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How is the role of dental health cadres during the Covid-19 pandemic? - Patient referrals and counseling

Eliati Sri Suharja1*, Yun Wahyuni², Cahyo Nugroho³

1,3 Department of Dental Health, Poltekkes Kemenkes Tasikmalaya, Indonesia

2 Dental Therapist, Puskesmas Banjar 1, Banjar City, Indonesia.

INTRODUCTION

Dental health problems in Indonesia are in the high category, the results of the 2018 Basic Health Research that the largest proportion of dental problems in Indonesia is tooth decay/cavities/pain by 45.3%. Meanwhile, the majority of oral health problems experienced by the Indonesian population are swollen gums and/or ulcers (abscesses) by 14%.^1,2 The policies of the West Java provincial government are now continuously evaluating several policies related to Covid-19, one of which is regarding health services during the Covid-19 pandemic. This is in line with the policy on dental and oral health services at public health center.

The Strategic Plan of the Banjar City Health Office for 2019 - 2023 is an indicative planning document containing health development programs that are carried out directly by the Health Office or by encouraging the active role of the community an independent society for healthy living is a condition in which Indonesian people are aware, willing and able to recognize, prevent and overcome health problems faced independently so that they can increase their productivity such as activities at posyandu (Integrated Healthcare Center).

Posyandu is an activity carried out by, from, and for the community that aims to improve the health status of the community in general and the health of mothers and children in particular. Meanwhile, those who act as posyandu implementers are cadres.^3,4

A cadre is a volunteer recruited from, by and for the community, whose task is to assist the smooth running of health services. Implement posyandu activities, and are willing and able to mobilize the community to carry out and participate in posyandu activities.^5,6

The data obtained in the 2020 Report from the Banjar 1 Health Center, Banjar City, West Java, includes a dental polyclinic visit report and a UKGM activity report based on the number of people who visited during the Covid-19 period for the 2019-2020 period, it was found that 58.32% of patients who visited the Banjar 1 Health Center and dental patient visits only 54% of the people who visit for dental and oral health services either to the public health center or who come to the posyandu for dental and oral health checks. The results of data analysis during the covid-19 period in the period 2019-2020 there was a significant decrease.

MATERIALS AND METHODS

The type of research used is descriptive analytic research with a cross sectional design, which is a study used to determine the dynamics of variable analysis where data concerning the independent variable and the dependent variable will be measured or collected at the same time.⁷

The population in this study were all registered cadres from 8 Posyandu located in the Balokang Village Area, Banjar City as many as 70 people. Sampling in this study was purposive sampling, where the researcher only determined representatives of cadres from each posyandu to be used as research sample.⁸ Reasons for taking samples using purposive sampling according to inclusion criteria: Active cadres, willing to provide counseling and write referral letters and from 8 posyandu, 5 active cadres were taken from each posyandu so the total sampling was 40 cadres.

The research instrument used included a checklist for observing the role of cadres in dental health counseling. The referral filling sheet was filled out by cadres and given to patients who would seek dental and oral health treatment at the dental polyclinic of the Banjar 1 Health Center and finally the observation sheet for cadre activities was filled out by cadres and reported at the end of the research month.⁴

The data collection technique in this study in the form of primary data is data that is collected directly from the results of the assessment of the role of cadres during counseling and referral letters for dental patients to the Banjar Health Center 1. Data analysis was analyzed statistically with Chi Square used to determine the relationship between the participation of health cadres in counseling efforts and referral of dental and oral patients with visits to the dental polyclinic of the Banjar 1 Public Health Center.

