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Volume 13, Issue 1 (2025)
Health Educ Health Promot 2025, 13(1): 39-47 |
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Received: 2024/12/20 | Accepted: 2025/01/22 | Published: 2025/01/26
Received: 2024/12/20 | Accepted: 2025/01/22 | Published: 2025/01/26
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Enhancing Scabies Prevention Knowledge in Boarding School Students through the BETRI Model for Health Promotion. Health Educ Health Promot 2025; 13 (1) :39-47
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URL: http://hehp.modares.ac.ir/article-4-79000-en.html
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Introduction
Infectious diseases remain one of the primary challenges in public health, with environmental factors playing a crucial role in their emergence and spread [1-3]. Unsanitary, overcrowded, and health-compromising environments significantly increase the risk of various diseases [4, 5]. Government Regulation No. 66/2014 on Environmental Health highlights that environmental media (such as water, air, soil, food, and public facilities) can serve as pathways for substances or agents that cause health problems or diseases in humans [6]. This underscores the critical need for effective environmental management as a preventive measure against disease [7].
Globally, the rapid spread and potential for outbreaks make infectious diseases a significant public health concern [8, 9]. As outlined in Law No. 4 of 1984 on Communicable Diseases, illnesses, such as typhus, smallpox, cholera, and bubonic plague demand immediate intervention. Additionally, endemic diseases like malaria, tuberculosis, and trachoma are key targets of government eradication programs [10]. Environmental factors and community behaviors are often pivotal in the transmission of these diseases. Scabies, for instance, remains a global health issue closely linked to such determinants [11, 12].
Scabies is a highly contagious skin condition caused by an infestation of Sarcoptes scabiei mites. Affecting more than 200 million people worldwide at any given time, the disease has a particularly high prevalence in tropical regions and densely populated areas. According to the World Health Organization (WHO), scabies affects up to 71% of the population in some regions, with children and vulnerable groups, such as the elderly, being disproportionately impacted [13]. The disease is strongly associated with poor environmental hygiene and poverty, often marked by inadequate access to clean water and sanitation facilities [14, 15]. By addressing the environmental and behavioral factors that contribute to the spread of infectious diseases like scabies, public health initiatives can better target vulnerable populations and implement sustainable prevention strategies.
Living in crowded environments, such as boarding schools, prisons, and orphanages increases the risk of scabies transmission due to direct contact and the sharing of personal items. Habits, such as exchanging clothes, towels, and bedding are the main routes for spreading the disease. In addition, low knowledge about prevention and treatment further exacerbates the situation. Many individuals rely solely on traditional medicine or use ointments without an adequate understanding of effective preventive measures [16].
Islamic boarding schools (pesantren) face unique challenges that contribute to the high prevalence of scabies compared to other environments [17]. The communal lifestyle in pesantren, characterized by shared sleeping spaces, clothing, and personal hygiene facilities, creates ideal conditions for scabies transmission. Limited access to clean water and inadequate sanitation further compounds the problem. Many students lack personal hygiene supplies such as soap, clean towels, and bedding, which increases their vulnerability to infestation. Additionally, the perception that scabies is a minor or inevitable condition in pesantren leads to a lack of urgency in seeking treatment or implementing preventive measures. The combination of these factors necessitates targeted interventions to improve hygiene practices and enhance disease prevention efforts in pesantren settings [18-20].
Several studies have shown that the level of community knowledge greatly influences the prevalence of scabies. Research by Abdillah [21] in Islamic boarding schools found that the low level of knowledge among students is directly proportional to the high number of scabies cases. Meanwhile, according to Setiaji & Fitriani [22], education using media, such as flipbooks, can increase students’ knowledge and hygienic behavior, thereby reducing the prevalence of this disease. This underscores the importance of community-based health education programs to prevent the transmission of scabies.
