behavior
der to provide optimal satisfaction. The main problem as a health (PHBS), Quality of Health Service against Overcoming Diarrhea
service institution that many competitors are the services provided Disease in sub-division Karang Jaya Palembang
whether it is in accordance expectations of patients/consumers or
not so that community satisfaction about health services will be
2. Literature Review
achieved so that people avoid infectious diseases such as diarrhea.
There are many factors that cause diarrhea due to the low
2.1 Quality of Health Services
healthy lifestyle of the community, especially the provision of good
sanitation facilities to support environmental health. Because until
now, it is estimated that about 47% of Indonesian people still defe- The realization of a healthy state is the desire of all parties not only
cate carelessly, there are those who defecate to rivers, gardens, rice by individuals, but also by their families, groups and even people.
fields, ponds and other four open places. Such behavior is clearly To be able to make it happen healthy things are many things that
very detrimental to public health conditions, because the stool is need to be done. One of them is considered to have a significant
known as a medium where e.coli bacteria that potentially cause di- role is to provide health services (Azrul, 1996). Levey and Loom-
arrheal disease live. In accordance with research Kusumaningrum, ba (1973) Levey's health services is any effort that is self-admin-
et al (2011) there is a significant relationship between the use of istered or jointly within an organization to maintain and improve
latrines and the incidence of diarrhea of under-five year in Sub-di- health, prevent and cure diseases and restore the health of individ-
vision Gandus Palembang. uals, families, groups and or society (Azrul 1996) . In accordance
Based on cases of diarrhea that occurred in the city of Palem- with such limits it is immediately easy to understand that forms and
bang caused by the condition of environmental sanitation is still types of health can be found in many ways. A health service is said
bad. Palembang city also experienced the process of dynamics and to be good (Azrul, 1996) if the following conditions:
the flow of urbanization with various interests that impact on popu-
lation growth. Currently, the population growth of Palembang City 1. Available and sustainable
reaches 2.65%. This relatively high rate of population growth if not A good health service is a health service needed by the
matched by the availability of basic urban infrastructure will cre- community is not hard to find, and its presence in the community
ate complicated problems for the government. One of the problems is at any time needed.
faced by the city of Palembang is the emergence of slums (slums 2. Acceptable and reasonable
area), especially along the Musi River. This means that health services are not contrary to the beliefs
The high incidence of diarrhea in the Karang Jaya sub-division and beliefs of society.
area is one of the causes Behavior and Habit on average do not 3. Easy to reach
wash hands with soap after defecation, there are 10 families do To be able to realize good health service then arrangement
not have latrines and do defecate in the river, the condition of the distribution of health facility become very important. Health
toilet is not clean, to septic tank with a swan neck. The people of services that are too concentrated in urban areas alone and
sub-division Karang Jaya generally use clean water source from the while not found in rural areas, are not good health services.
Drinking Water Company (PAM), there is also using well water. 4. Easy to reach
Waste management using a system burned after a few days pre- The affordability is from the point of cost.
viously dumped in the back of the house; do not think about the 5. Quality
development of settlements. The pattern of serving the community That is indicating the level of perfection of health services held,
usually does not cover the food stored so easily visited by flies. which on one hand can satisfy the users of services, and on
When preparing food, people pay less attention to the cleanliness the other hand the procedures of implementation in accordance
of foodstuffs and cooking supplies with codes of ethics and standards that have been set.
Implementation of environmental-based sanitation in the pre-
vention of diarrheal diseases has led to public satisfaction with the Elements forming hospital services are grouped into 4 (four)
sanitation program and the prevention of diarrheal diseases. The groups:
level of community satisfaction with the environment-based san- 1. Input element
itation program and the prevention of diarrhea by the government The input element is everything that is necessary for the
is still quite low as evidenced by some empirical research on the implementation of hospital services. This group includes the
quality of environmental-based sanitation and the prevention of di- building where the services are held, medical and non medical
arrhea. There are several factors related to the implementation of equipment, human resources and budget.
total sanitation based PHBS programs with diarrhea events such 2. Process Elements
as demographic conditions, behavior and community satisfaction. Process elements are all activities undertaken in the framework
The results of research on the analysis of various factors that influ- of service or any interaction that occurs between the resources
ence the implementation of clean and healthy life behavior, shows of the hospital with the patient.
