The Hospital Health Promotion Toward Clean

Healthy Living Behavior in the Covid-19 Era

Ade Rizky Sianturi
Dept. of Public Health
Universitas Prima Iindonesia
Medan, Indonesia
ikysianturi222@gmail.com
Chrismis Novalinda Ginting Sri Wahyuni Nasution
Dept. of Public Health Dept. of Public Health
Universitas Prima Iindonesia Universitas Prima Iindonesia
Medan, Indonesia Medan, Indonesia
chrismis@unprimdn.ac.id sriwahyuni_nst88@yahoo.com

Suci Erawati
Department of Dentistry, Faculty of
Medicine
Universitas Prima Indonesia
Medan, Indonesia
Esuci64@gmail.com

Abstract— Hospital Health Promotion (HHP) is an effort
by hospital management to improve the ability to accelerate
patient recovery and improve their health. Efforts can be
made in the form of implementing clean and healthy living
behavior (CHLB). This study aimed to analyze the application
of health promotion management of CHLB in the era of the
covid-19 pandemic. This research uses mixed methods by
using a sequential explanatory design located at the RSU
Royal Prima Medan with a quantitative sample of 111 patient
assistants and qualitative research informants. Data were
obtained using questionnaires and in-depth interviews. Based
on the research results from 111 respondents who accompany
patients, 63 respondents (56.8) have bad CHLB. Data were
analyzed using chi-square, it was found that knowledge
attitude has the most significant influence on the
implementation of CHLB. The results of multiple logistic
regression indicate that HHP is the most dominant variable
that can affect CHLB. This research suggested maximizing
HHP with existing human resources (HR) in increasing the
knowledge and attitudes of patient companions, making
unique installations of health promotion programs. HR
selection must refer to regulations, consistent budgeting of
HHP funds, maintaining HHP facilities, and maintaining a
well-running documentation system.
Keywords: HHP, Attitude, CHLB, Covid-19 Era
I. INTRODUCTION
The health system in the past was more disease-oriented.
Maintaining health requires a series of efforts because the
care and treatment carried out in hospitals is a small part of
the series of businesses. The hospital health system also
changes hospital efficiency and profitability [1] [2].
Hospitals in Indonesia only emphasize curative and
rehabilitative services. This situation causes the Hospital to
become an elite health facility and is separated from the
health system, so that hospital reforms are needed in
Indonesia [3] [4].
Health promotion is part of the Hospital to empower the
community to maintain and improve their health promotion
affects health determinants to achieve the highest level of
health. Therefore, health motion contributes to reducing
inequality in health, guaranteeing fundamental human
rights, and building social capital. The ultimate goal of
health promotion is to increase health expectations and
reduce disparities in health expectations between countries
and groups [5]. In this case, health promotion in hospitals
tries to positively raise awareness and interest of patients
and hospitalities to heal and prevent disease. Therefore,
health promotion is an inseparable part of hospitals' health
service efforts because health promotion efforts to heal
patients will be more successful [6].
Hospitals that implemented HHP reported that HHP had
shortened patient days. The decrease in inpatient care days
impacts the hospital quality because patients treated recover
quickly, thereby increasing the Hospital's prestige. This
affects increasing the hospital occupancy rate as one of the
indicators of a good hospital [7]. Further, the CHLB can
minimize and even break the chain of disease spread of
Covid-19 disease.
During the COVID-19 pandemic, the government's
campaign for CHLB was echoed again by the government
to the community so that it could be implemented to break
the chain of virus spread. However, the implementation of
CHLB to prevent Covid-19 is not an easy thing for citizens
to do. Therefore, the government also urges community
leaders, both formal and informal, in each region to play an
active role in campaigning for CHLB to citizens to prevent
the spread of Covid-19 and also play a role in efforts to
overcome the impact of the pandemic [8].
