Nurse Media Journal of Nursing e-ISSN: 2406-8799, p-ISSN: 2087-7811 https://ejournal.
id/index.
php/medianers 11.
:71-84.
April 2021 https://doi.
org/10.
14710/nmjn.
ORIGINAL RESEARCH
Validity and Reliability of Indonesian Public Health Nursing Competencies in Achieving Indonesian Healthy Program with a Family Approach: A Pilot Study Tantut Susanto1.
Latifa Aini Susumaningrum1.
Hanny Rasni1.
Rismawan Adi Yunanto1 1Department of Community.
Family & Geriatric Nursing.
Faculty of Nursing.
Universitas Jember.
Indonesia Article Info Article History:
Received: 26 April 2020 Revised: 13 February 2021 Accepted: 18 February 2021 Online: 21 April 2021 Keywords:
Community.
public health nurse.
public health Corresponding Author:
Tantut Susanto Department of Community.
Family & Geriatric Nursing.
Faculty of Nursing.
Universitas Jember.
Indonesia Email: tantut_s.
psik@unej.
Abstract Background: Indonesia has the Indonesian Healthy Program with a Family Approach (IHP-FA) to solve various health problems in the country.
The public health providers in Indonesia play a very vital role in realizing this program.
There have not been clear reference standards regarding the Indonesian Public Health Nursing (IPHN) competencies.
This condition causes the provision of nursing services in public health centers (PHC.
to be suboptimal.
Purpose: This study aimed to identify the validity and reliability of the core competencies of IPHN standards in a practice setting to achieve the IHP-FA.
Methods: A pilot study using a descriptive correlational study was conducted among 55 coordinators of public health nursing (PHN) program from 50 PHCs in Jember.
Indonesia.
The IPHN practices were accessed using the five PHN core competencies .
ncluding activities in PHCs and nursing care for follow-up patients, family, special needs group in the community, and communit.
The IHP-FA was measured using 12 indicators.
Content Validity Index (CVI) was used to examine the validity of core competencies.
Internal consistency was explored using CronbachAo coefficient.
Construct validity using the known-groups technique was explored to measure the correlational between IPHN competencies and indicator of IHP-FA.
Results: The CVI indicated adequate content validity .
and high reliability (CronbachAos alpha coefficient=0.
There was a significant correlation between five core IPHN competencies and achievement of IHP-FA .
afe birth delivery, immunization, growth and development, management of tuberculosis, smoking, and access to clean wate.
Conclusion: IPHN competencies contain valid, reliable, and psychometrically robust measures.
However, some programs in IHP-FA could not be achieved with five IPHN core competencies, demonstrating the need for developing the IPHN competencies in the future.
How to cite: Susanto.
Susumaningrum.
Rasni.
, & Yunanto.
Validity and reliability of Indonesian public health nursing competencies in achieving Indonesian healthy program with a family approach: A pilot study.
Nurse Media Journal of Nursing, 11.
, 71-84.
https://doi.
org/10.
14710/nmjn.
Introduction Family health nursing, as a primary form of family service in the community, can facilitate healthy family development through the preservation of healthy values in family institutions and family dynamics based on the family structure and function (Susanto et al.
, 2.
The government of Indonesia designed the Indonesian Healthy Program through Family approach (IHP-FA) (Ministry of Health Republic of Indonesia, 2016.
This program is realized through the fifth agenda of the 10 IndonesiaAos president agenda .
alled in Bahasa Indonesia: Nawa Cit.
(Rahayu, 2.
The Nawa Cita program is related to 17 indicators in Sustainable Development Goals (SDG.
(World Health Organization, 2.
, which is to improve the quality of life of the Indonesian people (Ministry of Health Republic of Indonesia, 2016.
On the other hand, families in Indonesia experience problems of family growth and development, both at risk or vulnerable to health problems (Nur et al.
, 2017.
Susanto.
Yunanto et al.
, 2.
This is due to the suboptimal practice of family nursing care services through home visits within the framework of the public health nursing (PHN) program at the public health centers (PHC.
(Susanto.
Bachtiar et al.
, 2.
Therefore, a comprehensive effort to implement PHN is needed to achieve the IHP-FA program at the PHCs.
Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 72 The IHP-FA consists of four priority areas which include decreasing maternal and infant mortality rates, decreasing stunting prevalence, controlling infectious diseases, and controlling non-communicable diseases (Ministry of Health Republic of Indonesia, 2016.
The target achievement of the SDGs program in Indonesia is still low in the health sector, which includes 9% of malnutrition and 11.
5% of stunting among under-five children, 17.
3% of malnutrition, 9% of anemia among pregnant women (Ministry of Health Republic of Indonesia, 2.
Maternal and child health problems are the fourth indicator of SDGs and priority areas of the IHP-FA program, which are the key to the success of nation-building by describing the socioeconomic conditions of the community and their abilities (Ministry of Health Republic of Indonesia, 2016.
, thus requiring efforts to improve health services in the community through PHN in reducing the risk and vulnerability of health problems in the community.
An imbalance between host, agent, behavior, and the environment results in changes in the epidemiological transition of infectious diseases in Indonesia.
Furthermore, the prevalence rate for communicable diseases in Indonesia is very high, such as 0.
4% of tuberculosis, 4% of pneumonia, 6.
8% of diarrhea, 0.
2% of hepatitis, and 0.
4% of malaria.
Meanwhile, changes in unhealthy lifestyles that lead to the problem of chronic diseases or non-communicable diseases are increasing in Indonesia, such as 2.
4% of asthma, 1.
8% of cancer, 10.
9% of stroke, 3.
8% of kidney diseases, 7.
3% of joint and bone diseases, 2% of diabetes, 1.
5% of heart diseases, and 8% of hypertension (Ministry of Health Republic of Indonesia, 2.
Furthermore, infectious and chronic diseases are triggered by unhealthy lifestyles on the meaning of healthy living and self-improvement desired by individuals and can be changed through health promotion (Pender et al.
, 2.
, thus requiring adaptation because it becomes a burden on family dependents that will be able to weaken general health conditions in the community.
Maternal and child health problems, infectious diseases, and chronic diseases in the community require comprehensive and sustainable treatment.
Handling can be done through prevention, promotion, and protection programs at the PHCs to support the sustainability of the SDGs and the achievement of IHP-FA through the PHN program.
Meanwhile, the Ministry of Health of Indonesia made regulation of public health nurses (PHN.
duties for PHN services to achieve healthy programs in the PHCs (Ministry of Health Republic of Indonesia, 2.
However, regarding the evaluation of the results of 2015.
PHCs still lack for implementing PHN, because only 663 out of a total of 9,655 of PHCs .
069%) were able to implement PHN services according to the guidelines in 27 provinces from the 33 existing provinces (Ministry of Health Republic of Indonesia, 2.
Furthermore, obstacles in the implementation of the PHN services will have an impact on the implementation of the IHP-FA program at the PHCs in achieving 12 indicators of IHP-FA.
Furthermore, previous studies showed that there was a relationship between PHNsAo knowledge and attitudes and the performance of the PHN services that resulted in low coverage of performance implementation PHN services (Susanto.
Bachtiar et al.
, 2.
In an effort to increase the role of PHN, it is necessary to collaborate with the community and family through empowerment and partnership competencies of PHN for implementing PHN services (Widyarani et al.
, 2.
Furthermore.
PHNs in Indonesia have only focused on the indicators of achievements of the program without looking at the extent to which the process of PHNs' activities in the field is related to the role of PHNs based on the indicators of inputs, processes, and outputs of PHN activities (Susanto.
Bachtiar et al.
, 2.
This situation needs a solution for developing PHNsAo duties for PHN services to achieve healthy programs in the PHCs.
On the other hand, there are no studies in Indonesia setting to develop five core IPHN competencies from the Indonesian Ministry of Health in 2006 (Ministry of Health Republic of Indonesia, 2.
, although this regulation has become a standard to evaluate the performance of PHNs in Indonesia.
The present study aimed to identify the validity and reliability of core competencies for the IPHN standards in a practice setting by public health professionals for the achievement of IHP-FA in an Indonesian context.
Methods 1 Research design A descriptive correlational study design was used to explore the IPHN core competencies for the achievement of the IHP-FA.
Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 73 2 Setting and sample This study was conducted in May 2019 in Jember regency.
East Java.
Indonesia.