that there is a relationship between attitude variables and knowl- 3. Out put elements
edge about PHBS household. Element output is everything as a result of the process of
Based on these descriptions the authors are interested to con- organizing services in the hospital include among others,
duct research on Environmental Factors and Behavior as an effort healing, death, disability, satisfaction and others.
to improve the quality of community life related to public health 4. Environmental elements
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 Suwono et al. | Sriwijaya Journal of Environemnt, 3(1) 2018

The element of the environment is anything that d. Details of costs / tariffs of public services and procedures for
is regulating or limiting activities in the hospital. payment
The input elements, process elements, and environment e. Scheduled time of public service completion
with their respective components have interconnected f. Hak and the obligations of both the grantor and the recipient
characteristics, as well as mutual influence and all of which are of the public service based on the receipt of the application /
factors that affect the quality of hospital services (Noor, 2001). completeness, as a means to ensure starting from the process
of public service to the completion.
In addition, the implementation of excellent health services g. Officers who receive public complaints when there is some-
need to pay attention to the following matters (Wijono, 1999): thing unclear and dissatisfied with the services provided to the
public (customers).
1. Seek clear exposure through information boards or easy-to-un- 3. Security, in the sense that the process and outcome of public
derstand instructions and obtain at each place/location of ser- services can provide security and convenience and can give
vice in accordance with its importance concerning procedures/ general assurance
procedures of service, registration, sampling or inspection 4. Disclosure, in the sense of procedure / procedure of require-
results, fees/tariffs/services and schedule. ment, work unit of responsible officer of public service, time of
2. Any rules on procedures/procedures/guidelines as mentioned completion and detail of cost / tariff and other matters relating
above shall be executed appropriately, consistently and consis- to process of public service must be informed open to be easily
tently in accordance with applicable laws and regulations. known and understood by society , either asked or did not ask.
3. The rights and obligations of the giver or recipient of service 5. Efficient, in the sense that the requirements of public services
shall be clearly stipulated every requirement required in order are limited to matters directly related to the achievement of
to receive services shall be easily obtained and directly related service targets while maintaining the cohesiveness between the
to the interests of the service and shall not increase the burden requirements and the products of public services provided.
of the recipient community. 6. Economical, in the sense that the costs to be paid by the com-
4. Available information booths and suggestion boxes for recip- munity must remain reasonable
ients of services that are easy to see/be found at any place of 7. Equitable Justice
service. 8. Timeliness of service
5. Handling the service process wherever possible by authorized
or competent, capable, skilled and professional officers in The Health Center is the spearhead of health services for the
accordance with the specifications of their duties. community as it is effective enough to assist the community in pro-
6. Always strived to create appropriate service patterns in ac- viding first aid with health service standards. Well-known health
cordance with the nature and types of services concerned with services should make Center for Public Health the primary health
considering the efficiency and effectiveness in the implemen- service for the community, but in reality many people prefer health
tation. services to private practice physicians or other health practitioners.
6. The cost/tariff of service should be set fairly by taking into This condition is based on the negative initial perception of the
account the ability of the community. Should be strived to community on the Center for Public Health service, for example
regulate the levy mechanisms that facilitate their payments and the assumption that the quality of the service is seemingly im-
do not incur high costs. probable, meaning that the health center is not sufficient enough
7. Provision of services shall be conducted in an orderly, orderly to provide services to the community, whether viewed from the
and fair manner by not distinguishing the social status of the facilities and infrastructure or from medical personnel or budget
community. used to support his daily activities. So a lot of services provided to
8. The sanitation and sanitation of the premises of premises and the community is not in accordance with Standard Operating Pro-
service facilities should always be guaranteed through routine cedure (SOP) that has been established. The undisciplined attitude
cleaning. of medical personnel in the health center of health services unit
9. Always strived for officers to provide services with a friendly also becomes a problem. People are always treated poorly by med-
and polite attitude and strive to improve the performance of ics who are considered arrogant, arguing that the limited supply of
health services optimally. medicines at health center has caused many patients to buy drugs
10. Achievement of excellent service in health will always be at pharmacies. Not only the things that have been disclosed above,
monitored and evaluated regularly and periodically. Gradually more than that, there are still problems that arise in the scope of
excellent service should be implemented by all existing health health centers, for example: Health Center work hours are very
service units (Wijono, 1999). short just until 12.00 WIB and additional time overtime until 14.00
pm, limited local financial capacity, Health Center lacking the au-
The excellent service indicators are as follows (Sampara, 2005): thority to take advantage of existing opportunities, Health Center
not yet accustomed to manage their activities independently, and
1. Simplicity, in the sense that the procedure / procedure of lack of employee welfare that affect the motivation in performing
service is carried out easily, smoothly, quickly, not convoluted, duties at Health Center.
