HEALTH CRISIS MANAGEMENT: A STUDY ON THE HANDLING OF
SCABIES AS A COMMUNICABLE DISEASE AT AL HUSAIN ISLAMIC
BOARDING SCHOOL
Aini Hidayati.
Nurul Isnaini Febriarini STIKES AL Islam Yogyakarta Corresponding Email: ainihidayati26@gmail.
ABSTRACT
Keywords Islamic boarding schools are densely populated and communal environments that are highly vulnerable to the spread of infectious diseases such as scabies.
Scabies transmission not only affects morbidity rates but also impacts student attendance, psychological well-being, and economic burden.
This study aims to analyze the effectiveness of health crisis management in addressing scabies at Pondok Pesantren Al Husain.
Magelang.
A quantitative approach was employed using path analysis based on Structural Equation Modeling (SEM) through SmartPLS 3.
A total of 220 students were selected as respondents using the Slovin formula.
Data were collected through questionnaires.
Findings indicate that policy and protocol variables have the most significant influence on response speed and the effectiveness of crisis management ( = p = 0.
Response speed also serves as the main mediator that strengthens the relationship between healthcare access and the effectiveness of crisis management ( = 0.
p = 0.
Conversely, health education and occupancy density variables did not show a significant effect.
The effectiveness of health crisis management in Islamic boarding schools is influenced by a combination of strong policies, rapid response, and adequate access to health services.
Structural interventions and strengthening of response systems are key to preventing scabies.
INTRODUCTION
Islamic boarding schools religious based educational institutions that play a vital role in shaping morally upright and knowledgeable generations.
Due to their communal living environment, pesantren also face significant challenges in Health Managemen Effectiveness .
Scabies.
Islamic Boarding Schools maintaining the health of their students, particularly concerning infectious diseases.
One of the most common infectious diseases found in pesantren settings is scabies.
Scabies, a skin condition commonly known as mange, is caused by an infestation of the International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
Issue 2.
August 2025 Sarcoptes scabiei mite (Bernigaud, 2020 .
Thomas, 2020 .
Nugroho et al.
, 2.
According to the World Health Organization (WHO, 2.
, the prevalence of scabies ranges from approximately 0.
to 71% and is estimated to affect more than 200 million people at any given time.
2017, scabies and other ectoparasitic diseases were classified as Neglected Tropical Diseases (NTD.
The global prevalence of scabies is reported to be around 130 million cases annually (Faidah & Saputro, 2.
Based on the International Alliance for the Control of Scabies (IACS), the occurrence of scabies ranges from 0.
to 46%.
According to the Ministry of Health of the Republic of Indonesia, the prevalence of scabies in Indonesia is between 5.
95%, making it the third most common skin disease among the twelve most frequent dermatological conditions in the country (Purbowati, 2.
The Ministry of Health has launched the AuScabies-Free Indonesia 2030Ay initiative to reduce its prevalence and impact, particularly among high-risk populations such as Islamic boarding schools.
Scabies is a common disease in Islamic .
ondok pesantre.
, primarily due to overcrowded living conditions, poor environmental sanitation, and inadequate personal hygiene among students (Sulistiarini, 2020.
Saraha et , 2.
Scabies infections occur through direct skin-to-skin contact or via transmission from mites attached to clothing, bedding, or towels (Wijaya et al.
Scabies, as a contagious disease, impacts not only morbidity rates but also students' school attendance, psychological well-being, and economic burden (Salawah.
Without effective strategies for prevention and treatment, scabies can spread rapidly, disrupt daily activities in the pesantren, and even lead to complications (Isramilda et al.
, 2.
According to Nurlita and Rahman .
, scabies can reduce students' quality of life and academic Students suffering from scabies-related experience symptoms such as redness, pus, and scaly skin, which can cause discomfort, low self-confidence, and embarrassment.
These symptoms may escalate into more serious psychological issues, including a negative self-concept (Abida et al.
, 2.
Pondok Pesantren Al Husain Magelang is one of the larger Islamic educational institutions with a significant number of students.
Due to its densely populated environment and communal activities, the pesantren is particularly vulnerable to the spread of contagious skin diseases such as scabies.