Based on a preliminary survey, the implementation of
HHP with CHLB at the RSU Royal Prima Medan has been
carried out. It can be seen from the existence of health
promotion media both through print media such as posters,
banners, leaflets, the primary job duties in implementing the
HHP program, and the provision of hand sanitizers. The
facilities in the implementation of HHP are pretty complete,
but implementing the health promotion program is not as
expected. This can be seen from interviews conducted with
45 hospital patient assistants. Thirty patient hospital
companions are not aware of the importance of washing
hands. Even though handwashing facilities have been
provided, 36 hospital patient assistants do not use masks
properly, and 31 patient companions. Hospital did not apply
the proper physical distancing. In the initial survey that will
be under, taken researchers also found 27 place hand
sanitizers spread disease in the inpatient room area but
discovered 16 empty places. Currently, health promotion
has not changed many people's behavior into CHLB.

XXX-X-XXXX-XXXX-X/XX/$XX.00 ©20XX IEEE

 II. METHODS Clean and healthy living behavior
(CHLB)
Variables p-value
A. Aims and Scope Good Not Good Total
n % n % n %
To evaluate the application of HHP toward CHLB in the Knowledge
era of the covid-19 pandemic at the RSU Royal Prima Good 34 53,1 30 46,9 64 100,0
0,014
Medan. Not Good 14 29,8 33 70,2 47 100,0
Attitude
B. Survey methodology Strongly agree 28 59,6 19 40,4 47 100,0
Agree 5 17,9 23 82,1 28 100,0 0,002
This study involved a11 patient assistants and Disagree 6 30 14 70 20 100,0
qualitative research informants such are the Director, HHP Disagree 9 56,3 7 43,8 16 100,0
officers, the head of the service division, the head of the Action
general and equipment division, the head of the budget Strongly agree 16 42,1 22 57,9 38 100,0
Agree 15 38,5 24 61,5 39 100,0 0,673
department, the staff inpatient services, and patient Disagree 10 45,5 12 54,5 22 100,0
companions. Data were obtained using questionnaires and Disagree 7 58,3 5 41,7 12 100,0
in-depth reviews. Data were analyzed with chi-square and Hospital Health
multiple logistic regression analysis. Promotion
(HHP)
C. Variables used Good 37 51,4 35 48,6 72 100,0
Not Good 11 28,2 28 71,8 39 100,0 0,019
All variables were examined with operational
definitions based on dependent and independent variables,
i.e., ages, education, knowledge, attitude, actions, HHP dan Based on table 2, statistical analysis results using the
CHLB in the distributed questionnaires. chi-square test obtained a value of p = 0.002 of attitude,
followed by p = 0.014 of knowledge. P = 0.019 of HHP so
III. RESULTS that statistically, it can be concluded that there is an
influence between knowledge and actions on CHLB in all
A. Distribution Data Analysis
disease inpatient rooms in the RSU Royal Prima.
The frequency distribution of age, education,
knowledge, attitudes, actions, HHP, and CHLB for patient Further data analysis shows that the independent
companions in inpatient illness rooms at RSU Royal Prima variables that meet the criteria for the next step, multivariate
was shown in Table 1. analysis, are attitude (p = 0.002), knowledge (p = 0.014),
and followed by HHP (p = 0.019).
TABLE 1. DISTRIBUTION DATA ANALYSIS OF SAMPLE CHARACTERISTICS
C. Logistic Regression of Multivariate Analysis
No. Dependent & Independent Variables F % The constant relevancies of all independent variables
Age
1 >26 YEARS 69 62.2
were analyzed with logistic regression analysis. In this
≤26 YEARS 42 37.8 study, we use the Backward LR method. The results are
Education shown in Table 3.
