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Qualitative Study of Effectiveness of Early Warning System and Dengue Fever Case Response in West Tulang Bawang Regency, Lampung, Indonesia

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The Early Warning and Response System (EWARS) plays a role in detecting potential outbreaks of infectious diseases through weekly reports. West Tulang Bawang Regency experienced an increase in dengue fever cases in 2024–2025, but the early detection function of the EWARS has not been running optimally as indicated by the still low number of alerts compared to the number of reported cases. This study aims to explore the effectiveness of the EWARS for dengue fever cases in West Tulang Bawang Regency, Lampung, Indonesia. The study used a qualitative approach with a case study method. Data collection was carried out from October to December 2025 in three community health centers with 14 research informants consisting of village cadres, village midwives, community health center surveillance officers, Health Office surveillance officers, community health center heads, and village heads selected using a purposive sampling technique. Data collection was carried out through in-depth interviews, observation, and documentation with thematic data analysis. Input components: training is not evenly distributed, competencies are not in accordance with education, limited funds that are not specifically for EWARS reporting, limited facilities and infrastructure (computers, internet network constraints and disruptions to the EWARS web application system). Process components: tiered data collection from networks, health centers via WA to health offices, health centers do not yet have access to the EWARS web application, manual data entry, data validation for signal verification (alert), data presentation in graphical form, feedback via weekly bulletins in the WA group, monitoring, evaluation and follow-up have been carried out according to procedures. The effectiveness of EWARS for DHF cases in West Tulang Bawang Regency is influenced by limited funding, limited facilities and infrastructure, staff competencies that do not match education, uneven training causes different understanding of staff, implementers do not understand what to report, so that cases that are often reported are cases that are already positive or cases that have been treated in hospitals, this is not in accordance with the principles of EWARS. There is a need to increase human resource capacity, provide adequate facilities and infrastructure, integrate web-based reporting systems at the community health center level and mobile SDKR at the network level, encourage symptom-based reporting and provide funding support.

The Influence of Public Sphere, Perceived Usefulness, and Trust on Mobile Payment Intention with Attitude as a Mediating Variable

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The objective of this study is to understand the social and psychological factors that influence user intentions and attitudes in using mobile payment services in Indonesia. This study examines the influence of Public Sphere, Perceived Usefulness, and Trust on user attitudes and intentions, as well as the role of Attitude as a mediating variable.  A quantitative method is used in this study by collecting data through an online survey using Google Forms in which the respondents are active users of mobile payment services in Indonesia. The data analysis is conducted using descriptive and inferential statistics to examine the relationships between variables. The result of this study shows that Perceived Usefulness and Trust significantly influence users’ positive attitudes toward mobile payment. Moreover, the Public Sphere, which presents user discussions and experiences through social media, also has a positive effect on perceived usefulness and users’ intention to keep using the service. On the other hand, Public Sphere has no direct effect on attitudes, and Trust does not mediate attitudes toward usage intentions. The main findings indicate that user attitudes play an important role as mediators that strengthen the influence of perceived usefulness and trust on their intention to use mobile payments in the future. This study provides implications which are crucial for the digital financial services industry and policymakers. The strategies that emphasize to increase trust through security features and strengthen positive experiences and discussions in digital public spaces can increase the intention and sustainability of mobile payment use in Indonesia. Furthermore, developing humanistic content and emphasizing user experiences in digital public spaces is necessary to shape better attitudes and usage intentions.

Between Readiness and Reality: EFL Teachers’ Deep Learning Implementation in Indonesia’s Merdeka Curriculum Amid Remote-Region Constraints