If not addressed promptly and appropriately, scabies cases can lead to serious consequencesAinot only for the physical health of the students but also for their psychosocial well-being and the overall effectiveness of the teaching and learning process within the pesantren (Jaya et al.
, 2022.
Wahyuni et al.
, 2.
In this context, an effective health crisis management system is essential to prevent, identify, and respond to outbreaks of infectious diseases such as scabies.
Health crisis management in the pesantren setting involves promotive, preventive, curative, and rehabilitative efforts that are wellcoordinated students, and their families.
However, there is still limited information regarding the level of preparedness and effectiveness of pesantren in managing health crises caused by infectious diseases.
Although several previous studies have identified risk factors for scabies in Islamic boarding schools, such as personal environmental sanitation (Sulistiarini, 2020.
Saraha et al.
, 2.
, most research has International Journal of Nursing and Midwifery Science (IJNMS).
Volume 9.
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August 2025 focused on individual behavioral aspects or physical environmental factors.
Quantitative studies examining the role of structural and managerial factors such as health policies, treatment protocols, and response speed remain very limited.
According to Donabedian .
, the quality of health management depends not only on behavior but also on the structure of the system and the service delivery process.
This study addresses this gap by analyzing the interrelationship between structural factors, processes, and outcomes in the effectiveness of health crisis management in Islamic boarding schools, particularly in the context of scabies control.
Based on this background, the present study aims to examine how health crisis management is implemented at Pondok Pesantren Al Husain.
Magelang, particularly in handling scabies cases.
Unlike previous studies, no research to date has quantitatively integrated structural factors .
olicies, protocols, healthcare acces.
, process factors .
esponse speed, .
ffectiveness of crisis managemen.
within the context of Islamic boarding schools, especially for scabies.
This study is expected to provide a comprehensive picture of the strategies and challenges encountered, as well as serve as a basis for formulating more effective health interventions in the boarding school environment.
METHOD
This study employed a quantitative method with a path analysis approach to measure the effectiveness of health crisis management strategies in improving the health crisis management process in Islamic boarding schools.
Data analysis was conducted using partial least squares (PLS) structural equation modeling (SEM) with SmartPLS 3.
0 software.
The study population comprised all students at the junior high school (SMP) and senior high school/vocational school (SMA/SMK) levels at Pondok Pesantren Al Husain, totaling 500 students.
The sampling technique used was probability sampling with proportionate stratified random sampling based on education level.
The sample size was determined using the Slovin formula, resulting in 220 students.
Data were collected through questionnaire distribution.
The questionnaire consisted of eight main constructs: residential density, sanitation and hygiene, health education, healthcare access, policies and protocols, health awareness and behavior, response speed, and the effectiveness of health crisis RESULTS Table 1.
RespondentsAo Demographic Characteristics Variable Category Gender Male Female Age .
11Ae14 15Ae18 Length of Stay in the Boarding 5Ae10 School .
> 10 Based on the distribution results presented in Table 1, it was found that the majority of respondents were female, totaling 116 individuals .
9%), while male respondents numbered 104 individuals .
1%).
In terms of age, most respondents were in the 15Ae18 year age group, comprising 116 individuals .
9%), while the remaining 104 individuals .
1%) were aged 11Ae14 years.
Regarding length of stay at the pesantren, the majority of respondents had been living in the pesantren for less than 5 years, totaling 151 individuals .
65%).
International Journal of Nursing and Midwifery Science (IJNMS).
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Path Analysis Results Table 3.
Direct Effects Path
Value ( /-) Analysis HA Ie CME
HA Ie RS
HA Ie HAB
HE Ie CME
HE Ie RS
HE Ie HAB
PP Ie RS
PP Ie HAB
RS Ie CME
HD Ie HAB
HAB Ie
CME
SH Ie CME
SH Ie RS
SH Ie HAB
SDV
Tstatistic(>1.
P-value (<0.
Decision Rejected Accepted Rejected Rejected Rejected Rejected Accepted Accepted Accepted Rejected Accepted Rejected Rejected Accepted Based on the path analysis results in Table 3, healthcare access has a significant direct effect on response speed ( = 0.
= 0.