Fifty-five coordinators of PHN program from 50 PHCs in Jember were recruited, involving at least 1 PHN from each PHCs.
The data from the Department of Public Health of Jember reported that the achievement of PHN services was only 44.
87% of caring for community groups from 50 PHCs (Susanto et al.
, 2.
Therefore, all coordinators of PHN program from 50 PHCs were included to do an assessment on their competencies.
The inclusion criteria in this study were the coordinator of PHN program, length of duties as the coordinator of PHN program was at least 3 months, and had a license of coordinator of PHN program.
3 Measurement and data collection 1 Tools development The core competencies of PHN in this study were developed based on the five core IPHN competencies .
ncluding activities in PHCs and nursing care for follow-up patients, family, special needs group in the community, and communit.
with regard to the regulation from the Ministry of Health of Indonesia in 2006 (Ministry of Health Republic of Indonesia, 2.
These competencies consist of 35 items that are divided into five core competencies, including activities in PHCs .
, nursing care for follow-up patients .
, nursing care for family .
, nursing care for special needs group in the community .
, and nursing care for community .
For developing the tool in this study, the IPHN competencies were accessed using a Likert scale .
lways=4.
often=3.
sometimes=2.
and never=.
Then, all of the items from the questionnaire were summed to obtain the total score of IPHN and the overall score of five cores of IPHN, respectively.
2 Measurement A self-administered questionnaire was used to measure the sociodemographic data of the coordinators of PHN program .
ncluding age, gender, educational background, profession status, length of becoming of the coordinator of PHN program, occupation status.
PHN training program, and experience of working in a hospita.
The IPHN competencies were measured using the PHN competencies developed by the researchers as described in the previous section .
ool developmen.
For the IHP-FA program, we used the IHP-FA from the Ministry of Health of Indonesia in 2016 (Ministry of Health Republic of Indonesia, 2016.
The IHP-FA was measured using 12 indicators .
ncluding family planning, safe birth delivery, immunization, exclusive breastfeeding, growth and development, management of tuberculosis, management of hypertension, rehabilitation mental illness, smoking, coverage health insurance, access to clean water, and healthy sanitar.
The secondary data of the IHP-FA report were also accessed in this study as reported by PHNs monthly to the Department of Public Health of Jember regency from 50 PHCs.
For the purpose of data collection, 55 coordinators of PHN program from 50 PHCs were invited to attend this study in the Department of Public Health of Jember Regency.
These participants were informed of the aim and procedures of this study.
They signed informed consent for their participation.
4 Data analysis This study used descriptive and correlational data analyses.
Descriptive statistics included frequencies and percentages for summarizing categorical measures.
Then, median and standard deviation were used for summarizing continuous measures.
Content Validity Index (CVI) was employed to determine item validity (Polit & Beck, 2.
Three experts of community and family health nurses were asked to rate each of the 35 items of IPHN competencies based on relevance and clarity for measuring the PHNs duties for PHN services to achieve healthy programs in the PHCs.
The questions rated employed a four-point Likert scale with a score of 1 meaning not relevant, a score of 2 meaning somewhat relevant, a score of 3 meaning quite relevant, and a score of 4 meaning highly relevant.
The surveyAos internal consistency was assessed using CronbachAos alpha.
In reliability analysis, means and standard deviations of the items were examined to measure the item difficulty for judgment and Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 74 endorsement purposes, while the item-total correlation was employed to examine item discrimination (Susanto et al.
, 2.
Finally, construct validity using the known-groups technique was performed to refer to an instrumentAos ability to differentiate between the coordinators of PHN program competencies on the achievement of IHP-FA.
A PearsonAos product moment was used to measure the correlational between coordinators of PHN program competencies and indicator of IHP-FA.
To determine the statistical significance based on the assumption of the appropriate test was performed using a twoAatailed significance level of 0.
5 Ethical considerations This study was approved by the Institutional Review Boards (IRB) of the Faculty of Dentistry.
Universitas Jember.
Indonesia .
eference number 189/UN25.
8/KEPK/DL/2.
All participants signed informed consent for their participation.
Results 1 Characteristics of participants Table 1 shows that the mean age of the participants was 37.
1 years, and the mean of length of becoming PHN coordinator was 10.
9 months.
The majority of the participants were males .