easy to understand and easy to do; Implementation of management is a crucial important in achiev-
2. Clarity and certainty: the clarity of certainty about: ing the efficient and effective goals of the Health Center goals. It can
a. Procedures / procedures of public services be said also that the lack of knowledge of the Head of Health Center
b. General service requirements, both technical and administra- and the low discipline/work ethic of the staff, makes this element of
tive management is not running. Of course this impedes performance.
c. nit work and or officials authorized and responsible in provid- The facilities and infrastructure at the Health Center in Indonesia
ing public services seem to be disregarded by the government on the grounds that geo-
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graphical areas are difficult to reach, so that the facilities and infra- 2.3 Diarrheal diseases
structure in the Health Center are very limited, both in the form of
medical devices and medicines. This happens as a result of the fi- According to the World Health Organization (WHO), diarrheal
nancial resources owned by the Health Center is limited so that the disease is a disease characterized by changes in the shape and con-
quality of Health Center Health services becomes low because it is sistency of stools soft to melt and increased frequency of bowel
not in accordance with the standard of health. Medical personnel: A movements more than usual, which is 3 times or more a day which
very small number of medical personnel result in their inability to may be accompanied by vomiting or bloody stools. The disease is
implement programs from the Health Office. most common in children under five, especially in the first 3 years
of life, where a child may have 1-3 episodes of severe diarrhea
2.2 Clean and Healthy Living Behavior (PHBS) (Simatupang, 2004).
In the Department of Child Health FKUI, diarrhea is defined
Clean and healthy life behavior (PHBS) is an effort to provide a as an abnormal bowel movement or a watery form of stool with
learning experience or create a condition for individuals, families, more frequencies than usual. Neonatal diarrhea declared when the
groups and communities, by opening lines of communication, pro- frequency of bowel movements for more than 4 times, while for
viding information and educating, to improve knowledge, attitude infants older than 1 month and children, the frequency is more than
and behavior through leadership (advocacy), social support and 3 times (Simatupang, 2004).
empowerment so that they can apply healthy ways of life in order According to WHO (2005) diarrhea can be classified to:
to maintain, maintain and improve public health (Dinkes, 2006). 1. Acute diarrhea, which is diarrhea lasting less than 14
The purpose of PHBS is to increase the knowledge, aware- days.
ness and willingness of the community to live healthy, as well as 2. Dysentery, which is diarrhea accompanied by blood.
to increase the active role of the community, including the private 3. Persistent diarrhea, ie diarrhea lasting more than 14 days.
sector and the business community, in order to realize optimal life 4. Diarrhea accompanied by severe malnutrition
(Dinkes, 2006). (Simatupang, 2004).
In the household setting, the indicator of PHBS is (Dinkes, According to Ahlquist and Camilleri (2005), diarrhea is divid-