Preliminary studies conducted at the Mambaul Ulum Islamic Boarding School in Jambi showed that many students have habits that increase the risk of scabies, such as using damp clothes and rarely changing bed linen. Most students also consider scabies to be a common disease in the pesantren environment, leading to a lack of concern about its prevention. These factors indicate the need for more effective interventions to increase students’ awareness and knowledge about scabies and the importance of personal hygiene.
Based on this background, the main problem identified was the low level of knowledge and attitudes of students in boarding schools regarding scabies prevention efforts. Therefore, the development of an innovative and effective health promotion model was deemed a necessary solution to improve preventive behaviors against this disease. With the right educational approach, it is expected that the prevalence of scabies could be reduced, especially in high-risk environments such as boarding schools. This study aimed to develop the BETRI model in health promotion to increase knowledge of scabies prevention among students.
Materials and Methods
Design study
This experimental study, conducted in 2024, utilized a research and development (R&D) approach with the ADDIE framework (analysis, design, development, implementation, evaluation). This approach was designed to produce and test the effectiveness of a health promotion model aimed at improving scabies prevention efforts in boarding schools. The ADDIE model was chosen because it is systematic and flexible, allowing for continuous evaluation and development to generate applicable and effective solutions. During the evaluation of the educational model, the researchers assessed its effectiveness using a pre-test-post-test one-group design.
Participants
The participants were students at boarding schools, specifically Pondok Pesantren Mambaul Ulum and SMAN Titian Teras in Jambi. In the small group trial, the study involved ten students from each institution, while the field trial was conducted with 120 students (60 students from each institution). Participants were selected through simple randomization based on the inclusion criteria, including students who are active, live in the dormitory, are willing to participate, and come from an environment with a high prevalence of scabies.
The majority of participants were aged between 16 and 18 years, which is the typical age range for high school students, with a smaller proportion aged 19-20, particularly in Pondok Pesantren Mambaul Ulum, where some students continue their religious studies beyond the conventional high school years. Both male and female students were included in the study, with SMAN Titian Teras having a relatively balanced gender ratio, while Pondok Pesantren Mambaul Ulum had a higher proportion of male students. Most students had been living in the dormitory for at least one year, with some residing there for up to three years or more. Longer dormitory stays increased the likelihood of exposure to scabies due to shared living spaces, personal items, and hygiene practices.
Before the research was conducted, each participant was provided with a detailed explanation regarding the purpose, procedures, benefits, and potential risks of participating in the study. The informed consent process was implemented by giving participants a consent form, which had to be signed after they understood all the information provided. For participants under the age of 18, consent was also obtained from their parents or guardians. This ensures that participation in the study is voluntary and based on full understanding, while also maintaining ethical standards in the research.
In addition, the sample selection was conducted randomly using a simple random sampling method to minimize bias in the study. With this technique, every student who met the inclusion criteria had an equal chance of being selected as a respondent. This approach aimed to obtain results that are more representative and can be generalized to a broader population. The randomization process also reduces the possibility of selection bias, ensuring that the results are more objective and reflect the actual conditions of students living in dormitories.
Procedure
This research was conducted through the five stages of the ADDIE model. The first stage is analysis, which includes needs analysis, context analysis, and literature analysis to understand the prevalence of scabies, risk factors, and educational needs. Next, the design stage involves creating a prototype of a health promotion model that includes educational media, such as videos, posters, pocket books, and model books. At the development stage, the prototype was further refined based on input from the initial analysis and validated by experts in the field of health promotion and skin diseases. The next stage is implementation, during which the prototype is tested on small groups and in field trials using a weak experimental design (pre-test-post-test one-group design). Finally, at the evaluation stage, a formative evaluation is conducted to identify weaknesses, revise the product, and ensure that the health promotion model meets the criteria for feasibility and effectiveness (Figure 1).