2 High 88 79.3
Low 23 20.7 TABLE 3. LOG REGRESSION ANALYSIS OF INDEPENDENT VARIABLES
Knowledge
3 Good 64 57.7 Coefficient p-
Not Good 47 42.3 Step Variable Exp.B
(B) value
Attitude 1 Constant 0,094 -2,360 0,006
Strongly agree 47 42.3 Knowledge 2,384 0,869 0,038
4 Agree 28 25.2 Attitude 1,113 0,107 0,571
Disagree 20 18 Hospital Health Promotion 2,454 0,898 0,040
Strongly Disagree 16 14.4 (HHP)
Action 2 Constant 0,109 -2,212 0,007
Strongly agree 38 34.2 Knowledge 2,479 0,908 0,028
5 Agree 39 35.1 Hospital Health Promotion 2,481 0,909 0,037
Disagree 22 19.8 (HHP)
Strongly Disagree 12 10.8
Hospital Health Promotion (HHP)
6 Good 72 64.9 Based on the results of the analysis in table 4 in stage 1,
Not Good 39 35.1
Clean and Healthy Living Behavior (CHLB) it is known that after the knowledge, attitudes, and hospital
7 Good 48 43.2 health promotion variables were entered into the
Not Good 63 56.8 multivariate analysis, it turned out that the attitude variable
had the most significant p-value, namely p = 0.571 or Exp
B. Bivariate Analysis
value. B, close to the value of 1, is 1.113, so that the attitude
To evaluate the influence of knowledge, attitudes, variable is excluded/eliminated from stage 2. In stage 2, it is
actions, HHP, and CHLB for patient companions in known that the variables analyzed are the knowledge and
inpatient illness rooms at RSU Royal Prima was shown in health promotion variables of the Hospital. In stage 2, it is
Table 2. known that hospital health promotion has the largest Exp. B
value, which is 2.481, meaning that hospital health
TABLE 2. BIVARIATE ANALYSIS OF VARIABLES OF THE AND CHILD promotion is the most influential variable or dominant factor
in this study.
Furthermore, the results of the multivariate analysis
were followed by multiple logistic regression equation
models to identify the probability of clean and healthy living
behavior as follows:
p = 1/(1+e^(-y) )
p = 1/(1+〖2,7〗^(-(-2,212+0,909+0,908)) )
p = 1/2,99 x 100
p = 0,3345 x 100
p = 33,45%
whereas;
p = Probability of clean and healthy living behavior
y = Total regression coefficient constant, knowledge and
hospital health promotion
e = Natural number = 2.7
Based on the equation, it is known that if the respondent
has good knowledge and promotion of hospital health, it can
affect clean and healthy living behavior by 33.45%, and the
other 66.55 % is influenced by other variables that are not
included in this research variable.
IV. DISCUSSION
A. Knowledge
Based on the results of the study, it was found that there
is an influence between knowledge on clean and healthy
living behavior (CHLB) in all kind of disease inpatient
rooms in the RSU Royal Prima Medan and based on
multivariate analysis showed that the variables of
knowledge are the most variable air influence on CHLB.
Increased knowledge of patient assistants is fully
supported by hospital management through hospital health
promotion programs starting from the planning (planing),
implementation (Do), assessment (check), and Repair (Act)
stages. The results of this study are in line with [9], which
states that there is a close relationship between knowledge
and efforts to improve behavior, the expected level of
knowledge about the COVID-19 virus, and implemented
proper strategies to prevent its spread. Thus increasing
knowledge will give significant results to improve behavior.
In addition, the knowledge or cognitive level is also
dominant for the behavior, and behavior based on
knowledge will last longer than behavior that is not based
on knowledge [10].
The results of this study are also in line with research
conducted by [11] in Medan on students at the Rapha-El
Simalingkar Orphanage, proving that good knowledge
about CHLB will also affect a person's condition to be good
too. Good knowledge about CHLB will reduce existing
complaints, o that the quality of life will be improved.
B. Attitude
The cross-tabulation results between attitudes towards
clean and healthy living behavior in all inpatient rooms at
the RSU Royal Prima Medan obtained data can be
concluded that there is an influence between attitudes
towards clean and healthy living behavior.
The results of our study are supported by previous
research that [12] states that there is a significant
relationship between attitudes and CHLB. This shows that
the positive attitude of the respondents shown by the attitude
of accepting, responding, appreciating, and being
responsible for CHLB will have a positive impact.