2006): ed into acute if it is less than 2 weeks, persistent if it lasts for 2-4
1. Relief delivery by health personnel weeks, and chronic if it lasts more than 4 weeks. More than 90%
2. Immunization and weighing of the causes of acute diarrhea are infectious agents and will be
3. Family latrines accompanied by vomiting, fever and abdominal pain. Another 10%
4. Clean water is due to treatment, intoxication, ischemia and other conditions. In
5. Handling garbage contrast to acute diarrhea, the cause of chronic diarrhea is com-
6. Nail hygiene monly caused by non-infectious causes such as allergies and others.
7. Family nutrition Among the steps that can be done most important is to maintain
8. Smoking habits and abuse of drugs personal hygiene well. This can be done by carrying out healthy
9. PMS / AIDS Information behaviors, namely washing hands with soap after disposing of
10. JPKM / Health Fund / other Askes. faeces and after defecation and also before preparing food to the
Environmental indicators by DHO (2006), in PHBS, include: child. Mothers should also train their children early on about hand-
1. There are latrines, including their use and maintenance washing behavior especially before eating and after playing. This
2. There is clean water and utilization for health can prevent the occurrence of transmission of germs that can cause
3. There is a dumpster and its management diarrhea.
4. There is a sewerage and its management Based on many studies, affordability of the use of clean wa-
5. There is ventilation ter facilities is essential to reduce the risk of diarrhea. Therefore,
6. Density of occupants the public should ensure that the water used at home is completely
7. Floor is not ground clean and qualifies ie it has no color, smell and taste before being
PHBS in the workplace is an effort to empower workers to used for daily purposes.
know, willing and able to practice PHBS and play an active role 1. Diarrhea Prevention Based on Dehydration Level (WHO, 2005)
in realizing a healthy workplace. Implementation of PHBS in the a) Without Dehydration
workplace is necessary to maintain, maintain and maintain workers' In children under 2 years of age, oral solution may be 50-
health in order to remain healthy and productive (Dinkes, 2009). 100ml/ times and for ages over 2 years is given the same
The benefits of PHBS in the workplace among the people around solution with a dose of 100-200ml/ diarrhea. For the avoidance
the workplace to be healthier and not easily sick, and the environ- of dehydration, mothers should raise the usual provision of
ment around the workplace to be cleaner, beautiful and healthy. drinks and food to their children. In addition it can also be
Terms of healthy public places according to DHO (2009) are: given zinc (10-20mg/ day) as an additional food.
b) Light Dehydration
1. Eat nutritious foods In this circumstance ORALIT ORALITE is required with
2. Perform physical activity every day Ringer Lactate or Ringer Acetate crystalloid solution with
3. No smoking in the workplace
4. Hand wash with clean water and soap a complete formula containing glucose and electrolytes
5. Using clean water and administered as much as possible according to the
6. Fighting larvae at work child's abilities and the mother is encouraged to continue
7. Using latrines breastfeeding and still be handled by the family at home.
8. Take out the garbage in its place According to WHO, ORS solution should contain 90mEq/L

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 Suwono et al. | Sriwijaya Journal of Environemnt, 3(1) 2018

sodium, 20mEq/L potassium chloride and 111mEq/L glucose. Table 1. Distribution of Respondents by Education
c) Dehydration Medium
In these circumstances require more specific attention and
No Education Frekuensi Percentage
oral administration should be performed by personnel at
health facilities and patients should be monitored for 3-4 1 Eliminery School 17 17.89
hours. If the patient has better conditions, the patient can be 2 Junior High School 31 32.63
taken home to be treated at home with oralit. Dose of ORS for
3 Senior High School 37 38.95
age less than 1 year, every of defecation is given 50-100ml,
for 3 hours first 300ml. For children aged 1-4 years each of 4 Tamat PT 10 10.53
defecation is given 100-200ml, for the first 3 hours 600ml. Jumlah 95 100
d) Severe dehydration
In this situation the patient will be given intravenous hydra- Sources: Primary Data
tion solution with 100ml/kgBB/3-6 hours. The dosage of flu-
id for age less than 1 year is 30ml / kgBB for 1 hour and the
next is given 75ml/kgBB every 5 hours. The dosing of fluids 4. Result
for children 1-4 years is 30ml/kgBB for the first ½ hour and
so is given 70ml/kgBB every 2 ½ hours. Respondents in this study were respondents who are diarrhea resi-
d) Complications dent in Gandus District Health Center work area that is as much as
The major complications of gastroenteritis are dehydration 95 respondents, with the average age of respondents 30.29. Median
and cardiovascular problems due to severe hypovolemia. If age of respondents 29.00. Minimum age of respondents is 22 years
the diarrhea is caused by Shigella, high fever and seizures may and the maximum age of respondents is 43 years, and Standard
arise. Abscesses of the intestinal tract may also arise from the Deviation (S.D) is 5,139.