![src=./files/hehp/images/HTML_Publish/79000/Screenshot_2025-05-14_134626.png]()
Figure 1. The used model
Parameters
The independent parameter was the health promotion model, which included educational media, intervention methods, and delivery strategies. The dependent parameters included knowledge about scabies, scabies prevention behavior, and scabies prevalence. Knowledge about scabies was measured using a questionnaire with a closed scale, where each correct answer received a score of one and each incorrect answer received a score of zero. The total score was then categorized into low, medium, and high knowledge levels. Scabies prevention behavior was measured with a Likert scale-based questionnaire, which included five rating levels ranging from strongly disagree to strongly agree. The total score was also categorized into low, medium, and high behavior levels. Meanwhile, the prevalence of scabies was measured through clinical observation by health workers, who recorded the number of cases before and after the intervention.
Prior to use, the questionnaires employed underwent validity and reliability testing. The validity test was conducted using item-total correlation analysis to ensure that each item was relevant to the construct being measured, while the reliability test used Cronbach’s Alpha coefficient, with a value of ≥0.7 indicating good reliability. However, several question items in each variable did not meet the validity and reliability requirements, necessitating their replacement to ensure that the measurement results are more accurate.
Data analysis
Data analysis was conducted using both qualitative and quantitative approaches. Qualitative data were obtained through in-depth interviews, behavioral observations, and comments from experts, which were analyzed using spiral or Miles-Huberman techniques, as well as content and context analysis techniques. Meanwhile, quantitative data were obtained from knowledge surveys, pre-test-post-test results, and questionnaires. Quantitative data analysis involved descriptive statistics to summarize the data, and inferential statistics, specifically the mean difference test (t-test), to assess the effectiveness of the health promotion model. Next, a Cohen’s d test was conducted to determine the effect size of the difference in mean scores between the study groups. Data analysis was done using SPPSS version 23.
Findings
In developing this health promotion model, several processes were carried out using the ADDIE framework, which included analysis, design, development, implementation, and evaluation and the results of the development procedure at each stage are described below.
1. Stage
At this stage, several analysis steps were conducted, including needs analysis, contextual analysis, and literature analysis. The following describes the stages of analysis in the development of a health promotion model for the prevention of scabies among students in boarding schools.
a. Needs analysis
Scabies is a common infectious skin disease in crowded environments, such as dormitories. Risk factors included poor personal hygiene, lack of education, and limited access to health facilities. The designed health promotion model aimed to raise awareness about personal hygiene, the importance of sanitation, and scabies control through community approaches, digital media, and school programs.
b. Contextual analysis
This analysis included stakeholders (pesantren/school residents), target groups (students), availability of facilities (educational media, infrastructure), organizational policies (lack of education and monitoring of healthy habits), and program feasibility. The results indicated the need to focus on scabies prevention through continuous education and awareness-raising.
c. Literature analysis
Scabies, caused by the Sarcoptes scabiei mite, is a global health problem with a high prevalence in at-risk environments. Prevention involved personal hygiene, environmental management, and education about the disease. In Indonesia, the prevalence of scabies is high, especially in dormitories and Islamic boarding schools, due to low knowledge and poor hygiene practices. Education, drug availability, and community-based counseling were key to controlling this disease.
2. Design stage
After the analysis, the researchers designed research products for the health promotion of scabies prevention among boarding school students. The products included educational videos, posters, a pocketbook titled “Let’s Prevent Scabies,” and a health promotion model book. The initial stage involved creating a storyboard that outlined the sequence of images or activities in the educational video. This video included narration and supporting music, covering definitions, dangers, symptoms, causes, and prevention of scabies. Additionally, the design of the posters and pocketbook aimed to provide practical guidance for students to understand and prevent scabies.