%) and hold Diploma 3 of nursing/midwifery .
%).
Regarding the core competencies for IPHN standard from three expert panels, the content validity index indicated adequate content validity .
80Ae0.
Table 1.
Characteristic of participants .
= .
Variable Age .
Gender Male Female Education Diploma 1 (Nursin.
Diploma 3 (Nursing and Midwifer.
Diploma 4 (Midwifer.
Bachelor of nursing Bachelor of public health Master of public health Status of profession Nurse (Diplom.
Nurse (RN) Midwifery Sanitarian Nutritionist Public health Length of becoming PHN coordinator .
Status occupation Public government Private Temporary Training PHN program Attending Not yet Having experience working in a hospital Under-five years More than five years Mean C SD 1 C 8.
9 C 7.
Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 75 2 Internal consistency of IPHN competencies Table 2 indicates that the core competencies of IPHN standards had high reliability (CronbachAos alpha coefficient=0.
, including activities in PHCs (CronbachAos alpha=0.
nursing care for follow-up patient (Cronbach's alpha=0.
, nursing care for family (CronbachAos alpha=0.
, nursing care for special needs group in community (CronbachAos alpha=0.
, and nursing care for community (CronbachAos alpha=0.
In Figure 1 .
ee Appendix .
, from 12 indicators of IHP-FA, the top three achievements of PHN activities were 6% for health care of mental illness patients, 86.
1% for family planning with contraceptives 7% for birth delivery with midwifery.
3 Construct validity of the correlation between IPHN competencies and IHP-FA indicators Table 3 indicates that there was a significant correlation between the five core IPHN competencies .
or activities in PHCs, nursing care for follow-up patient, nursing care for family, nursing care for special needs group in the community, and nursing care for the communit.
and the achievement of IHP-FA .
<0.
However, there was no correlation between the total score of five core IPHN competencies and the achievement of IHP-FA .
>0.
The core competencies of PHN for activities in PHCs were correlated with safe birth delivery with midwifery, basic immunization for under-five children, and monitoring growth and development of under-five children.
Meanwhile, core competencies of public health professionals for nursing care for follow-up patients were correlated with safe birth delivery with midwifery, basic immunization for under-five children, monitoring growth and development of under-five children, management of tuberculosis patients, and access to clean Then, core competencies for nursing care for family and nursing care for the community were correlated with safe birth delivery with midwifery and stopping smoking habit in the Furthermore, the core competencies of PHN for nursing care for special needs groups in the community was only correlated with stopping smoking habits in the family.
Discussion The IPHN competencies are a valid and reliable instrument for measuring the coordinators of PHN programAo duties and PHN services to achieve healthy programs in the PHCs and predict the achievement of IHP-FA.
The competencies contained 35 items with five core competencies .
ncluding activities in PHCs, nursing care for follow-up patient, nursing care for family, nursing care for special needs group in the community, and nursing care for a communit.
with adequate content validity .
, and high reliability .
verall CronbachAos alpha=0.
The five core competencies of IPHN are correlated with the achievement of IHP-FA, although some of the core competencies are not predictable for the achievement of IHP-FA.
The IPHN competencies that contained 35 items with five core competencies are valid and reliable, although the items are different from the Quad Council Practice Competencies (QCPC) for PHN (Swider et al.
, 2.
QCPC for PHN consisted of eight core competencies with a total 79 of items .
ncluding analytic and assessment skills, policy development/program planning skills, communication skills, cultural competency skill, the community of dimensions of practice skills, public of health sciences skills, financial management and planning skills, and leadership and systems thinking skill.
and ten domains competencies of primary health care professional .
rofessional values, communication, teamwork, management, community-oriented, health promotion, problem-solving, health care, and education and basic public health science.
(Witt & de Almeida, 2.
Whereas in this study, the IPHN competencies include five core competencies with 35 items, such as activities in PHCs, nursing care for follow-up patient, nursing care for family, nursing care for special needs group in the community, and nursing care for community (Ministry of Health Republic of Indonesia, 2.
However, a previous study reduced the QCPC for PHN to six factors that integrated important concepts of both the nursing process and the intervention wheel (Reckinger et al.
, 2.
The differences in this competencies may be explained that IPHN competencies are just focused on the duties of coordinators of PHN program for their activities in PHN services.