infection of shigella and salmonella especially in typhoid fever In Table 1. Known that the education of most of the respondents
which can cause perforation of the intestinal tract. It is very is high school graduation, which amounts to 37 people (38.95%)
dangerous and life threatening. Severe vomiting can cause and the least is graduated from university (PT) which is 10 people
aspiration and tears in the esophagus (Kliegman, Marcdante, (10.53%). The result of cross-tabulation of the availability of clean
Jenson, Behrman, 2006). water facilities with the incidence of diarrhea in toddlers is known
that among 63 respondents who did not have clean water facilities,
Theoretical framework used by the authors in this study consists there were 36 people (57.14%) who had a child with a history of
of 3 (three) theories of H.L.Blum theory in Wibowo (2014); Law- diarrhea and 27 people (42.9%) with bales - it has no history of
rence Green's theory in Notoatmodjo (2003). Determinant factors diarrhea. Among the 32 respondents who had clean water facili-
of health and disease are increasingly evolving along with the great ties, there were 7 people (21.9%) with a history of diarrhea and 25
transition that occurs in an infection pattern that is more vulnerable people (78.1%). This is in accordance with the proposed by Slamet
to epidemic diseases that occur in both old and new cases. In addi- (2002: 95), that the source of drinking water is often a source of
tion, cases of non-communicable diseases show an increasing trend pollutants in water borne disease. Therefore drinking water sourc-
from year to year. es must meet the requirements of localization and construction.
Localization requirements require that drinking water sources be
3. Research Methods protected from contamination, so it is necessary to consider the dis-
tance of drinking water sources with latrines, waste excavation pits,
The type of research used in this study is analytic research that excavation pits for waste water, and other pollutant sources. Clean
not only describes certain characteristics, but also analyzes and ex- water can be a contagious medium for various diseases carried by
plains why or how it happens (Hermawan, 2006). This research water if the facility is not sanitizer. Clean water facilities other than
was conducted in Palembang City selected area sub-division of Ka-​​ quantity, the quality must meet the prevailing standards, to prevent
rang Jaya Sub-district Gandus. The study took place in May August the occurrence and widespread disease of water congenital. How-
2016-June 2017. Population is a generalization area consisting of ever, clean water is often stored in areas where water is not clean or
objects/subjects that have certain qualities and characteristics set easily contaminated, then safe or healthy water will become dan-
by the researchers to be studied and then drawn conclusions (Sugi- gerous again (Slamet, 2002: 111). One effort to minimize the risk
yono, 2009). of diarrheal diseases, namely the procurement and improvement of
The population in this study is the entire community recorded clean water facilities cleanliness so as to avoid contamination of
in Karang Jaya as many as 325 people. Sampling technique in this disease-causing agents. In addition, the public must cook drinking
study using simple random sampling. Random sampling was con- water first to turn off the disease-causing agent contained in the
ducted on a certain cluster of areas considered to be representative clean water (Stefano, 2011).
of the population to be studied (Azwar and Prihartono, 2003). The The results of logistic regression analysis explain the factors
sample of the study was 100 people affected by diarrhea in 2017. that influence the occurrence of diarrhea is analyzed using Logistic
The variables of this study are independent variables (Independent Regression approach, where the dependent variable is qualitative
variable), ie community behavior (X1) and service quality (X2). data in the form of nominal data in dummy form. The dummy of
The dependent variable in this research is the prevention of Diar- this dependent variable is yes (buy) or not (do not buy). The meth-
rhea Disease (Y1). Method of data analysis used univariate analysis od of dummy code is given by using the category stated with the
done to each variable from research result. By using the frequency number 1 called the included group for diarrhea category and as-
distribution to know the description of the characteristics of re- signed a value of 0 (zero) called the excluded group for the non di-
spondents. Multivariate analysis using logistic regression. arrhea category. Factors affecting the incidence of diarrhea (Y) are
PHBS (X1) and quality of health care (X2). The results of logistic
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 Suwono et al. | Sriwijaya Journal of Environemnt, 3(1) 2018

Table 2 Logistic Regression Analysis

Variables B SE Wald Sig. Exp (B) 95% C.I. for EXP(B)

Lower Upper
PHBS (X1) -0.274 0.367 5.558 0.045 0.76 0,370 1.561
Quality Of Health Care -0.469 0.357 5.723 0.009 1.598 0.794 3.217
(X2)
Constanta 0.722 0.282 6.566 0.01 2.059

Table 3. Omnibus Tests of Model Coefficients Table 3 Iteration History and Model Summary

Chi-square Df Sig Step -2 Log Likelihood Cox & Snell R Nagelkerke R

Step 1 Step 12.244 4 0 Square Square
Block 12.244 4 0 1 74.137a 0.437 0.451
Model 12.244 4 0
Table 4 Hosmer and Lemeshow Test Goodness-of-fit
regression analysis of factors considered to affect the incidence of
diarrhea are presented in Table 2 below. Step Chi-square df Sig.