3. Development phase
The development stage involved creating model books, educational videos, health posters, and pocketbooks as health promotion media for scabies prevention. After development, the products were validated by experts in material, concept, media design, and practitioners. Expert validation resulted in various suggestions related to the logic of the concept, consistency of theory, systematic presentation, and attractiveness of the media, which were then refined over several rounds until they were deemed suitable for testing. Practitioner validation involved teachers and boarding school caregivers, who provided high scores and stated that the product was very feasible for use. The next stage, a one-on-one trial with three students, demonstrated that the educational media were easy to use, engaging, and effective in conveying information. Furthermore, a small group trial with 25 students confirmed the effectiveness of the media and provided an opportunity for improvement before the field test stage. The developed products successfully increased students’ enthusiasm, understanding, and awareness regarding scabies prevention.
4. Implementation stage (large group trial)
The next stage was the implementation stage, specifically the Large Group Trial, which is often referred to as a field trial. This trial was conducted with 51 students at Pondok Pesantren Mambaul Ulum in Jambi City and 39 students at SMAN Titian Teras in Jambi. The purpose of this large group trial stage was to assess the potential impact of using the health promotion model product on a larger number of participants and to evaluate its effectiveness in scabies prevention efforts. During this trial, the activities were led by the head of the boarding school and the vice student of the school, while the researcher acted as a resource person and observer. The implementation of this large group trial also aimed to test whether the product can be effectively utilized and to determine if it provides significant results in increasing knowledge and efforts to prevent scabies, particularly in a boarding school environment.
5. Evaluation stage
In the final stage of the research, a summative evaluation was conducted to thoroughly assess the impact of the application of the health promotion model and other supporting products implemented with students at Pondok Pesantren Mambaul Ulum and SMAN Titian Teras in Jambi. The researchers used assessment tools in the form of pre-test and post-test sheets to measure knowledge and efforts to prevent scabies in boarding schools.
The evaluation employed a one-group pre-test-post-test design, which allowed for comparison of results before and after the implementation of the health promotion model. The results of the pre-test and post-test indicated significant improvements in various components of the assessment.
There was a significant improvement across all components measured. The respondents demonstrated a notable increase in their understanding of the ease of use of educational media, clarity of audio and visuals, clarity of educational material, and user attitude after the intervention. These findings suggest that the educational media was effective in enhancing the participants’ comprehension and positive responses, reflecting an overall positive impact of the intervention (Table 1).
Table 1. Description of pre- and post-test results
![src=./files/hehp/images/HTML_Publish/79000/Screenshot_2025-05-14_134639.png]()
The average knowledge score increased significantly from the pre-test (54.11±7.17) to the post-test (95.00±4.10), accompanied by a noticeable reduction in the variability of the scores. The statistical analysis confirmed that this improvement was highly significant, indicating that the health promotion model had a strong positive effect on students’ knowledge (p=0.0001). Cohen’s d=6.99 indicated that the intervention, or the difference between groups, is indeed large and has an extraordinary impact.
Discussion
This study aimed to develop the BETRI model in health promotion to increase knowledge of scabies prevention among students. The development of a health promotion model for the prevention of scabies in a boarding school environment was conducted by following the systematic stages outlined in the ADDIE framework. This approach ensures that every aspect of the health promotion model is appropriately designed to address the health challenges faced by students [23]. Each of these stages plays a crucial role in producing a product that is effective and efficient in preventing the spread of scabies in a boarding environment.
The first stage, analysis, served as an important foundation for the development of this health promotion model. At this stage, a needs analysis, contextual analysis, and literature analysis were conducted to gain a deep understanding of the problems faced by the students. Scabies, an infectious skin disease that often occurs in densely populated environments, such as dormitories, urgently requires special attention. Risk factors such as poor personal hygiene and a lack of knowledge about how to prevent this disease necessitate a more intensive and structured approach. In the contextual analysis, it is essential to involve stakeholders, such as the school and caregivers, to support this health promotion program in a sustainable manner. The results from this stage suggest that prevention efforts should involve the entire community, with a focus on improved education, hygiene, and environmental control [7, 24].