, but it does not have a significant effect on crisis management effectiveness ( = 0.
p = 0.
or on health awareness and behavior ( = 0.
p = 0.
Policy and protocol show a significant direct influence on both response speed ( = 0.
p = 0.
and health awareness and behavior ( = 0.
p = 0.
Furthermore, response speed has a strong and significant effect on crisis management effectiveness ( = 0.
p = 0.
, as does health awareness and behavior, which also Effectiveness ( = 0.
p = 0.
On the other hand, sanitation and hygiene only show a significant direct effect on health awareness and behavior ( = 0.
= 0.
, but not on crisis management effectiveness ( = -0.
p = 0.
or response speed ( = 0.
p = 0.
Meanwhile, health education does not exhibit any significant direct influence on all outcome variables, management effectiveness ( = 0.
, response speed ( = 0.
, and health awareness and behavior ( = 0.
p = 0.
Similarly, housing density does not show a significant direct effect on health awareness and behavior ( = p = 0.
International Journal of Nursing and Midwifery Science (IJNMS).
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August 2025 Table 4.
Indirect Effects Path Analysis Value ( /-) HA Ie RS Ie CME
HE Ie RS Ie CME
PP Ie RS Ie CME
SH Ie RS Ie CME
HA Ie HAB Ie
CME
HE Ie HAB Ie
CME
PP Ie HAB Ie CME
HD Ie HAB Ie
CME
SH Ie HAB Ie CME
SDV
T-statistic (>1.
P-value (<0.
Accepted Rejected Accepted Rejected Rejected Rejected Rejected Rejected Rejected Based on the results of the indirect path analysis in Table 4, access to healthcare services has a significant indirect effect on crisis management effectiveness through response speed ( = 0.
p = 0.
This indicates that better access to healthcare leads to faster response times, which in turn enhances the effectiveness of crisis Similarly, policy and protocol also show a significant indirect effect on crisis management effectiveness through response speed ( = 0.
p = 0.
This suggests that appropriate policies and clear protocols can accelerate crisis response, thereby improving the overall effectiveness of crisis handling.
Table 5.
Total Effects Variable Path HA Ie CME HA Ie RS HA Ie HAB HE Ie CME HE Ie RS HE Ie HAB PP Ie CME PP Ie RS PP Ie HAB HD Ie CME HD Ie HAB HAB Ie CME SH Ie CME Original Sample (O) Decision The indirect influence paths from health education, sanitation & hygiene, and housing density through response speed or health awareness and behavior did not show a significant effect on crisis management effectiveness .
> 0.
This indicates that the mediating roles of these variables in this context remain weak or suboptimal.
Overall, response speed has been proven to be an effective mediator in strengthening the relationship between healthcare access and policy with crisis management effectiveness, whereas health awareness and behavior have not played a significant mediating role in any of the tested paths.
T Statistics (O/STDEV) Values Decision Standard Deviation (STDEV) Accepted Rejected Accepted Rejected Accepted International Journal of Nursing and Midwifery Science (IJNMS).
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August 2025 Based on the results of the total effect measurement in Table 5, the variable with the most substantial total influence on the effectiveness of crisis management is policy and protocol ( = 0.
, followed by health access ( = 0.
, and sanitation and hygiene ( = 0.
Variables such as health education and housing density require further reinforcement or reconsideration, as their total effects have not been statistically Table 7.
Structural Model Assessment: RA and eA Values Variable Housing Density (HD) Sanitation & Hygiene (SH) Health Education (HE) Healthcare Access (HA) Policy & Protocol (PP) Health Awareness & Behavior
(HAB)
Response Speed (RS) Crisis Management Effectiveness (CME) RA Value Interpretation eA .
o KPK) Weak Moderate Strong The RA analysis results in Table 7 indicate that the variables in the model are able to explain 63% of the variance in crisis management effectiveness, reflecting a strong predictive power.
Meanwhile, response speed is explained by 55.
8% of the variance, indicating a moderately good level of predictive capability.
However, for health awareness and behavior, the model accounts for only 31% of the variance, suggesting that there are still other external factors significantly influencing this variable.
The effect size .
A) analysis in Table 7 shows that the variable Policy & Protocol has a large effect on Response Speed .