The calculation result of logistic regression analysis of factors 1 9.069 8 0.336
that influence the occurrence of diarrhea obtained by equation as
follows:
sented in Table 4.
Based on Table 4, the value of Hosmer and Lemeshow Test
Y = 2.059 – 0.904 X1 – 0.903
Goodness-of-fit is 9.069 with significance value 0.336 (p>
0.05), so it can be concluded that the model is acceptable.
To test that the model (which has included its independent variable)
The size of LR statistics in logistic model is similar to F test on
is fit with the data, it should be seen from:
multiple linear regressions. The F value as shown in 6 which in the
Based on the above table, the value of c2-count is 12,244 with
logistic model is called LR statistic of 12.2244 with the level of
degrees of freedom = 4, whereas the value of c²-table with degrees
significance equal to zero then the first hypothesis is proved. This
of freedom = 6 is 9.48, means c²-count> c²-table (12.244> 9.48).
shows that simultaneously all advertising variables have a signifi-
Thus the model is fit with the data and analysis can be continued.
cant effect on Canon camera purchase decision. The waldz test is
Assessing the whole model shows a better logistic model or vice
used to partially test the effect. Hypothesis test results are described
versa between logistic models on Block number = 0 and Block
as follows.
number = 1. This is based on the Log-2 Log Value. According
to Appendix 6, we get the Log-2 value of Block Number = 0 for a. Coefficient of PHBS with odds ratio-0.760 (1,561-0,370) with
74.213 while Block number = 1 is 74.137. This decrease shows a significance of 0.045 less than the 0.05 significance level (α).
better logistic model, meaning the logistics model on Block num- This means that hypothesis one (H1) is accepted if the variable
ber = 1 is better than Block number = 0. quality of health service, constant then every increase PHBS
The new model determination is better than the initial model effect on the occurrence of diarrhea. The better PHBS will
indicated by the Log Likelihood value drop-2 from the initial mod- decrease the incidence of diarrhea.
el. Cox & Snell R Square value is a measure that tries to mimic b. The coefficient of health care quality with an odds ratio of 1.598
R2 size in multiple regression based on likelihood estimation tech- (3,217-0,74) with significance of 0.009 less than the 0.05
nique with maximum value less than 1 (one), while for Nagelk- significance level (α). This means that hypothesis two (H2)
erke R2 value can be equated with Adjusted R2 value in multiple is accepted if the variable PHBS, constant then the quality of
regression. The results of iteration history and model summary are health services affect the occurrence of diarrhea. The better
presented in the following table. quality of health care will reduce the incidence of diarrhea.
Based on Table 3 shows that the value of Nagelkerke R Square Based on the value of Cox and Snell R square of 0.290 or 29%
obtained value of 0.437 which means that the variability of the de- and Nagelkerke R Square of 0.410 or 41% means PHBS and
pendent variable Y (factors affecting the occurrence of diarrhea) the quality of health services to the incidence of diarrhea by
which can be explained by the variability of the independent vari- 41% while the rest influenced by outside the research variables
ables (product, health service quality, message format and message of 69%.