At the design stage, the analyzed steps were transformed into health promotion products, including educational videos, posters, pocketbooks, and health promotion model books [25]. The educational video designed contained comprehensive content regarding the definition, dangers, symptoms, causes, and preventive measures for scabies. Using a storyboard, this video was crafted to provide visually appealing information, accompanied by a narrative that is easily understood by students [26-28]. Additionally, the poster and pocketbook are designed to offer practical information that can serve as a daily guide for students, thereby increasing their awareness of the importance of maintaining personal and environmental hygiene [29]
Infectious diseases remain one of the primary challenges in public health, with environmental factors playing a crucial role in their emergence and spread [1-3]. Unsanitary, overcrowded, and health-compromising environments significantly increase the risk of various diseases [4, 5]. Government Regulation No. 66/2014 on Environmental Health highlights that environmental media (such as water, air, soil, food, and public facilities) can serve as pathways for substances or agents that cause health problems or diseases in humans [6]. This underscores the critical need for effective environmental management as a preventive measure against disease [7].
Globally, the rapid spread and potential for outbreaks make infectious diseases a significant public health concern [8, 9]. As outlined in Law No. 4 of 1984 on Communicable Diseases, illnesses, such as typhus, smallpox, cholera, and bubonic plague demand immediate intervention. Additionally, endemic diseases like malaria, tuberculosis, and trachoma are key targets of government eradication programs [10]. Environmental factors and community behaviors are often pivotal in the transmission of these diseases. Scabies, for instance, remains a global health issue closely linked to such determinants [11, 12].
Scabies is a highly contagious skin condition caused by an infestation of Sarcoptes scabiei mites. Affecting more than 200 million people worldwide at any given time, the disease has a particularly high prevalence in tropical regions and densely populated areas. According to the World Health Organization (WHO), scabies affects up to 71% of the population in some regions, with children and vulnerable groups, such as the elderly, being disproportionately impacted [13]. The disease is strongly associated with poor environmental hygiene and poverty, often marked by inadequate access to clean water and sanitation facilities [14, 15]. By addressing the environmental and behavioral factors that contribute to the spread of infectious diseases like scabies, public health initiatives can better target vulnerable populations and implement sustainable prevention strategies.
Living in crowded environments, such as boarding schools, prisons, and orphanages increases the risk of scabies transmission due to direct contact and the sharing of personal items. Habits, such as exchanging clothes, towels, and bedding are the main routes for spreading the disease. In addition, low knowledge about prevention and treatment further exacerbates the situation. Many individuals rely solely on traditional medicine or use ointments without an adequate understanding of effective preventive measures [16].
Islamic boarding schools (pesantren) face unique challenges that contribute to the high prevalence of scabies compared to other environments [17]. The communal lifestyle in pesantren, characterized by shared sleeping spaces, clothing, and personal hygiene facilities, creates ideal conditions for scabies transmission. Limited access to clean water and inadequate sanitation further compounds the problem. Many students lack personal hygiene supplies such as soap, clean towels, and bedding, which increases their vulnerability to infestation. Additionally, the perception that scabies is a minor or inevitable condition in pesantren leads to a lack of urgency in seeking treatment or implementing preventive measures. The combination of these factors necessitates targeted interventions to improve hygiene practices and enhance disease prevention efforts in pesantren settings [18-20].
Several studies have shown that the level of community knowledge greatly influences the prevalence of scabies. Research by Abdillah [21] in Islamic boarding schools found that the low level of knowledge among students is directly proportional to the high number of scabies cases. Meanwhile, according to Setiaji & Fitriani [22], education using media, such as flipbooks, can increase students’ knowledge and hygienic behavior, thereby reducing the prevalence of this disease. This underscores the importance of community-based health education programs to prevent the transmission of scabies.
Preliminary studies conducted at the Mambaul Ulum Islamic Boarding School in Jambi showed that many students have habits that increase the risk of scabies, such as using damp clothes and rarely changing bed linen. Most students also consider scabies to be a common disease in the pesantren environment, leading to a lack of concern about its prevention. These factors indicate the need for more effective interventions to increase students’ awareness and knowledge about scabies and the importance of personal hygiene.