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This study investigates the readiness of EFL teachers in Toraja, a geographically remote region of South Sulawesi, Indonesia, to implement the Deep Learning approach within Indonesia’s Merdeka Curriculum, and examines the systemic, pedagogical, student-related, and infrastructural challenges they encounter during implementation.A sequential explanatory mixed-methods design was employed, involving six purposively selected junior secondary school EFL teachers. Quantitative data were collected through a validated 20-item questionnaire measuring four readiness dimensions (pedagogical, technological, psychological, and institutional) on a five-point Likert scale, analyzed using descriptive statistics. Qualitative data were gathered through in-depth semi-structured interviews and analyzed using reflexive thematic analysis within Miles and Huberman’s interactive framework. Quantitative results revealed Very High overall teacher readiness (M = 4.28, SD = 0.470), with pedagogical and psychological readiness achieving Very High categorization (M = 4.40 each) and technological and institutional readiness achieving High categorization (M = 4.20 and 4.13 respectively). Four of six teachers (66.7%) were classified as Very High readiness. However, qualitative analysis identified four major challenge themes that systematically constrain implementation: (1) systemic institutional constraints inadequate sporadic professional development, rigid curriculum structures, and heavy administrative burden; (2) pedagogical instructional difficulties severe time constraints, challenges implementing inquiry and reflection phases, and authentic assessment design gaps; (3) student-related barriers uneven readiness, limited EFL vocabulary, passive learning habits, and cultural deference norms; and (4) infrastructure and technological limitations limited shared devices, unstable internet, and forced pedagogical regression reducing deep learning quality by up to 50%. This study reveals a critical readiness-reality gap: teachers demonstrate high internal readiness, yet face substantial external constraints that systematically undermine implementation quality. The findings contribute evidence-based insights to the emerging literature on Deep Learning implementation in under-resourced Indonesian EFL contexts and offer targeted recommendations for teachers, school leaders, district authorities, and national policymakers to achieve sustainable implementation in Toraja and comparable remote regions.​

Analysis of the Relationship between Duration of Diabetes Mellitus and HbA1c Levels in Type 2 DM Patients at Primary Health Center in Kupang City

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Background: Type 2 diabetes mellitus (T2DM) is a growing global health challenge characterised by chronic hyperglycaemia and progressive metabolic dysfunction. Glycated haemoglobin (HbA1c) serves as the gold standard for assessing long-term glycaemic control and is closely linked to the risk of diabetes-related complications. Disease duration has been hypothesised to influence glycaemic outcomes; however, findings from previous studies remain inconsistent, warranting further investigation.

Objective: This study aimed to examine the association between disease duration and glycaemic control, as measured by HbA1c levels, in patients with type 2 diabetes mellitus.

Methods: An analytical observational study with cross-sectional design was conducted on 71 type 2 diabetes mellitus patients at three primary health centres in Kupang City from July to August 2025. Disease duration data were obtained through interviews and medical records, categorised as less than one year, one to five years, and more than five years. HbA1c levels were measured using high performance liquid chromatography method. Data analysis used Spearman’s correlation test with significance level of α=0.05.

Results: Mean HbA1c levels demonstrated an ascending trend across duration categories: 8.25±3.15% for less than one year, 9.06±2.14% for one to five years, and 9.92±2.76% for more than five years. Spearman correlation analysis revealed a statistically significant positive relationship between disease duration and HbA1c levels (r=0.247; p=0.038).

Conclusion: A significant positive correlation exists between type 2 diabetes mellitus duration and HbA1c levels, although with weak correlation strength. This finding emphasises the importance of regular glycaemic monitoring and comprehensive multifactorial management approaches, as glycaemic control is influenced not only by disease duration but also by modifiable factors including medication adherence, lifestyle modifications, and psychosocial support.

Comparative Economic Burden of Tuberculosis Patients with and Without Diabetes Mellitus in Kupang City, Indonesia: A Comparative Cross-Sectional Study

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Background: Tuberculosis and diabetes mellitus are major public health problems with a well-recognized bidirectional relationship. Diabetes mellitus increases the risk of active tuberculosis, while tuberculosis may worsen glycemic control. This comorbidity may also increase household economic burden through higher non-medical expenses, productivity loss, and catastrophic health expenditure. Evidence comparing the economic burden of tuberculosis patients with and without diabetes mellitus in Kupang City remains limited.

Objective: To compare the economic burden between tuberculosis patients without diabetes mellitus and tuberculosis patients with diabetes mellitus in Kupang City, Indonesia, in 2025.