source) 43.7%. The Likelihood Log -2 values is 74.137 whereas -2
Log Likelihoods initially of 45.1%, it means that the Log-Likeli- 5. Disscusion
hood value decrease and Log-Likelihood Log-2 decrease indicates
that the new model is better, so the analysis can proceed. 5.1 Effect of PHBS on Diarrhea Occurrence
To see that the model made is good and fit with the data then
seen on the statistical value of Hosmer and Lemeshow Test Good- The behavior of healthy living is related to the degree of health and
ness-of-fit. The Goodness-of-fit Hosmer and Lemeshow Test is pre-
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 Suwono et al. | Sriwijaya Journal of Environemnt, 3(1) 2018

the level of disease transmission in the community. Poor environ- clean water will cause diarrhea. The results of this study are con-
mental sanitation also affects the occurrence of diarrhea. Interac- sistent with Gaffar's (2012) research, Elfi Rahmawati et al (2008),
tions between agents, diseases and host and environmental factors Bui Viet Hung (2006) and Juan Correa et. al (2013) indicating that
that cause disease need to be taken into account in the prevention PHBS has an effect on the occurrence of diarrhea.
of diarrhea. The role of environmental factors (water, excreta, food,
flies and other insects), entire--bacteria, intestinal parasite, viruses, 5.2 Quality of Health Services
fungi and some chemicals have been classically proven in various
epidemiological investigations as causes of diarrheal disease En- Good health care is a necessity for everyone. Everyone wants to
vironmental health in Indonesia is still a major problem in efforts be served and get the same position in health service. In the 1945
to improve public health status. These environmental health con- Constitution, Article 28 and Article 34 states that the state guaran-
cerns include the lack of clean drinking water supply and health tees every citizen to live a healthy life, health, and health service
requirements, lack of healthy sewage disposal, generally unhealthy in Indonesia, but there is often a dichotomy in the effort of health
housing conditions, hygiene and sanitation of incomplete food, the service, capable societies while the less well-off are not treated
number of disease factors, the lack of hygiene and sanitation of equally and proportionally. Health services are one of the basic
the industry intensively, lack of monitoring and prevention efforts rights of the community whose provision must be administered by
against environmental pollution, waste disposal in poor residential the government.
areas. The results of data analysis show that health services have an
The result of data analysis showed that PHBS had an effect on effect on the occurrence of diarrhea. If community satisfaction on
the occurrence of diarrhea. If PHBS community is better than the health services is better then the incidence of diarrhea will be sup-
incidence of diarrhea will be suppressed or decreased because a pressed or decreased because apola healthy life has been applied
pole healthy life has been applied in society. PHBS in this study in the community. Public satisfaction with health services in this
with attitude, actions and public behavior about drinking water, study was measured by those obtained in improving health status.
environment, cleanliness, waste management and the surrounding One of the health facilities that many people use is Center for
environment. Public Health. As the spearhead of health services and development
The main drinking water source is one of the most important in Indonesia, Center for Public Health need to get attention espe-
sanitation facilities related to the occurrence of diarrhea. Some in- cially related to health service quality of Center for Public Health
fectious germs that cause diarrhea are transmitted through the oral so in this case Center for Public Health especially at Center for
fecal pathway. They can be transmitted by inserting into mouths, Public Health equipped with inpatient unit is demanded to always
fluids or contaminated articles with feces, such as drinking water, increase the professionalism of its employees and improve its facil-
fingers, and food prepared in pots that are washed with polluted wa- ities / provide satisfaction to the community of health-care users. In
ter (Ministry of Health of the Republic of Indonesia, 2000). Accord- the incidence of diarrhea, Center for Public Health services in Gan-
ing to Slamet (2002) various sources of drinking water include: 24 dus sub-district can affect the incidence of diarrhea in this region.
a) Surface water is water that is on the ground surface. For example Azrul Azwar (1988: 40) defines health services as any effort
river water, swamp water and lakes. b) Depth-dependent soil water that is carried out independently or jointly within an organization
may be called shallow groundwater or deep ground water. Water in to maintain and improve health, prevent and treat disease and re-
soil is water obtained by collecting water on deep soil layers. For store the health of individuals, groups, and or society. Azrul Azwar
example water wells, water from springs. c) Space air is water that (1994: 21) states that the quality of health services is pointing to
comes from the atmosphere, like rain and snow. According to the the level of perfection of the appearance of health services that can
Ministry of Health of the Republic of Indonesia (2000), things to satisfy every user of health services 6 in accordance with the level
consider in the provision of clean water are: Taking water from a of satisfaction of the average population, the procedure of imple-
clean water source. b) Take and store water in a clean and enclosed mentation in accordance with standards and professional codes of
place and use a special scoop to collect water. c) Maintain or main- ethics that has been set.