Based on this background, the main problem identified was the low level of knowledge and attitudes of students in boarding schools regarding scabies prevention efforts. Therefore, the development of an innovative and effective health promotion model was deemed a necessary solution to improve preventive behaviors against this disease. With the right educational approach, it is expected that the prevalence of scabies could be reduced, especially in high-risk environments such as boarding schools. This study aimed to develop the BETRI model in health promotion to increase knowledge of scabies prevention among students.
Materials and Methods
Design study
This experimental study, conducted in 2024, utilized a research and development (R&D) approach with the ADDIE framework (analysis, design, development, implementation, evaluation). This approach was designed to produce and test the effectiveness of a health promotion model aimed at improving scabies prevention efforts in boarding schools. The ADDIE model was chosen because it is systematic and flexible, allowing for continuous evaluation and development to generate applicable and effective solutions. During the evaluation of the educational model, the researchers assessed its effectiveness using a pre-test-post-test one-group design.
Participants
The participants were students at boarding schools, specifically Pondok Pesantren Mambaul Ulum and SMAN Titian Teras in Jambi. In the small group trial, the study involved ten students from each institution, while the field trial was conducted with 120 students (60 students from each institution). Participants were selected through simple randomization based on the inclusion criteria, including students who are active, live in the dormitory, are willing to participate, and come from an environment with a high prevalence of scabies.
The majority of participants were aged between 16 and 18 years, which is the typical age range for high school students, with a smaller proportion aged 19-20, particularly in Pondok Pesantren Mambaul Ulum, where some students continue their religious studies beyond the conventional high school years. Both male and female students were included in the study, with SMAN Titian Teras having a relatively balanced gender ratio, while Pondok Pesantren Mambaul Ulum had a higher proportion of male students. Most students had been living in the dormitory for at least one year, with some residing there for up to three years or more. Longer dormitory stays increased the likelihood of exposure to scabies due to shared living spaces, personal items, and hygiene practices.
Before the research was conducted, each participant was provided with a detailed explanation regarding the purpose, procedures, benefits, and potential risks of participating in the study. The informed consent process was implemented by giving participants a consent form, which had to be signed after they understood all the information provided. For participants under the age of 18, consent was also obtained from their parents or guardians. This ensures that participation in the study is voluntary and based on full understanding, while also maintaining ethical standards in the research.
In addition, the sample selection was conducted randomly using a simple random sampling method to minimize bias in the study. With this technique, every student who met the inclusion criteria had an equal chance of being selected as a respondent. This approach aimed to obtain results that are more representative and can be generalized to a broader population. The randomization process also reduces the possibility of selection bias, ensuring that the results are more objective and reflect the actual conditions of students living in dormitories.
Procedure
This research was conducted through the five stages of the ADDIE model. The first stage is analysis, which includes needs analysis, context analysis, and literature analysis to understand the prevalence of scabies, risk factors, and educational needs. Next, the design stage involves creating a prototype of a health promotion model that includes educational media, such as videos, posters, pocket books, and model books. At the development stage, the prototype was further refined based on input from the initial analysis and validated by experts in the field of health promotion and skin diseases. The next stage is implementation, during which the prototype is tested on small groups and in field trials using a weak experimental design (pre-test-post-test one-group design). Finally, at the evaluation stage, a formative evaluation is conducted to identify weaknesses, revise the product, and ensure that the health promotion model meets the criteria for feasibility and effectiveness (Figure 1).
