Exploring the implementation of community-based health promotion programs for childhood diarrhea prevention in primary healthcare: A qualitative study
DOI:
https://doi.org/10.61099/junedik.v4i2.469Keywords:
child health, diarrhea, health promotion, primary health careAbstract
Introduction: Childhood diarrhea remains a major public health challenge in low- and middle-income countries despite the widespread implementation of health promotion initiatives through primary healthcare services. While previous studies have largely evaluated intervention effectiveness using quantitative indicators, there is limited evidence on how community-based health promotion programs are implemented in routine primary healthcare settings. This study aimed to explore the implementation of community-based health promotion programs to prevent childhood diarrhoea from multiple stakeholders' perspectives.
Research Methodology: A qualitative descriptive study with an interpretive approach was conducted between January and March 2026 in the working area of Bontomangape Primary Health Center, Takalar Regency, Indonesia. Twenty-five purposively selected informants, including healthcare managers, health promotion officers, healthcare professionals, community health volunteers, and mothers of children under five years, participated in semi-structured in-depth interviews. Non-participant observations and document reviews were used to strengthen data triangulation. Data were analyzed using Braun and Clarke's six-phase Reflexive Thematic Analysis supported by NVivo Release 14. Trustworthiness was established through credibility, transferability, dependability, and confirmability.
Results: Four interconnected themes emerged: implementation of community-based health promotion activities, perceived program benefits, barriers to implementation, and strategies for program strengthening. Participants reported that health education, home visits, and Posyandu activities improved caregivers' knowledge and preventive practices. However, workforce shortages, limited educational resources, and inconsistent community participation constrained program sustainability. Data saturation was achieved after the twenty-third interview and confirmed through two additional interviews.
Conclusion: Community-based health promotion is an essential component of childhood diarrhoea prevention but requires stronger organisational capacity, sustained community engagement, and intersectoral collaboration to maximise its effectiveness. Strengthening primary healthcare systems through context-sensitive, community-centred health promotion strategies may improve program sustainability and help reduce the burden of preventable childhood diarrhoea
Downloads
References
1. Kyu HH, Vongpradith A, Dominguez R-MV, et al. Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Infect Dis. 2025;25(5):519-536. doi:https://doi.org/10.1016/ S1473-3099(24)00691-1
2. Anthonj C, Setty K, Hoeser C, Brown J, Ihnacik L, Poague K. Assessing water and health insecurity in informal settlements: Bringing Europe’s invisible, marginalized Roma communities into focus. A systematic scoping review. Soc Sci Med. 2025;384:118526. doi:https://dx.doi.org/10.1016/j.socscimed.2025.118526
3. Ayenew AA, Mol BW, Abeje G, Bradford B. Healthcare and community perspectives on female genital mutilation/cutting (FGM/C): a qualitative study. eClinicalMedicine. 2025;90:103604. doi:https://doi.org/10.1016/j.eclinm.2025.103604
4. Bhandari D, Robinson E, Pollock W, Watterson J, Su TT, Lokmic-Tomkins Z. Mapping multilevel adaptation response to protect maternal and child health from climate change impacts: a scoping review. iScience. Published online 2025:111914. doi:https://doi.org/10.1016/j.isci.2025.111914
5. Thobari JA, Mulyadi AWE, Watts E, et al. Direct and indirect costs of acute diarrhea in children under five years of age in Indonesia: Health facilities and community survey. Lancet Reg Heal Pacific. 2022;19. doi: https://dx.doi.org/10.1016/j.lanwpc.2021.100333
6. Cenderadewi M, Franklin RC, Fathana PB, Devine SG. Adapting WHO drowning prevention strategies for children in Indonesia: barriers, enablers, and policy perspectives for LMICs. Lancet Reg Heal - Southeast Asia. 2025;43:100697. doi:https://doi.org/10.1016/j.lansea.2025.100697
7. Haderer M, Hofmann R, Bartelmeß T, et al. General practitioner-centered rural obesity management: Design, protocol and baseline data of the German HAPpEN pragmatic trial. Prev Med Reports. 2025;49:102959. doi:https://doi.org/10.1016/j.pmedr.2024.102959
8. Herrera-Almanza C, Rosales-Rueda MF. Community-based health programs and child vaccinations: Evidence from Madagascar. World Dev. 2023;170:106322. doi:https://dx.doi.org/10.1016/j.worlddev.2023.106322
9. House ET, Kerr E, Taki S, et al. A comparison of early childhood obesity prevention in Australian general practice and child and family health settings: A mixed methods study. J Pediatr Nurs. 2025;81:97-107. doi:https://doi.org/10.1016/j.pedn.2025.01.021