tain water sources from pollution by animals, children, and sources
of contamination. The distance between drinking water sources and Conslusions and Recomendations
sources of sewage such as septic tanks, landfills and wastewater
must be more than 10 meters. d) Using boiled water. e) Washing all The coefficient of PHBS with odds ratio-0.760 (1.561-0.370) with
cooking utensils and eating with clean and sufficient water. a significance of 0.045 less than the 0.05 significance level (α). This
Based on the results of research in the area of ​​Karang Jaya means that hypothesis one (H1) is accepted if the variable quality
against the incidence of Diarrhea, that more respondents who diar- of health service, constant then every increase PHBS effect on the
rhea. It shows that people with diarrhea are still low. Due to the use occurrence of diarrhea. The better PHBS will decrease the inci-
of clean water, the community has no concern for the use of clean dence of diarrhea. Coefficient of health service quality with odds
water in daily life (such as drinking, washing vegetables and wash- ratio 1.598 (3.217-0.74) with significance equal to 0.009 less than
ing other foods). Communities accessible by clean water provision level of significance (α) 0.05. This means that hypothesis two (H2)
have a lower risk of diarrhea than people who do not get clean is accepted if the variable PHBS, constant then the quality of health
water. As stated in the Diarrhea Diagnostic Guidelines (MOH RI, services affect the occurrence of diarrhea. The better quality of
2003) that Diarrhea is one of the most environmentally-based dis- health care will reduce the incidence of diarrhea.
eases, the dominant factors allow the occurrence of Diarrhea such Suggestions that can be submitted in this study among
as clean water facilities, and the use of healthy latrines and fecal others:
matter disposal will interact with human behavior (individual/fam- a. Maintain environmental conditions such as taking into ac-
ily members/community). If the factor is not healthy due to con- count the conditions of household SPAL to be kept clean,
taminated germs. Diarrhea and accumulate with unhealthy human keeping the yard of the house, the cleanliness of the sewer-
behavior, i.e. through food and drink or do not wash hands with age, the use of latrines, the management of garbage by dis-
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 Suwono et al. | Sriwijaya Journal of Environemnt, 3(1) 2018

posing of waste in place, not defecating or disposing of baby Cairncross S, Valdmanis, 2006. V. Water Supply, Sanitation and
diapers or pampers in any place to prevent the occurrence Hygiene Promotion. In: Dean T Jamison ea, editor. Disease
of transmission of infectious diseases, especially diarrhea. Control Priorities in Developing Countries.2nd edition ed.
b. Doing the habit of washing hands with soap well and cor- Washington (DC): World Bank. p. 771-92.
rectly, store and cook food well to be protected from pol- Chang, Ju Young. 2008. Decreased Diversity of the Fecal Micro-
lution and pay attention to the use of clean water sources. biome in Recurrent Clostridium difficile-Associated Diarrhea.
c. Diarrhea is still one of the major public health problems, be- J Infect Dis., 197(3): 435-438
cause of the high rate of morbidity and mortality. The main Glanz K, Rimer, B.K and Viswanath, K. Health. 2008. Behav-
cause of the incidence of diarrhea associated with healthy ior and health education: theory, research, and practice. 4th ed
life style that exists in everyday life. Rehydration efforts us- ed. San Francisco: Jossey-Bass; 2008. p. 45-65, 189-207 and
ing oral rehydration fluids are the only recommended thera- 407-30
peutic approach. The replacement of fluids and electrolytes Glanz K, Rimer, B.K and Viswanath, K. Social Cognitive
is an important element in the treatment of acute diarrhea. Theory. In: Alfred L.McAlister CLPe, Guy S. Parcel, editor.
Failure due to diarrhea is caused due to dehydration is too Health Behavior And Health Education Theory, Research and
late handling. Another thing to note is the provision of ade- Practice. San Francisco: Jossey-Bass; 2008. p. 170-88.
quate food or nutrition during diarrhea and treat comorbidities Gordis L. 2000. Case Control and Cross Sectional Studies in
Epidemiology 2nd Ed ed.Philadelphia: W.B Saunders Compa-
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