Methods: This comparative cross-sectional study included 86 respondents, consisting of 43 tuberculosis patients without diabetes mellitus and 43 tuberculosis patients with diabetes mellitus who were receiving outpatient treatment at 10 primary health centers in Kupang City.

Results: A significant difference in economic burden was observed between the two groups. The median total cost among tuberculosis patients without diabetes mellitus was IDR 255,000, whereas the median total cost among tuberculosis patients with diabetes mellitus was IDR 850,000. Direct non-medical costs and indirect costs were also higher in the tuberculosis-diabetes mellitus group. Catastrophic costs were significantly more frequent in the TB-DM group than in the TB non-DM group (44.2% vs. 20.9%; p = 0.021).

Conclusion: Diabetes mellitus significantly increases the economic burden among tuberculosis patients. Compared with tuberculosis patients without diabetes mellitus, those with tuberculosis and diabetes mellitus incur higher total costs, greater non-medical expenditures, and higher indirect costs. These findings support the need for integrated tuberculosis-diabetes services and stronger financial protection strategies for vulnerable patients.

Intergenerational Caregiver Strategies in Caring for Parents and Maintaining Personal Well-Being

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This study explores how young intergenerational caregivers navigate caregiving responsibilities toward aging parents while maintaining their personal well-being. Employing a qualitative descriptive design, the research examines the lived experiences of three university students in Jakarta who simultaneously manage academic commitments, paid employment, and family caregiving. Data were collected through in-depth interviews, observation, and documentation, and analyzed using Miles and Huberman’s interactive model supported by NVivo 12 Plus. The findings reveal that caregiving among young adults operates as a multidimensional process involving financial management, emotional regulation, and role negotiation. Participants adopted structured income allocation strategies, pursued flexible supplementary work, and practiced careful time management to balance parental care with personal and educational needs. Despite these adaptive efforts, caregivers experienced significant psychosocial pressures, including stress, fatigue, and heightened moral responsibility, shaped by cultural expectations of filial duty and uneven family role distribution. Caregiving responsibilities frequently concentrated on individuals who were structurally available, accelerating their transition into adult roles and constraining personal aspirations.The study highlights forms of everyday resilience developed through pragmatic coping practices and family solidarity. However, reliance on individual adaptability also exposes gaps in formal support systems. These findings underscore the need to reconceptualize intergenerational caregiving as a shared social responsibility rather than an individual burden. Policy interventions integrating financial assistance, educational flexibility, mental health services, and community-based caregiver support are essential to sustain the well-being of young caregivers. The study contributes to caregiving and social development literature by providing empirical insight into how young adults construct meaning, strategy, and identity within intergenerational care arrangements in urban Indonesia.

Challenges of Intestinal Parasitic Infections in Children in Coastal Areas: A Literature Review on Prevalence and Risk Factors

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Background: Intestinal Parasitic Infections (IPIs), particularly soil-transmitted helminths (STHs), remain a significant burden for children in low-and middle-income countries. Coastal ecosystems that characterized by sandy soil, high water tables, and tidal flooding, present unique ecological determinants that create transmission pathways distinct from inland settings.

Methods: This review synthesizes data from over 50 studies (2000–2025), specifically focusing on coastal settlements, fishermen villages, and tidal flood-prone areas across Indonesia and Southeast Asia.

Results: Findings indicate that coastal children face elevated risks, with STH prevalence in Indonesian hotspots reaching 30%–70%. While Trichuris trichiura and Ascaris lumbricoides dominate due to humidity, sandy terrains specifically favor the persistence of hookworms and Strongyloides. Crucially, high water tables and tidal inundation render conventional sanitation (pit latrines/septic tanks) ineffective, causing direct fecal contamination of the environment.

Conclusion: Standard terrestrial sanitation is maladapted to coastal hydrological contexts. Mitigation requires the deployment of amphibious infrastructure, such as the Tripikon-S system and elevated latrines, combined with targeted behavioral change communication to disrupt littoral transmission cycles.