10. Jannah R, Kolopaking LM, Adiwibowo S, Maarif S. Global Climate Commitments and Local Disconnect: Imagining Climate Change through Indonesia’s Community Climate Program. Glob Transitions. Published online June 2025. doi:https://dx.doi.org/10.1016/j.glt.2025.06.008
11. Kuhn ALR, Rariden CA. Social Prescribing: Healing People Through Community. J Nurse Pract. 2024;20(2):104894. doi:https://doi.org/10.1016/j.nurpra.2023.104894
12. Li EPH, Kushnerik T, Seaton CL, et al. Rural digital social innovation for health and social care: A systematic review. SSM - Heal Syst. 2025;5:100143. doi:https://doi.org/10.1016/j.ssmhs.2025.100143
13. Mora-García CA, Pesec M, Prado AM. The effect of primary healthcare on mortality: Evidence from Costa Rica. J Health Econ. 2024;93:102833. doi:https://doi.org/10.1016/j.jhealeco.2023.102833
14. Morales F, Guerendiain M. Health assessment of 4–13 years students living in a rural Andean region: The EVANES study design protocol. Clin Nutr Open Sci. 2025;62:189-207. doi:https://doi.org/10.1016/j.nutos.2025.06.003
15. Musa Mohammed MO. Prevalence and risk factors associated with under-five years children diarrhea in Malawi: Application of survey logistic regression. Heliyon. 2024;10(7):e29335. doi:https://doi.org/10.1016/j.heliyon.2024.e29335
16. Oerther S, Phillips Z, Zhang Z, Salas J, Farabi S, Otey T. Characterizing pediatric discharge diagnoses associated with daily extreme heat exposure in the Midwestern US: A retrospective case-crossover study. Heliyon. 2025;11(3):e42129. doi:https://doi.org/10.1016/j.heliyon.2025.e42129
17. Orimadegun AE, Jegede AS, Gaffey MF, et al. A mixed-methods study of the drivers of stunting reduction among children under five in Nigeria, 2008–2018. Am J Clin Nutr. 2025;121:S86-S94. doi:https://doi.org/10.1016/j.ajcnut.2025.02.022
18. Pauzi RY, Ilmi AN, Kumaratih LW. Gut microbiota dysbiosis and probiotic interventions in childhood stunting: Mechanistic insights and therapeutic potential. Med Microecol. 2025;26:100152. doi:https://doi.org/10.1016/j.medmic.2025.100152
19. Ragwar V, Brown M. Causal factors of childhood pneumonia high mortalities and the impact of community case management on child survival in Sub-Saharan Africa: a systematic review. Public Health. 2023;223:131-138. doi:https://doi.org/10.1016/j.puhe.2023.07.033
20. Rich JR, Dymock M, Seppanen EJ, et al. Evaluating the impact of the ‘Blow, Breathe, Cough’ health promotion intervention in resolving otitis media with effusion in children: An adaptive randomized-controlled trial protocol. Contemp Clin Trials Commun. 2025;47:101531. doi:https://doi.org/10.1016/j.conctc.2025.101531
21. Setiawati A, Arda D, Nordianiwati N, Aris Tyarini I, Indryani I. Factors associated with nutritional status in children under five. J Edukasi Ilm Kesehat. 2023;1(3):99-106. doi:https://dx.doi.org/10.61099/junedik.v1i3.24
22. Sharma M, Lakhan RBT-EA to GHI. Chapter 9 - Child health. In: Academic Press; 2025:191-210. doi:https://doi.org/10.1016/B978-0-443-29098-5.00001-1
23. Shrestha P, Afsana K, Weerasinghe MC, et al. Strengthening primary health care through community health workers in South Asia. Lancet Reg Heal - Southeast Asia. 2024;28:100463. doi:https://doi.org/10.1016/j.lansea.2024.100463
24. Suprapto. Stunting Policy Implementation in Indonesia: A Primary Health Care Perspective. J Ilm Kesehat Sandi Husada. 2026;15(1):347-361. doi:https://doi.org/10.35816/jiksh.v15i1.302
25. Syarif I, Langelo W, Jukarnain J, Nursiah A, Masita N. Family Health Tasks and Childhood Stunting in Primary Care: A Cross-Sectional Study in Indonesia. J Ilm Kesehat Sandi Husada. 2026;15(1 SE-Articles):49-59. doi:https://doi.org/10.35816/jiksh.v15i1.206
26. Tag ZM, Alashwal H, Chemaitelly H, Abu-Raddad LJ. Global childhood diarrhoea prevalence and its determinants: a systematic meta-analytic assessment, 1985–2024. eBioMedicine. Published online 2025:105956. doi:https://doi.org/10.1016/j.ebiom.2025.105956
27. Thacker SB, Sencer DJ, Jaffe HW, Gantt JM, Hilpertshauser ME. Centers for Disease Control and Prevention. In: Quah SRBT-IE of PH (Third E, ed. Academic Press; 2025:731-739. doi:https://doi.org/10.1016/B978-0-323-99967-0.00160-5
28. Yang KP, Bray TM, Chaudhuri A, Syam SB, Khanna SK. Barriers to child nutrition in Bengaluru slums: Caregiver insights from the SCOPE strategy. Eval Program Plann. 2025;111:102612. doi:https://doi.org/10.1016/j.evalprogplan.2025.102612
29. Yu W, Geng M, Li G, et al. Human settlement environment and childhood diarrhea in low- and middle-income countries. Environ Res. 2025;287:123103. doi:https://doi.org/10.1016/j.envres.2025.123103
Additional Files
Published
How to Cite
Issue
Section
Categories
Citation Check
License
Statement:
The authors retain the copyright of this work and grant Jurnal Edukasi Ilmiah Kesehatan the right of first publication. The work is simultaneously licensed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original author(s) and the initial publication in this journal are properly credited. The authors are permitted to copy and redistribute the published version of the work, including posting it to an institutional repository or including it in a book, with acknowledgment of its initial publication in Jurnal Edukasi Ilmiah Kesehatan.