Figure 1. The used model
Parameters
The independent parameter was the health promotion model, which included educational media, intervention methods, and delivery strategies. The dependent parameters included knowledge about scabies, scabies prevention behavior, and scabies prevalence. Knowledge about scabies was measured using a questionnaire with a closed scale, where each correct answer received a score of one and each incorrect answer received a score of zero. The total score was then categorized into low, medium, and high knowledge levels. Scabies prevention behavior was measured with a Likert scale-based questionnaire, which included five rating levels ranging from strongly disagree to strongly agree. The total score was also categorized into low, medium, and high behavior levels. Meanwhile, the prevalence of scabies was measured through clinical observation by health workers, who recorded the number of cases before and after the intervention.
Prior to use, the questionnaires employed underwent validity and reliability testing. The validity test was conducted using item-total correlation analysis to ensure that each item was relevant to the construct being measured, while the reliability test used Cronbach’s Alpha coefficient, with a value of ≥0.7 indicating good reliability. However, several question items in each variable did not meet the validity and reliability requirements, necessitating their replacement to ensure that the measurement results are more accurate.
Data analysis
Data analysis was conducted using both qualitative and quantitative approaches. Qualitative data were obtained through in-depth interviews, behavioral observations, and comments from experts, which were analyzed using spiral or Miles-Huberman techniques, as well as content and context analysis techniques. Meanwhile, quantitative data were obtained from knowledge surveys, pre-test-post-test results, and questionnaires. Quantitative data analysis involved descriptive statistics to summarize the data, and inferential statistics, specifically the mean difference test (t-test), to assess the effectiveness of the health promotion model. Next, a Cohen’s d test was conducted to determine the effect size of the difference in mean scores between the study groups. Data analysis was done using SPPSS version 23.
Findings
In developing this health promotion model, several processes were carried out using the ADDIE framework, which included analysis, design, development, implementation, and evaluation and the results of the development procedure at each stage are described below.
1. Stage
At this stage, several analysis steps were conducted, including needs analysis, contextual analysis, and literature analysis. The following describes the stages of analysis in the development of a health promotion model for the prevention of scabies among students in boarding schools.
a. Needs analysis
Scabies is a common infectious skin disease in crowded environments, such as dormitories. Risk factors included poor personal hygiene, lack of education, and limited access to health facilities. The designed health promotion model aimed to raise awareness about personal hygiene, the importance of sanitation, and scabies control through community approaches, digital media, and school programs.
b. Contextual analysis
This analysis included stakeholders (pesantren/school residents), target groups (students), availability of facilities (educational media, infrastructure), organizational policies (lack of education and monitoring of healthy habits), and program feasibility. The results indicated the need to focus on scabies prevention through continuous education and awareness-raising.
c. Literature analysis
Scabies, caused by the Sarcoptes scabiei mite, is a global health problem with a high prevalence in at-risk environments. Prevention involved personal hygiene, environmental management, and education about the disease. In Indonesia, the prevalence of scabies is high, especially in dormitories and Islamic boarding schools, due to low knowledge and poor hygiene practices. Education, drug availability, and community-based counseling were key to controlling this disease.
2. Design stage
After the analysis, the researchers designed research products for the health promotion of scabies prevention among boarding school students. The products included educational videos, posters, a pocketbook titled “Let’s Prevent Scabies,” and a health promotion model book. The initial stage involved creating a storyboard that outlined the sequence of images or activities in the educational video. This video included narration and supporting music, covering definitions, dangers, symptoms, causes, and prevention of scabies. Additionally, the design of the posters and pocketbook aimed to provide practical guidance for students to understand and prevent scabies.
3. Development phase
The development stage involved creating model books, educational videos, health posters, and pocketbooks as health promotion media for scabies prevention. After development, the products were validated by experts in material, concept, media design, and practitioners. Expert validation resulted in various suggestions related to the logic of the concept, consistency of theory, systematic presentation, and attractiveness of the media, which were then refined over several rounds until they were deemed suitable for testing. Practitioner validation involved teachers and boarding school caregivers, who provided high scores and stated that the product was very feasible for use. The next stage, a one-on-one trial with three students, demonstrated that the educational media were easy to use, engaging, and effective in conveying information. Furthermore, a small group trial with 25 students confirmed the effectiveness of the media and provided an opportunity for improvement before the field test stage. The developed products successfully increased students’ enthusiasm, understanding, and awareness regarding scabies prevention.