A = .
and a moderate effect on Health Awareness & Behavior .
A = 0.
contrast, other variables such as Health Education.
Healthcare Access.
Sanitation & Hygiene, and Housing Density mostly demonstrate only small effects on the respective dependent variables.
No large effects were found on Health Awareness & eA .
o KR) eA .
o CME) Behavior, indicating that many other external factors may play a more significant role in shaping this variable.
DISCUSSION
This study demonstrates that the effectiveness of health crisis management in handling scabies cases at Pondok Pesantren Al Husain.
Magelang, is influenced by several key variables, with varying strengths of association.
These findings highlight the importance of a multi factor approach in managing infectious diseases in communal environments such as Islamic boarding The findings of this study can be analyzed using DonabedianAos Model, which views the quality of healthcare services through three main components: structure, process, and outcome (Donabedian, 1.
In the context of this study, structure includes the presence of health policies and protocols, access to healthcare facilities and personnel, as well as the availability of sanitation facilities.
Process encompasses the speed of response to scabies cases and International Journal of Nursing and Midwifery Science (IJNMS).
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August 2025 the implementation of health education for Outcome is represented by the effectiveness of health crisis management in the boarding school.
The analysis revealed that structural components, particularly policies and protocols, exert the strongest influence on the process .
esponse spee.
and directly enhance the outcome .
ffectiveness of crisis This extends the findings of Saraha et al.
, who concluded that most previous studies in Islamic boarding schools have focused on process-related individual behavioral factors such as personal hygiene and residential density, while structural aspects have rarely been examined quantitatively.
Thus, this study addresses the knowledge gap by demonstrating that the success of scabies prevention and control is determined not only by studentsAo behavior but also by a well-organized crisis management system supported by written policies, clear protocols, and coordinated rapid response.
Furthermore, the findings support the argument that strengthening service structures such as developing health standard operating procedures (SOP.
, establishing a boarding school health post, and providing isolation facilities can facilitate faster response processes, ultimately reducing the spread of infectious This approach is relevant for implementation in other Islamic boarding environmental characteristics.
Policies and protocols demonstrated the most significant direct effect on response speed ( = 0.
p = 0.
and on health awareness and behavior ( = 0.
The total effect on the effectiveness of crisis management was also the largest ( = 0.
These findings are consistent with Paul .
, who stated that effective crisis management may include making bold decisions, clearly articulated policies, thorough planning, timely communication with stakeholders, and taking swift action to avert disaster.
This underscores that scabies management requires written, systematic regulations that can be implemented According to Purbowati et al.
, policy interventions that include case mapping, isolation protocols, and significantly reduce the incidence of scabies in densely populated or communal settings such as Islamic boarding schools.
A similar study by Isramilda .
in an Islamic boarding school in Batam also found that the absence of clear health SOPs was a major factor contributing to the high incidence of skin diseases in the boarding school An effective policy not only requires the availability of written documents but also the involvement of all elements within the boarding school in its This is in line with the view of Nurlita and Rahman .
, who stated that the participation of students and administrators in decision-making and compliance with health policies.
Consistent with the findings of Sari .
in a study conducted at Pondok Pesantren An-Nur Ngrungkem.
Yogyakarta, the active roles of boarding school leaders, administrators, and students were found to be crucial in improving health within the boarding school In addition, this study found that response speed had a very strong direct effect on the effectiveness of crisis management ( = 0.
p = 0.
and served as a significant mediator between health policies/actions and the effectiveness of disease control.
This is consistent with Salvador-Carulla et al.
, who stated that rapid response is a key component in reducing the impact of infectious disease International Journal of Nursing and Midwifery Science (IJNMS).
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Saraha et al.
, in their scoping review, highlighted personal hygiene and residential density as major risk factors for scabies in Islamic boarding schools.
This difference may be attributed to the relatively homogeneous residential density in the current studyAos field setting, as well as the delivery of health education that was less contextual or participatory, thereby limiting its impact on studentsAo health behaviors (Faidah & Saputro, 2.
In the context of closed institutions such as Islamic boarding schools, prompt responses to student complaints, isolation of active cases, and continuous education are Nugroho et al.
demonstrated that a delay of more than 48 hours in addressing early symptoms of scabies increases the risk of transmission by up to threefold.