Furthermore, the results of this study are also agreed with
the previous report, show a relationship between attitudes
and clean and healthy living behavior in households [13].
C. Actions
The Action consists of various levels: 1) Perception,
recognizing and selecting various objects in connection with
the action to be taken is the first level of action. 2) Response
guided (guided response), can do things according to the
correct order following the example is an indicator of the
action level. 3) Mechanism, if someone has been able to do
something right automatically, or something has become a
habit, then he has reached the third level of action. 4)
Adaptation (adaptational), adaptation is a practice or action
that has developed well.
Using the chi-square test, the statistical analysis results
obtained a value of p = 0.673 (p> 0.05. Thus, statistically,y
it can be concluded that there is no effect between clean and
healthy living behavior in all inpatientdiseasese.
D. Promotion(HHP)
The Decree of the Minister of Health No.
1114/Menkes/SK/VIII/2005 concerning Guidelines for the
Implementation of Health Promotion in the Regions, health
promotion is an effort to improve the ability of the
community through learning from, by, for, and with the
community, so that they can help themselves. As well as
developing activities based on community resources,
following local socio-cultural and supported by health-
oriented public policies. The results of statistical analysis
using the chi-square test obtained a value of p = 0.019 (p
<0.05) so that statistically, it can be concluded that there is
an influence between hospital health promotion on clean
and healthy living behavior [14].
E. Work Plan (Job Description)
A work plan/job description is a set of goals and
processes that can help a team/person achieve the goals they
want to achieve. The work plan in the HHP can help to work
on the program regularly. The job description is a systematic
record of a particular position's duties, authorities, and
responsibilities, which is defined based on the existing facts.
Job descriptions should explain and focus on the job itself
and not on the person who fills the job. Again, job
descriptions do not focus on the person who fills the job.
The preparation of this job description is essential,
especially to avoid differences in understanding to avoid
duplicate work and to know the limits of responsibility and
authority of each position [15].
Based on the results of our study, it is known that the
RSU Royal Prima already has a plan and job description,
delivered the obligation that must be carried out. This is
following Permenkes No.004 the Year 2012 on Technical
Guidelines HHP.
Based on the results, it can be seen that the job
descriptions in the implementation of health promotion have
been carried out well. Improvement efforts are made based
on the results of the evaluation of activities that have been
running. If there are any that are not appropriate, an
evaluation will be carried out. The results of the evaluation
will be a reference in improving the job description.
F. Human Resources
In this study, it was found that the available human
resources in the HHP program were the result of the
recommendation of the chairman of the HHP RSU Royal
Prima Medan. The recommended human resources came
from various installations considered to have the
competence and had to master the material or topic to be
promoted. There are currently no existing human resources
that specifically handle Hospital HHP. All. Human
resources still have multiple jobs. In determining the HR of
the HHP, it is the HRD and the Hospital Director. This is
not following Permenkes No. 004 of 2012 concerning
Technical Guidelines for the Implementation of HHP,
which requires exceptional staff for HHP, namely functional
public health extension officers who have special training
for HHP.
This research was in line with research conducted by
[16] on the Implementation of Hospital Health Promotion at
RSJD dr. Amino Gondohutomo of Central Java Province,
where the Executive team HHP consists of various
professions and not all diploma/undergraduate health
members are taken from every hospital area that HHP team
can reach all parts of the Hospital. For three years running,
the entire HHP team has never received special health
promotion training. This is because there are still two jobs
from the primary profession, and the training in the
profession of each member is still hampered.
Performance comes from the word job performance or
actual performance, which means work performance or
actual achievement achieved by someone. Therefore, the
definition of performance (work achievement) results from
work in quality and quantity achieved by an employee in
carrying out his functions following the responsibilities
given to him.
This research was in line with research conducted by
[17] with the title Implementation of Health Promotion at
the Airlangga University Hospital Surabaya reported the
process of monitoring the course of HHP at the Airlangga
University Hospital is always supervised by the HHP team
who constantly monitors and evaluates all health promotion
activities, which have been implemented.