RESULT

Table 1. Frequency distribution of respondent characteristics 

Table 1 showed that the majority were female (82.5%) with age < 40 years (55 years)

Table 2. Frequency distribution of role of cadres in counseling, patient referrals and visits to dental polyclinic patients

Table 2 shows that the level of cadre's ability in dental and oral health counseling is based on the results of the assessment In the field, the highest criteria are enough criteria as many as 25 people (62.5%), while the good criteria are only 15 people (37.5%). The level of ability of cadres in an effort to refer patients to the dental polyclinic is the highest, namely good criteria as many as 28 cadres (70%) and enough criteria as many as 12 cadres (30%). Visits of dental polyclinic patients showed majority good criteria (70%).

Table 3. Table 3. Chi square results on the ability of cadres in counseling dental and oral health and the ability to refer to the number of visits to dental polyclinic patients

Table 2 showed that the chi square results show p = 0.011 (< 0.05) so it can be concluded that there is a relationship between the role of cadres in counseling and referral of dental and oral patients with visits to the dental polyclinic during the Covid 19 period at the Banjar 1 Health Center.

DISCUSION

Based on research conducted on September 30, 2021 to November 30, 2021 in the Balokang Village Area, Banjar District, Banjar City regarding the role of cadres in counseling and referral of dental and oral patients with visits to the Dental Polyclinic during the Covid 19 period at the Banjar 1 Health Center, with a research sample as many as 40 respondents where the respondents are active health cadres from 8 posyandu each 5 cadres selected by the head of each posyandu.

The results of the study can be seen that there are three parameters that indicate the role of cadres, namely the first to assess the level of ability of cadres in dental and oral health counseling. The Ministry of Health of the Republic of Indonesia, 2006, said that the posyandu work system is a series of activities that include input, process and output. Input is the availability of resources needed in the implementation of posyandu including extension equipment and service equipment. Counseling is an activity of disseminating knowledge information, while knowledge is the basis for the formation of a behavior, if the level of knowledge is higher, the attention to dental and oral health will be high and vice versa, if knowledge is less concerned about dental and oral care, it is also low. Knowledge of dental and oral health is very important to be understood by the community because of the many dental and oral health problems experienced by the community. Assessment based on the level of ability in dental and oral health counseling can be seen that cadres with good criteria scores as many as 15 people (37.5%), and with enough criteria scores as many as 25 people (62.5%).

The second parameter is to examine the efforts of cadres in referring dental patients to the dental polyclinic of the Banjar 1 Public Health Center, counseling on dental and oral health and referring people who experience dental and oral health complaints/disorders for cadres, which are very important in order to better understand the state of dental and oral health in the community. Based on the results of the recapitulation of the ability level of cadres in an effort to refer patients to dental polyclinic in October and November 2021, the highest criteria were 28 cadres (70%) and enough criteria were 12 cadres (30%).

The third parameter is to analyze the active participation of cadres in counseling and referral of dental and oral health patients to dental polyclinic of Banjar Health Center 1. With the results of the study the highest value was the role of counseling with good criteria with the role of efforts referring to good criteria, there were 15 cadres, and with a score of 15 cadres. the lowest is the role of counseling with sufficient criteria with the role of efforts to refer to sufficient criteria, there are 12 cadres, this happens there are some cadres who are less confident at the time of counseling or to make dental and oral health referrals.

Based on the results of the chi square statistical test from the output above, the ability of the role of cadres in counseling with the number of visits at the dental polyclinic obtained p value = 0.011 (<0.05), while the ability of cadres in an effort to refer patients with the number of visits at the dental polyclinic was obtained p = 0.011 (<0.05), it can be concluded that there is a significant linear relationship between the independent variable and the dependent variable, meaning that the role of cadres in counseling efforts and dental health referrals is related to the variable of visits to the dental polyclinic of Banjar Health Center 1.

CONCLUSION

Based on the results of the study, it can be concluded there is a relationship between the participation of cadres in counseling and referral of dental and oral patients with visits to the dental polyclinic during the Covid-19 period at the Banjar 1 Health Center.

ACKNOWLEDGEMENTS

The authors thank to all participants and research assistants.

CONFLICT OF INTEREST

The authors declare that they have no conflict interests.

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