Although healthcare access did not show a significant direct effect on the effectiveness of crisis management .
= .
, it played an indirect role through response speed .
= 0.
This indicates that the presence of healthcare personnel, basic treatment facilities, and a boarding school health post is crucial as the first line of defense in controlling infectious diseases.
According to Salawah .
, active internal health facilities encourage studentsAo trust to report symptoms promptly, which indirectly Furthermore, the presence of a boarding school health post can bridge promotive, preventive, and curative health needs within a confined environment (Nurlita & Rahman, 2.
Sanitation and hygiene had a direct effect only on health awareness and behavior .
= 0.
and an indirect effect on the effectiveness of crisis management.
This is consistent with the findings of Syailindra and Mutiara .
, who stated that poor sanitation is a major risk factor for the spread of scabies, but is not sufficient to halt transmission without the support of response and managerial factors.
A study in Islamic boarding schools in Batanghari Regency by Salawah .
emphasized that, although room cleanliness and sanitation facilities were adequate, the primary determinant in scabies prevention was the behavior of individuals within the boarding school, including both students and The health education variable did not show a significant effect, either directly or indirectly, on the effectiveness of crisis management.
This may be due to the form of education being insufficiently contextual or not tailored to the characteristics of the students.
This variable had a significant effect on the effectiveness of crisis management ( = 0.
p = 0.
, but failed to serve as a mediator in most indirect influence This means that although healthy behavior is important, efforts to develop such behavior require time and a long-term As stated by Nugroho et al.
, fostering a culture of clean living in Islamic boarding schools should be an integral part of daily curriculum activities, rather than merely an incidental intervention when cases occur.
Residential density did not have a significant effect in the results of this model, although theoretically it is a major risk factor in the transmission of infectious diseases in closed institutions (Pondaag, 2024.
Isramilda et al.
, 2.
This finding is consistent with the study by Ridwan et al.
, which reported no relationship between residential density and the International Journal of Nursing and Midwifery Science (IJNMS).
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August 2025 incidence of scabies.
This may be due to the homogeneity of the studentsAo living conditions, which did not vary greatly, or the presence of protective factors such as the use of individual beds or staggered bathing The findings of this study reinforce the concept that health crisis management in institutions requires a combination of structural aspects .
olicies, protocol.
, operational aspects .
apid response, service acces.
, and cultural aspects .
Consistent with the findings of Ifendi .
, effective health management in Islamic boarding schools requires strong collaboration among school stakeholders in planning, organization, implementation, and The successful control of scabies cannot rely solely on education or facility improvement but necessitates a wellcoordinated emergency response system.
These findings provide a new perspective that, although behavioral factors such as personal hygiene remain important, the effectiveness of scabies control in Islamic boarding schools is more strongly determined by the readiness of infrastructure and the quality of crisis management Therefore, health policies in boarding schools should prioritize the establishment of clear protocols, ensure the availability of internal health facilities, and enhance response speed, rather than focusing solely on short-term educational Unlike previous studies, which generally highlighted individual behavioral aspects and physical environmental factors (Saraha et al.
, 2022.
Sulistiarini et al.
, 2.
this study quantitatively examines the influence of structural factors such as policies, protocols, and access to health services on crisis management effectiveness, including mapping direct and indirect relationships through path analysis.
These findings contribute new insights by demonstrating that structural factors and response speed play a more dominant role in improving crisis management effectiveness compared to behavioral factors, thereby providing a basis for strengthening health policies in Islamic boarding schools.
CONCLUSIONS
Based on the research findings, it can be concluded that the effectiveness of health crisis management in addressing scabies at Al Husain Islamic Boarding School in Magelang is strongly influenced by robust policies and protocols, rapid response to cases, and adequate access to healthcare services.
Clear and promptly implemented policies have been shown to enhance health behavior awareness and strengthen response effectiveness.
contrast, health education, housing density, and environmental sanitation did not demonstrate significant direct effects.
Therefore, strengthening policy systems and ensuring a rapid response mechanism are key strategies in controlling the spread of scabies within the boarding school
REFERENCES