G. Budget
This study was in line with research conducted by [17]
with the title Implementation of Health Promotion at the
Airlangga University Hospital Surabaya, which said that the
budget allocation for the implementation of HHP is always
listed in the Annual Budget Work Plan (RKAT). Regarding
the budget for the Hospital, health promotion efforts found
that the budget for the HHP Installation did not yet exist as
the person in charge and manager of hospital health
promotion efforts. To get a budget for hospital health
promotion efforts, the HHP installation must submit a
budget planning proposal to the home directory for
processing. If approved, the new budget is lowered to the
HHP installation as the person in charge of hospital health
promotion efforts. Thus, the implementation of HHP is
charged to the budget and implies that the availability of
funds for health promotion is not sufficient. This is due to
an understanding of the importance of health promotion to
preventive actions in health problems that budget providers
have not adequately understood.
H. Facilities
Based on research, the Royal Hospital Prima has had
HHP facilities that are good for program implementation.
Health promotion facilities are essential in supporting the
success of HHP in hospitals [18]. Therefore, promotional
facilities have been submitted to hospital management
ranging from promotional facilities outside the Hospital to
inside the hospital building, such as hand sanitizers, all in
the room, banners, brochures, banners, leaflets, etc. This
follows Permenkes No.004 of 2012, which supports the
implementation of health promotion in the availability of
facilities in the form of facilities and infrastructure such as
leaflets, posters, banners, and others.
In the implementation of health promotion efforts in
hospitals, it will not be carried out properly if it is not
accompanied by facilities that can support the success of
these efforts. States that it takes equipment used for
efficiency purposes through reduction. The facilities
provided should be comfortable to use and have a period of
use, easy to clean and maintain [19].
Based on research results, HHP at RSU Royal Prima
uses print media facilities such as leaflets, brochures,
banners, etc. However, suppose there is something that
rarely happens that causes the need for facilities to increase.
In that case, the HHP Team immediately proposes
procurement, such as when this is the coronavirus
pandemic, all facilities related to the coronavirus are being
requested.
I. Documentation
In implementing health promotion at RSU Royal Prima,
documentation activities have been carried out for every
health promotion activity. The results of this documentation
are made as a form of activity reports from the results of the
implementation of health promotion. This documentation
will later be used as a reference for evaluating the HHP
program. This is following the Health Promoter Hospital
Standard [20], where one of the sub-standards in HHP is the
availability of documentation as part of evaluating the
implementation of HHP.
J. Patient Assessment
Based on the research results, it is known that the
planning of the assessment of health promotion efforts for
patient companions has been carried out starting from
outside the building to inside the building, in the form of
banners, posters, and hand sanitizers. The implementation
of the HHP at the RSU Royal Prima showed that health
promotion efforts for patients had been carried out.
However, the implementation was not optimal because
those who had not received direct health promotion
byHospitall human resources, doctors, nurses, and other
medical professionals. Based on the research results that
have been done in implementing the hospital health
promotion assessment of the patient companion, some get
services in the form of direct health promotion, some
indirectly, while the rest. In contrast, research that has been
carried out, it is known that in improving hospital health
promotion to escort the patient's nothing to be fixed, where
there are respondents who did not get a promotion directly
by hospitals’ staff, up doctors and nurses.
 V. CONCLUSION
Based on the analysis of data distribution, bivariate and
multivariate analysis showed that the knowledge attitude
has the most significant influence on the implementation of
CHLB. Therefore, to improve the hospital health promotion,
management should maximize HHP with existing human
resources (HR) in increasing the knowledge and attitudes of
patient companions, makinguniquel installations of health
promotion programs, HR selection with regulations,
consistent in HHP budgeting, conducting maintenance of
HHP facilities, and maintaining a well-running
documentation system.
ACKNOWLEDGMENT
The author acknowledges Universitas Prima Indonesia
and RSU Royal Prima Medan, who facilitate the research
with accessible resources and sample population.
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