4. Implementation stage (large group trial)
The next stage was the implementation stage, specifically the Large Group Trial, which is often referred to as a field trial. This trial was conducted with 51 students at Pondok Pesantren Mambaul Ulum in Jambi City and 39 students at SMAN Titian Teras in Jambi. The purpose of this large group trial stage was to assess the potential impact of using the health promotion model product on a larger number of participants and to evaluate its effectiveness in scabies prevention efforts. During this trial, the activities were led by the head of the boarding school and the vice student of the school, while the researcher acted as a resource person and observer. The implementation of this large group trial also aimed to test whether the product can be effectively utilized and to determine if it provides significant results in increasing knowledge and efforts to prevent scabies, particularly in a boarding school environment.
5. Evaluation stage
In the final stage of the research, a summative evaluation was conducted to thoroughly assess the impact of the application of the health promotion model and other supporting products implemented with students at Pondok Pesantren Mambaul Ulum and SMAN Titian Teras in Jambi. The researchers used assessment tools in the form of pre-test and post-test sheets to measure knowledge and efforts to prevent scabies in boarding schools.
The evaluation employed a one-group pre-test-post-test design, which allowed for comparison of results before and after the implementation of the health promotion model. The results of the pre-test and post-test indicated significant improvements in various components of the assessment.
There was a significant improvement across all components measured. The respondents demonstrated a notable increase in their understanding of the ease of use of educational media, clarity of audio and visuals, clarity of educational material, and user attitude after the intervention. These findings suggest that the educational media was effective in enhancing the participants’ comprehension and positive responses, reflecting an overall positive impact of the intervention (Table 1).
Table 1. Description of pre- and post-test results
The average knowledge score increased significantly from the pre-test (54.11±7.17) to the post-test (95.00±4.10), accompanied by a noticeable reduction in the variability of the scores. The statistical analysis confirmed that this improvement was highly significant, indicating that the health promotion model had a strong positive effect on students’ knowledge (p=0.0001). Cohen’s d=6.99 indicated that the intervention, or the difference between groups, is indeed large and has an extraordinary impact.
Discussion
This study aimed to develop the BETRI model in health promotion to increase knowledge of scabies prevention among students. The development of a health promotion model for the prevention of scabies in a boarding school environment was conducted by following the systematic stages outlined in the ADDIE framework. This approach ensures that every aspect of the health promotion model is appropriately designed to address the health challenges faced by students [23]. Each of these stages plays a crucial role in producing a product that is effective and efficient in preventing the spread of scabies in a boarding environment.
The first stage, analysis, served as an important foundation for the development of this health promotion model. At this stage, a needs analysis, contextual analysis, and literature analysis were conducted to gain a deep understanding of the problems faced by the students. Scabies, an infectious skin disease that often occurs in densely populated environments, such as dormitories, urgently requires special attention. Risk factors such as poor personal hygiene and a lack of knowledge about how to prevent this disease necessitate a more intensive and structured approach. In the contextual analysis, it is essential to involve stakeholders, such as the school and caregivers, to support this health promotion program in a sustainable manner. The results from this stage suggest that prevention efforts should involve the entire community, with a focus on improved education, hygiene, and environmental control [7, 24].
At the design stage, the analyzed steps were transformed into health promotion products, including educational videos, posters, pocketbooks, and health promotion model books [25]. The educational video designed contained comprehensive content regarding the definition, dangers, symptoms, causes, and preventive measures for scabies. Using a storyboard, this video was crafted to provide visually appealing information, accompanied by a narrative that is easily understood by students [26-28]. Additionally, the poster and pocketbook are designed to offer practical information that can serve as a daily guide for students, thereby increasing their awareness of the importance of maintaining personal and environmental hygiene [29]