The five core competencies of IPHN are included in both of the core competencies of the QCPC for PHN .
ncluding analytic and assessment skills and community of dimensions of practice skill.
(Widyarani et al.
, 2.
Therefore, the IPHN competencies should be developed that used confirmatory factor analysis with QCPC for PHN.
Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 76 Table 2.
Item means, standard deviation, corrected item to total correlations, squared multiple correlations, and alpha if item deleted for PHN competencies scale .
= .
Competency of PHN Activities in PHCs Nursing care for out-patient and in-patient Case finding and early detection for out-patient Provide health education Observation and evaluation adherence of medication Case reference or case reports with health care workers in PHCs Provide health counseling Intervention delegation of authority regarding procedures operational standard Provide therapeutic environment during health care services in PHCs Nursing documentation Nursing care for follow-up patient Case finding which cross-contact diseases in one home Provide health education for patients and family Observation and evaluation adherence of medication Home visit/home health nursing regarding the schedule Provide direct care and indirect care to fulfill the basic needs of the patient Provide health counseling Nursing documentation Nursing care for family Identify family with risk/vulnerable/poverty related to health in the community Case finding which cross-contact diseases in one home Provide health education for the family as a system of care Home visit/home health nursing regarding the schedule Provide direct care and indirect care to fulfill the basic needs of the patient Provide health care regularly based on nursing care plan for long-term care Provide health counseling in home Nursing documentation Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811
Mean SD
CITC SMC AID
Cronbach's alpha ()= 0.
Cronbach's alpha ()= 0.
Cronbach's alpha ()= 0.
Nurse Media Journal of Nursing, 11.
, 2021, 77 Table 2.
Continued Competency of PHN
Nursing care for special needs group in the community Identify risk factors related to health problem among the groups in the community Provide health education based on the groups' needs Provide direct care for patients in the groups who need nursing care
Motivate for forming, guidance, and evaluation health cadres regarding the group
Nursing documentation Nursing care for the community Identify health problem that founded in the community area related to specific of diseases Encourage participation through motivating the community to form community-based health care
Provide health education for the community Motivate to form, develop, and evaluate health cadres in the community Implementing, following, and monitor of clean living and healthy behavior
Nursing documentation Overall alpha for PHN competencies Mean SD
CITC SMC
Cronbach's alpha ()= 0.
Cronbach's alpha ()= 0.
Note.
PHN=Public health nurses.
PHCs=Public health center.
SD=Standard deviation.
CITC=Corrected item to total correlations.
SMC=Squared multiple correlation.
AID=alpha if item deleted Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811
AID
Nurse Media Journal of Nursing, 11.
, 2021, 78 Table 3.
Correlation between PHN competencies and coverage 12 indicators of healthy of Indonesia with a family approach 12 indicators of healthy of Indonesia with a family approach Family planning with contraceptive Birth delivery with midwifery Basic immunization for under five Exclusive breastfeeding Monitoring growth and development of under five Management of tuberculosis patient Management of hypertension patient Healthcare for mental illness patient Stopping smoking habit in the family Coverage health insurance for family members Access for clean water Healthy sanitary toilet A0.
A0.
A0.
A0.
A0.
A0.
A0.
PHN Competencies A0.
A0.
A0.
A0.
A0.
A0.
A0.
A0.
A0.
Note.
PHN=Public health nurses.
*p<0.
**p<0.
A= Activities in public health centers.
B= Nursing care for follow-up patient.
C= Nursing care for family.
D= Nursing care for special needs group in the community.
E= Nursing care for community.
F= Total score of PHN competency Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 79 Our finding indicated that the core competencies of coordinators of PHN program for activities in PHCs were correlated with safety birth delivery with midwifery, basic immunization for under-five children, and monitoring growth and development of under-five children.
It is similar with a previous study that the overall level of competency of QCPC was most strongly associated with the duration of professional experience in rural areas (Bigbee et al.
, 2.
This situation shows that the majority of IPHNs work in rural areas, in which the major health problems are maternal and child health care (Susanto, 2.
Therefore, the IPHC competencies could be implemented for PHNs to perform their activities of PHN services in rural areas.