Core Revenue of the State: The Opportunities and Challenges of State Revenue Authority (SRA) Establishment in Indonesia

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This study conducts a systematic literature review (SLR) of the opportunities and challenges surrounding the establishment of a State Revenue Authority (SRA) board for Indonesia. Drawing on comparative experiences across Latin America, Africa, and Asia, the review identifies how board structures can enhance strategic oversight, digital transformation, data governance, and integrity safeguards in revenue administration. Evidence suggests that boards add value when their mandates are clear, their composition is diverse and professional, and accountability is institutionalized through transparent reporting and performance metrics. However, autonomy alone does not guarantee stronger outcomes; revenue performance is shaped by the interaction of policy design, administrative capability, and service quality. For Indonesia, stabilizing the Core Tax Administration System (CTAS), embedding data governance under the Satu Data Indonesia and Personal Data Protection frameworks, and institutionalizing integrity measures emerge as near-term priorities. The findings contribute to global debates on tax administration reform while offering practical guidance for policymakers navigating fiscal modernization in Indonesia.

Core State Revenue: Reconstructing the Policy of Centralization of State Revenue Management and Ease of Doing Business in Indonesia (A Systematic Literature Review)

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This study conducts a systematic literature review (SLR) of 58 academic and policy sources published between 2019 and 2025 to analyze the centralization of state revenue management and its implications for the Ease of Doing Business (EoDB) in Indonesia. Following PRISMA 2020 guidelines, the review integrates evidence from peer-reviewed journals, government publications, and international organization reports. Findings indicate that legal reforms, particularly Law No. 1/2022, and the deployment of the Core Tax Administration System (CTAS) are pivotal in harmonizing tax administration, improving compliance, and enhancing fiscal transparency. Comparative international experiences suggest that technological integration and function-based organizational restructuring can yield significant revenue gains, with projections indicating a 2–3 percentage point increase in the tax-to-GDP ratio by 2027. Additionally, centralization is expected to reduce compliance times, improve EoDB indicators, and boost investor confidence. However, the literature cautions against risks of over-centralization, institutional capacity gaps, and regional disengagement. The study concludes that a “controlled centralization” model, combining national coherence with regional inclusivity, offers the most sustainable path forward. Recommendations for future research include longitudinal impact studies, comparative analyses, and qualitative assessments of taxpayer experiences.

Core-Tax System Implementation and Tax Revenue in Indonesia and OECD Countries: A Systematic Literature Review

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The implementation of core-tax systems represents a transformative step in modernizing tax administration, offering the potential to enhance efficiency, compliance, and revenue generation. This systematic literature review examines the relationship between core-tax system implementation and tax revenue, with a particular focus on Indonesia and comparisons with OECD countries. Drawing from studies published between 2011 and 2024, the review synthesizes insights on the benefits, challenges, and impacts of these systems across different economic and technological contexts. Key findings highlight that digital tax systems improve administrative efficiency, reduce compliance costs, and foster greater transparency. However, challenges such as infrastructure deficits, taxpayer resistance, and regulatory complexity persist, particularly in developing countries like Indonesia. By contrast, OECD countries benefit from advanced infrastructure, streamlined regulations, and higher taxpayer trust, providing valuable lessons for nations transitioning to digital systems. In Indonesia, initiatives such as the Core Tax Administration System (CTAS) have shown promise in addressing compliance gaps and increasing revenue collection. Nevertheless, significant barriers remain, including uneven internet access, low digital literacy, and cultural resistance to digital adoption. Comparative analysis underscores the importance of targeted investments in infrastructure, simplification of tax procedures, and fostering trust through transparent practices. This review identifies gaps in the literature, such as the long-term impact of core-tax systems on economic growth and fiscal stability, and calls for future research to explore these dimensions. Policymakers are urged to adopt a holistic approach that integrates technological advancements with robust policy frameworks and taxpayer engagement. By addressing these challenges, countries can leverage core-tax systems to enhance governance, strengthen public finances, and drive sustainable economic development. This study contributes to the growing body of knowledge on tax modernization and its critical role in shaping equitable and efficient fiscal systems.