Meanwhile, the core competencies for nursing care for follow-up patients were correlated with safety birth delivery with midwifery, basic immunization for under-five children, monitoring growth and development of under-five children, management of tuberculosis patients, and access to clean water.
This indicates that so far, the health services provided by the coordinators of PHN program have focused on completing Indonesia's national agenda in reducing maternal and child mortality (Ministry of Health of Republic Indonesia, 2016.
, although several infectious diseases in Indonesia have yet to finish the program (Ministry of Health of Republic Indonesia 2.
, and clean and healthy living behavior in Indonesia still low (Susanto et al.
, 2.
This is likely because the case finding and prevention of some infectious diseases have not been optimal (Susanti et al.
, 2.
Thus, the tools of competencies of IPHN should be sensitive to measure their activities for preventing communicable diseases.
Then, the core competencies for nursing care for family and nursing care for the community were correlated with safe birth delivery with midwifery and stopping smoking habits in the These results are relevant to the previous study that the core competencies model of PHN could predict the family planning program (Hewitt et al.
, 2.
However, some negative behavior, such as smoking, has begun to be identified as the cause of health problems (Susanto & Widayati, 2.
This indicates that coordinators of PHN program need to conduct regular and continuous home visits in providing nursing care services to reach the level of family independence in solving their health problems.
The level of family independence is the main goal of providing family nursing care in facilitating the continuity of family functions (Ministry of Health of Republic Indonesia, 2.
Therefore, family empowerment needs to be carried out optimally by coordinators of PHN program to solve the health problems of fostered families.
Furthermore, the core competencies for nursing care for special needs groups in the community was only correlated with stopping smoking habits in the family.
This result is similar with previous studies that chronic diseases and non-communicable diseases is a health problem in the rural area as a state of health transition related to smoking behavior (Low et al.
, 2015.
Ng.
However, smoking regulation needs appropriate bargaining through the government institutions, as previous research indicated that the competence of coordinators of PHN program is required for the management of policies and organizations (Polivka & Chaudry.
Therefore, skills in negotiation and organizational planning need to be developed in PHN Implication and limitation The IPHN competency instrument developed in this study can be used as a reference in measuring the performance of PHNs in Indonesia.
The results of this pilot study could be used by the government, especially the health office, in developing the competencies of coordinators of PHN program in PHCs.
This tool could also be used for evaluating the performance of the coordinators of PHN program in carrying out the HIP-FA.
However, it can only estimate the tasks and obligations that must be performed at PHCs.
In order to be able to measure more broadly, the competency standard of PHN in Indonesia needs to be developed again related to other dimensions by referring to the QCPC for PHN.
Therefore, the achievement of IHP-FA can be accelerated in its completion.
This study has some limitations.
First.
PHN competencies developed in this study only used the IPHN competencies, so the results cannot be generalized.
For this reason, further research can conduct explanatory and confirmatory factor analysis between IPHN competencies and QCPC for PHN.
Second, the research is only conducted in one region in Indonesia.
therefore, it needs to be conducted in a larger population in order to measure the achievement of IHP-FA.
Copyright A 2021.
NMJN, e-ISSN 2406-8799, p-ISSN 2087-7811 Nurse Media Journal of Nursing, 11.
, 2021, 80 Conclusion The IPHN competencies contain valid, reliable, and psychometrically robust measures.
However, some programs in IHP-FA could not be achieved with the five core competencies of IPHN, demonstrating the need for developing the IPHN competencies in the future.
The IPHN competencies are very important to be a standard for achieving the 12 indicators of IHP-FA.
Therefore, developing the PHN core competencies of IPHN should be standardized in the Indonesian setting.
Subsequent research to focus more on confirmatory and explanatory factor analysis between the IPHN and QCPC for PHN is necessary.
IPHN competences can measure PHN services in PHCs in achieving the IHP-FA.
Acknowledgment The authors would like to thank the Faculty of Nursing and Department of Research and Community Engagement of Universitas Jember for funding of Research Group Caring for Risk and Vulnerable Populations in the Community.
We also thank the coordinators of PHN program from 50 PHCs in Jember Regency.
East Java.
Indonesia, who participated in this study, and the Department of Public Health of Jember Regency to act as the center of this study.
Conflict of interest The authors declared no conflict of interest in this study.
References